@Article{info:doi/10.2196/66770, author="Poyraz Isleyen, Tugce and Tarakci, Ela and Leblebici, Gokce and Yeldan, Ipek and Zulfikar, Bulent", title="Comparison of Efficiency of Closed Kinetic Chain Exercises Versus Proprioceptive Exercises in Improving Balance and Gait in People With Hemophilia: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="24", volume="14", pages="e66770", keywords="hemophilia A", keywords="hemophilia B", keywords="exercise", keywords="gait", keywords="postural balance", keywords="efficiency", keywords="hemophilia", keywords="proprioceptive exercises", keywords="balance", keywords="protocol", keywords="randomized controlled trial (RCT)", keywords="bleeding disorder", keywords="protein deficiencies", keywords="blood clotting", keywords="quality of life", keywords="young adult", keywords="teenager", abstract="Background: Inherited bleeding disorders involve prolonged bleeding due to clotting protein deficiencies, with hemophilia A and B being the most common types. The severity of bleeding in people with hemophilia depends on the deficient factor level. Treatment includes coagulation factor concentrates, nonreplacement preparations, gene therapies, and physiotherapy, whereby bleeding is prevented, symptoms are reduced, and the quality of life is improved. Closed kinetic chain exercises improve joint stability and neuromuscular control by stabilizing the proximal base, making them favored in musculoskeletal rehabilitation. Proprioceptive exercise training improves the sensorimotor system's adaptability and injury prevention through tailored programs involving progressively complex movements and surfaces. Objective: The aim of this study is to investigate the effects of closed kinetic chain exercises and proprioceptive exercise training on improving balance and walking in people with hemophilia. Methods: This study is a 3-arm, parallel-group randomized controlled trial with 63 people with hemophilia aged 13-25 years who meet the inclusion criteria. The primary outcome measures are medio-lateral swing, anterior-posterior swing, walking speed, and Hemophilia Joint Health Score. Secondary outcome measures are kinematic assessment of gait, one-leg stand test, 6-minute walk distance (6MWD) test, proprioception assessment, and the Functional Independence Score in Hemophilia. Participants will be evaluated with the Biodex balance system for postural sway, 10-meters walking test for gait speed, Hemophilia Joint Health Score for joint health, Kinovea 2D motion analysis for kinematic evaluation of gait, one-leg stand test for balance measurement, 6MWD for functional capacity, digital goniometer for proprioception, and Functional Independence Score in Hemophilia for functional independence. Participants will be randomly assigned to a closed kinetic chain exercise group, a proprioceptive exercise group, or a control group. All participants in exercise training groups will receive a 30-minute education session on joint protection techniques and energy conservation prior to the first exercise session. Closed kinetic chain exercises will include progressive lower limb exercises of approximately 45 minutes each session. Proprioceptive exercise training will focus on vibration training; reposition exercises and proprioception exercises will be administered to increase proprioceptive input for the same duration as the other group. The control group will receive no intervention. All participants will undergo 24 exercise sessions (2 days a week for 12 weeks). After the treatment, the initial measurements will be repeated. Results: This study began in September 2023 and is scheduled to be completed in May 2025. A total of 34 participants have completed the study to date. Conclusions: This study will investigate the effects of 2 different exercises on functional parameters in people with hemophilia. The effects of different exercise protocols on parameters such as postural sway, walking speed, and joint health will be evaluated. It is predicted that both exercise methods may have positive effects on balance and gait. Trial Registration: Clinical Trials.gov NCT05879549; https://clinicaltrials.gov/study/NCT05879549 International Registered Report Identifier (IRRID): DERR1-10.2196/66770 ", doi="10.2196/66770", url="https://www.researchprotocols.org/2025/1/e66770" } @Article{info:doi/10.2196/71057, author="Wang, Zi-Ru and Wang, Yunqi and Duan, Shuning and Chen, Xier and Ni, Guoxin", title="Effects of an e-Learning Program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis [PEAK]) on Chinese Physical Therapists' Confidence and Knowledge: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="18", volume="27", pages="e71057", keywords="osteoarthritis", keywords="telehealth", keywords="exercise therapy", keywords="e-learning", keywords="physiotherapist", keywords="Knee Osteoarthritis Knowledge Scale", abstract="Background: Knee osteoarthritis (OA) presents a significant burden in China due to its high prevalence, aging population, and rising obesity rates. Despite clinical guidelines recommending evidence-based care, limited practitioner training and inadequate telehealth integration hinder effective OA management. Objective: The aim of this study was to evaluate the effectiveness of an e-learning program in improving the confidence and knowledge of Chinese physical therapists in managing knee OA and to explore their perceptions of the program. Methods: This was a randomized controlled trial with 2 parallel arms involving 81 rehabilitation practitioners from 18 Chinese provinces. The intervention group completed a 4-week web-based training program (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis [PEAK]-Chinese), while the control group received no training. The primary outcome was self-reported confidence in OA management (11-point scale). Secondary outcomes included knowledge (Chinese Knee Osteoarthritis Knowledge Scale [KOAKS]) and likelihood of clinical application of core OA treatments. Process measures and semistructured interviews captured participants' training perceptions. Quantitative data were analyzed using regression models, 2-sided t tests, and descriptive statistics, while thematic analysis was performed on the interview data of 10 participants. Results: A total of 80 participants completed the outcome measures at 4 weeks. The intervention group demonstrated significant improvements in confidence compared to the control group, including managing OA with exercise-based programs (adjusted mean difference=3.27, 95\% CI 2.72-3.81), prescribing exercise (adjusted mean difference=3.13, 95\% CI 2.55-3.72), and delivering telehealth (adjusted mean difference=4.41, 95\% CI 3.77-5.05). KOAKS scores also improved significantly (mean change=9.46); however, certain belief bias related to OA concepts and the use of scans remained unchanged (25/41, 61\% and 27/41, 66\%, respectively). Approximately 73\% (30/41) of the intervention participants rated the course as extremely useful. Interviews emphasized the need for cultural adaptation and practical telehealth training with real-life scenarios to enhance program applicability. Conclusions: The PEAK program improved Chinese practitioners' confidence and knowledge in managing knee OA, underscoring e-learning's potential to support evidence-based OA care in China. To optimize future implementations, further research strategies could include enhancing cultural relevance, addressing misconceptions, and incorporating practical, real-world training. Trial Registration: Chinese Clinical Trial Register ChiCTR2400091007; https://www.chictr.org.cn/showproj.html?proj=239680 ", doi="10.2196/71057", url="https://www.jmir.org/2025/1/e71057" } @Article{info:doi/10.2196/67275, author="Hutchison, G. Michael and Di Battista, P. Alex and Pyndiura, L. Kyla", title="Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study", journal="JMIR Form Res", year="2025", month="Apr", day="11", volume="9", pages="e67275", keywords="mild traumatic brain injury", keywords="recovery", keywords="mHealth", keywords="app", keywords="digital health", keywords="smartphone", keywords="eHealth", keywords="digital", keywords="technology", keywords="usability", keywords="concussion rehabilitation", keywords="brain injury", keywords="rehabilitation protocols", keywords="evidence-based exercise", keywords="single-arm pilot study", keywords="home-based rehabilitation", keywords="user-friendly", keywords="questionnaire", keywords="telehealth", keywords="telemedicine", abstract="Background: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions. Objective: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions. Methods: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from ``strongly agree'' to ``strongly disagree''. Results: Twenty-six participants consented and were enrolled in the study, with 23 participants (82\%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100\% positive responses, with no single question scoring below 83\% positive responses. In the ``ease of use and satisfaction'' category, 100\% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83\%-96\% (19-22) of users responded positively to the remaining four questions. In the ``system information arrangement'' category, 100\% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87\%-96\% of users approving action acknowledgment, error recovery, and expected functions. Under the ``usefulness'' category, 96\% (n=22) of users found the app beneficial for health and well-being, and 91\% (n=21) users felt it effectively managed their health. For the five custom questions, 100\% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations. Conclusions: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app's potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience. ", doi="10.2196/67275", url="https://formative.jmir.org/2025/1/e67275" } @Article{info:doi/10.2196/57413, author="Wiesm{\"u}ller, Fabian and Haag, David and Sareban, Mahdi and Mayr, Karl and M{\"u}rzl, Norbert and Porodko, Michael and Puelacher, Christoph and Moser, Lisa-Marie and Philippi, Marco and Traninger, Heimo and H{\"o}fer, Stefan and Niebauer, Josef and Schreier, G{\"u}nter and Hayn, Dieter", title="Clinical, Psychological, Physiological, and Technical Parameters and Their Relationship With Digital Tool Use During Cardiac Rehabilitation: Comparison and Correlation Study", journal="JMIR Mhealth Uhealth", year="2025", month="Apr", day="8", volume="13", pages="e57413", keywords="mHealth", keywords="telehealth", keywords="cardiac rehabilitation", keywords="wearable", keywords="adherence", keywords="health-related quality of life", keywords="intrinsic motivation", keywords="self-efficacy", keywords="health action process approach", keywords="cardiac", keywords="rehabilitation", keywords="quality of life", keywords="efficacy", keywords="psychological", keywords="physiological", keywords="digital tools", keywords="home training", keywords="monitoring", keywords="questionnaire", keywords="cardiac risk", abstract="Background: Home and telehealth-based interventions are increasingly used in cardiac rehabilitation, a multidisciplinary model of health care. Digital tools such as wearables or digital training diaries are expected to support patients to adhere to recommended lifestyle changes, including physical exercise programs. As previously published, the EPICURE study (effect of digital tools in outpatient cardiac rehabilitation including home training) analyzed the effects of digital tools, that is, a digital training diary, adherence monitoring, and wearables, on exercise capacity during outpatient cardiac rehabilitation phase III (OUT-III) which includes an approximately 12-week home-training phase. The study encompassed 149 Austrian patients, of which 50 used digital tools. Objective: The present paper takes a deeper look into the EPICURE data to better understand the relation between the use of digital tools and various psychological, clinical, and physiological parameters, and the relation between these parameters and the improvement of exercise capacity during cardiac rehabilitation. Methods: For this work, we analyzed questionnaires concerning the patients' cardiac rehabilitation. On all these parameters we performed 2 analyzes: (1) Comparison of the 2 groups with and without digital tools and (2) correlation with the change in the maximum workload as achieved during the exercise stress test. If data pre- and post OUT-III were available, the change in the respective parameter during OUT-III was determined and group analysis and correlation were applied on data pre OUT-III, data post OUT-III, and the change during OUT-III. Results: We found significant improvements in quality of life in both groups, with no discernible differences between patients with or without digital tools (P=.53). Patients with digital tools perceived significantly higher competence during cardiac rehabilitation (P=.05), and they anticipated higher cardiac risks if nonadherent to physical activity (P=.03). Although, the overall subjectively reported adherence was not significantly different in the 2 groups (P=.50), specific items differed. Patients with digital tools were significantly more likely to do their exercises even when they were tired (P=.01) and less likely to forget their exercises (P=.01). Concerning reasons for (non-) adherence, patients with digital tools reported significantly more often to do their exercises because they enjoyed them (P=.01), whereas they were significantly less likely to stop exercising when muscular pain was worse (P=.01) and to continue doing their exercises when muscular pain improved (P=.02). Finally, patients who reported a high level of concrete planning achieved significantly higher improvements in exercise capacity (r=0.14, P=.04). Conclusions: This comprehensive analysis provides valuable insights into the multifaceted impact of digital tools on outpatient cardiac rehabilitation including home training, shedding light on the importance of digital tools for increased competence and a higher risk perception during cardiac rehabilitation. In addition, the impact of digital tools on adherence and their influence on patient outcomes were assessed in the evolving landscape of digital health interventions. Trial Registration: ClincalTrials.gov NCT04458727; https://clinicaltrials.gov/study/NCT04458727 ", doi="10.2196/57413", url="https://mhealth.jmir.org/2025/1/e57413" } @Article{info:doi/10.2196/63064, author="Suzuki, Takuya and Kono, Yuji and Ogasawara, Takayuki and Mukaino, Masahiko and Aoshima, Yasushi and Furuzawa, Shotaro and Fujita, Yurie and Matsuura, Hirotaka and Yamaguchi, Masumi and Tsukada, Shingo and Otaka, Yohei", title="Moving Standard Deviation of Trunk Acceleration as a Quantification Index for Physical Activities: Validation Study", journal="JMIR Form Res", year="2025", month="Apr", day="8", volume="9", pages="e63064", keywords="smart clothing", keywords="step count", keywords="moving standard deviation of acceleration", keywords="MSDA", keywords="wheelchair", keywords="activity quantification", keywords="physical activities", keywords="validation study", keywords="accelerometer", keywords="regular gait patterns", keywords="older people", keywords="aging", keywords="motor impairments", keywords="step detection", keywords="stroke", keywords="hemiparesis", keywords="measurement system", keywords="walking", keywords="mobility", keywords="rehabilitation", abstract="Background: Step count is used to quantify activity in individuals using accelerometers. However, challenges such as difficulty in detecting steps during slow or irregular gait patterns and the inability to apply this method to wheelchair (WC) users limit the broader utility of accelerometers. Alternative device-specific measures of physical activity exist, but their specificity limits cross-applicability between different device sensors. Moving standard deviation of acceleration (MSDA), obtained from truncal acceleration measurements, is proposed as another alternative variable to quantify physical activity in patients. Objective: This study aimed to evaluate the validity and feasibility of MSDA for quantifying physical activity in patients with stroke-induced hemiparesis by comparing it with the traditional step count. Methods: We enrolled 197 consecutive patients with stroke hemiparesis admitted to a convalescent rehabilitation ward. Using the hitoe system, a smart clothing--based physical activity measurement system, we measured the MSDA of trunk movement and step count. The correlation between MSDA and step count was examined in all participants. Based on their daily living mobility levels, measured using the Functional Independence Measure (FIM), participants were categorized into 6 subgroups: FIM1-4, FIM5 (WC), FIM5 (walking), FIM6 (WC), FIM6 (walking), and FIM7 (walking). Intersubgroup differences in MSDA were analyzed. Results: A strong correlation was observed between MSDA and step count (r=0.78; P<.001), with a stronger correlation in the walking group (r=0.79; P<.001) compared with the WC group (r=0.55; P<.001). The Shapiro-Wilk test indicated no significant results for MSDA across all subgroups, supporting a normal distribution within these groups. In contrast, the step count data for the WC subgroups showed significant results, indicating a deviation from a normal distribution. Additionally, 10.2\% (20/197) of participants recorded zero steps, demonstrating a floor effect in the step count data. The median MSDA values for the 6 subgroups (FIM1-4, FIM5 WC, FIM5 walking, FIM6 WC, FIM6 walking, and FIM7) were 0.006, 0.007, 0.010, 0.011, 0.011, and 0.014, respectively, reflecting their levels of independence based on the FIM mobility scores. The median step counts for these subgroups were 68, 233, 1386, 367, 2835, and 4462, respectively. FIM5 participants who walked had higher step counts than FIM6 participants using WCs, though the difference was marginally but not statistically significant (P=.07), highlighting the impact of mobility type (walking vs WC). Conclusions: The results suggest the validity of MSDA as a variable for physical activity in patients with stroke, applicable to patients with stroke irrespective of their mobility measures. This finding highlights the potential of MSDA for use in individuals with motor impairments, including WC users, underscoring its broad utility in rehabilitation clinical practice. ", doi="10.2196/63064", url="https://formative.jmir.org/2025/1/e63064" } @Article{info:doi/10.2196/72466, author="Plavoukou, Theodora and Iosifidis, Michail and Papagiannis, Georgios and Stasinopoulos, Dimitrios and Georgoudis, Georgios", title="The Effectiveness of Telerehabilitation in Managing Pain, Strength, and Balance in Adult Patients With Knee Osteoarthritis: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="8", volume="12", pages="e72466", keywords="telerehabilitation", keywords="knee osteoarthritis", keywords="pain management", keywords="remote physiotherapy", keywords="digital health", keywords="remote therapy", keywords="physiotherapy", keywords="strength", keywords="balance", keywords="functional mobility", keywords="rehabilitation technology", abstract="Background: Knee osteoarthritis (KOA) is a chronic, degenerative joint disease characterized by pain, stiffness, and functional impairment, significantly affecting mobility and quality of life. Traditional rehabilitation, mainly through in-person physiotherapy, is widely recommended for KOA management. However, access to these services is often limited due to geographic, financial, and mobility constraints. Telerehabilitation has emerged as an alternative, providing remote rehabilitation through digital platforms. Despite its increasing adoption, its effectiveness in improving key functional parameters such as pain, strength, and balance remains uncertain. While previous studies have focused primarily on pain relief and overall functional improvement, a broader assessment of its impact on mobility and fall prevention is needed. Objective: This systematic review examines the effectiveness of telerehabilitation in improving pain, strength, and balance in adults with KOA compared with traditional rehabilitation or no intervention. In addition, it evaluates the impact of different telerehabilitation models, such as therapist-guided versus self-managed programs, and explores the feasibility of integrating telerehabilitation as an alternative in KOA management. Methods: A systematic search of 4 databases (PubMed, PEDro, Cochrane, and Scopus) was conducted to identify randomized controlled trials (RCTs) published from May 2004 to May 2024. Inclusion criteria consisted of adults with KOA, evaluation of telerehabilitation either as a stand-alone intervention or in comparison to traditional rehabilitation or no intervention, and measurement of at least one primary outcome (pain, strength, or balance). A total of 2 independent reviewers assessed the risk of bias using validated tools. Due to variations in intervention programs and assessment methods, a narrative synthesis was performed instead of a meta-analysis. The review followed established guidelines, and data extraction was conducted using appropriate software. Results: A total of 6 RCTs (N=581 participants) met the inclusion criteria. The results indicate that telerehabilitation effectively reduces pain and improves strength and balance, although the extent of benefits varies. Some studies reported similar pain reductions between telerehabilitation and traditional rehabilitation, while others highlighted greater functional improvements in telerehabilitation groups. Therapist-guided telerehabilitation was associated with higher adherence rates and better functional outcomes compared with self-managed programs. The risk of bias assessment showed that most studies were of moderate to good quality, though common issues included selection bias, performance bias, and participant attrition. Conclusions: Telerehabilitation is a promising alternative for KOA management, especially for individuals facing barriers to in-person therapy. It is effective in reducing pain and improving strength and balance, though its success depends on patient engagement, intervention delivery, and rehabilitation protocols. Therapist-guided programs yield better outcomes than self-managed approaches. Further research is needed to standardize intervention protocols, integrate emerging technologies, and evaluate cost-effectiveness to guide clinical practice and health care policies. Trial Registration: PROSPERO CRD42024564141; https://tinyurl.com/25ykvy7d ", doi="10.2196/72466", url="https://rehab.jmir.org/2025/1/e72466", url="http://www.ncbi.nlm.nih.gov/pubmed/40198917" } @Article{info:doi/10.2196/59228, author="Yu, Kaitao and Yin, Baobing and Zhu, Ying and Meng, Hongdao and Zhu, Wenwei and Lu, Lu and Wang, Junqiao and Chen, Shugeng and Ni, Jun and Lin, Yifang and Jia, Jie", title="Efficacy of a Digital Postoperative Rehabilitation Intervention in Patients With Primary Liver Cancer: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Apr", day="7", volume="13", pages="e59228", keywords="digital health", keywords="surgery", keywords="exercise rehabilitation", keywords="randomized controlled trial", keywords="primary liver cancer", abstract="Background: Rehabilitation is considered a fundamental component of cancer treatment, especially for patients undergoing cancer surgery. In contrast to conventional rehabilitation education, digital rehabilitation has the potential to improve patients' access to postoperative rehabilitation programs. While digital health has rapidly emerged to aid patients with various diseases, their clinical efficacy in the recovery of patients with primary liver cancer (PLC) undergoing hepatectomy remains inadequately investigated. Objective: This study aims to evaluate whether a digital postoperative rehabilitation intervention is efficient in improving physical fitness, enhancing exercise adherence, and alleviating fatigue among patients with PLC after hepatectomy. Methods: A randomized controlled trial was undertaken across 2 university-affiliated hospitals in Eastern China. A total of 100 participants were enrolled in this study and were allocated randomly to either the digital health (intervention group, n=50) or the rehabilitation manual-based group (control group, n=50) at a 1:1 ratio. Patients were unblinded and prospectively followed for the intervention of 3 weeks. Outcome measures included physical fitness, exercise adherence, and status of fatigue. Results: Overall, 91 out of 100 patients completed the research and were evaluated after 3 weeks of intervention. The digital health group showed better cardiopulmonary endurance than the control group. The mean difference in the change of 6-minute walk test distance from baseline between the groups was 70.21 (95\% CI 0.730-82.869) m (P=.05). No statistically significant effects were found for grip strength, 5-repetition-sit-to-stand test time, and fatigue. The exercise adherence in the digital health group was higher than that in the control group ($\chi$22=15.871, P<.001). Conclusions: The findings suggested that the implementation of digital health had a positive impact on recovery in exercise capacity after hepatectomy. In addition, rehabilitation exercise mode based on digital health has the potential to improve the exercise adherence of patients with PLC compared to conventional manual-based rehabilitation guidance. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052911; https://www.chictr.org.cn/showproj.html?proj=135351 ", doi="10.2196/59228", url="https://mhealth.jmir.org/2025/1/e59228" } @Article{info:doi/10.2196/65342, author="Xi, Yu and Li, Zhongsheng and Vatatheeswaran, Surendran and Devecchi, Valter and Gallina, Alessio", title="Assessment of Pelvic Motion During Single-Leg Weight-Bearing Tasks Using Smartphone Sensors: Validity Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="1", volume="12", pages="e65342", keywords="smartphone", keywords="kinematics", keywords="acceleration", keywords="exercise", keywords="squat", abstract="Background: Clinicians and athletic training specialists often assess the performance of single-leg, weight-bearing tasks to monitor rehabilitation progress and guide exercise progression. Some of the key metrics assessed are excessive pelvic motion, balance, and duration of each repetition of the exercise. Motion can be objectively characterized using motion capture (MOCAP); however, MOCAP is often not available in clinics due to the high costs and complexity of the analyses. Smartphones have built-in sensors that can be used to measure changes in body segment orientation and acceleration, which may make them a more feasible and affordable technology to use in practice. Objective: This study aimed to determine if, compared to gold-standard MOCAP, smartphone sensors can provide valid measures of pelvic orientation, acceleration, and repetition duration during single-leg tasks in healthy individuals. Methods: Overall, 52 healthy participants performed single-leg squats and step-down tasks from heights of 15 and 20 cm. Pelvic motion was assessed using MOCAP and a smartphone placed over the sacrum. The MATLAB (MathWorks) mobile app was used to collect smartphone acceleration and orientation data. Individual repetitions of each exercise were manually identified, and the following outcomes were extracted: duration of the repetition, mediolateral acceleration, and 3D pelvic orientation at peak squat. Validity was assessed by comparing metrics assessed with a smartphone and MOCAP using intraclass correlation coefficients (ICCs) and paired Wilcoxon tests. Differences between tasks were compared using 1-way ANOVA or the Friedman test. Results: Across the 3 single-leg tasks, smartphone estimates demonstrated consistently high agreement with the MOCAP for all metrics (ICC point estimates: >0.8 for mediolateral acceleration and frontal plane orientation; >0.9 for squat duration and orientation on the sagittal and transverse plane). Bias was identified for most outcomes (multiple P<.001). Both smartphone and MOCAP recordings identified clear differences between tasks, with step-down tasks usually requiring larger changes in pelvic orientation and larger mediolateral sways. Duration did not differ between tasks. Conclusions: Despite a consistent bias, the smartphone demonstrated good to excellent validity relative to gold-standard MOCAP for most outcomes. This demonstrates that smartphones offer an accessible and affordable tool to objectively characterize pelvic motion during different single-leg weight-bearing tasks in healthy participants. Together with earlier reports of good between-day reliability of similar measures during single-leg squats, our results suggest that smartphone sensors can be used to assess and monitor single-leg task performance. Future studies should investigate whether smartphone sensors can aid in the assessment and treatment of people with musculoskeletal disorders. More user-friendly interfaces and data analysis procedures may also facilitate the implementation of this technology in practice. ", doi="10.2196/65342", url="https://rehab.jmir.org/2025/1/e65342" } @Article{info:doi/10.2196/58393, author="Mbada, E. Chidozie and Awosika, Akintunji Henry and Sonuga, Ademola Oluwatobi and Akande, Micheal and Gebrye, Tadesse and Woolf, Richard and Fatoye, Francis", title="Effect of Clinic-Based and Asynchronous Video-Based Exercise on Clinic and Psychosocial Outcomes in Patients With Knee Osteoarthritis: Quasi-Experimental Study", journal="J Med Internet Res", year="2025", month="Mar", day="26", volume="27", pages="e58393", keywords="knee osteoarthritis", keywords="video", keywords="physiotherapy", keywords="exercise", keywords="mobile phone", keywords="telehealth", keywords="telemedicine", keywords="randomized", keywords="controlled trial", keywords="asynchronous", keywords="rehabilitation", keywords="knees", keywords="joints", keywords="osteoarthritis", keywords="musculoskeletal", keywords="rheumatology", keywords="physical therapy", abstract="Background: Telerehabilitation is promising for improving knee osteoarthritis, but the effect of different telerehabilitation strategies on knee osteoarthritis is unclear. Objective: This study aimed to examine the effect of a clinic-based strengthening exercise (CbSE) and asynchronous video-based strengthening exercise (AVbSE) on pain, range of motion, muscle strength, quality of life, and physical function among patients with knee osteoarthritis. Methods: A total of 52 consenting patients participated in this 8-week experimental study; they were assigned to the CbSE or AVbSE group at 2 different study sites. CbSE is a circuit exercise module comprising knee flexion and extension warm-up in sitting, quadriceps isometric setting, quadriceps strengthening exercise, hamstring clenches, wall squat, and a cooldown of knee flexion and extension. The AVbSE is an asynchronous video-based version of the CbSE. Results: This study spanned from March 31, 2021, to November 26, 2021. Eight out of 62 participants discontinued participation. Data collection and analysis have been completed. Significant differences were only observed in the mental health (t50=--3, P=.004), pain (t39.4=--3.6, P<.001), social support (t50=--2.7, P=.009), and social activities (t50=2.2, P=.03) domains of the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire with higher scores in the AVbSE group at the end of week 4. At the end of week 8, significant differences were observed in mental health (t50=--2.1, P=.04) and pain (t37.3=--2.8, P=.008) measures with higher scores in AVbSE; however, a significantly higher score was observed in the CbSE group for the Quadruple Visual Analog Scale. No significant main effect of time was observed in this study, except in the muscle strength (F2100=1.5, P=.24), social support (F2100=2.5, P=.09), and social activity (F2100=0.7, P=.48) domains of the OAKHQoL questionnaire and activity limitation (F2100=0.1, P=.90), and performance restriction (F2100=1.3, P=.27) domains of the Ibadan Knee and Hip Osteoarthritis Outcome Measure (IKHOAM) questionnaire. There was no significant difference between groups in all OAKHQoL domains except social activities (mean 17.6, SD 1.2 vs 22.8, SD 1.2; P=.003) and average pain (2.8, SD 1.6 vs 2.3, SD 1.6; P=.03) with higher AVbSE mean scores. However, a higher score was observed for the CbSE group in the Quadruple Visual Analog Scale's least pain domain (1.2, SD 0.2 vs 0.7, SD 0.2; P=.04). Also, interaction effects showed that AVbSE scores were significantly higher for the OAKHQoL questionnaire's physical activity and mental health domains at all time points. However, the CbSE score was higher for the physical performance domain of the IKHOAM questionnaire in the eighth week. Conclusions: CbSE circuit training and its AVbSE variant effectively improve treatment outcomes and increase the quality of life of patients. While AVbSE was associated with higher improvement in most health-related quality of life domains, CbSE led to higher improvement in average pain. Trial Registration: Pan African Clinical Trial Registry PACTR202208515182119, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23943 ", doi="10.2196/58393", url="https://www.jmir.org/2025/1/e58393" } @Article{info:doi/10.2196/65767, author="Touali, Rachid and Zerouaoui, Jamal and Chakir, Mahjoub El and Bui, Tien Hung and Leone, Mario and Allisse, Maxime", title="Impact of a Sensorimotor Integration and Hyperstimulation Program on Global Motor Skills in Moroccan Children With Autism Spectrum Disorder: Exploratory Clinical Quasi-Experimental Study", journal="JMIR Form Res", year="2025", month="Mar", day="26", volume="9", pages="e65767", keywords="classical physical education", keywords="children with a neurotypical profile", keywords="children with ASD", keywords="UQAC-UQAM test battery", keywords="University of Qu{\'e}bec in Chicoutimi-University of Qu{\'e}bec in Montr{\'e}al", keywords="sensorimotor integration", keywords="hyperstimulation", keywords="Morocco", keywords="sensorimotor", keywords="integration", keywords="motor skill", keywords="Moroccan children", keywords="Moroccan", keywords="children", keywords="autism spectrum disorder", keywords="ASD", keywords="exploratory study", keywords="autism", keywords="mental health", keywords="young", keywords="youth", keywords="feasibility", abstract="Background: Children with autism spectrum disorders (ASDs) often struggle with processing information, which can impact their coordination, balance, and other motor skills. Studies have demonstrated that intervention programs based on sensory integration can enhance motor performance in these children. Objective: The objective of this study is to evaluate the applicability of a standardized battery of gross motor skill tests for Moroccan children aged 6 to 12 years with ASD. The objective is to assess the potential efficacy of an innovative pedagogical approach focused on sensorimotor integration and hyperstimulation. This approach will be compared to traditional physical education (PE) sessions to determine its feasibility and potential to bridge the developmental gaps in motor skills between children with ASD and those with a neurotypical profile. Methods: A convenience sample of 14 Moroccan children with ASD aged 6 to 12 years participated in this exploratory study. Children with ASD were divided into an experimental group (n=7) and a control group (n=7) based on age, sex, motor performance, and socioeconomic status. The control group followed the standard PE program, while the experimental group underwent a specialized program combining sensorimotor integration and hyperstimulation for a period of 15 weeks. All participants were classified as level 2 (moderate) on the Autism Severity Rating Scale based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. Gross motor skills were measured at baseline and after 15 weeks of intervention using the UQAC-UQAM (University of Qu{\'e}bec in Chicoutimi-University of Qu{\'e}bec in Montr{\'e}al) test battery protocol, which includes 10 items. Results: At baseline (T1), no significant difference was observed between the control and experimental groups of children with ASD. Following the 15-week intervention, the group participating in traditional PE showed an overall improvement in motor skills of approximately 14.5\%. Conversely, the results of the ASD experimental group suggest a more substantial improvement of 44.5\%. Additionally, the experimental group exhibited significant better performance across all motor skill variables compared to the control group (minimum P values of <.02) with large effect sizes (>0.80). In this regard, a 2-way repeated measures ANOVA confirms the efficiency of the program implemented within the experimental group, demonstrating significant effects associated with both group and time factors as well as a clinically highly significant group{\texttimes}time interaction across all measured variables ($\eta$2p>0.14). Conclusions: The results of this study suggest that the approach that emphasizes sensorimotor integration and management of hyperstimulation was more effective in improving motor skills in this population. However, other more exhaustive studies will need to be carried out in order to be able to more precisely measure the full potential of this approach. ", doi="10.2196/65767", url="https://formative.jmir.org/2025/1/e65767", url="http://www.ncbi.nlm.nih.gov/pubmed/40137439" } @Article{info:doi/10.2196/57537, author="Tandon, Puneeta and Ismond, P. Kathleen and Purdy, Graeme and Cruz, Christofer and Etruw, Evelyn and Suderman, Kirsten and Hyde, Ashley and Stickland, Michael and Spence, C. John and Lien, C. Dale and Bhanji, Rahima and Prado, M. Carla and Miguel-Cruz, Antonio and Joy, A. Anil and Yaskina, Maryna and McNeely, L. Margaret", title="Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Mar", day="24", volume="27", pages="e57537", keywords="eHealth", keywords="patient-centered care", keywords="adults", keywords="geriatrics", keywords="self-management", keywords="web-based", keywords="nutrition", keywords="exercise rehabilitation", keywords="wearable", keywords="activity tracker", keywords="quality of life", keywords="physical health", keywords="2-minute step test", keywords="patients with cancer", keywords="chronic diseases", keywords="COVID-19", keywords="randomized controlled trial", keywords="acceptability", keywords="effectiveness", keywords="intervention", abstract="Background: In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation. Objective: This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion. Methods: A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist--led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle. Results: Of 216 participants, 202 (93.5\%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4\%; cancer: 126/202, 62.4\%). Adherence exceeded a priori targets, with 82\% (105/128) attending >75\% of the program elements including postintervention tests. Participants rated the program as ``quite a bit'' or ``very'' useful, with similar ratings between Heal-Me Light (56/64, 88\%) and Heal-Me Intensive (51/58, 88\%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred. Conclusions: The demonstrated satisfaction, adherence, and effectiveness highlight the high acceptability of a web-based, semisupervised nutrition and exercise intervention delivered entirely digitally in individuals with chronic disease. Future studies may benefit from having a baseline physical function inclusion threshold, the use of a more sensitive primary physical function measure, and a higher intensity digital exercise intervention in exercise-experienced participants. Trial Registration: Clinicaltrials.gov NCT04666558; https://clinicaltrials.gov/study/NCT04666558 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106791 ", doi="10.2196/57537", url="https://www.jmir.org/2025/1/e57537", url="http://www.ncbi.nlm.nih.gov/pubmed/40126542" } @Article{info:doi/10.2196/60162, author="Rafiei, Mahdie and Das, Supratim and Bakhtiari, Mohammad and Roos, Maria Ewa and Skou, T. S{\o}ren and Gr{\o}nne, T. Dorte and Baumbach, Jan and Baumbach, Linda", title="Personalized Predictions for Changes in Knee Pain Among Patients With Osteoarthritis Participating in Supervised Exercise and Education: Prognostic Model Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Mar", day="21", volume="12", pages="e60162", keywords="osteoarthritis", keywords="prediction", keywords="pain intensity", keywords="exercise therapy", keywords="machine learning", abstract="Background: Knee osteoarthritis (OA) is a common chronic condition that impairs mobility and diminishes quality of life. Despite the proven benefits of exercise therapy and patient education in managing OA pain and functional limitations, these strategies are often underused. To motivate and enhance patient engagement, personalized outcome prediction models can be used. However, the accuracy of existing models in predicting changes in knee pain outcomes remains insufficiently examined. Objective: This study aims to validate existing models and introduce a concise personalized model predicting changes in knee pain from before to after participating in a supervised patient education and exercise therapy program (GLA:D) among patients with knee OA. Methods: Our prediction models leverage self-reported patient information and functional measures. To refine the number of variables, we evaluated the variable importance and applied clinical reasoning. We trained random forest regression models and compared the rate of true predictions of our models with those using average values. In supplementary analyses, we additionally considered recently added variables to the GLA:D registry. Results: We evaluated the performance of a full, continuous, and concise model including all 34 variables, all 11 continuous variables, and the 6 most predictive variables, respectively. All three models performed similarly and were comparable to the existing model, with R2 values of 0.31?0.32 and root-mean-squared errors of 18.65?18.85---despite our increased sample size. Allowing a deviation of 15 (visual analog scale) points from the true change in pain, our concise model correctly estimated the change in pain in 58\% of cases, while using average values that resulted in 51\% accuracy. Our supplementary analysis led to similar outcomes. Conclusions: Our concise personalized prediction model provides more often accurate predictions for changes in knee pain after the GLA:D program than using average pain improvement values. Neither the increase in sample size nor the inclusion of additional variables improved previous models. Based on current knowledge and available data, no better predictions are possible. Guidance is needed on when a model's performance is good enough for clinical practice use. ", doi="10.2196/60162", url="https://rehab.jmir.org/2025/1/e60162" } @Article{info:doi/10.2196/59570, author="Jansen, Carl-Philipp and Nijland, D{\'e}sir{\'e}e and Oppert, Jean-Michel and Alcan, Veysel and Keskinen, E. Kirsi and Matikainen-Tervola, Emmi and Pajalic, Zada and Rantakokko, Merja and Tomsone, Signe and Tuomola, Essi-Mari and Portegijs, Erja and Timmermans, J. Erik", title="The Role of Environmental Factors in Technology-Assisted Physical Activity Intervention Studies Among Older Adults: Scoping Review", journal="JMIR Mhealth Uhealth", year="2025", month="Mar", day="13", volume="13", pages="e59570", keywords="environmental factors", keywords="intervention", keywords="older adults", keywords="physical activity", keywords="technology", keywords="PRISMA", abstract="Background: The rapidly emerging integration of both technological applications and environmental factors in physical activity (PA) interventions among older adults highlights the need for an overarching investigation. Objective: This scoping review compiled the current literature and aimed to provide an overview of the role of physical, social, socioeconomic, and systemic environmental factors in technology-assisted PA interventions for older adults. Methods: We systematically searched 6 common databases up to September 16, 2024, for original longitudinal studies (with at least one preintervention measurement and one postintervention measurement) that reported on the role of environmental factors in technology-assisted PA interventions for independently living, community-dwelling older adults. In a stepwise process, data on study characteristics (step 1), environmental factors and their role in the included studies (step 2), and intervention outcomes and effects by type of environmental factor (step 3) were summarized. Results: A total of 8020 articles were screened, and 25 (0.31\%) were included. Most studies were conducted in Europe (11/25, 44\%), followed by North America (5/25, 20\%), Asia (5/25, 20\%), and Oceania (4/25, 16\%). Social environmental factors were most often considered (19/25, 76\%), followed by factors from the physical (8/25, 32\%), socioeconomic (1/25, 4\%), and systemic environment (1/25, 4\%). Environmental factors were used as the outcome (8/25, 32\%), setting variable (7/25, 28\%), moderator or facilitator (8/25, 32\%), and intervention component (3/25, 12\%). In most studies (19/25, 76\%), the intervention had a beneficial effect on the outcome of interest, and the included environmental factor played a supportive role in achieving this effect. In some studies, no effect (3/25, 12\%), mixed effects (2/25, 8\%), or adverse effects (1/25, 4\%) of the interventions were reported. Conclusions: This is the first comprehensive description of how environmental factors interact with technology-assisted interventions to increase or optimize PA in older adults. It was found that the investigation of environmental factors in this field is at an early stage. Environmental factors were found to play a supportive role in achieving beneficial effects of technology-assisted PA interventions, but the findings were based on a heterogeneous empirical platform. Still, certain aspects such as the application of virtual reality environments and social (or peer) comparison have shown significant potential that remains to be leveraged. A better understanding of intervention results and support in tailoring intervention programs can be provided through the inclusion of environmental aspects in technology-assisted PA interventions for older adults. ", doi="10.2196/59570", url="https://mhealth.jmir.org/2025/1/e59570" } @Article{info:doi/10.2196/60115, author="Li, Guangqi and Zhou, Xueyan and Deng, Junyue and Wang, Jiao and Ai, Ping and Zeng, Jingyuan and Ma, Xuelei and Liao, Hu", title="Digital Therapeutics--Based Cardio-Oncology Rehabilitation for Lung Cancer Survivors: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="25", volume="13", pages="e60115", keywords="cardio-oncology rehabilitation", keywords="digital therapeutics", keywords="telerehabilitation", keywords="non-small cell lung cancer", keywords="exercise prescription", keywords="cardiology", keywords="oncology", keywords="rehabilitation", keywords="cardiorespiratory fitness", keywords="cardiopulmonary", keywords="cancer", keywords="physical activity", keywords="digital health", keywords="digital technology", keywords="randomized controlled trial", keywords="wearable", keywords="app", keywords="quality of life", keywords="survivor", abstract="Background: Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice. Objective: The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL). Methods: Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence--driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band--based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients' HR reached the target zone (HRresting + [HRmax -- HRresting] {\texttimes} [?40\%-60\%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL. Results: A total of 40 (85\%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2\%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (--0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (--8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (--0.31, SD 0.44 vs --0.05, SD 0.29; P=.048), and daytime dysfunction (--0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period. Conclusions: The 5-month, digital therapeutics--based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594 ", doi="10.2196/60115", url="https://mhealth.jmir.org/2025/1/e60115" } @Article{info:doi/10.2196/66802, author="Xu, Shiqi and Xu, Yanwen and Wen, Ruyi and Wang, Jun and Qiu, Yuyu and Chan, CH Chetwyn", title="Virtual Reality Enhanced Exercise Training in Upper Limb Function of Patients With Stroke: Meta-Analytic Study", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e66802", keywords="virtual reality", keywords="stroke", keywords="upper limb function", keywords="exercise training", keywords="meta-analysis", abstract="Background: Recovery of upper limb function after stroke secondary to ischemia or hemorrhage is crucial for patients' independence in daily living and quality of life. Virtual reality (VR) is a promising computer-based technology designed to enhance the effects of rehabilitation; however, the results of VR-based interventions remain equivocal. Objective: This study aims to review the plausible factors that may have influenced VR's therapeutic effects on improving upper limb function in patients with stroke, with the goal of synthesizing an optimal VR intervention protocol. Methods: The databases PubMed, EMBASE, Web of Science, and Cochrane Library were queried for English-language papers published from May 2022 onward. Two reviewers independently extracted data from the included papers, and discrepancies in their findings were resolved through consensus during joint meetings. The risk of bias was assessed using the Physiotherapy Evidence Database Scale and the Methodological Index for Non-Randomized Studies. Outcome variables included the Action Research Arm Test, Box-Block Test, Functional Independence Measure, Upper Extremity Fugl-Meyer Assessment, and Wolf Motor Function Test. The plausible factors examined were age, total dosage (hours), trial length (weeks), session duration (hours/session), frequency (sessions/week), and VR content design. The Bonferroni adjustment was applied to P values to prevent data from being incorrectly deemed statistically significant. Results: The final sample included 15 articles with a total of 1243 participants (age range 48.6-75.59 years). Participants in the VR therapy (VRT) group (n=455) demonstrated significantly greater improvements in upper limb function and independence in activities of daily living compared with those in the conventional therapy group (n=301). Significant factors contributing to improved outcomes in upper limb function were younger age (mean difference [MD] 5.34, 95\% CI 2.18-8.5, P<.001; I2=0\%), interventions lasting more than 15 hours (MD 9.67, 95\% CI 4.19-15.15, P<.001; I2=0\%), trial lengths exceeding 4 weeks (MD 4.02, 95\% CI 1.39-6.65, P=.003; I2=15\%), and more than 4 sessions per week (MD 3.48, 95\% CI 0.87-6.09, P=.009; I2=0\%). However, the design of the VR content, including factors such as the number of features (eg, offering exercise and functional tasks; individualized goals; activity quantification; consideration of comorbidities and baseline activity level; addressing patient needs; aligning with patient background such as education level; patient-directed goals and interests; goal setting; progressive difficulty levels; and promoting self-efficacy), did not demonstrate significant effects (MD 3.89, 95\% CI --6.40 to 1.09; effect Z=1.36, P=.16). Conclusions: Greater VR effects on improving upper limb function in patients with stroke were associated with higher training doses (exceeding 15 hours) delivered over 4-6 weeks, with shorter sessions (approximately 1 hour) scheduled 4 or more times per week. Additionally, younger patients appeared to benefit more from the VR protocol compared with older patients. ", doi="10.2196/66802", url="https://www.jmir.org/2025/1/e66802", url="http://www.ncbi.nlm.nih.gov/pubmed/39969977" } @Article{info:doi/10.2196/56397, author="Binyamin-Netser, Reut and Handelzalts, Shirley and Goldhamer, Noy and Avni, Inbar and Tayer Yeshurun, Adi and Koren, Yogev and Bibas Levy, Ofri and Kramer, Shilo and Bar Haim, Simona and Shmuelof, Lior", title="Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients With Subacute Stroke: Feasibility Study", journal="JMIR Serious Games", year="2025", month="Feb", day="13", volume="13", pages="e56397", keywords="stroke", keywords="rehabilitation", keywords="neurotechnology", abstract="Background: Upper-extremity hemiparesis is a common and debilitating impairment after stroke, severely restricting stroke survivors' ability to participate in daily activities and function independently. Alarmingly, only a small percentage of stroke patients fully recover upper extremity function. Animal models indicate that high-dose upper extremity training during the early poststroke phase can significantly enhance motor recovery. However, translating such programs for human patients remains challenging due to resource limitations, patient compliance issues, and administrative constraints. Objective: This study aimed to assess the feasibility and potential efficacy of an intensive, video game--based upper-extremity training protocol designed to improve movement quality during inpatient stroke rehabilitation. Additionally, it evaluated the resources required for this intervention. Specifically, the protocol provides high-intensity, high-dose training to facilitate motor recovery by engaging patients in targeted interactive exercises. Methods: Twelve patients with upper-extremity hemiparesis completed a 4-week intensive training program comprising 40 sessions of 60 minutes; the training was conducted for 2 hours per day, 5 days per week. This was delivered in addition to standard care, which included 3 therapeutic sessions daily. Two video game--based platforms were used: one platform (tech 1) targeted proximal movements involving the shoulder and elbow, while the second platform (tech 2) emphasized distal movements of the wrist and fingers. Feasibility was assessed using the measure of time on task and measures of patients' motivation and engagement. Potential effectiveness was assessed using the Fugl-Meyer Assessment of the upper extremity (FMA-UE) scale, Action Research Arm Test (ARAT), and Stroke Impact Scale (SIS). Results: Of the 12 patients, 8 completed the full protocol, 3 completed 34?38 sessions, and 1 completed 27 sessions. On average, patients actively engaged in exercises for 35 (SD 4) minutes per hour on the proximal platform (tech 1) and 37 (SD 2) minutes on the distal platform (tech 2). Patients reported high motivation and enjoyment throughout the sessions, with an Intrinsic Motivation Inventory enjoyment score of 6.49 (SD 0.66) out of 7. Pain levels were minimal, with a visual analogue scale (VAS) mean score of 2.00 (SD 2.32). Significant improvements were observed in motor function assessments: the mean improvement in FMA-UE score was 16.5 (SD 10.2) points, ARAT scores increased by 22.9 (SD 13.1) points, and the SIS Hand Function and Recovery score showed a mean delta of 1.23 (SD 0.80) points and a 23.33\% (SD 21.5\%) improvement, respectively. Conclusions: These findings demonstrate that a high-dose, high-intensity, video game--based training protocol is feasible and can be successfully integrated into subacute stroke rehabilitation. Additionally, preliminary evidence suggests that this supplementary intervention may be effective in enhancing motor recovery. This approach holds promise for future stroke rehabilitation protocols by offering an engaging, high-dose, and high-intensity program during early recovery. Trial Registration: Clinicaltrials.gov NCT04737395, https://clinicaltrials.gov/study/NCT04737395 ", doi="10.2196/56397", url="https://games.jmir.org/2025/1/e56397" } @Article{info:doi/10.2196/55298, author="Faqar Uz Zaman, Fatima Sara and Sliwinski, Svenja and Mohr-Wetzel, Lisa and Dreilich, Julia and Filmann, Natalie and Detemble, Charlotte and Zmuc, Dora and Chun, Felix and Derwich, Wojciech and Schreiner, Waldemar and Bechstein, Wolf and Fleckenstein, Johannes and Schnitzbauer, A. Andreas", title="Validity, Accuracy, and Safety Assessment of an Aerobic Interval Training Using an App-Based Prehabilitation Program (PROTEGO MAXIMA Trial) Before Major Surgery: Prospective, Interventional Pilot Study", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="10", volume="13", pages="e55298", keywords="digital health", keywords="prehab", keywords="major surgery", keywords="surgical oncology", keywords="smartwatches", keywords="safety and quality", keywords="surgery", keywords="surgical", keywords="oncology", keywords="validity", keywords="accuracy", keywords="safety management", keywords="management", keywords="aerobic", keywords="aerobic training", keywords="app", keywords="prehabilitation", keywords="pilot study", keywords="quality of life", keywords="medical device", keywords="wearable", keywords="wearables", keywords="heart rate", abstract="Background: Major surgery is associated with significant morbidity and a reduced quality of life, particularly among older adults and individuals with frailty and impaired functional capacity. Multimodal prehabilitation can enhance functional recovery after surgery and reduce postoperative complications. Digital prehabilitation has the potential to be a resource-sparing and patient-empowering tool that improves patients' preoperative status; however, little remains known regarding their safety and accuracy as medical devices. Objective: This study aims to test the accuracy and validity of a new software in comparison to the gold-standard electrocardiogram (ECG)-based heart rate measurement. Methods: The PROTEGO MAXIMA trial was a prospective interventional pilot trial assessing the validity, accuracy, and safety of an app-based exercise program. The Prehab App calculates a personalized, risk-stratified aerobic interval training plan based on individual risk factors and utilizes wearables to monitor heart rate. Healthy students and patients undergoing major surgery were enrolled. A structured risk assessment was conducted, followed by a 6-minute walking test and a 37-minute supervised interval session. During the exercise, patients wore app-linked wearables for heart rate and distance measurements, which were compared with standard ECG and treadmill measurements. Safety, accuracy, and usability assessments included testing alarm signals, while the occurrence of adverse events served as the primary and secondary outcome measures. Results: A total of 75 participants were included. The mean heart rate differences between wearables and standard ECG were ?5 bpm (beats per minute) with a mean absolute percentage error of ?5\%. Regression analysis revealed a significant impact of the BMI (odds ratio 0.90, 95\% CI 0.82-0.98, P=.02) and Timed Up and Go Test score (odds ratio 0.12, 95\% CI 0.03-0.55, P=.006) on the accuracy of heart rate measurement; 29 (39\%) patients experienced adverse events: pain (5/12, 42\%), ECG electrode--related skin irritations (2/42, 17\%), dizziness (2/42, 17\%), shortness of breath (2/42, 17\%), and fatigue (1/42, 8\%). No cardiovascular or serious adverse events were reported, and no serious device deficiency was detected. There were no indications of clinically meaningful overexertion based on laboratory values measured before and after the 6-minute walking test and exercise. The differences in means and ranges were as follows: lactate (mmol/l), mean 0.04 (range --3 to 6; P=.47); creatinine kinase (U/l), mean 12 (range --7 to 43; P<.001); and sodium (mmol/l), mean --2 (range --11 to 12; P<.001). Conclusions: The interventional trial demonstrated the high safety of the exercise program and the accuracy of heart rate measurements using commercial wearables in patients before major surgery, paving the way for potential remote implementation in the future. Trial Registration: German Clinical Trials Register DRKS00026985; https://drks.de/search/en/trial/DRKS00026985 and European Database on Medical Devices (EUDAMED) CIV-21-07-0307311. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069394 ", doi="10.2196/55298", url="https://mhealth.jmir.org/2025/1/e55298" } @Article{info:doi/10.2196/50669, author="Chang, Chien-Hsiang and Wei, Chun-Chun and Lien, Wei-Chih and Yang, Tai-Hua and Liu, Bo and Lin, Yimo and Tan, Thong Poh and Lin, Yang-Cheng", title="The Usability and Effect of a Novel Intelligent Rehabilitation Exergame System on Quality of Life in Frail Older Adults: Prospective Cohort Study", journal="JMIR Serious Games", year="2025", month="Jan", day="21", volume="13", pages="e50669", keywords="frailty", keywords="exergame", keywords="older adults", keywords="intelligent rehabilitation", keywords="reminiscence therapy", keywords="eHealth care", abstract="Background: Aging in older adults results in a decline in physical function and quality of daily life. Due to the COVID-19 pandemic, the exercise frequency among older adults decreased, further contributing to frailty. Traditional rehabilitation using repetitive movements tends not to attract older adults to perform independently. Objective: Intelligent Rehabilitation Exergame System (IRES), a novel retro interactive exergame that incorporates real-time surface electromyography, was developed and evaluated. Methods: Frail older adults were invited to use the IRES for rehabilitation using lower limb training twice per week for 4 weeks. Participants were required to have no mobility or communication difficulties and be willing to complete the 4-week study. The enrolled cohort had baseline scores ranging from 1 to 5 on the Clinical Frailty Scale, as described by Rockwood et al. Three major lower limb movements (knee extension, plantar flexion, and dorsiflexion) were performed 20 times for each leg within 30 minutes. The surface electromyography collected and analyzed muscle potential signals for review by health care professionals to customize the protocol for the next training. The System Usability Scale (SUS) and Taiwanese version of the EuroQol-5 Dimensions (EQ-5D) were administered after completing the first (week 1, baseline) and last training (week 4, one-month follow-up) to evaluate the usability of the IRES and its effects on the quality of life of participants. Results: A total of 49 frail older adults (mean age 74.6 years) were included in the analysis. The usability of the IRES improved according to the mean SUS score, from 82.09 (good) at baseline to 87.14 (good+) at 1-month follow-up. The willingness to use (t96=?4.51; P<.001), learnability (t96=?4.83; P<.001), and confidence (t96=?2.27; P=.02) in working with the IRES increased. After using the IRES for 1 month, significant improvements were observed in the ease of use (t47=2.05; P=.04) and confidence (t47=2.68; P<.001) among participants without previous rehabilitation experience. No sex-based differences in the SUS scores were found at baseline or 1-month follow-up. The quality of life, as assessed by the EQ-5D, improved significantly after 1 month of IRES training compared to that at baseline (t96=6.03; P<.001). Conclusions: The novel IRES proposed in this study received positive feedback from frail older adults. Integrating retro-style exergame training into rehabilitation not only improved their rehabilitation motivation but also increased their learning, system operability, and willingness to continue rehabilitation. The IRES provides an essential tool for the new eHealth care service in the post--COVID-19 era. ", doi="10.2196/50669", url="https://games.jmir.org/2025/1/e50669" } @Article{info:doi/10.2196/64825, author="Mastropietro, Alfonso and Peruzzo, Denis and Taccogna, Giovanna Maria and Sanna, Nicole and Casali, Nicola and Nossa, Roberta and Biffi, Emilia and Ambrosini, Emilia and Pedrocchi, Alessandra and Rizzo, Giovanna", title="Multiparametric MRI Assessment of Morpho-Functional Muscle Changes Following a 6-Month FES-Cycling Training Program: Pilot Study in People With a Complete Spinal Cord Injury", journal="JMIR Rehabil Assist Technol", year="2025", month="Jan", day="16", volume="12", pages="e64825", keywords="functional electrical stimulation", keywords="FES", keywords="cycling", keywords="exercise", keywords="physical activity", keywords="spinal cord injury", keywords="multiparametric MRI", keywords="skeletal muscle", keywords="rehabilitation", keywords="magnetic resonance imaging", keywords="muscle", keywords="muscular", keywords="musculoskeletal", keywords="spine", keywords="MRI", keywords="mpMRI", keywords="image", keywords="imaging", abstract="Background: Spinal cord injuries (SCIs) cause debilitating secondary conditions such as severe muscle deterioration, cardiovascular, and metabolic dysfunctions, significantly impacting patients' quality of life. Functional electrical stimulation (FES) combined with cycling exercise (FES-cycling) has shown promise in improving muscle function and health in individuals with SCI. Objective: This pilot study aimed to investigate the potential role of multiparametric magnetic resonance imaging (MRI) to assess muscle health during and after an FES-cycling rehabilitation program. Methods: Four male participants with chronic SCI underwent a 6-month FES-cycling training program, consisting of two 30-minute sessions per week. MRI scans were performed at baseline (T0), after 3 months (T1), at the end of the training (T2), and 1-month posttraining (T3). The MRI protocol included T1-weighted imaging for volume quantification, Dixon imaging for fat fraction, multi-echo spin echo for T2 relaxation times, and diffusion tensor imaging to assess diffusion parameters. Results: Muscle hypertrophy was observed, with an average increase in muscle volume of 22.3\% at T1 and 36.7\% at T2 compared with baseline. One month posttraining, muscle volume remained 23.2\% higher than baseline. Fat fraction decreased from 11.1\% at T0 to 9.1\% at T2, with a rebound to 10.9\% at T3. T2 relaxation times showed a reduction even though this was not consistent among participants. Diffusion tensor imaging parameters revealed subtle changes in muscle tissue microstructure, with a decrease in fractional anisotropy mainly associated to an increase of radial diffusivity. Conclusions: Although preliminary, this study provides evidence that 6 months of low-intensity FES-bike training can increase muscle volume and decrease fat infiltration in individuals with SCI. The study demonstrates that the use of a multiparametric MRI provides comprehensive insights into both macroscopic and microscopic changes within muscle tissues, supporting its integration into clinical practice for assessing the efficacy of rehabilitation interventions. Trial Registration: ClinicalTrials.gov NCT06321172; https://clinicaltrials.gov/study/NCT06321172 ", doi="10.2196/64825", url="https://rehab.jmir.org/2025/1/e64825" } @Article{info:doi/10.2196/57423, author="Kim, Yumi and Rimmer, H. James and Lai, Byron and Oster, Robert and Cowan, Rachel and Young, Hui-Ju and Fisher, Gordon and Kim, Younguk and Giannone, John and Wilroy, D. Jereme", title="Cardiometabolic Health Intervention Using Music and Exercise (CHIME) Delivered via Telehealth to Wheelchair Users: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Jan", day="15", volume="14", pages="e57423", keywords="exercise", keywords="physical activity", keywords="wheelchair user", keywords="telehealth", keywords="disability", abstract="Background: Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality. Objective: The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos. Methods: This study's design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3{\texttimes}/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded. Results: Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission. Conclusions: The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users. Trial Registration: ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432 International Registered Report Identifier (IRRID): DERR1-10.2196/57423 ", doi="10.2196/57423", url="https://www.researchprotocols.org/2025/1/e57423" } @Article{info:doi/10.2196/64121, author="Soulard, Julie and Kairy, Dahlia and Walha, Roua and Duclos, Cyril and Nadeau, Sylvie and Auger, Claudine", title="Professionals' Perspectives of Smart Stationary Bikes in Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Dec", day="31", volume="11", pages="e64121", keywords="health professionals", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="cross-sectional", keywords="survey", keywords="questionnaire", keywords="technology", keywords="stationary bike", keywords="cycling", keywords="rehabilitation", keywords="physical activity", keywords="bike", keywords="bicycle", keywords="qualitative", keywords="content analysis", keywords="digital health", abstract="Background: Stationary bikes are used in numerous rehabilitation settings, with most offering limited functionalities and types of training. Smart technologies, such as artificial intelligence and robotics, bring new possibilities to achieve rehabilitation goals. However, it is important that these technologies meet the needs of users in order to improve their adoption in current practice. Objective: This study aimed to collect professionals' perspectives on the use of smart stationary bikes in rehabilitation. Methods: Twelve health professionals (age: mean 43.4, SD 10.1 years) completed an online questionnaire and participated in a semistructured interview regarding their needs and expectations before and after a 30-minute session with a smart bike prototype. Results: A content analysis was performed with inductive coding. Seven main themes emerged: (1) bike functionalities (cycling assistance, asymmetric resistance, and forward and backward cycling), (2) interface between bike and users (simple, user-friendly, personalized, with written reminders during training), (3) feedback to users (user and performance data), (4) training programs (preprogrammed and personalized, and algorithmic programs), (5) user engagement (telerehabilitation, group sessions, music, and automatic suggestion of training), (6) the bike as a physical device (dimensions, comfort, setup, screen, etc), and (7) business model (various pricing strategies, training for professionals, and after-sales service). Conclusions: This study provides an interpretive understanding of professionals' perspectives regarding smart stationary bikes and is the first to identify the expectations of health professionals regarding the development of future bikes in rehabilitation. ", doi="10.2196/64121", url="https://rehab.jmir.org/2024/1/e64121" } @Article{info:doi/10.2196/60374, author="Pearce, Nettleton Louise Michelle and Pryor, Julie and Redhead, Jason and Sherrington, Catherine and Hassett, Leanne", title="Advanced Technology in a Real-World Rehabilitation Setting: Longitudinal Observational Study on Clinician Adoption and Implementation", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e60374", keywords="rehabilitation", keywords="technology", keywords="digital health", keywords="virtual reality", keywords="robotics", keywords="exoskeleton device", keywords="implementation science", keywords="physiotherapy", keywords="physical therapy", keywords="occupational therapy", keywords="mobile phone", abstract="Background: Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. Objective: This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. Methods: This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Results: Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65\%), occupational therapists (1396/4208, 33\%), and allied health assistants (96/4208, 2\%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70\%). Devices were typically used to target impairment and activity limitation--related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94\%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47\%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51\%, vs outpatient services, 963/2335, 41\%) ($\chi$21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51\%, vs all other conditions, between 24\%-31\%; $\chi$25=16.8, P=.005). Conclusions: The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use. ", doi="10.2196/60374", url="https://www.jmir.org/2024/1/e60374" } @Article{info:doi/10.2196/65734, author="Smiley, Aref and Finkelstein, Joseph", title="Home Automated Telemanagement System for Individualized Exercise Programs: Design and Usability Evaluation", journal="JMIR Biomed Eng", year="2024", month="Dec", day="27", volume="9", pages="e65734", keywords="telemedicine", keywords="home-based exercise", keywords="telerehabilitation", keywords="remote cycling", keywords="usability", keywords="physical rehabilitation", keywords="exercise therapy", abstract="Background: Exercise is essential for physical rehabilitation, helping to improve functional performance and manage chronic conditions. Telerehabilitation offers an innovative way to deliver personalized exercise programs remotely, enhancing patient adherence and clinical outcomes. The Home Automated Telemanagement (HAT) System, integrated with the interactive bike (iBikE) system, was designed to support home-based rehabilitation by providing patients with individualized exercise programs that can be monitored remotely by a clinical rehabilitation team. Objective: This study aims to evaluate the design, usability, and efficacy of the iBikE system within the HAT platform. We assessed the system's ability to enhance patient adherence to prescribed exercise regimens while minimizing patient and clinician burden in carrying out the rehabilitation program. Methods: We conducted a quasi-experimental study with 5 participants using a pre- and posttest design. Usability testing included 2 primary tasks that participants performed with the iBikE system. Task completion times, adherence to exercise protocols, and user satisfaction were measured. A System Usability Scale (SUS) was also used to evaluate participants' overall experience. After an initial introduction, users performed the tasks independently following a 1-week break to assess retention of the system's operation skills and its functionality. Results: Task completion times improved substantially from the pretest to the posttest: execution time for task 1 reduced from a mean of 8.6 (SD 4.7) seconds to a mean of 1.8 (SD 0.8) seconds, and the time for task 2 decreased from a mean of 315 (SD 6.9) seconds to a mean of 303.4 (SD 1.1) seconds. Adherence to the prescribed cycling speed also improved, with deviations from the prescribed speed reduced from a mean of 6.26 (SD 1.00) rpm (revolutions per minute) to a mean of 4.02 (SD 0.82) rpm (t=3.305, n=5, P=.03). SUS scores increased from a mean of 92 (SD 8.6) to a mean of 97 (SD 3.3), indicating high user satisfaction and confidence in system usability. All participants successfully completed both tasks without any additional assistance during the posttest phase, demonstrating the system's ease of use and effectiveness in supporting independent exercise. Conclusions: The iBikE system, integrated into the HAT platform, effectively supports home-based telerehabilitation by enabling patients to follow personalized exercise prescriptions with minimal need for further training or supervision. The significant improvements in task performance and exercise adherence suggest that the system is well-suited for use in home-based rehabilitation programs, promoting sustained patient engagement and adherence to exercise regimens. Further studies with larger sample sizes are recommended to validate these findings and explore the long-term benefits of the system in broader patient populations. ", doi="10.2196/65734", url="https://biomedeng.jmir.org/2024/1/e65734", url="http://www.ncbi.nlm.nih.gov/pubmed/39658220" } @Article{info:doi/10.2196/51536, author="Jones, Tamara and Edbrooke, Lara and Rawstorn, C. Jonathan and Denehy, Linda and Hayes, Sandra and Maddison, Ralph and Sverdlov, L. Aaron and Koczwara, Bogda and Kiss, Nicole and Short, E. Camille", title="Demographics and Health Characteristics Associated With the Likelihood of Participating in Digitally Delivered Exercise Rehabilitation for Improving Heart Health Among Breast Cancer Survivors: Cross-Sectional Survey Study", journal="JMIR Cancer", year="2024", month="Dec", day="16", volume="10", pages="e51536", keywords="digital health", keywords="breast cancer", keywords="exercise", keywords="rehabilitation", keywords="cardiotoxicity", keywords="demographic", keywords="cancer survivor", keywords="exercise rehabilitation", keywords="home-based program", keywords="pathologic process", keywords="radiation", keywords="physical phenomena", keywords="heart care", keywords="cardiovascular disease", keywords="diagnosis", keywords="cross-sectional study", keywords="chronic disease", keywords="statistics", abstract="Background: Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnoses. However, less than one-third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behavior change, and social support into home-based programs. Objective: This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (ie, offered generally, before, during, or after treatment). Secondary aims were to explore the knowledge of cardiac-related treatment side-effects, exercise behavior, additional intervention interests (eg, diet, fatigue management), and service fee capabilities. Methods: This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A self-reported questionnaire was used to collect outcomes of interests, including the likelihood of uptaking a digitally delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarize sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios (ORs) <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at P?.05. Results: A high proportion (194/208, 93\%) of the sample (mean age 57, SD 11 years; median BMI=26, IQR 23?31 kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area (compared with living in a major city) was associated with higher odds of uptake in each model (OR 3.86?8.57, 95\% CI 1.04-68.47; P=.01?.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR 1.42, 95\% CI 1.02-1.96; P=.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education (compared with university education) were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about the cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median Aus \$10, IQR 10-15 per session; Aus \$1=US \$0.69 at time of study). Conclusions: These findings can be used to better inform future research and the development of intervention techniques that are critical to improving the delivery of a digital service model that is effective, equitable, and accessible, specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models. ", doi="10.2196/51536", url="https://cancer.jmir.org/2024/1/e51536" } @Article{info:doi/10.2196/51771, author="Widhalm, Klaus and Maul, Lukas and Durstberger, Sebastian and Putz, Peter and Klupper, Carissa and Werner, Franz", title="Real-Time Digitized Visual Feedback in Exercise Therapy for Lower Extremity Functional Deficits: Qualitative Study of Usability Factors During Prototype Testing", journal="JMIR Serious Games", year="2024", month="Dec", day="10", volume="12", pages="e51771", keywords="visualization", keywords="lower extremity", keywords="digitized visual feedback", keywords="exercise therapy", keywords="functional deficit", keywords="serious game", keywords="rehabilitation", keywords="osteoarthritis", keywords="usability", keywords="physiotherapy", keywords="mobile phone", abstract="Background: Osteoarthritis is one of the most common degenerative diseases of the musculoskeletal system and can ultimately lead to the need for surgery, such as total knee or hip arthroplasty. Functional movement deficits can be a prognostic factor for osteoarthritis in the lower extremities. Thus, training physiological movement patterns may help in the treatment of such functional deficits. Motivation to exercise frequently is of utmost importance and can be promoted by using digital real-time feedback. Objective: This qualitative study aims to gather user recommendations for prototype feedback visualizations in a real-time exercise-feedback system called homeSETT for the treatment of functional deficits. The system provides real-time feedback to participants while performing exercises that focus on functional deficits, such as lateral trunk lean, pelvic drop, and valgus thrust. The findings of this study should help to optimize the prototype feedback visualizations. Thus, the main research questions were how patients, physiotherapists, and physicians evaluate the presented, current state of prototype feedback visualizations for selected functional exercises, and what improvements and variations would be recommended. Methods: Testing of the prototype feedback visualizations took place at a movement laboratory using a 3D optoelectronic movement analysis system. Data on usability factors were acquired using the thinking aloud method during and semistructured interviews after prototype testing. Transcribed audio recordings of semistructured interviews as well as scribing logs of the thinking aloud method were examined using qualitative content analysis. Results: Data were analyzed from 9 participants, comprising 2 (22\%) patients, 2 (22\%) physicians, and 5 (56\%) physiotherapists. The mean age of the participants was 45 (SD 9) years and the mean work experience among the participating physiotherapists and physicians was 22 (SD 5) years. Each participant tested 11 different exercise-feedback combinations. Overall, results indicated that participants enjoyed the prototype feedback visualizations and believed that they could be used in therapeutic settings. Participants appreciated the simplicity, clarity, and self-explanatory nature of the feedback visualizations. While most participants quickly familiarized themselves, some struggled to recognize the feedback goals and connect the visualizations to their movements. Recommendations for improvement included optimizing color schemes, sensitivity, and difficulty adjustments. Adding instructional information and game design elements, such as repetition counting and reward systems, was deemed useful. The main study limitations were the small sample size and the use of feedback on performance as the sole feedback modality. Conclusions: The prototype feedback visualizations were positively perceived by the participants and were considered applicable in therapy settings. Insights were gathered on improving the color scheme, sensitivity, and recognizability of the feedback visualizations. The implementation of additional gamification and instructional elements was emphasized. Future work will optimize the prototype feedback visualizations based on study results and evaluate the homeSETT system's efficacy in eligible patient populations. ", doi="10.2196/51771", url="https://games.jmir.org/2024/1/e51771" } @Article{info:doi/10.2196/59136, author="Krohn, Maria and Rintala, Aki and Immonen, Jaakko and Sj{\"o}gren, Tuulikki", title="The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials", journal="J Med Internet Res", year="2024", month="Dec", day="2", volume="26", pages="e59136", keywords="stroke", keywords="chronic", keywords="virtual reality", keywords="physiotherapy", keywords="therapeutic exercise", keywords="balance", keywords="walking", abstract="Background: Well-targeted balance, walking, and weight-shift training can improve balance capabilities in the chronic phase of stroke. There is an urgent need for a long-term approach to rehabilitation that extends beyond the acute and subacute phases, supporting participation without increasing the demand for health care staff. Objective: This study aims to evaluate the effectiveness of therapeutic exercise interventions with virtual reality (VR) training on balance and walking at the activity and participation levels in individuals with chronic stroke, compared with control groups receiving no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without VR. Methods: Studies were searched across 6 databases. The inclusion criteria were as follows: Adults aged 18 years or older with a stroke diagnosis for at least 6 months (population). Therapeutic exercises within a VR environment, using VR glasses or interactive games (intervention). Control groups without the use of VR (including no treatment, conventional physical therapy, specific training, similar treatment without VR, or identical treatment without the additional use of VR; comparison). We evaluated the Berg Balance Scale score, Functional Reach Test performance, Activities-specific Balance Confidence Scale score, Six-minute Walk Test, Two-minute Walk Test, 10-meter Walk Test results, and cadence (outcome measures). We investigated randomized controlled trials (study design). A meta-analysis and a meta-regression analysis were conducted to evaluate whether the content of VR interventions or control groups, as well as the level of VR immersion used, was related to balance or walking outcomes. Results: A total of 43 randomized controlled trials involving 1136 participants were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (standardized mean difference 0.51, 95\% CI 0.29-0.72; P<.001) and a moderate effect on walking (standardized mean difference 0.31, 95\% CI 0.09-0.53; P=.006) in individuals with chronic stroke, compared with pooled control groups (no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR). According to the meta-regression findings, the content of VR interventions (P=.52), the type of control groups (P=.79), and the level of VR immersion (P=.82) were not significantly related to the pooled balance or walking outcomes. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was moderate for balance and low for walking. Conclusions: Therapeutic exercise training with VR had a positive, albeit moderate, effect on balance and a low impact on walking at the level of activity (capacity), even in the chronic phase of stroke, without serious side effects. The results are applicable to working-aged stroke rehabilitees who are able to walk without assistance. Further research is needed with defined VR methods and outcomes that assess performance at the level of real-life participation. ", doi="10.2196/59136", url="https://www.jmir.org/2024/1/e59136", url="http://www.ncbi.nlm.nih.gov/pubmed/39621381" } @Article{info:doi/10.2196/58175, author="Guo, Hongzhi and Cao, Jianwei and He, Shichun and Wei, Meiqi and Meng, Deyu and Yu, Ichen and Wang, Ziyi and Chang, Xinyi and Yang, Guang and Wang, Ziheng", title="Quantifying the Enhancement of Sarcopenic Skeletal Muscle Preservation Through a Hybrid Exercise Program: Randomized Controlled Trial", journal="JMIR Aging", year="2024", month="Nov", day="15", volume="7", pages="e58175", keywords="sarcopenia", keywords="older adults", keywords="physical exercise program", keywords="explainable artificial intelligence", keywords="tai chi", abstract="Background: Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of older people who endure sarcopenia may be improved via the practice of strength training and tai chi. However, it remains unclear if the hybridization of strength exercise training and traditional Chinese exercise will have a better effect. Objective: We designed a strength training and tai chi exercise hybrid program to improve sarcopenia in older people. Moreover, explainable artificial intelligence was used to predict postintervention sarcopenic status and quantify the feature contribution. Methods: To assess the influence of sarcopenia in the older people group, 93 participated as experimental participants in a 24-week randomized controlled trial and were randomized into 3 intervention groups, namely the tai chi exercise and strength training hybrid group (TCSG; n=33), the strength training group (STG; n=30), and the control group (n=30). Abdominal computed tomography was used to evaluate the skeletal muscle mass at the third lumbar (L3) vertebra. Analysis of demographic characteristics of participants at baseline used 1-way ANOVA and $\chi$2 tests, and repeated-measures ANOVA was used to analyze experimental data. In addition, 10 machine-learning classification models were used to calculate if these participants could reverse the degree of sarcopenia after the intervention. Results: A significant interaction effect was found in skeletal muscle density at the L3 vertebra, skeletal muscle area at the L3 vertebra (L3 SMA), grip strength, muscle fat infiltration, and relative skeletal muscle mass index (all P values were <.05). Grip strength, relative skeletal muscle mass index, and L3 SMA were significantly improved after the intervention for participants in the TCSG and STG (all P values were <.05). After post hoc tests, we found that participants in the TCSG experienced a better effect on L3 SMA than those in the STG and participants in the control group. The LightGBM classification model had the greatest performance in accuracy (88.4\%), recall score (74\%), and F1-score (76.1\%). Conclusions: The skeletal muscle area of older adults with sarcopenia may be improved by a hybrid exercise program composed of strength training and tai chi. In addition, we identified that the LightGBM classification model had the best performance to predict the reversion of sarcopenia. Trial Registration: ClinicalTrials.gov NCT05694117; https://clinicaltrials.gov/study/NCT05694117 ", doi="10.2196/58175", url="https://aging.jmir.org/2024/1/e58175" } @Article{info:doi/10.2196/57873, author="Merry, Kohle and MacPherson, M. Megan and Whittaker, L. Jackie and Napier, Christopher and Holsti, Liisa and Scott, Alex", title="An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study", journal="JMIR Hum Factors", year="2024", month="Nov", day="13", volume="11", pages="e57873", keywords="exercise therapy", keywords="physical therapy modalities", keywords="rehabilitation", keywords="tendons", keywords="tendinopathy", keywords="mobile health", keywords="mHealth", keywords="mobile phone", abstract="Background: People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective: This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods: The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results: By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions: Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies. ", doi="10.2196/57873", url="https://humanfactors.jmir.org/2024/1/e57873" } @Article{info:doi/10.2196/59915, author="Barr{\'i}a, Patricio and Andrade, Asterio and Gomez-Vargas, Daniel and Yelincic, Alejandro and Roberti, Flavio and Bahamonde, Eduardo and Aguilar, Rolando and Cordova, Bessie", title="Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Oct", day="16", volume="11", pages="e59915", keywords="rehabilitation", keywords="home-based therapy", keywords="physical therapy", keywords="psychological therapy", keywords="home physiotherapy", keywords="disabilities", keywords="occupational therapy", keywords="personalized care", keywords="patient care", keywords="motor disorder", keywords="mood disorder", keywords="motor function", abstract="Background: Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy. Objective: This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood. Methods: A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively. Results: The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15\% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8\% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score. Conclusions: This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being. Trial Registration: ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791 ", doi="10.2196/59915", url="https://rehab.jmir.org/2024/1/e59915", url="http://www.ncbi.nlm.nih.gov/pubmed/39412860" } @Article{info:doi/10.2196/52563, author="Lo, Man Hermione Hin and Ng, Marques and Fong, Hugo Pak Yiu and Lai, Ki Harmony Hoi and Wang, Bo and Wong, Yeung-shan Samuel and Sit, Shan Regina Wing", title="Examining the Feasibility, Acceptability, and Preliminary Efficacy of an Immersive Virtual Reality--Assisted Lower Limb Strength Training for Knee Osteoarthritis: Mixed Methods Pilot Randomized Controlled Trial", journal="JMIR Serious Games", year="2024", month="Sep", day="27", volume="12", pages="e52563", keywords="virtual reality", keywords="VR", keywords="immersive", keywords="knee", keywords="joint", keywords="arthritis", keywords="arthritic", keywords="osteoarthritis", keywords="knee osteoarthritis", keywords="gerontology", keywords="geriatric", keywords="older adult", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="aging", keywords="pain", keywords="function", keywords="acceptability", keywords="user experience", keywords="RCT", keywords="randomized", keywords="controlled trial", keywords="limb", keywords="strength", keywords="muscle", keywords="muscular", keywords="physiotherapy", abstract="Background: Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology. Objective: We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee). Methods: A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays. Results: The recruitment rate was 100\% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8?66.3) years, with 76\% (n=23) being female. The response rates were 80\% and 93\% for the VRiKnee and control groups. Dropout rates were 13\% for VRiKnee and 7\% for the control group. Median exercise adherence was 77\% (IQR 37-104\%) for VRiKnee and 62\% (IQR 40-166\%) for the control group, respectively, with adherence reduction over this study's period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33\%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee. Conclusions: VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice. Trial Registration: Chinese Clinical Trial Registry CHiCTR2100046313; https://www.chictr.org.cn/showprojEN.html?proj=125404 ", doi="10.2196/52563", url="https://games.jmir.org/2024/1/e52563" } @Article{info:doi/10.2196/57185, author="Grube, Lara and Petit, Pascal and Vuillerme, Nicolas and Nitschke, Marlies and Nwosu, Bertrand Obioma and Knitza, Johannes and Krusche, Martin and Seifer, Ann-Kristin and Eskofier, M. Bjoern and Schett, Georg and Morf, Harriet", title="Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study", journal="JMIR Form Res", year="2024", month="Sep", day="19", volume="8", pages="e57185", keywords="DTx", keywords="DHA", keywords="usability", keywords="Yoga", keywords="YogiTherapy", keywords="ankylosing spondylitis", keywords="axial spondylarthritis", keywords="digital health application", keywords="eHealth", keywords="self-assessment", keywords="physical exercise", keywords="patient acceptance", keywords="therapy", keywords="home exercise", keywords="exercise", keywords="patients", keywords="patient", keywords="spondyloarthritis", keywords="usability study", keywords="app", keywords="apps", keywords="rheumatic disease", keywords="chronic", keywords="spine", keywords="adjacent joints", keywords="joints", keywords="joint", keywords="correlation analysis", keywords="digital therapeutics", abstract="Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. Results: A total of 65 patients with AS (33, 51\% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95\% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43\% (26/65 nonpromoters, 42\% (25/65) indifferent, and 15\% (9/65) promoters. A total of 7\% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is --26\%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95\% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=--0.21, P<.001). Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. ", doi="10.2196/57185", url="https://formative.jmir.org/2024/1/e57185" } @Article{info:doi/10.2196/54356, author="Dieter, Valerie and Janssen, Pia and Krauss, Inga", title="Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Sep", day="9", volume="12", pages="e54356", keywords="digital app", keywords="mobile health", keywords="mHealth", keywords="knee osteoarthritis", keywords="exercise", keywords="knee brace", abstract="Background: Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. Objective: This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. Methods: This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. Results: A total of 61 participants were included (IG: n=30, 49\%; CG: n=31, 51\%; male: n=31, 51\%; female: n=30, 49\%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5\% (899/972) of all scheduled exercise sessions. Conclusions: Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. Trial Registration: German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269 ", doi="10.2196/54356", url="https://mhealth.jmir.org/2024/1/e54356", url="http://www.ncbi.nlm.nih.gov/pubmed/39250181" } @Article{info:doi/10.2196/59755, author="Widhalm, Klaus and Maul, Lukas and Durstberger, Sebastian and Putz, Peter and Leder-Berg, Sebastian and Kainz, Hans and Augat, Peter", title="Efficacy of Real-Time Feedback Exercise Therapy in Patients Following Total Hip Arthroplasty: Protocol for a Pilot Cluster-Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Aug", day="20", volume="13", pages="e59755", keywords="hip replacement", keywords="exercise therapy", keywords="real-time feedback", keywords="movement analysis", abstract="Background: Osteoarthritis of the hip joint is an increasing functional and health-related problem. The most common surgical treatment is hip replacement to reduce pain and improve function. Rehabilitation after total hip arthroplasty (THA) is not regulated in Austria and mostly depends on the patient's own initiative and possibilities. Functional deficits, such as valgus thrust of the leg, functional Trendelenburg gait, or Duchenne limp, are characteristic symptoms before and, due to the performance learning effect prior to surgery, also after the operation. Addressing these deficits is possible through neuromuscular-focused exercise therapy. The efficacy of such therapy relies significantly on the quality of performance, the frequency of exercise, and the duration of engagement. Enhancing sustainability is achievable through increased motivation and real-time feedback (RTF) on exercise execution facilitated by digital feedback systems. Objective: This study will be performed to quantify the medium-term effectiveness of digital home exercise feedback systems on functional performance following THA. Methods: A clinical trial with a cluster-randomized, 2-arm, parallel-group design with an 8-week intervention phase and subsequent follow-ups at 3 and 6 months postsurgery will be conducted. Feedback during exercising will be provided through a blended-care program, combining a supervised group exercise program with a self-developed digital feedback system for home exercise. In total, 70 patients will be recruited for baseline. The primary outcome parameters will be the frontal knee range of motion, pelvic obliquity, and lateral trunk lean. Secondary outcomes will be the sum scores of patient-reported outcomes and relevant kinematic, kinetic, and spatiotemporal parameters. Results: The trial started in January 2024, and the first results are anticipated to be published by June 2025. RTF-supported home exercise is expected to improve exercise execution quality and therapeutic adherence compared to using paper instructions for excise guidance. Conclusions: The anticipated findings of this study aim to offer new insights into the effect of a blended-care program incorporating digital RTF on exercise therapy after unilateral THA, in addition to knowledge on the functional status 3 and 6 months postsurgery, for further improvement in the development of rehabilitation guidelines following THA. Trial Registration: ClinicalTrials.gov: NCT06161194; https://clinicaltrials.gov/study/NCT06161194 International Registered Report Identifier (IRRID): PRR1-10.2196/59755 ", doi="10.2196/59755", url="https://www.researchprotocols.org/2024/1/e59755" } @Article{info:doi/10.2196/48787, author="Lo, Man Hermione Hin and Zhu, Mengting and Zou, Zihui and Wong, Lee Cho and Lo, Shan Suzanne Hoi and Chung, Chi-Ho Vincent and Wong, Yeung-Shan Samuel and Sit, Shan Regina Wing", title="Immersive and Nonimmersive Virtual Reality--Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Aug", day="19", volume="26", pages="e48787", keywords="virtual reality", keywords="VR", keywords="physical therapy", keywords="musculoskeletal", keywords="pain", keywords="physiotherapy", keywords="chronic pain", keywords="musculoskeletal pain", keywords="low back pain", keywords="neck pain", keywords="osteoarthritis", keywords="knee pain", keywords="shoulder pain", keywords="disability", keywords="kinesiophobia", keywords="arthritis", keywords="systematic", keywords="review methods", keywords="review methodology", keywords="immersive", keywords="simulation", keywords="simulations", abstract="Background: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain. Objective: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes. Methods: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2. Results: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] --1.79, 95\% CI --2.72 to --0.87; P<.001), improving disability (SMD --0.44, 95\% CI --0.72 to --0.16; P=.002), and kinesiophobia (SMD --2.94, 95\% CI --5.20 to --0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD --8.15, 95\% CI --15.29 to --1.01; P=.03), and kinesiophobia (SMD --4.28, 95\% CI --8.12 to --0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD --0.55, 95\% CI --1.02 to --0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8\%) studies had a high risk of bias. Conclusions: Both nonimmersive and immersive VR--assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain. Trial Registration: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=302912 ", doi="10.2196/48787", url="https://www.jmir.org/2024/1/e48787" } @Article{info:doi/10.2196/48355, author="Xu, Zijun and Zheng, Xiaoxiang and Ding, Hanyue and Zhang, Dexing and Cheung, Man-Hin Peter and Yang, Zuyao and Tam, Wa King and Zhou, Weiju and Chan, Cheong-Chun Dicken and Wang, Wenyue and Wong, Yeung-Shan Samuel", title="The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="23", volume="10", pages="e48355", keywords="walking", keywords="depression", keywords="anxiety", keywords="systematic review", keywords="meta-analysis", abstract="Background: Previous literature lacks summative information on the mental health benefits achieved from different forms of walking. Objective: The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety. Methods: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95\% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool. Results: This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD ?0.591, 95\% CI ?0.778 to ?0.403; I2=84.8\%; $\tau$2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD ?0.446, 95\% CI ?0.628 to ?0.265; I2=81.1\%; $\tau$2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD ?1.863, 95\% CI ?2.764 to ?0.962; I2=86.4\%; $\tau$2=0.8929) and those who were not depressed (RCTs: n=39; SMD ?0.442, 95\% CI ?0.604 to ?0.280; I2=77.5\%; $\tau$2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD ?0.126, 95\% CI ?0.343 to 0.092; I2=58\%; $\tau$2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD ?0.053, 95\% CI ?0.311 to 0.206, I2=67.7\%, $\tau$2=0.1421; P=.69). Conclusions: Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021247983; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=247983 ", doi="10.2196/48355", url="https://publichealth.jmir.org/2024/1/e48355" } @Article{info:doi/10.2196/55716, author="Marcuzzi, Anna and Klevanger, Elisabeth Nina and Aasdahl, Lene and Gismervik, Sigmund and Bach, Kerstin and Mork, Jarle Paul and Nordstoga, Lovise Anne", title="An Artificial Intelligence--Based App for Self-Management of Low Back and Neck Pain in Specialist Care: Process Evaluation From a Randomized Clinical Trial", journal="JMIR Hum Factors", year="2024", month="Jul", day="9", volume="11", pages="e55716", keywords="low back pain", keywords="neck pain", keywords="self-management", keywords="smartphone app", keywords="process evaluation", keywords="focus group", keywords="focus groups", keywords="musculoskeletal", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="usage", keywords="interview", keywords="interviews", keywords="qualitative", keywords="engagement", abstract="Background: Self-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence--based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. Objective: This study is a process evaluation aiming to explore patients' engagement and experiences with the selfBACK app and specialist health care practitioners' views on adopting digital self-management tools in their clinical practice. Methods: App usage analytics in the first 12 weeks were used to explore patients' engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. Results: Nearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. Conclusions: Although the app's uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. Trial Registration: ClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043 ", doi="10.2196/55716", url="https://humanfactors.jmir.org/2024/1/e55716", url="http://www.ncbi.nlm.nih.gov/pubmed/38980710" } @Article{info:doi/10.2196/56081, author="Ong, Winslet and Omar, Arfa Noor and Zanudin, Asfarina and Alias, Faiz Muhamad and Hui Wen, Lim and Thang Xue Ee, Angel and Mohd Nordin, Azlin Nor and Manaf, Haidzir and Husin, Basri and Ahmad, Mahadir and Hisham, Hafifi", title="The Relationship Between Physical Activity and Mental Health Among Individuals With Spinal Cord Injury: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Jun", day="12", volume="13", pages="e56081", keywords="access barriers", keywords="depression", keywords="disability", keywords="exercise interventions", keywords="mental health", keywords="mobility limitations", keywords="physical activity", keywords="psychological outcomes", keywords="quality of life", keywords="spinal cord injury", keywords="SCI", keywords="mobility", keywords="scoping review", keywords="exercise", keywords="effectiveness", keywords="well-being", keywords="impairments", keywords="physical function", keywords="prevalence", abstract="Background: Spinal cord injury (SCI) is a devastating condition that often leads to significant impairments in physical function, leading to disability and mental health disorders. Hence, understanding the prevalence of SCI and the relationship between physical activity and mental health in individuals with SCI is crucial for informing rehabilitation strategies and optimizing outcomes. Objective: This study aims to comprehensively analyze existing research on the link between physical activity and mental health and identify the level of physical activity and mental health status, the barriers to physical activity, and SCI's impacts on psychological well-being in individuals with SCI. Methods: An electronic search strategy will be used to identify prevalence studies published since 1993 in health-related databases such as PubMed, MEDLINE, COCHRANE Library, and Wiley Library using the following query: ``Spinal Cord Injury'' OR ``Paraplegia'' OR ``Tetraplegia'' AND ``Physical Activity'' OR ``Exercise'' AND ``Mental Health'' OR ``Mental Illness'' OR ``Mental Disorder.'' Bibliographies of primary studies and review articles meeting the inclusion criteria will be searched manually to identify further eligible studies. The risk of bias in the included studies will be appraised using the Joanna Briggs Institute checklist for prevalence studies by 2 review authors. Any disagreement will be resolved by reaching a consensus. Results: Funding was received in October 2023, data collection will commence in July 2024, and the results are expected by 2025. We will summarize the selection of the eligible studies using a flowchart. The data from the studies will be extracted and tabulated. This scoping review will be published in a peer-reviewed journal in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Conclusions: This scoping review underscores the complex relationship between physical activity and mental health among individuals with SCI, highlighting the level of physical activity and mental health status, barriers to physical activity engagement, and psychological implications. Understanding these dynamics is crucial in devising tailored interventions aimed at enhancing mental well-being. This synthesis of evidence emphasizes the need for personalized strategies to promote physical activity, addressing unique challenges faced by this population to foster improved mental health outcomes and overall quality of life. Trial Registration: Open Science Framework osf.io/ugx7d; https://osf.io/ugx7d/ International Registered Report Identifier (IRRID): PRR1-10.2196/56081 ", doi="10.2196/56081", url="https://www.researchprotocols.org/2024/1/e56081", url="http://www.ncbi.nlm.nih.gov/pubmed/38865699" } @Article{info:doi/10.2196/54605, author="Adhikari, Prasad Shambhu and Stranges, N. Tori and Tehrani, Zadeh Setareh Nouri and Porter, Shaun and Mason, Karen and van Donkelaar, Paul", title="Investigating the Efficacy of a Community Support Network Rehabilitation Intervention for Improving Resiliency, Quality of Life, and Neurocognitive Function in Survivors of Intimate Partner Violence--Caused Brain Injury: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2024", month="May", day="24", volume="13", pages="e54605", keywords="brain injury", keywords="cognitive functions", keywords="community support network", keywords="intimate partner violence", keywords="quality of life", keywords="rehabilitation", abstract="Background: Globally, approximately 1 in 3 women experience intimate partner violence (IPV) in their lifetime. Brain injury (BI) is a common, yet often unrecognized, consequence of IPV. BIs caused by IPV tend to be mild, occur repetitively over the course of months or years, are remote in time, and result in chronic symptoms. Similar to BI from other causes, therapeutic treatment for women with IPV-caused BI (IPV-BI) is crucial to help resolve any physical or cognitive impairments, enhance the quality of life (QoL), and minimize longer-term neurodegeneration. Objective: This study aims to investigate the feasibility and efficacy of a community support network (CSN) rehabilitation intervention regarding its impact on resiliency, QoL, and neurocognitive function. Methods: In this pre- and postexperimental design, women (aged 18 to 50 years) who are survivors of IPV and IPV-BI will be recruited from various community organizations serving survivors of IPV. Exclusion criteria will include current pregnancy and any diagnosed neurological disorder known to affect cerebrovascular, neurocognitive, or sensorimotor function. A CSN rehabilitation intervention that includes aerobic exercise, cognitive training, mindfulness meditation, and counseling will be administered. A trauma-informed approach will be integrated into the design and implementation of the program. Furthermore, the program will include a participant navigator who will provide trauma- and violence-informed advocacy and systems navigation support to participants, in addition to facilitating a monthly peer support group. The intervention will be provided for 2.5 hours a day and 2 days a week for 3 months. Participants will complete psychological assessments and provide clinic-demographic information in the first assessment. In the second (before intervention), third (after intervention), and fourth (at follow-up) sessions, they will complete tests of resiliency, QoL, and neurocognition. The estimated sample size is 100. The objective of this study will be accomplished by quantitatively measuring resiliency, QoL, and neurocognition before and immediately after the intervention. A follow-up assessment will occur 3 months after the completion of the intervention to evaluate the maintenance of any improvements in function. One-way ANOVAs will be used to evaluate the intervention outcome across the testing times. Relationships among various variables will be explored using regression analysis. Results: We anticipate that the CSN rehabilitation intervention will be effective in improving resiliency, QoL, and neurocognitive function in women who have experienced IPV-BI. Furthermore, we anticipate that this intervention will be feasible in terms of study recruitment, adherence, and retention. Conclusions: The CSN rehabilitation intervention will have a positive impact on resiliency, QoL, and neurocognitive functions in survivors of IPV-BI. Subsequently, a comparative study will be conducted by recruiting a control group receiving usual care. International Registered Report Identifier (IRRID): PRR1-10.2196/54605 ", doi="10.2196/54605", url="https://www.researchprotocols.org/2024/1/e54605", url="http://www.ncbi.nlm.nih.gov/pubmed/38788207" } @Article{info:doi/10.2196/46067, author="Evans, Stuart", title="Sacroiliac Joint Dysfunction in Endurance Runners Using Wearable Technology as a Clinical Monitoring Tool: Systematic Review", journal="JMIR Biomed Eng", year="2024", month="May", day="20", volume="9", pages="e46067", keywords="sacroiliac", keywords="sacroiliac dysfunction", keywords="sacroiliac wearables", keywords="sensors", keywords="injury management", abstract="Background: In recent years, researchers have delved into the relationship between the anatomy and biomechanics of sacroiliac joint (SIJ) pain and dysfunction in endurance runners to elucidate the connection between lower back pain and the SIJ. However, the majority of SIJ pain and dysfunction cases are diagnosed and managed through a traditional athlete-clinician arrangement, where the athlete must attend regular in-person clinical appointments with various allied health professionals. Wearable sensors (wearables) are increasingly serving as a clinical diagnostic tool to monitor an athlete's day-to-day activities remotely, thus eliminating the necessity for in-person appointments. Nevertheless, the extent to which wearables are used in a remote setting to manage SIJ dysfunction in endurance runners remains uncertain. Objective: This study aims to conduct a systematic review of the literature to enhance our understanding regarding the use of wearables in both in-person and remote settings for biomechanical-based rehabilitation in SIJ dysfunction among endurance runners. In addressing this issue, the overarching goal was to explore how wearables can contribute to the clinical diagnosis (before, during, and after) of SIJ dysfunction. Methods: Three online databases, including PubMed, Scopus, and Google Scholar, were searched using various combinations of keywords. Initially, a total of 4097 articles were identified. After removing duplicates and screening articles based on inclusion and exclusion criteria, 45 articles were analyzed. Subsequently, 21 articles were included in this study. The quality of the investigation was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) evidence-based minimum set of items for reporting in systematic reviews. Results: Among the 21 studies included in this review, more than half of the investigations were literature reviews focusing on wearable sensors in the diagnosis and treatment of SIJ pain, wearable movement sensors for rehabilitation, or a combination of both for SIJ gait analysis in an intelligent health care setting. As many as 4 (19\%) studies were case reports, and only 1 study could be classified as fully experimental. One paper was classified as being at the ``pre'' stage of SIJ dysfunction, while 6 (29\%) were identified as being at the ``at'' stage of classification. Significantly fewer studies attempted to capture or classify actual SIJ injuries, and no study directly addressed the injury recovery stage. Conclusions: SIJ dysfunction remains underdiagnosed and undertreated in endurance runners. Moreover, there is a lack of clear diagnostic or treatment pathways using wearables remotely, despite the availability of validated technology. Further research of higher quality is recommended to investigate SIJ dysfunction in endurance runners and explore the use of wearables for rehabilitation in remote settings. ", doi="10.2196/46067", url="https://biomedeng.jmir.org/2024/1/e46067", url="http://www.ncbi.nlm.nih.gov/pubmed/38875697" } @Article{info:doi/10.2196/55452, author="de Graaf, Debbie and de Vries, M. Nienke and van de Zande, Tessa and Schimmel, P. Janneke J. and Shin, Sooyoon and Kowahl, Nathan and Barman, Poulami and Kapur, Ritu and Marks Jr, J. William and van 't Hul, Alex and Bloem, R. Bastiaan", title="Measuring Physical Functioning Using Wearable Sensors in Parkinson Disease and Chronic Obstructive Pulmonary Disease (the Accuracy of Digital Assessment of Performance Trial Study): Protocol for a Prospective Observational Study", journal="JMIR Res Protoc", year="2024", month="May", day="7", volume="13", pages="e55452", keywords="Parkinson disease", keywords="COPD", keywords="chronic obstructive pulmonary disease", keywords="physical activity", keywords="physical capacity", keywords="wearable devices", keywords="walking", keywords="exercise", keywords="locomotion", keywords="home-based", keywords="wearable", keywords="wearables", keywords="wearable sensor", keywords="dementia", keywords="smartwatch", keywords="StepWatch", keywords="treatment", abstract="Background: Physical capacity and physical activity are important aspects of physical functioning and quality of life in people with a chronic disease such as Parkinson disease (PD) or chronic obstructive pulmonary disease (COPD). Both physical capacity and physical activity are currently measured in the clinic using standardized questionnaires and tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go test (TUG). However, relying only on in-clinic tests is suboptimal since they offer limited information on how a person functions in daily life and how functioning fluctuates throughout the day. Wearable sensor technology may offer a solution that enables us to better understand true physical functioning in daily life. Objective: We aim to study whether device-assisted versions of 6MWT and TUG, such that the tests can be performed independently at home using a smartwatch, is a valid and reliable way to measure the performance compared to a supervised, in-clinic test. Methods: This is a decentralized, prospective, observational study including 100 people with PD and 100 with COPD. The inclusion criteria are broad: age ?18 years, able to walk independently, and no co-occurrence of PD and COPD. Participants are followed for 15 weeks with 4 in-clinic visits, once every 5 weeks. Outcomes include several walking tests, cognitive tests, and disease-specific questionnaires accompanied by data collection using wearable devices (the Verily Study Watch and Modus StepWatch). Additionally, during the last 10 weeks of this study, participants will follow an aerobic exercise training program aiming to increase physical capacity, creating the opportunity to study the responsiveness of the remote 6MWT. Results: In total, 89 people with PD and 65 people with COPD were included in this study. Data analysis will start in April 2024. Conclusions: The results of this study will provide information on the measurement properties of the device-assisted 6MWT and TUG in the clinic and at home. When reliable and valid, this can contribute to a better understanding of a person's physical capacity in real life, which makes it possible to personalize treatment options. Trial Registration: ClinicalTrials.gov NCT05756075; https://clinicaltrials.gov/study/NCT05756075 International Registered Report Identifier (IRRID): DERR1-10.2196/55452 ", doi="10.2196/55452", url="https://www.researchprotocols.org/2024/1/e55452", url="http://www.ncbi.nlm.nih.gov/pubmed/38713508" } @Article{info:doi/10.2196/56417, author="Kim, Yuyoung and Kim, Minjung and Kim, Jinwoo and Song, Tae-Jin", title="Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility", journal="J Med Internet Res", year="2024", month="Apr", day="25", volume="26", pages="e56417", keywords="dysarthria", keywords="stroke", keywords="smartphone", keywords="speech therapy", keywords="app", keywords="acute and early subacute", keywords="feasibility", keywords="mobile phone", abstract="Background: Dysarthria is a common poststroke speech disorder affecting communication and psychological well-being. Traditional speech therapy is effective but often poses challenges in terms of accessibility and patient adherence. Emerging smartphone-based therapies may offer promising alternatives for the treatment of poststroke dysarthria. Objective: This study aimed to assess the efficacy and feasibility of smartphone-based speech therapy for improving speech intelligibility in patients with acute and early subacute poststroke dysarthria. This study also explored the impact of the intervention on psychological well-being, user experience, and overall feasibility in a clinical setting. Methods: Participants were divided into 2 groups for this randomized, evaluator-blinded trial. The intervention group used a smartphone-based speech therapy app for 1 hour per day, 5 days per week, for 4 weeks, with guideline-based standard stroke care. The control group received standard guideline-based stroke care and rehabilitation. Speech intelligibility, psychological well-being, quality of life, and user acceptance were assessed using repeated measures ANOVA. Results: In this study, 40 patients with poststroke dysarthria were enrolled, 32 of whom completed the trial (16 in each group). The intervention group showed significant improvements in speech intelligibility compared with the control group. This was evidenced by improvements from baseline (F1,30=34.35; P<.001), between-group differences (F1,30=6.18; P=.02), and notable time-by-group interactions (F1,30=6.91; P=.01). Regarding secondary outcomes, the intervention led to improvements in the percentage of correct consonants over time (F1,30=5.57; P=.03). In addition, significant reductions were noted in the severity of dysarthria in the intervention group over time (F1,30=21.18; P<.001), with a pronounced group effect (F1,30=5.52; P=.03) and time-by-group interaction (F1,30=5.29; P=.03). Regarding quality of life, significant improvements were observed as measured by the EQ-5D-3L questionnaire (F1,30=13.25; P<.001) and EQ-VAS (F1,30=7.74; P=.009) over time. The adherence rate to the smartphone-based app was 64\%, with over half of the participants completing all the sessions. The usability of the app was rated high (system usability score 80.78). In addition, the intervention group reported increased self-efficacy in using the app compared with the control group (F1,30=10.81; P=.003). Conclusions: The smartphone-based speech therapy app significantly improved speech intelligibility, articulation, and quality of life in patients with poststroke dysarthria. These findings indicate that smartphone-based speech therapy can be a useful assistant device in the management of poststroke dysarthria, particularly in the acute and early subacute stroke stages. Trial Registration: ClinicalTrials.gov NCT05146765; https://clinicaltrials.gov/ct2/show/NCT05146765 ", doi="10.2196/56417", url="https://www.jmir.org/2024/1/e56417", url="http://www.ncbi.nlm.nih.gov/pubmed/38509662" } @Article{info:doi/10.2196/47600, author="Lee, J. Edmund W. and Tan, W. Warrick and Pham, Phat Ben Tan and Kawaja, Ariffin and Theng, Yin-Leng", title="Addressing Data Absenteeism and Technology Chauvinism in the Use of Gamified Wearable Gloves Among Older Adults: Moderated Usability Study", journal="JMIR Serious Games", year="2024", month="Apr", day="24", volume="12", pages="e47600", keywords="wearables", keywords="exergames", keywords="older adults", keywords="active aging", keywords="rehabilitation", keywords="stroke", abstract="Background: Digital health technologies have the potential to improve health outcomes for older adults, especially for those recovering from stroke. However, there are challenges to developing these technologies, such as data absenteeism (where older adults' views are often underrepresented in research and development) and technology chauvinism (the belief that sophisticated technology alone is the panacea to addressing health problems), which hinder their effectiveness. Objective: In this study, we aimed to address these challenges by developing a wearable glove integrated with culturally relevant exergames to motivate older adults to exercise and, for those recovering from stroke, to adhere to rehabilitation. Methods: We conducted a moderated usability study with 19 older adults, of which 11 (58\%) had a history of stroke. Our participants engaged in a 30-minute gameplay session with the wearable glove integrated with exergames, followed by a quantitative survey and an in-depth interview. We used descriptive analysis to compare responses to the System Usability Scale between those who had a history of stroke and those who did not. In addition, we analyzed the qualitative interviews using a bottom-up thematic analysis to identify key themes related to the motivations and barriers regarding the use of wearable gloves for rehabilitation and exercise. Results: Our study generated several key insights. First, making the exergames exciting and challenging could improve exercise and rehabilitation motivation, but it could also have a boomerang effect, where participants may become demotivated if the games were very challenging. Second, the comfort and ease of use of the wearable gloves were important for older adults, regardless of their stroke history. Third, for older adults with a history of stroke, the functionality and purpose of the wearable glove were important in helping them with specific exercise movements. Conclusions: Our findings highlight the importance of providing contextual support for the effective use of digital technologies, particularly for older adults recovering from stroke. In addition to technology and usability factors, other contextual factors such as gamification and social support (from occupational therapists or caregivers) should be considered to provide a comprehensive approach to addressing health problems. To overcome data absenteeism and technology chauvinism, it is important to develop digital health technologies that are tailored to the needs of underserved communities. Our study provides valuable insights for the development of digital health technologies that can motivate older adults recovering from stroke to exercise and adhere to rehabilitation. ", doi="10.2196/47600", url="https://games.jmir.org/2024/1/e47600", url="http://www.ncbi.nlm.nih.gov/pubmed/38656778" } @Article{info:doi/10.2196/49312, author="Su, Zhenzhen and Zhang, Liyan and Lian, Xuemin and Guan, Miaomiao", title="Virtual Reality--Based Exercise Rehabilitation in Cancer-Related Dysfunctions: Scoping Review", journal="J Med Internet Res", year="2024", month="Feb", day="26", volume="26", pages="e49312", keywords="virtual reality", keywords="cancer", keywords="virtual reality--based exercise rehabilitation", keywords="cancer-related dysfunction", keywords="rehabilitation", keywords="scoping review", abstract="Background: Virtual reality--based exercise rehabilitation (VRER) is a promising intervention for patients with cancer-related dysfunctions (CRDs). However, studies focusing on VRER for CRDs are lacking, and the results are inconsistent. Objective: We aimed to review the application of VRER in patients with CRDs. Methods: This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist framework. Publications were included from the time of database establishment to October 14, 2023. The databases were PubMed, Embase, Scopus, Cochrane, Web of Science, ProQuest, arXiv, IEEE Xplore, MedRxiv, CNKI, Wanfang Data, VIP, and SinoMed. The population included patients with cancer. A virtual reality (VR) system or device was required to be provided in exercise rehabilitation as an intervention. Eligible studies focused on VRER used for CRDs. Study selection and data extraction were performed by 2 reviewers independently. Extracted data included authors, year, country, study type, groups, sample size, participant age, cancer type, existing or potential CRDs, VR models and devices, intervention programs and durations, effectiveness, compliance, satisfaction, and safety. Results: We identified 25 articles, and among these, 12 (48\%) were randomized clinical trials, 11 (44\%) were other experimental studies, and 2 (8\%) were observational studies. The total sample size was 1174 (range 6-136). Among the 25 studies, 22 (88\%), 2 (8\%), and 1 (4\%) included nonimmersive VR, immersive VR, and augmented reality, respectively, which are models of VRER. Commercial game programs (17/25, 68\%) were the most popular interventions of VRER, and their duration ranged from 3 to 12 weeks. Using these models and devices, VRER was mostly applied in patients with breast cancer (14/25, 56\%), leukemia (8/25, 32\%), and lung cancer (3/25, 12\%). Furthermore, 6 CRDs were intervened by VRER, and among these, postmastectomy syndromes were the most common (10/25, 40\%). Overall, 74\% (17/23) of studies reported positive results, including significant improvements in limb function, joint range of motion, edema rates, cognition, respiratory disturbance index, apnea, activities of daily living, and quality of life. The compliance rate ranged from 56\% to 100\%. Overall, 32\% (8/25) of studies reported on patient satisfaction, and of these, 88\% (7/8) reported satisfaction with VRER. Moreover, 13\% (1/8) reported mild sickness as an adverse event. Conclusions: We found that around half of the studies reported using VRER in patients with breast cancer and postmastectomy dysfunctions through nonimmersive models and commercial game programs having durations of 3-12 weeks. In addition, most studies showed that VRER was effective owing to virtualization and interaction. Therefore, VRER may be an alternate intervention for patients with CRDs. However, as the conclusions were drawn from data with acknowledged inconsistencies and limited satisfaction reports, studies with larger sample sizes and more outcome indictors are required. ", doi="10.2196/49312", url="https://www.jmir.org/2024/1/e49312", url="http://www.ncbi.nlm.nih.gov/pubmed/38407951" } @Article{info:doi/10.2196/45168, author="Brassel, Sophie and Brunner, Melissa and Campbell, Andrew and Power, Emma and Togher, Leanne", title="Exploring Discussions About Virtual Reality on Twitter to Inform Brain Injury Rehabilitation: Content and Network Analysis", journal="J Med Internet Res", year="2024", month="Jan", day="19", volume="26", pages="e45168", keywords="virtual reality", keywords="Twitter", keywords="brain injury", keywords="rehabilitation", keywords="cognitive communication", keywords="social networks", keywords="social media", keywords="brain injury rehabilitation", keywords="engagement", keywords="development", keywords="clinical practice", keywords="injury", keywords="users", abstract="Background: Virtual reality (VR) use in brain injury rehabilitation is emerging. Recommendations for VR development in this field encourage end user engagement to determine the benefits and challenges of VR use; however, existing literature on this topic is limited. Data from social networking sites such as Twitter may further inform development and clinical practice related to the use of VR in brain injury rehabilitation. Objective: This study collected and analyzed VR-related tweets to (1) explore the VR tweeting community to determine topics of conversation and network connections, (2) understand user opinions and experiences of VR, and (3) identify tweets related to VR use in health care and brain injury rehabilitation. Methods: Publicly available tweets containing the hashtags \#virtualreality and \#VR were collected up to twice weekly during a 6-week period from July 2020 to August 2020 using NCapture (QSR International). The included tweets were analyzed using mixed methods. All tweets were coded using inductive content analysis. Relevant tweets (ie, coded as ``VR in health care'' or ``talking about VR'') were further analyzed using Dann's content coding. The biographies of users who sent relevant tweets were examined descriptively. Tweet data networks were visualized using Gephi computational analysis. Results: A total of 260,715 tweets were collected, and 70,051 (26.87\%) were analyzed following eligibility screening. The sample comprised 33.68\% (23,596/70,051) original tweets and 66.32\% (46,455/70,051) retweets. Content analysis generated 10 main categories of original tweets related to VR (ie, advertising and promotion, VR content, talking about VR, VR news, general technology, VR industry, VR live streams, VR in health care, VR events, and VR community). Approximately 4.48\% (1056/23,596) of original tweets were related to VR use in health care, whereas 0.19\% (45/23,596) referred to VR in brain injury rehabilitation. In total, 14.86\% (3506/23,596) of original tweets featured commentary on user opinions and experiences of VR applications, equipment, and software. The VR tweeting community comprised a large network of 26,001 unique Twitter users. Users that posted tweets related to ``VR in health care'' (2124/26,001, 8.17\%) did not form an interconnected VR network, whereas many users ``talking about VR'' (3752/26,001, 14.43\%) were connected within a central network. Conclusions: This study provides valuable data on community-based experiences and opinions related to VR. Tweets showcased various VR applications, including in health care, and identified important user-based considerations that can be used to inform VR use in brain injury rehabilitation (eg, technical design, accessibility, and VR sickness). Limited discussions and small user networks related to VR in brain injury rehabilitation reflect the paucity of literature on this topic and the potential underuse of this technology. These findings emphasize that further research is required to understand the specific needs and perspectives of people with brain injuries and clinicians regarding VR use in rehabilitation. ", doi="10.2196/45168", url="https://www.jmir.org/2024/1/e45168", url="http://www.ncbi.nlm.nih.gov/pubmed/38241072" } @Article{info:doi/10.2196/48900, author="Villada Castillo, Felipe Julian and Montoya Vega, Fernanda Maria and Mu{\~n}oz Cardona, Edison John and Lopez, David and Qui{\~n}ones, Leonardo and Henao Gallo, Alberto Oscar and Lopez, Fernando Jose", title="Design of Virtual Reality Exergames for Upper Limb Stroke Rehabilitation Following Iterative Design Methods: Usability Study", journal="JMIR Serious Games", year="2024", month="Jan", day="11", volume="12", pages="e48900", keywords="stroke", keywords="user-centered design", keywords="exergame", keywords="design", keywords="virtual reality", keywords="playtest", keywords="upper limb rehabilitation", abstract="Background: Since the early 2000s, there has been a growing interest in using exercise video games (exergames) and virtual reality (VR)--based interventions as innovative methods to enhance physical rehabilitation for individuals with multiple disabilities. Over the past decade, researchers and exercise professionals have focused on developing specialized immersive exercise video games for various populations, including those who have experienced a stroke, revealing tangible benefits for upper limb rehabilitation. However, it is necessary to develop highly engaging, personalized games that can facilitate the creation of experiences aligned with the preferences, motivations, and challenges communicated by people who have had an episode of stroke. Objective: This study seeks to explore the customization potential of an exergame for individuals who have undergone a stroke, concurrently evaluating its usability as a technological tool in the realm of physical therapy and rehabilitation. Methods: We introduce a playtest methodology to enhance the design of a VR exergame developed using a user-centered approach for upper limb rehabilitation in stroke survivors. Over 4 playtesting sessions, stroke survivors interacted with initial game versions using VR headsets, providing essential feedback for refining game content and mechanics. Additionally, a pilot study involving 10 stroke survivors collected data through VR-related questionnaires to assess game design aspects such as mechanics, assistance, experience, motion sickness, and immersion. Results: The playtest methodology was beneficial for improving the exergame to align with user needs, consistently incorporating their perspectives and achieving noteworthy results. The pilot study revealed that users had a positive response. In the first scenario, a carpenter presents a game based on the flexion-extension movement of the elbow; the second scenario includes a tejo game (a traditional Colombian throwing game) designed around game mechanics related to the flexion-extension movement of the shoulder; and in the third scenario, a farmer challenges the player to perform a movement combining elbow flexion and extension with internal and external rotation of the shoulder. These findings suggest the potential of the studied exergame as a tool for the upper limb rehabilitation of individuals who have experienced a stroke. Conclusions: The inclusion of exergames in rehabilitation for stroke-induced hemiparesis has significantly benefited the recovery process by focusing on essential shoulder and elbow movements. These interactive games play a crucial role in helping users regain mobility and restore practical use of affected limbs. They also serve as valuable data sources for researchers, improving the system's responsiveness. This iterative approach enhances game design and markedly boosts user satisfaction, suggesting exergames have promising potential as adjunctive elements in traditional therapeutic approaches. ", doi="10.2196/48900", url="https://games.jmir.org/2024/1/e48900", url="http://www.ncbi.nlm.nih.gov/pubmed/38206670" } @Article{info:doi/10.2196/50571, author="Ota, Hirofumi and Mukaino, Masahiko and Inoue, Yukari and Matsuura, Shoh and Yagi, Senju and Kanada, Yoshikiyo and Saitoh, Eiichi and Otaka, Yohei", title="Movement Component Analysis of Reaching Strategies in Individuals With Stroke: Preliminary Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="5", volume="10", pages="e50571", keywords="stroke", keywords="upper limb paresis", keywords="compensatory movements", keywords="three-dimensional motion analysis", keywords="reaching movement", keywords="rehabilitation", keywords="motion analysis", keywords="reaching", keywords="3D", keywords="three dimensional", keywords="motion capture", keywords="motion", keywords="movement", keywords="limb", keywords="extremity", keywords="extremities", keywords="mobility", keywords="hemiparesis", keywords="paralysis", keywords="compensate", keywords="compensatory", abstract="Background: Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings. Objective: This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action. Methods: A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger's MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated. Results: A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5\%, SD 24.5\% vs mean 85.2\%, SD 4.5\%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0\%, SD 28.5\% vs mean 3.0\%, SD 2.8\%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8\%, SD 23.7\% vs mean 90.7\%, SD 11.8\%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5\%, SD 5.7\% vs mean 6.5\%, SD 3.0\%; P=.02 and mean 16.5\%, SD 18.7\% vs mean 3.0\%, SD 10.4\%; P=.02, respectively). Conclusions: Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation. ", doi="10.2196/50571", url="https://rehab.jmir.org/2023/1/e50571", url="http://www.ncbi.nlm.nih.gov/pubmed/38051570" } @Article{info:doi/10.2196/45307, author="van Dartel, Dieuwke and Wang, Ying and Hegeman, H. Johannes and Vollenbroek-Hutten, R. Miriam M. and ", title="Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="30", volume="10", pages="e45307", keywords="continuous ambulatory monitoring", keywords="physical activity", keywords="pattern prediction", keywords="older patients", keywords="hip fracture rehabilitation", keywords="wearable sensing", abstract="Background: Building up physical activity is a highly important aspect in an older patient's rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients' recovery for timely adaptive interventions. Objective: This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home. Methods: The physical activity of patients aged ?70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F1-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F1-score for all physical activity patterns together. Results: The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F1-score=1) and a 100\% correct classification of the 2 most common physical activity patterns. Conclusions: Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves. ", doi="10.2196/45307", url="https://rehab.jmir.org/2023/1/e45307", url="http://www.ncbi.nlm.nih.gov/pubmed/38032703" } @Article{info:doi/10.2196/49813, author="Vos-Draper, L. Tamara and Morrow, B. Melissa M. and Ferguson, E. John and Mathiowetz, G. Virgil", title="Effects of Real-Time Pressure Map Feedback on Confidence in Pressure Management in Wheelchair Users With Spinal Cord Injury: Pilot Intervention Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="12", volume="10", pages="e49813", keywords="spinal cord injury", keywords="wheelchair", keywords="pressure injury prevention", keywords="self-efficacy", keywords="pressure mapping", keywords="pressure", keywords="mapping", keywords="map", keywords="interface", keywords="spine", keywords="spinal cord", keywords="feedback", keywords="real time", keywords="mobile phone", abstract="Background: Wheelchair users with a spinal cord injury (SCI) are at a high risk for developing pressure injuries (PIs). Performing weight shifts is a primary method of pressure management for PI prevention; however, individuals with SCI may lack confidence in their abilities to perform adequate pressure relief due to their lack of sensation. Real-time seat interface pressure mapping feedback may provide partial substitution for sensory feedback such that an individual's confidence is improved. Objective: We aim to examine how confidence for pressure management by wheelchair users with SCI was impacted by providing access to real-time, on-demand seat interface pressure mapping feedback. Methods: Adults with SCI (N=23) completed self-efficacy questions addressing confidence around 4 factors related to performing weight shifts in this longitudinal, repeated-measures study. We evaluated the impact of providing standard PI prevention education and access to live pressure map feedback on confidence levels for performing weight shifts. Results: Access to live pressure map feedback while learning how to perform weight shifts resulted in significantly higher confidence about moving far enough to relieve pressure at high-risk areas. Confidence for adhering to the recommended weight shift frequency and duration was not significantly impacted by in-clinic education or use of pressure map feedback. Confidence that performing weight shifts reduces PI risk increased most following education, with slight additional increase when pressure map feedback was added. Conclusions: Access to live pressure mapping feedback improves confidence about performing weight shifts that relieve pressure when provided in the clinical setting and demonstrates potential for the same in the home. This preliminary exploration of a smartphone-based pressure mapping intervention highlights the value of access to continuous pressure mapping feedback to improve awareness and confidence for managing pressure. Trial Registration: ClinicalTrials.gov NCT03987243; https://clinicaltrials.gov/study/NCT03987243 ", doi="10.2196/49813", url="https://rehab.jmir.org/2023/1/e49813", url="http://www.ncbi.nlm.nih.gov/pubmed/37824188" } @Article{info:doi/10.2196/50474, author="Prochaska, Eveline and Ammenwerth, Elske", title="A Digital Box and Block Test for Hand Dexterity Measurement: Instrument Validation Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Sep", day="15", volume="10", pages="e50474", keywords="assessment", keywords="Box and Block Test", keywords="BBT", keywords="concurrent validity", keywords="dexterity", keywords="digital Box and Block Test", keywords="dBBT", keywords="hand dexterity assessment", keywords="interrater reliability", keywords="test-retest reliability", keywords="validate", keywords="validity", abstract="Background: The Box and Block Test (BBT) measures unilateral gross manual dexterity and is widely used in clinical settings with a wide range of populations, including older people and clients with neurological disorders. Objective: In this study, we present a newly developed digitized version of the BBT, called the digital BBT (dBBT). The physical design is similar to the original BBT, but the dBBT contains digital electronics that automate the test procedure, timing, and score measurement. The aim of this study is to investigate the validity and reliability of the dBBT. Methods: We performed measurements at 2 time points for 29 healthy participants. BBT and dBBT were used at the first measurement time point, and dBBT was used again at the second measurement time point. Concurrent validity was assessed using the correlation between BBT and dBBT, the paired t test, and the Bland-Altman analysis. Test-retest reliability and interrater reliability were examined using the interclass correlation coefficient (ICC) by repeated measures with the dBBT within an interval of 10 days. Results: Our results showed moderate concurrent validity (r=0.48, P=.008), moderate test-retest reliability (ICC 0.72, P<.001), a standard error of measurement of 3.1 blocks, and the smallest detectable change at a 95\% CI of 8.5 blocks. Interrater reliability was moderate with an ICC of 0.67 (P=.02). The Bland-Altman analysis showed sufficient accuracy of the dBBT in comparison with the conventional BBT. Conclusions: The dBBT can contribute to objectifying the measurement of gross hand dexterity without losing its important characteristics and is simple to implement. ", doi="10.2196/50474", url="https://rehab.jmir.org/2023/1/e50474", url="http://www.ncbi.nlm.nih.gov/pubmed/37713251" } @Article{info:doi/10.2196/43985, author="Afzal, Waqar M. and Ahmad, Ashfaq and Hanif, Bilal Hafiz Muhammad and Chaudhary, Nauman and Gilani, Amir Syed", title="Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Sep", day="15", volume="10", pages="e43985", keywords="low back pain, lumbar range of motion", keywords="pain", keywords="Oswestry disability index", keywords="virtual reality", keywords="exercise", keywords="back pain", keywords="lumbar", keywords="range of motion", keywords="VR", keywords="rehabilitation", keywords="gaming", keywords="serious game", abstract="Background: Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation. Objective: This study aimed to compare the effects of VR games on chronic low back pain. Methods: This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P?.05. Results: The study comprised a sample of 40 patients with low back pain; 12 (40\%) were female and 28 (60\%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were --.60 (P=.76), --2.30 (P<.001), and --1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects. Conclusions: VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups. Trial Registration: Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916 ", doi="10.2196/43985", url="https://rehab.jmir.org/2023/1/e43985", url="http://www.ncbi.nlm.nih.gov/pubmed/37713252" } @Article{info:doi/10.2196/37604, author="Chae, Joo Han and Kim, Ji-Been and Park, Gwanmo and O'Sullivan, Michael David and Seo, Jinwook and Park, Jung-Jun", title="An Artificial Intelligence Exercise Coaching Mobile App: Development and Randomized Controlled Trial to Verify Its Effectiveness in Posture Correction", journal="Interact J Med Res", year="2023", month="Sep", day="12", volume="12", pages="e37604", keywords="home workout", keywords="mobile assistant", keywords="deep-learning", keywords="posture correction", keywords="physical activity", keywords="exercise", keywords="social distance", keywords="COVID-19", keywords="mobile device", keywords="workout", abstract="Background: Insufficient physical activity due to social distancing and suppressed outdoor activities increases vulnerability to diseases like cardiovascular diseases, sarcopenia, and severe COVID-19. While bodyweight exercises, such as squats, effectively boost physical activity, incorrect postures risk abnormal muscle activation joint strain, leading to ineffective sessions or even injuries. Avoiding incorrect postures is challenging for novices without expert guidance. Existing solutions for remote coaching and computer-assisted posture correction often prove costly or inefficient. Objective: This study aimed to use deep neural networks to develop a personal workout assistant that offers feedback on squat postures using only mobile devices---smartphones and tablets. Deep learning mimicked experts' visual assessments of proper exercise postures. The effectiveness of the mobile app was evaluated by comparing it with exercise videos, a popular at-home workout choice. Methods: Twenty participants were recruited without squat exercise experience and divided into an experimental group (EXP) with n=10, age=21.90 (2.18), and BMI=20.75 (2.11); and a control group (CTL) with n=10, age=22.60 (1.95), and BMI=18.72 (1.23) using randomized controlled trials. A data set with over 20,000 squat videos annotated by experts was created and a deep-learning model was trained using pose estimation and video classification to analyze the workout postures. Subsequently, a mobile workout assistant app, Home Alone Exercise, was developed, and a 2-week interventional study, in which the EXP used the app while the CTL only followed workout videos, showed how the app helps people improve squat exercise. Results: The EXP significantly improved their squat postures evaluated by the app after 2 weeks (Pre: 0.20 vs Mid: 4.20 vs Post: 8.00, P=.001), whereas the CTL (without the app) showed no significant change in squat posture (Pre: 0.70 vs Mid: 1.30 vs Post: 3.80, P=.13). Significant differences were observed in the left (Pre: 75.06 vs Mid: 76.24 vs Post: 63.13, P=.02) and right (Pre: 71.99 vs Mid: 76.68 vs Post: 62.82, P=.03) knee joint angles in the EXP before and after exercise, with no significant effect found for the CTL in the left (Pre: 73.27 vs Mid: 74.05 vs Post: 70.70, P=.68) and right (Pre: 70.82 vs Mid: 74.02 vs Post: 70.23, P=.61) knee joint angles. Conclusions: EXP participants trained with the app experienced faster improvement and learned more nuanced details of the squat exercise. The proposed mobile app, offering cost-effective self-discovery feedback, effectively taught users about squat exercises without expensive in-person trainer sessions. Trial Registration: Clinical Research Information Service KCT0008178 (retrospectively registered); https://cris.nih.go.kr/cris/search/detailSearch.do/24006 ", doi="10.2196/37604", url="https://www.i-jmr.org/2023/1/e37604/" } @Article{info:doi/10.2196/49236, author="Pak, S. Sang and Janela, Dora and Freitas, Nina and Costa, Fab{\'i}ola and Moulder, Robert and Molinos, Maria and Areias, C. Anabela and Bento, Virg{\'i}lio and Cohen, P. Steven and Yanamadala, Vijay and Souza, B. Richard and Correia, Dias Fernando", title="Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="Aug", day="18", volume="25", pages="e49236", keywords="chronic shoulder", keywords="clinical outcome", keywords="digital care", keywords="digital health intervention", keywords="musculoskeletal pain", keywords="pain management", keywords="physical therapy", keywords="remote sensing technology", keywords="telerehabilitation", abstract="Background: Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. Objective: The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. Methods: We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. Results: A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (--1.8, 95\% CI --13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. Conclusions: This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. Trial Registration: ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528 ", doi="10.2196/49236", url="https://www.jmir.org/2023/1/e49236", url="http://www.ncbi.nlm.nih.gov/pubmed/37490337" } @Article{info:doi/10.2196/49673, author="Areias, C. Anabela and Janela, Dora and Molinos, Maria and Moulder, G. Robert and Bento, Virg{\'i}lio and Yanamadala, Vijay and Cohen, P. Steven and Correia, Dias Fernando and Costa, Fab{\'i}ola", title="Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="15", volume="10", pages="e49673", keywords="aged", keywords="digital therapy", keywords="eHealth", keywords="musculoskeletal conditions", keywords="older adults", keywords="pain", keywords="physical therapy", keywords="telehealth", keywords="telerehabilitation", abstract="Background: Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). Objective: This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. Methods: We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ?44 years old (young adults), 45-64 years old (middle-aged adults), and ?65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30\%), analgesic usage, mental health, work productivity, and non--work-related activity impairment. Results: Of 16,229 patients, 12,082 started the program: 38.3\% (n=4629) were young adults, 55.7\% (n=6726) were middle-aged adults, and 6\% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95\% CI 1.45-2.06; P<.001 and OR 2.40, 95\% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95\% CI 1.03-1.45; P=.03 and OR 1.38, 95\% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6\%; middle-aged adults: 1848/2834, 65.2\%; and older adults: 241/387, 62.3\%; P=.17). Conclusions: Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population. ", doi="10.2196/49673", url="https://rehab.jmir.org/2023/1/e49673", url="http://www.ncbi.nlm.nih.gov/pubmed/37465960" } @Article{info:doi/10.2196/41359, author="Alhasani, Rehab and George, Nicole and Radman, Dennis and Auger, Claudine and Ahmed, Sara", title="Methodologies for Evaluating the Usability of Rehabilitation Technologies Aimed at Supporting Shared Decision-Making: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="15", volume="10", pages="e41359", keywords="usability", keywords="technology", keywords="rehabilitation", keywords="shared decision-making", keywords="mobile phone", abstract="Background: The field of rehabilitation has seen a recent rise in technologies to support shared decision-making (SDM). Usability testing during the design process of SDM technologies is needed to optimize adoption and realize potential benefits. There is variability in how usability is defined and measured. Given the complexity of usability, a thorough examination of the methodologies used to measure usability to develop the SDM technologies used in rehabilitation care is needed. Objective: This scoping review aims to answer the following research questions: which methods and measures have been used to produce knowledge about the usability of rehabilitation technologies aimed at supporting SDM at the different phases of development and implementation? Which parameters of usability have been measured and reported? Methods: This review followed the Arksey and O'Malley framework. An electronic search was performed in the Ovid MEDLINE, Embase, CINAHL, and PsycINFO databases from January 2005 up to November 2020. In total, 2 independent reviewers screened all retrieved titles, abstracts, and full texts according to the inclusion criteria and extracted the data. The International Organization for Standardization framework was used to define the scope of usability (effectiveness, efficiency, and satisfaction). The characteristics of the studies were outlined in a descriptive summary. Findings were categorized based on usability parameters, technology interventions, and measures of usability. Results: A total of 38 articles were included. The most common SDM technologies were web-based aids (15/33, 46\%). The usability of SDM technologies was assessed during development, preimplementation, or implementation, using 14 different methods. The most frequent methods were questionnaires (24/38, 63\%) and semistructured interviews (16/38, 42\%). Satisfaction (27/38, 71\%) was the most common usability parameter mapped to types of SDM technologies and usability evaluation methods. User-centered design (9/15, 60\%) was the most frequently used technology design framework. Conclusions: The results from this scoping review highlight the importance and the complexity of usability evaluation. Although various methods and measures were shown to be used to evaluate the usability of technologies to support SDM in rehabilitation, very few evaluations used in the included studies were found to adequately span the selected usability domains. This review identified gaps in usability evaluation, as most studies (24/38, 63\%) relied solely on questionnaires rather than multiple methods, and most questionnaires simply focused on the usability parameter of satisfaction. The consideration of end users (such as patients and clinicians) is of particular importance for the development of technologies to support SDM, as the process of SDM itself aims to improve patient-centered care and integrate both patient and clinician voices into their rehabilitation care. ", doi="10.2196/41359", url="https://rehab.jmir.org/2023/1/e41359", url="http://www.ncbi.nlm.nih.gov/pubmed/37581911" } @Article{info:doi/10.2196/46619, author="Kerr, Andy and Keogh, Maisie and Slachetka, Milena and Grealy, Madeleine and Rowe, Philip", title="An Intensive Exercise Program Using a Technology-Enriched Rehabilitation Gym for the Recovery of Function in People With Chronic Stroke: Usability Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="21", volume="10", pages="e46619", keywords="rehabilitation technology", keywords="stroke", keywords="feasibility", keywords="intensive exercise", keywords="rehabilitation", keywords="exercise", keywords="motor impairment", keywords="feasibility study", keywords="telehealth", keywords="recovery", keywords="telerehabilitation", abstract="Background: Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment. Objective: This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research. Methods: This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures. Results: In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82\% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. Conclusions: This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population. International Registered Report Identifier (IRRID): RR2-doi.org/10.3389/fresc.2021.820929 ", doi="10.2196/46619", url="https://rehab.jmir.org/2023/1/e46619", url="http://www.ncbi.nlm.nih.gov/pubmed/37477954" } @Article{info:doi/10.2196/43813, author="Weber, Franziska and Kloek, Corelien and Arntz, Angela and Gr{\"u}neberg, Christian and Veenhof, Cindy", title="Blended Care in Patients With Knee and Hip Osteoarthritis in Physical Therapy: Delphi Study on Needs and Preconditions", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="7", volume="10", pages="e43813", keywords="telerehabilitation", keywords="osteoarthritis", keywords="physical therapy", keywords="knee", keywords="hip", keywords="blended", keywords="preconditions", keywords="Delphi", keywords="focus group", keywords="user need", abstract="Background: Osteoarthritis is a major public health concern. Despite existing evidence-based treatment options, the health care situation remains unsatisfactory. Digital care options, especially when combined with in-person sessions, seem to be promising. Objective: The aim of this study was to investigate the needs, preconditions, barriers, and facilitators of blended physical therapy for osteoarthritis. Methods: This Delphi study consisted of interviews, an online questionnaire, and focus groups. Participants were physical therapists, patients with hip and/or knee osteoarthritis with or without experience in digital care, and stakeholders of the health care system. In the first phase, interviews were conducted with patients and physical therapists. The interview guide was based on the Consolidated Framework For Implementation Research. The interviews focused on experiences with digital and blended care. Furthermore, needs, facilitators, and barriers were discussed. In the second phase, an online questionnaire and focus groups served the process to confirm the needs and collect preconditions. The online questionnaire contained statements drawn by the results of the interviews. Patients and physical therapists were invited to complete the questionnaire and participate in one of the three focus groups including (1) patients; (2) physical therapists; and (3) a patient, a physical therapist, and stakeholders from the health care system. The focus groups were used to determine concordance with the results of the interviews and the online questionnaire. Results: Nine physical therapists, seven patients, and six stakeholders confirmed that an increase of acceptance of the digital care part by physical therapists and patients is crucial. One of the most frequently mentioned facilitators was conducting regular in-person sessions. Physical therapists and patients concluded that blended physical therapy must be tailored to the patients' needs. Participants of the last focus group stated that the reimbursement of blended physical therapy needs to be clarified. Conclusions: Most importantly, it is necessary to strengthen the acceptance of patients and physical therapists toward digital care. Overall, for development and usage purposes, it is crucial to take the needs and preconditions into account. Trial Registration: German Clinical Trials Register DRKS00023386; https://drks.de/search/en/trial/DRKS00023386 ", doi="10.2196/43813", url="https://rehab.jmir.org/2023/1/e43813", url="http://www.ncbi.nlm.nih.gov/pubmed/37418301" } @Article{info:doi/10.2196/43888, author="Peterson, Gunnel and Peolsson, Anneli", title="Efficacy of Neck-Specific Exercise With Internet Support Versus Neck-Specific Exercise at a Physiotherapy Clinic in Chronic Whiplash-Associated Disorders: Multicenter Randomized Controlled Noninferiority Trial", journal="J Med Internet Res", year="2023", month="Jun", day="20", volume="25", pages="e43888", keywords="internet-based intervention", keywords="telerehabilitation", keywords="whiplash associated disorders", keywords="neck", keywords="whiplash", keywords="physiotherapy", keywords="physiotherapist", keywords="physical therapy", keywords="neck pain", keywords="exercise", keywords="chronic pain", keywords="digital health intervention", keywords="telehealth", keywords="rehabilitation", keywords="pain management", keywords="internet-based", keywords="telemedicine", keywords="digital health", abstract="Background: Neck-specific exercises (NSE) supervised by a physiotherapist twice a week for 12 weeks have shown good results in chronic whiplash-associated disorders (WADs), but the effect of exercise delivered via the internet is unknown. Objective: This study examined whether NSE with internet support (NSEIT) and 4 physiotherapy sessions for 12 weeks were noninferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE). Methods: In this multicenter randomized controlled noninferiority trial with masked assessors, we recruited adults aged 18-63 years with chronic WAD grade II (ie, neck pain and clinical musculoskeletal signs) or III (ie, grade II plus neurological signs). Outcomes were measured at baseline and at 3- and 15-month follow-ups. The primary outcome was change in neck-related disability, measured with the Neck Disability Index (NDI; 0\%-100\%), with higher percentages indicating greater disability. Secondary outcomes were neck and arm pain intensity (Visual Analog Scale [VAS]), physical function (Whiplash Disability Questionnaire [WDQ] and Patient-Specific Functional Scale [PSFS]), health-related quality of life (EQ-5D-3L and EQ VAS), and self-rated recovery (Global Rating Scale [GRS]). The analyses were conducted on an intention-to-treat basis and with the per-protocol approach as sensitivity analyses. Results: Between April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90\%) and 64 (91\%), respectively, were followed up at 3 months, and 56 (80\%) and 58 (83\%), respectively, at 15 months. NSEIT demonstrated noninferiority to NSE in the primary outcome NDI, as the 1-sided 95\% CI of the mean difference in change did not cross the specified noninferiority margin (7 percentage units). There were no significant between-group differences in change in NDI at the 3- or 15-month follow-up, with a mean difference of 1.4 (95\% CI --2.5 to 5.3) and 0.9 (95\% CI --3.6 to 5.3), respectively. In both groups, the NDI significantly decreased over time (NSEIT: mean change --10.1, 95\% CI --13.7 to --6.5, effect size=1.33; NSE: mean change --9.3, 95\% CI --12.8 to --5.7, effect size=1.19 at 15 months; P<.001). NSEIT was noninferior to NSE for most of the secondary outcomes except for neck pain intensity and EQ VAS, but post hoc analyses showed no differences between the groups. Similar results were seen in the per-protocol population. No serious adverse events were reported. Conclusions: NSEIT was noninferior to NSE in chronic WAD and required less physiotherapist time. NSEIT could be used as a treatment for patients with chronic WAD grades II and III. Trial Registration: ClinicalTrials.gov NCT03022812; https://clinicaltrials.gov/ct2/show/NCT03022812 ", doi="10.2196/43888", url="https://www.jmir.org/2023/1/e43888", url="http://www.ncbi.nlm.nih.gov/pubmed/37338972" } @Article{info:doi/10.2196/43637, author="Lopes, M{\'a}rio and Lopes, Susana and Monteiro, Mariana and Rodrigues, M{\'a}rio and Fertuzinhos, Aureliano and Coelho, Sousa Augusto de and Matos, Paulo and Borges, Ab{\'i}lio and Leite, Te{\'o}filo and Sampaio, C{\'a}tia and Costa, Rui and Alvarelh{\~a}o, Jos{\'e}", title="Exploring the Efficacy of a Set of Smart Devices for Postural Awareness for Workers in an Industrial Context: Protocol for a Single-Subject Experimental Design", journal="JMIR Res Protoc", year="2023", month="May", day="4", volume="12", pages="e43637", keywords="smart wear", keywords="smart health", keywords="occupational safety", keywords="motion sensing", keywords="devices", keywords="awareness", keywords="posture", keywords="fatigue", keywords="biomechanics", keywords="musculoskeletal disorder", keywords="smart device", keywords="pressure sensing", abstract="Background: In manufacturing industries, tasks requiring poor posture, high repetition, and long duration commonly induce fatigue and lead to an increased risk of work-related musculoskeletal disorders. Smart devices assessing biomechanics and providing feedback to the worker for correction may be a successful way to increase postural awareness, reducing fatigue, and work-related musculoskeletal disorders. However, evidence in industrial settings is lacking. Objective: This study protocol aims to explore the efficacy of a set of smart devices to detect malposture and increase postural awareness, reducing fatigue, and musculoskeletal disorders. Methods: A longitudinal single-subject experimental design following the ABAB sequence will be developed in a manufacturing industry real context with 5 workers. A repetitive task of screw tightening of 5 screws in a standing position into a piece placed horizontally was selected. Workers will be assessed in 4 moments per shift (10 minutes after the beginning of the shift, 10 minutes before and after the break, and 10 minutes before the end of the shift) in 5 nonconsecutive days. The primary outcomes are fatigue, assessed by electromyography, and musculoskeletal symptoms assessed by the Nordic Musculoskeletal Questionnaire. Secondary outcomes include perceived effort (Borg perceived exertion scale); range of motion of the main joints in the upper body, speed, acceleration, and deceleration assessed by motion analysis; risk stratification of range of motion; and cycle duration in minutes. Structured visual analysis techniques will be conducted to observe the effects of the intervention. Results for each variable of interest will be compared among the different time points of the work shift and longitudinally considering each assessment day as a time point. Results: Enrollment for the study will start in April 2023. Results are expected to be available still in the first semester of 2023. It is expected that the use of the smart system will reduce malposture, fatigue, and consequently, work-related musculoskeletal pain and disorders. Conclusions: This proposed study will explore a strategy to increase postural awareness in industrial manufacturing workers who do repetitive tasks, using smart wearables that provide real-time feedback about biomechanics. Results would showcase a novel approach for improving self-awareness of risk for work-related musculoskeletal disorders for these workers providing an evidence base support for the use of such devices. International Registered Report Identifier (IRRID): PRR1-10.2196/43637 ", doi="10.2196/43637", url="https://www.researchprotocols.org/2023/1/e43637", url="http://www.ncbi.nlm.nih.gov/pubmed/37140979" } @Article{info:doi/10.2196/43221, author="Gu{\'e}rin, Mathias and Sijobert, Benoit and Zaragoza, Benjamin and Cambon, Flore and Boyer, Laurence and Patte, Karine", title="Combining Intensive Rehabilitation With a Nonfunctional Isokinetic Strengthening Program in Adolescents With Cerebral Palsy: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="May", day="3", volume="12", pages="e43221", keywords="isokinetic", keywords="cerebral palsy", keywords="gait analysis", keywords="spasticity", keywords="muscle strength", abstract="Background: Cerebral palsy is the most common brain injury in the pediatric population. Patients with cerebral palsy present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with intensive rehabilitation may improve muscle strength and therefore gait efficiency. Objective: The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a nonfunctional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in patients with cerebral palsy. Another goal of this study is to determine whether adding an isokinetic program to intensive rehabilitation is more effective than intensive rehabilitation alone at decreasing spasticity and improving joint position sense in patients with cerebral palsy. Methods: A total of 30 adolescents with spastic diplegia cerebral palsy (Gross Motor Function Classification System levels I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic progressive strengthening group or an intensive rehabilitation control group. Gait parameters, muscle strength, spasticity, and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydrotherapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training sessions focusing on knee flexors and extensors with different execution speeds. Results: The protocol has been accepted by the French National Ethics Committee in October 2022. The inclusion of patients will start in November 2022. Conclusions: The combination of intensive rehabilitation with an isokinetic program on knee flexors and extensors has not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is beneficial for the improvement of gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia. International Registered Report Identifier (IRRID): PRR1-10.2196/43221 ", doi="10.2196/43221", url="https://www.researchprotocols.org/2023/1/e43221", url="http://www.ncbi.nlm.nih.gov/pubmed/36790338" } @Article{info:doi/10.2196/43265, author="Rezaeian, Zeinab and Andalib, Ali and Bokaee, Fateme and Poorpooneh Najafabadi, Maryam and Yeowell, Gillian and Sadeghi-Demneh, Ebrahim", title="The Efficacy of Trunk Bracing With an Instrumented Corrective Exercise on Spinal Deformity, Pulmonary Function, Trunk Muscle Endurance, and Quality of Life in Adolescent Idiopathic Scoliosis: Protocol for a Parallel Groups Clinical Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="29", volume="12", pages="e43265", keywords="home exercise", keywords="orthotic device", keywords="quality of life", keywords="scoliosis", abstract="Background: Adolescent idiopathic scoliosis is a 3D spine distortion with an unidentified etiology. It results in noticeable trunk deformity, decreased muscle strength and endurance at the trunk, changes in chest volume, breathing issues, and ultimately a decline in the quality of life. Trunk bracing and corrective exercises make up most of the treatment of patients with scoliosis when their deformity is between 20{\textdegree} and 45{\textdegree}, and they have not yet attained skeletal maturity. Evidence suggests that spinal deformity in people with scoliosis may result from improper motor control. Automatic response training is an exercise therapy technique that can modify the pattern of trunk muscle control for supporting the spinal column in normal alignment. An apparatus called a cantilever device is required for this type of exercise, which facilitates training at home. In spite of research showing the benefit of braces and therapeutic exercise in adolescents with scoliosis, less emphasis has been given to the impact of home-based training, especially when this intervention is paired with braces. Objective: We aim to compare the efficacy of bracing and a conventional exercise program to a combination treatment that includes trunk bracing and exercises with a cantilever device performed at home on the degree of spine curvature, pulmonary function, trunk muscular endurance, and quality of life. Methods: This study was a 2-arms parallel-group clinical study. A total of 16 adolescents with idiopathic scoliosis and single lumbar and thoracolumbar curves of 20{\textdegree}-45{\textdegree} were recruited and randomly assigned into 2 groups. Group A received a combination of trunk bracing and exercise using an instrument known as a ``cantilever.'' Group B (controls) received trunk bracing and a conventional exercise program (without a tool). The study outcomes were the Cobb angle of the scoliotic curve, pulmonary function, the endurance of the trunk muscles, and quality of life. The study outcomes were measured at 2 time points: before the intervention (T1) and 12 weeks following the start of the intervention (T2; at this time, the intervention period has been completed). Multivariate analysis of variance was used to test between- and within-group differences. Results: Recruitment for this study began in fall 2022 and is expected to be completed by the end of summer 2023. Conclusions: We studied the efficacy of a combined trunk bracing program and postural response exercises using a cantilever device in treating adolescent idiopathic scoliosis and compared it with trunk bracing and conventional home exercises. Exercises performed at home using a cantilever device are anticipated to raise the endurance of trunk muscles, which will help reduce trunk deformity, enhance pulmonary function, and improve the quality of life of participants. Trial Registration: Iranian Registry of Clinical Trials IRCT20220330054371N1; https://www.irct.ir/trial/62811 International Registered Report Identifier (IRRID): PRR1-10.2196/43265 ", doi="10.2196/43265", url="https://www.researchprotocols.org/2023/1/e43265", url="http://www.ncbi.nlm.nih.gov/pubmed/36989018" } @Article{info:doi/10.2196/35757, author="Parel, Ilaria and Candoli, Valeria and Filippi, Vittoria Maria and Padolino, Antonio and Merolla, Giovanni and Sanniti, Stefano and Galassi, Riccardo and Paladini, Paolo and Cutti, Giovanni Andrea", title="Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program", journal="JMIR Res Protoc", year="2023", month="Mar", day="22", volume="12", pages="e35757", keywords="rotator cuff tear repair", keywords="wearable sensor", keywords="biomechanic", keywords="eHealth", keywords="rehabilitation", keywords="scapula", keywords="biofeedback", keywords="kinematic", keywords="exercise", keywords="shoulder", abstract="Background: The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. Objective: The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. Methods: For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient's rehabilitation program, a list of operative guidelines is provided. Results: We describe various applications of the ISEO exercise program in terms of frequency and intensity. Conclusions: An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. International Registered Report Identifier (IRRID): DERR1-10.2196/35757 ", doi="10.2196/35757", url="https://www.researchprotocols.org/2023/1/e35757", url="http://www.ncbi.nlm.nih.gov/pubmed/36947146" } @Article{info:doi/10.2196/41421, author="Cooley, Sarah and Nelson, M. Brittany and Rosenow, Alexander and Westerhaus, Elizabeth and Cade, Todd W. and Reeds, N. Dominic and Vaida, Florin and Yarasheski, E. Kevin and Paul, H. Robert and Ances, M. Beau", title="Exercise Training to Improve Brain Health in Older People Living With HIV: Study Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Mar", day="21", volume="12", pages="e41421", keywords="cardiorespiratory fitness", keywords="cognition", keywords="exercise", keywords="HIV", keywords="magnetic resonance imaging", keywords="resistance training", abstract="Background: With the advent of antiretrovirals, people living with HIV are living near-normal lifespans. However, people living with HIV are at greater risk of experiencing cognitive impairment and reduced brain integrity despite well-controlled viremia. A robust literature supports exercise interventions as a method of improving cognition and structural brain integrity in older individuals without HIV. The effects of exercise on cardiometabolic, neurocognitive, and neural structures in middle-aged to older people living with HIV are less well known, with few prospective studies examining these measures. Objective: This prospective randomized clinical trial will examine the effects of a 6-month exercise training intervention compared to a 6-month stretching intervention (control) on cardiorespiratory fitness, physical function and strength, cognition, and neuroimaging measures of brain volumes and cerebral blood flow in people living with HIV. Methods: Sedentary middle-aged to older people living with HIV (ages?40; n=150) with undetectable HIV viral load (<20 copies/mL) will be enrolled in the study. At the baseline and final visit, fasting plasma lipid, insulin, glucose, and brain neurotrophic factor concentrations; cardiorespiratory fitness; cognitive performance; brain volumes; and cerebral blood flow via a magnetic resonance imaging scan will be measured. Participants will be randomized in a 2:1 ratio to either the exercise or control stretching intervention. All participants will complete their assigned programs at a community fitness center 3 times a week for 6 months. A professional fitness trainer will provide personal training guidance at all sessions for individuals enrolled in both arms. Individuals randomized to the exercise intervention will perform endurance and strength training exercises, while those randomized to the control intervention will perform stretches to increase flexibility. A midpoint visit (at 3 months) will assess cognitive performance, and at the end point visit, subjects will undergo cardiorespiratory fitness and cognition testing, and a magnetic resonance imaging scan. Physical activity throughout the duration of the trial will be recorded using an actigraph. Results: Recruitment and data collection are complete as of December 2020. Data processing, cleaning, and organization are complete as of December 2021. Data analysis began in January 2022, with the publication of study results for primary aims 1 and 2 expected by early 2023. Conclusions: This study will investigate the effects of a 6-month aerobic and resistance exercise training intervention to improve cardiometabolic risk factors, cognitive performance, cerebral structure, and blood flow in sedentary people living with HIV. Results will inform clinicians and patients of the potential benefits of a structured aerobic exercise training program on the cognitive, functional, and cardiometabolic health status of older people living with HIV. Assessment of compliance will inform the development and implementation of future exercise programs for people living with HIV. Trial Registration: ClinicalTrials.gov NCT02663934; https://clinicaltrials.gov/ct2/show/NCT02663934 International Registered Report Identifier (IRRID): DERR1-10.2196/41421 ", doi="10.2196/41421", url="https://www.researchprotocols.org/2023/1/e41421", url="http://www.ncbi.nlm.nih.gov/pubmed/36943345" } @Article{info:doi/10.2196/43775, author="Teepe, Wilhelm Gisbert and Kowatsch, Tobias and Hans, Patricius Felix and Benning, Leo", title="Postmarketing Follow-Up of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time-Series and Matched-Pair Analysis", journal="J Med Internet Res", year="2023", month="Feb", day="27", volume="25", pages="e43775", keywords="digital therapeutics", keywords="digital health", keywords="musculoskeletal diseases", keywords="exercise training", abstract="Background: Musculoskeletal conditions are the main drivers of global disease burden and cause significant direct and indirect health care costs. Digital health applications improve the availability of and access to adequate care. The German health care system established a pathway for the approval of ``Digitale Gesundheitsanwendungen'' (DiGAs; Digital Health Applications) as collectively funded medical services through the ``Digitale-Versorgung-Gesetz'' (Digital Health Care Act) in 2019. Objective: This article presents real-world prescription data collected through the smartphone-based home exercise program ``Vivira,'' a fully approved DiGA, regarding its effect on self-reported pain intensity and physical inability in patients with unspecific and degenerative pain in the back, hip, and knee. Methods: This study included 3629 patients (71.8\% [2607/3629] female; mean age 47 years, SD 14.2 years). The primary outcome was the self-reported pain score, which was assessed with a verbal numerical rating scale. The secondary outcomes were self-reported function scores. To analyze the primary outcome, we used a 2-sided Skillings-Mack test. For function scores, a time analysis was not feasible; therefore, we calculated matched pairs using the Wilcoxon signed-rank test. Results: Our results showed significant reductions in self-reported pain intensity after 2, 4, 8, and 12 weeks in the Skillings-Mack test (T3628=5308;?P<.001). The changes were within the range of a clinically relevant improvement. Function scores showed a generally positive yet more variable response across the pain areas (back, hip, and knee). Conclusions: This study presents postmarketing observational data from one of the first DiGAs for unspecific and degenerative musculoskeletal pain. We noted significant improvements in self-reported pain intensity throughout the observation period of 12 weeks, which reached clinical relevance. Additionally, we identified a complex response pattern of the function scores assessed. Lastly, we highlighted the challenges of relevant attrition at follow-up and the potential opportunities for evaluating digital health applications. Although our findings do not have confirmatory power, they illustrate the potential benefits of digital health applications to improve the availability of and access to medical care. Trial Registration: German Clinical Trials Register DRKS00024051; https://drks.de/search/en/trial/DRKS00024051 ", doi="10.2196/43775", url="https://www.jmir.org/2023/1/e43775", url="http://www.ncbi.nlm.nih.gov/pubmed/36848211" } @Article{info:doi/10.2196/36126, author="Gallou-Guyot, Matthieu and Perrochon, Anaick and Marie, Romain and Bourgeois, Maxence and Mandigout, Stephane", title="Measured and Perceived Exercise Intensity During the Performance of Single-Task, Cognitive-Motor Dual-Task, and Exergame Training: Transversal Study", journal="JMIR Serious Games", year="2023", month="Feb", day="2", volume="11", pages="e36126", keywords="exergame", keywords="dual-task", keywords="exercise intensity", keywords="heart rate", keywords="cognitive load", keywords="active video game", keywords="physical activity", abstract="Background: The physical and cognitive loads borne during exergaming may differ from more conventional cognitive-motor dual-task trainings. Objective: The aim of this pilot transversal study was to compare objectively measured and perceived exercise intensity during exergame, cognitive-motor dual-task, and single-task training sessions. Methods: We recruited apparently healthy young adults who carried out one session of each type of training: exergaming, cognitive-motor dual-tasking, and single-tasking. We used a custom-made exergame as support. The sessions lasted 30 minutes, were spaced at least 24 hours apart, and took place in random order for each group of 4 participants. We used heart rates to assess exercise intensity and the modified Borg scale to assess perception of intensity. In all, 16 apparently healthy young participants carried out all sessions. Results: There was no difference between the different types of training in mean heart rates (P=.27), peak heart rates (P=.50), or Borg scale scores (P=.40). Our custom-made exergame's objectively measured and perceived physical load did not differ between cognitive-motor dual-task and single-task training. Conclusions: As a result, our exergame can be considered to be as challenging as more traditional physical training. Future studies should be conducted in older adults with or without cognitive impairments and incorporate an assessment of cognitive performance. ", doi="10.2196/36126", url="https://games.jmir.org/2023/1/e36126", url="http://www.ncbi.nlm.nih.gov/pubmed/36729572" } @Article{info:doi/10.2196/42178, author="Th{\'e}rouanne, Pierre and Hayotte, Meggy and Halgand, Florent and d'Arripe-Longueville, Fabienne", title="The Acceptability of Technology-Based Physical Activity Interventions in Postbariatric Surgery Women: Insights From Qualitative Analysis Using the Unified Theory of Acceptance and Use of Technology 2 Model", journal="JMIR Hum Factors", year="2023", month="Jan", day="23", volume="10", pages="e42178", keywords="acceptability", keywords="health technology", keywords="physical activity", keywords="obesity", keywords="UTAUT2", abstract="Background: Bariatric surgery offers an opportunity for physical activity (PA) promotion due to patients' increased ability to engage in PA. Technology-based PA interventions are promising tools for promoting PA to support patients in this key period. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model is a recognized theoretical model for examining technology acceptability. Although a previous study reported that 92\% of women with obesity have high acceptability of at least one technology-based PA intervention, little is known about the factors that lead to different levels of acceptability between technologies and therefore the reasons for choosing a preferred intervention. Objective: The purpose of this study was to (1) characterize the acceptability of 3 technology-based PA interventions (ie, telehealth, active video game, mobile app) in the context of bariatric surgery, and (2) explore patients' preference motives. This study, using a qualitative design, examined the suitability of the UTAUT2 model in this specific context. Methods: Participants (n=26) read written French descriptions of the technology-based PA interventions with illustrations and chose their preferred intervention. Semidirective interviews were conducted to explore the reasons for their choice of the preferred intervention, notably using the UTAUT2 framework. Data were analyzed based on inductive and deductive approaches. Results: All participants who preferred a technology-based PA intervention (ie, active video game, n=10; mobile app, n=10; telehealth, n=6) expressed a behavioral intention to use it. In addition, some of them expressed a high behavioral intention to use another technology (ie, active video game, n=4; mobile app, n=1; telehealth, n=7). All the constructs of the UTAUT2 emerged during the qualitative interviews and were specified through subcategories. Additional constructs also emerged, especially other motivational factors. Conclusions: This study showed that, in the context of technology-based PA interventions for postbariatric patients, the UTAUT2 is suitable, although additional motivational factors (which were not considered by the UTAUT2 model) should be considered. ", doi="10.2196/42178", url="https://humanfactors.jmir.org/2023/1/e42178", url="http://www.ncbi.nlm.nih.gov/pubmed/36689255" } @Article{info:doi/10.2196/39898, author="Hyodo, Kazuki and Kidokoro, Tetsuhiro and Yamaguchi, Daisuke and Iida, Michitaka and Watanabe, Yuya and Ueno, Aiko and Noda, Takayuki and Kawahara, Kenji and Nishida, Sumiyo and Kai, Yuko and Arao, Takashi", title="Feasibility, Safety, Enjoyment, and System Usability of Web-Based Aerobic Dance Exercise Program in Older Adults: Single-Arm Pilot Study", journal="JMIR Aging", year="2023", month="Jan", day="16", volume="6", pages="e39898", keywords="low-intensity exercise", keywords="home exercise", keywords="online exercise", keywords="supervised exercise", keywords="elderly", keywords="COVID-19", keywords="smartphone", keywords="tablet", keywords="videoconferencing platform", abstract="Background: During the COVID-19 epidemic, opportunities for social interaction and physical activity among older people are decreasing, which may have a negative impact on their health. As a solution, a web-based group exercise program provided through a videoconferencing platform would be useful. As a web-based exercise program that older adults can easily, safely, and enjoyably perform at home, we developed a short-duration, light-intensity aerobic dance exercise program. Before studying the effectiveness of this exercise program, its characteristics, such as feasibility, safety, enjoyment, and system usability, should be examined among older adults. Objective: This pilot study aimed to examine the feasibility, safety, and enjoyment of a web-based aerobic dance exercise program and the usability of a web-based exercise delivery system using a videoconferencing platform for older adults. Methods: This study was designed as a prospective single-arm pilot study. A total of 16 older adults participated in an 8-week web-based aerobic dance program held every morning (8:30 AM to 8:50 AM) on weekdays at home. Retention and adherence rates were measured for the program's feasibility. Safety was assessed by the heart rate reserve, an index of exercise intensity calculated from heart rate, and the number of adverse events during exercise sessions. Enjoyment of this exercise program was assessed by an 11-point Likert scale ranging from 0 (not enjoyable at all) to 10 (extremely enjoyable) obtained through telephone interviews after the first-, third-, sixth-, and eighth-week intervention. For usability, the ease of the videoconferencing platform system was assessed through telephone interviews after the intervention. Results: A female participant with hypertension dropped out in the second week because of the continuously reported high blood pressure (?180 mmHg) before attending the exercise session in the first week. Therefore, the retention rate was 93.8\% (15/16). Among the remaining participants, the median (IQR) overall adherence rate was 97.4\% (94.7-100). Regarding safety, the mean (SD) heart rate reserve during the aerobic dance exercise was 29.8\% (6.8\%), showing that the exercise was relatively safe with very light to light intensity. There were no adverse events during the exercise session. The enjoyment score (0-10 points) significantly increased from the first (6.7 [1.7]) to sixth (8.2 [1.3]) and eighth week (8.5 [1.3]). Regarding usability, 11 participants reported difficulties at the beginning, such as basic touch panel operations and the use of unfamiliar applications; however, all got accustomed to it and subsequently reported no difficulty. Conclusions: This study showed high feasibility, enjoyment, and safety of the web-based aerobic dance exercise program in older adults, and the web-based exercise delivery system may have areas for improvement, albeit without serious problems. Our web-based aerobic dance exercise program may contribute to an increase in physical and social activities among older adults. ", doi="10.2196/39898", url="https://aging.jmir.org/2023/1/e39898", url="http://www.ncbi.nlm.nih.gov/pubmed/36645705" } @Article{info:doi/10.2196/36325, author="Raffegeau, E. Tiphanie and Young, R. William and Fino, C. Peter and Williams, Mark A.", title="A Perspective on Using Virtual Reality to Incorporate the Affective Context of Everyday Falls Into Fall Prevention", journal="JMIR Aging", year="2023", month="Jan", day="11", volume="6", pages="e36325", keywords="aging", keywords="balance", keywords="perturbation", keywords="locomotion", keywords="cognition", keywords="exergame", keywords="anxiety", doi="10.2196/36325", url="https://aging.jmir.org/2023/1/e36325", url="http://www.ncbi.nlm.nih.gov/pubmed/36630173" } @Article{info:doi/10.2196/40325, author="Domingos, Josefa and Dean, John and Fernandes, Belo J{\'u}lio and Godinho, Catarina", title="An Online Dual-Task Cognitive and Motor Exercise Program for Individuals With Parkinson Disease (PD3 Move Program): Acceptability Study", journal="JMIR Aging", year="2022", month="Dec", day="22", volume="5", number="4", pages="e40325", keywords="Parkinson disease", keywords="dual-task training", keywords="exercise", keywords="digital intervention", keywords="online intervention", keywords="physical activity", keywords="physical therapy", keywords="elder", keywords="older adult", keywords="geriatric", keywords="neurodegenerative", keywords="adherence", keywords="acceptability", keywords="community based", keywords="group program", keywords="online program", keywords="physiotherapy", keywords="cognitive training online exercise", keywords="Parkinson's", keywords="neuromuscular", keywords="task training", keywords="physiotherapist", keywords="motor", keywords="movement", keywords="cognitive", keywords="cognition", keywords="vocal", keywords="voice", keywords="speech", abstract="Background: Dual-task training is an emerging field used for people with Parkinson disease (PD) to improve their physical and cognitive well-being, but the patients' acceptability, safety, and adherence to such training in online settings are unknown. Objective: This study aims to evaluate the acceptability of a dual-task cognitive and motor online training program for people with PD as a group online community program. Methods: People with PD were invited to participate in an online program (PD3 Move) consisting of physical and vocal exercises in response to different cognitive challenges displayed as dynamic backgrounds on Zoom. The program ran twice per week for 16 weeks. Patient acceptability was assessed at 4 months by monitoring attendance rates and feedback from an exit questionnaire emailed to all participants assessing satisfaction, perceived benefit, safety, and willingness to continue and recommend to others. Results: The online program was delivered to 15 participants (n=9, 60\%, females) with a diagnosis of PD, a mean age of 69.4 (SD 9.3) years, and Hoehn and Yahr (H\&Y) stages I-IV. The attendance rate was high, with participants coming to more than 13 (81\%) of the sessions. Participants were very satisfied (n=8, 53\%) or satisfied (n=7, 47\%) with the program. Participants reported that what they most liked were the new cognitive physical challenges. The 3 main facilitators to participating were perceiving the benefits, instructor's flexibility and engagement, and the social interaction moments with others. The 3 main difficulties were dealing with motor fluctuations (n=3, 20\%), difficulties in using technology (n=2, 13\%), and difficulty hearing instructions due to hearing loss (n=2, 13\%). Patients had favorable perceived benefits of the program, with 14 (93\%) considering it very useful for the current management of health and 1 (7\%) moderately useful. No adverse events were reported, and all participants said that they were willing to continue the program and recommend it to others. Conclusions: Our findings suggest that the online cognitive and motor program was well received, safe, and perceived to be of benefit to this group of medically stable people with PD in H\&Y stages I-IV. Access to specialized care and enhancement of long-term adherence to regular exercise can be achieved with online community group programs. ", doi="10.2196/40325", url="https://aging.jmir.org/2022/4/e40325", url="http://www.ncbi.nlm.nih.gov/pubmed/36548037" } @Article{info:doi/10.2196/39687, author="Fahr, Annina and Balzer, Julia and Keller, W. Jeffrey and van Hedel, A. Hubertus J.", title="Playfully Assessing Lower Extremity Selective Voluntary Motor Control in Children With Cerebral Palsy: Psychometric Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Dec", day="16", volume="9", number="4", pages="e39687", keywords="selective motor control", keywords="mirror movements", keywords="neurorehabilitation", keywords="validity", keywords="reliability", keywords="interactive computer play", keywords="eHealth", keywords="digital health", keywords="rehabilitation", keywords="cerebral palsy", keywords="movement", keywords="child", keywords="pediatric", keywords="game", keywords="accelerometer", keywords="motor", keywords="avatar", keywords="assessment", keywords="limb", keywords="joint", keywords="physiotherapy", keywords="physiotherapist", keywords="lower extremity", keywords="lower extremities", abstract="Background: Objective measures specifically assessing selective voluntary motor control are scarce. Therefore, we have developed an interval-scaled assessment based on accelerometers. Objective: This study provided a preliminary evaluation of the validity and reliability of this novel gamelike assessment measuring lower limb selective voluntary motor control in children with cerebral palsy (CP). Methods: Children with CP and their neurologically intact peers were recruited for this psychometric evaluation of the assessgame. The participants played the assessgame and steered an avatar by selective hip, knee, or ankle joint movements captured with accelerometers. The assessgame's scores provide information about the accuracy of the selective movement of the target joint and the amplitude and frequency of involuntary movements occurring in uninvolved joints. We established discriminative validity by comparing the assessgame scores of the children with CP with those of the neurologically intact children, concurrent validity by correlations with clinical scores and therapists' opinions, and relative and absolute test-retest reliability. Results: We included 20 children with CP (mean age 12 years and 5 months, SD 3 years and 4 months; Gross Motor Function Classification System levels I to IV) and 31 neurologically intact children (mean age 11 years and 1 month, SD 3 years and 6 months). The assessgame could distinguish between the children with CP and neurologically intact children. The correlations between the assessgame's involuntary movement score and the therapist's rating of the occurrence of involuntary movements during the game were moderate (Spearman $\rho$=0.56; P=.01), whereas the correlations of the assessgame outcomes with the Selective Control Assessment of the Lower Extremity and Gross Motor Function Classification System were low and not significant (|$\rho$|?0.39). The intraclass correlation coefficients were >0.85 and indicated good relative test-retest reliability. Minimal detectable changes amounted to 25\% (accuracy) and 44\% (involuntary movement score) of the mean total scores. The percentage of children able to improve by the minimal detectable change without reaching the maximum score was 100\% (17/17) for the accuracy score and 94\% (16/17) for the involuntary movement score. Conclusions: The assessgame proved reliable and showed discriminative validity in this preliminary evaluation. Concurrent validity was moderate with the therapist's opinion but relatively poor with the Selective Control Assessment of the Lower Extremity. We assume that the assessment's gamelike character demanded various other motor control aspects that are less considered in current clinical assessments. ", doi="10.2196/39687", url="https://rehab.jmir.org/2022/4/e39687", url="http://www.ncbi.nlm.nih.gov/pubmed/36525299" } @Article{info:doi/10.2196/38649, author="Teepe, Wilhelm Gisbert and Kowatsch, Tobias and Hans, Patricius Felix and Benning, Leo", title="Preliminary Use and Outcome Data of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time Series and Matched Analysis", journal="JMIR Mhealth Uhealth", year="2022", month="Dec", day="2", volume="10", number="12", pages="e38649", keywords="digital health", keywords="home exercise", keywords="musculoskeletal conditions", keywords="digital intervention", keywords="exercise", keywords="physical activity", keywords="smartphone", keywords="pain", keywords="management", keywords="back pain", keywords="hip pain", keywords="knee pain", keywords="mobility", keywords="intervention", abstract="Background: Musculoskeletal conditions are among the main contributors to the global burden of disease. International guidelines consider patient education and movement exercises as the preferred therapeutic option for unspecific and degenerative musculoskeletal conditions. Innovative and decentralized therapeutic means are required to provide access to and availability of such care to meet the increasing therapeutic demand for this spectrum of conditions. Objective: This retrospective observational study of preliminary use and outcome data explores the clinical outcomes of Vivira (hereafter referred to as ``program''), a smartphone-based program for unspecific and degenerative pain in the back, hip, and knee before it received regulatory approval for use in the German statutory health insurance system. Methods: An incomplete matched block design was employed to assess pain score changes over the intended 12-week duration of the program. Post hoc analyses were performed. In addition, a matched comparison of self-reported functional scores and adherence rates is presented. Results: A total of 2517 participants met the inclusion criteria and provided sufficient data to be included in the analyses. Overall, initial self-reported pain scores decreased significantly from an average of 5.19 out of 10 (SD 1.96) to an average of 3.35 out of 10 (SD 2.38) after 12 weeks. Post hoc analyses indicate a particularly emphasized pain score reduction over the early use phases. Additionally, participants with back pain showed significant improvements in strength and mobility scores, whereas participants with hip or knee pain demonstrated significant improvements in their coordination scores. Across all pain areas and pain durations, a high yet expected attrition rate could be observed. Conclusions: This observational study provides the first insights into the clinical outcomes of an exercise program for unspecific and degenerative back, hip, and knee pain. Furthermore, it demonstrates a potential secondary benefit of improved functionality (ie, strength, mobility, coordination). However, as this study lacks confirmatory power, further research is required to substantiate the clinical outcomes of the program assessed. Trial Registration: German Clinical Trials Register DRKS00021785; https://drks.de/search/en/trial/DRKS00021785 ", doi="10.2196/38649", url="https://mhealth.jmir.org/2022/12/e38649", url="http://www.ncbi.nlm.nih.gov/pubmed/36459399" } @Article{info:doi/10.2196/42157, author="Palmer, C. Louise and Neal, N. Whitney and Motl, W. Robert and Backus, Deborah", title="The Impact of COVID-19 Lockdown Restrictions on Exercise Behavior Among People With Multiple Sclerosis Enrolled in an Exercise Trial: Qualitative Interview Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="22", volume="9", number="4", pages="e42157", keywords="multiple sclerosis", keywords="exercise", keywords="physical activity", keywords="COVID-19", keywords="COVID-19 lockdown restrictions", keywords="telerehabilitation", keywords="interview study", abstract="Background: During spring and summer 2020, US states implemented COVID-19 pandemic restrictions, resulting in the closure of rehabilitation facilities and, with them, some of the clinical trials that were taking place. One such trial was the Supervised Versus Telerehabilitation Exercise Program for Multiple Sclerosis (``STEP for MS'') comparative effectiveness multiple sclerosis (MS) exercise trial. Although 1 study arm was implemented via telerehabilitation, the comparative arm took place in rehabilitation facilities nationwide and was subsequently closed during this time frame. The experience of the STEP for MS participants provides insights into the impact of lockdown restrictions on exercise behavior by mode of exercise delivery (telerehabilitation vs conventional facility based). Objective: This study sought to understand the impact of COVID-19 lockdown restrictions on exercise behavior among people with MS enrolled in an exercise trial at the time of the restrictions. Methods: Semistructured phone and video interviews were conducted with a convenience sample of 8 participants representing both arms of the exercise trial. We applied reflexive thematic analysis to identify, analyze, and interpret common themes in the data. Results: We identified 7 main themes and 2 different narratives describing the exercise experiences during lockdown restrictions. Although the telerehabilitation participants continued exercising without interruption, facility-based participants experienced a range of barriers that impeded their ability to exercise. In particular, the loss of perceived social support gained from exercising in a facility with exercise coaches and other people with MS eroded both the accountability and motivation to exercise. Aerobic exercises via walking were the most impacted, with participants pointing to the need for at-home treadmills. Conclusions: The unprecedented disruption of COVID-19 lockdown restrictions in spring and summer 2020 impacted the ability of facility-based STEP for MS exercise trial participants to exercise in adherence to the intervention protocol. By contrast, the participants in the telerehabilitation-delivered exercise arm continued exercising without interruption and reported positive impacts of the intervention during this time. Telerehabilitation exercise programs may hold promise for overcoming barriers to exercise for people with MS during COVID-19 lockdown restrictions, and potentially other lockdown scenarios, if the participation in telerehabilitation has already been established. ", doi="10.2196/42157", url="https://rehab.jmir.org/2022/4/e42157", url="http://www.ncbi.nlm.nih.gov/pubmed/36269870" } @Article{info:doi/10.2196/38994, author="Ga{\ss}ner, Heiko and Friedrich, Jana and Masuch, Alisa and Jukic, Jelena and Stallforth, Sabine and Regensburger, Martin and Marxreiter, Franz and Winkler, J{\"u}rgen and Klucken, Jochen", title="The Effects of an Individualized Smartphone-Based Exercise Program on Self-defined Motor Tasks in Parkinson Disease: Pilot Interventional Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="15", volume="9", number="4", pages="e38994", keywords="Parkinson disease", keywords="exercise", keywords="telemedicine", keywords="wearable sensors", keywords="patient-defined outcome measure", keywords="mobile phone", abstract="Background: Bradykinesia and rigidity are prototypical motor impairments of Parkinson disease (PD) highly influencing everyday life. Exercise training is an effective treatment alternative for motor symptoms, complementing dopaminergic medication. High frequency training is necessary to yield clinically relevant improvements. Exercise programs need to be tailored to individual symptoms and integrated in patients' everyday life. Due to the COVID-19 pandemic, exercise groups in outpatient setting were largely reduced. Developing remotely supervised solutions is therefore of significant importance. Objective: This pilot study aimed to evaluate the feasibility of a digital, home-based, high-frequency exercise program for patients with PD. Methods: In this pilot interventional study, patients diagnosed with PD received 4 weeks of personalized exercise at home using a smartphone app, remotely supervised by specialized therapists. Exercises were chosen based on the patient-defined motor impairment and depending on the patients' individual capacity (therapists defined 3-5 short training sequences for each participant). In a first education session, the tailored exercise program was explained and demonstrated to each participant and they were thoroughly introduced to the smartphone app. Intervention effects were evaluated using the Unified Parkinson Disease Rating Scale, part III; standardized sensor-based gait analysis; Timed Up and Go Test; 2-minute walk test; quality of life assessed by the Parkinson Disease Questionnaire; and patient-defined motor tasks of daily living. Usability of the smartphone app was assessed by the System Usability Scale. All participants gave written informed consent before initiation of the study. Results: In total, 15 individuals with PD completed the intervention phase without any withdrawals or dropouts. The System Usability Scale reached an average score of 72.2 (SD 6.5) indicating good usability of the smartphone app. Patient-defined motor tasks of daily living significantly improved by 40\% on average in 87\% (13/15) of the patients. There was no significant impact on the quality of life as assessed by the Parkinson Disease Questionnaire (but the subsections regarding mobility and social support improved by 14\% from 25 to 21 and 19\% from 15 to 13, respectively). Motor symptoms rated by Unified Parkinson Disease Rating Scale, part III, did not improve significantly but a descriptive improvement of 14\% from 18 to 16 could be observed. Clinically relevant changes in Timed Up and Go test, 2-minute walk test, and sensor-based gait parameters or functional gait tests were not observed. Conclusions: This pilot interventional study presented that a tailored, digital, home-based, and high-frequency exercise program over 4 weeks was feasible and improved patient-defined motor activities of daily life based on a self-developed patient-defined impairment score indicating that digital exercise concepts may have the potential to beneficially impact motor symptoms of daily living. Future studies should investigate sustainability effects in controlled study designs conducted over a longer period. ", doi="10.2196/38994", url="https://rehab.jmir.org/2022/4/e38994", url="http://www.ncbi.nlm.nih.gov/pubmed/36378510" } @Article{info:doi/10.2196/31345, author="Junkes-Cunha, Ma{\'i}ra and Sieczkowska, Mendes Sofia and Vilarino, Torres Guilherme and Bevilacqua, Guilherme and Andrade, Alexandro", title="A Rehabilitation Program for Individuals With Chronic Low Back Pain: Protocol for a Randomized Clinical Trial", journal="JMIR Res Protoc", year="2022", month="Oct", day="31", volume="11", number="10", pages="e31345", keywords="low back pain", keywords="chronic pain", keywords="therapeutic exercise", keywords="pain education", abstract="Background: Low back pain (LBP) is the leading cause of disability worldwide. Physical exercise, as a treatment, is beneficial for the improvement of quality of life in patients with LBP, and it is widely accepted. Objective: We aimed to develop a protocol for a feasibility study that is designed to compare the effectiveness of different interventions in reducing pain, functional, and psychosocial factors among patients with chronic LBP after 8 weeks of randomization. Methods: This is a study protocol for a randomized controlled trial that will consist of individuals with chronic LBP who are aged between 18 and 65 years. Participants will be allocated, through block randomization, to one of the following groups: the motor control exercises (MCEs), pain education, MCEs+pain education, and usual care groups. The primary outcome will be pain intensity, and the secondary outcomes will be the pressure pain threshold, which will be measured with a digital algometer; LBP-related disability; fears and beliefs; the fear of movement; quality of life; mood states; and levels of depression and anxiety. The trial was approved by the ethics committee for research involving human beings of the Federal University of Pelotas (reference number: 5.717.390) in September 2022, and it will be conducted until August 2023. Results: The researchers are being trained to apply the questionnaires and carry out the interventions. Patient recruitment will begin at the end of 2022 and results are expected to be achieved by August 2023. Conclusions: Our trial will provide preliminary data regarding the feasibility and safety of MCEs and pain education for patients with LBP. It will also provide preliminary outcome data that can be used to identify the most efficient intervention and the level of health care that should be implemented in public health services. Trial Registration: Brazilian Registry of Clinical Trials U1111-1221-4106; https://ensaiosclinicos.gov.br/rg/RBR-2xx2r2/ International Registered Report Identifier (IRRID): PRR1-10.2196/31345 ", doi="10.2196/31345", url="https://www.researchprotocols.org/2022/10/e31345", url="http://www.ncbi.nlm.nih.gov/pubmed/36315232" } @Article{info:doi/10.2196/35637, author="Newcomer, Valerie and Metzinger, Megan and Vick, Sydney and Robertson, Caroline and Lawrence, Taylor and Glass, Amanda and Elliott, Lauren and Williams, Ansleigh", title="A Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners: Usability Study", journal="JMIR Med Educ", year="2022", month="Sep", day="30", volume="8", number="3", pages="e35637", keywords="knowledge translation", keywords="task-oriented training", keywords="stroke assessments", keywords="telerehabilitation", keywords="occupational therapy", keywords="students", keywords="practitioners", keywords="educational program", abstract="Background: There are gaps in knowledge translation (KT) of current evidence-based practices regarding stroke assessment and rehabilitation delivered through teletherapy. A lack of this knowledge can prevent occupational therapy (OT) students and practitioners from implementing current research findings. Objective: The aim of this pilot study was to create an educational program to translate knowledge into practice regarding the remote delivery of stroke assessment and rehabilitation to OT students and practitioners. Four areas of focus were addressed in the educational program, including KT, task-oriented training, stroke assessments, and telerehabilitation. Methods: Two pilot studies were conducted to assess the knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale and general feedback questionnaire. Participants in study 1 were 5 OT practitioners and 1 OT assistant. Participants in study 2 were 9 current OT students. Four 1-hour modules were emailed weekly to participants over the course of 4 weeks, with each module covering a different topic (KT, task-oriented training, stroke assessments, and telerehabilitation). Preliminary results were reviewed using descriptive statistics. Results: Statistically significant results were found with increased scores of knowledge for both students and practitioners. Most of the educational modules had an above-average score regarding value and positive feedback for the educational program as a whole from the participants. Conclusions: Overall, the results of this pilot study indicate that a web-based educational program is a valuable, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. OT students and practitioners found the information presented to be valuable and relevant to their future profession and current practice. ", doi="10.2196/35637", url="https://mededu.jmir.org/2022/3/e35637", url="http://www.ncbi.nlm.nih.gov/pubmed/36178717" } @Article{info:doi/10.2196/38950, author="Munk, Niki and Daggy, K. Joanne and Evans, Erica and Kline, Matthew and Slaven, E. James and Laws, Brian and Foote, Trevor and Matthias, S. Marianne and Bair, J. Matthew", title="Therapist-Delivered Versus Care Ally--Assisted Massage for Veterans With Chronic Neck Pain: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Sep", day="27", volume="11", number="9", pages="e38950", keywords="Veterans", keywords="chronic neck pain", keywords="integrative medicine", keywords="whole health", keywords="modified trial design", keywords="therapist-delivered versus care ally--assisted massage for Veterans with chronic neck pain", keywords="TOMCATT", abstract="Background: Chronic neck pain (CNP) is prevalent, and it reduces functional status and quality of life and is associated with deleterious psychological outcomes in affected individuals. Despite the desirability of massage and its demonstrated effectiveness in CNP treatment, multiple accessibility barriers exist. Caregiver-applied massage has demonstrated feasibility in various populations but has not been examined in Veterans with CNP or compared in parallel to therapist-delivered massage. Objective: This manuscript described the original study design, lessons learned, and resultant design modifications for the Trial Outcomes for Massage: Care Ally--Assisted Versus Therapist-Treated (TOMCATT) study. Methods: TOMCATT began as a 3-arm, randomized controlled trial of 2 massage delivery approaches for Veterans with CNP with measures collected at baseline, 1 and 3 months after intervention, and 6 months (follow-up). Arm I, care ally--assisted massage, consisted of an in-person, 3.5-hour training workshop, an instructional DVD, a printed treatment manual, and three 30-minute at-home care ally--assisted massage sessions weekly for 3 months. Arm II, therapist-treated massage, consisted of two 60-minute sessions tailored to individual pain experiences and treatments per week for 3 months. The treatments followed a standardized Swedish massage approach. Arm III consisted of wait-list control. Results: Retention and engagement challenges in the first 30 months were significant in the care ally--assisted massage study arm (63\% attrition between randomization and treatment initiation) and prompted modification to a 2-arm trial, that is, removing arm I. Conclusions: The modified TOMCATT study successfully launched and exceeded recruitment goals 2.5 months before the necessary COVID-19 pause and is expected to be completed by early 2023. Trial Registration: ClinicalTrials.gov NCT03100539; https://clinicaltrials.gov/ct2/show/NCT03100539 International Registered Report Identifier (IRRID): DERR1-10.2196/38950 ", doi="10.2196/38950", url="https://www.researchprotocols.org/2022/9/e38950", url="http://www.ncbi.nlm.nih.gov/pubmed/36166287" } @Article{info:doi/10.2196/40703, author="Hong, Mindy and Loeb, Joey and Yang, Manshu and Bailey, F. Jeannie", title="Postoperative Outcomes of a Digital Rehabilitation Program After Total Knee Arthroplasty: Retrospective, Observational Feasibility Study", journal="JMIR Form Res", year="2022", month="Sep", day="19", volume="6", number="9", pages="e40703", keywords="total knee arthroplasty", keywords="surgical", keywords="digital intervention", keywords="musculoskeletal", keywords="telemedicine", abstract="Background: Surgery can sometimes be the best solution for chronic musculoskeletal pain, but presurgical preparation and postsurgical rehabilitation are often required to achieve the maximum benefits. A digital musculoskeletal surgical care program was developed to support the population of patients undergoing total knee arthroplasty. Objective: We aimed to demonstrate safety, engagement, and acceptability and explore clinical outcomes, health care use, and satisfaction among participants of a digital musculoskeletal surgical care program who were undergoing total knee arthroplasty. Methods: A retrospective, observational feasibility study comparing digital musculoskeletal surgical care program participants to a comparison group was conducted. The intervention group registered for a digital musculoskeletal surgical care program, which included health coaches, physical therapists, and tailored exercises and?educational articles to provide preoperative and postoperative support to patients who had recently undergone total knee arthroplasty. Comparison group members received standard-of-care treatment. Engagement (number of exercise therapy sessions and educational articles accessed per week) and acceptability (Net Promoter Score) were examined among intervention group participants. Descriptive statistics for postoperative outcomes, including safety (postoperative complications), clinical improvement?(pain, function, anxiety, and depression), and health care use and experiences (length of hospital stay, surgery satisfaction, and physical therapy adherence), were reported for both groups. Differences among postoperative results were compared by using the independent samples 2-tailed t test or Mann-Whitney test for continuous outcomes and the Fisher exact test or chi-square test for categorical outcomes. Results: Of the 53 participants (intervention group: n=22; comparison group: n=31) who were included in this study, 35 (66\%) were female and 25 (47\%) were aged from 45 to 60 years. On average, the intervention group completed 23 exercise sessions, read 2.7 educational articles, sent 45.5 texts to their health coaches, and were actively engaged for 6 weeks after their operation. Among 21 participants, 14 (67\%) self-reported as promoters on the Net Promoter Score scale. Intervention group members reported fewer postoperative complications (6/22, 27\%) than the comparison group (15/31, 48\%), and they experienced better outcomes with regard to function (Knee Injury and Osteoarthritis Outcome Score--Physical Function Short Form---intervention group: mean 23.0; comparison group: mean 32.5), depression (Patient Health Questionnaire 2-Item---intervention group: mean 0.4; comparison group: mean 1.6), anxiety (General Anxiety Disorder 2-Item---intervention group: mean 0.6; comparison group: mean 1.5), and impressions of change (Patient Global Impression of Change---intervention group: median 7.0; comparison group: median 6.0). Intervention group participants?also reported less health care use, better adherence to their physical therapy exercises, and higher surgery satisfaction. Conclusions: Our digital musculoskeletal surgical care program shows promising levels of engagement and acceptability among those who recently underwent total knee arthroplasty. The surgical care program may also help with improving postsurgical complications and clinical outcomes and lowering health care use. ", doi="10.2196/40703", url="https://formative.jmir.org/2022/9/e40703", url="http://www.ncbi.nlm.nih.gov/pubmed/36121690" } @Article{info:doi/10.2196/35316, author="Arensman, Remco and Kloek, Corelien and Pisters, Martijn and Koppenaal, Tjarco and Ostelo, Raymond and Veenhof, Cindy", title="Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise During Physical Therapy Treatment: Qualitative Study", journal="JMIR Hum Factors", year="2022", month="Sep", day="13", volume="9", number="3", pages="e35316", keywords="patient perspectives", keywords="mobile health", keywords="mHealth", keywords="home-based exercise", keywords="adherence", keywords="low back pain", keywords="physical therapy", abstract="Background: Home-based exercise is an important part of physical therapy treatment for patients with low back pain. However, treatment effectiveness depends heavily on patient adherence to home-based exercise recommendations. Smartphone apps designed to support home-based exercise have the potential to support adherence to exercise recommendations and possibly improve treatment effects. A better understanding of patient perspectives regarding the use of smartphone apps to support home-based exercise during physical therapy treatment can assist physical therapists with optimal use and implementation of these apps in clinical practice. Objective: The aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of a smartphone app to support home-based exercise following recommendations from a physical therapist. Methods: Using an interpretivist phenomenology approach, 9 patients (4 males and 5 females; aged 20-71 years) with nonspecific low back pain recruited from 2 primary care physical therapy practices were interviewed within 2 weeks after treatment ended. An interview guide was used for the interviews to ensure that different aspects of the patients' perspectives were discussed. The Physitrack smartphone app was used to support home-based exercise as part of treatment for all patients. Data were analyzed using the ``Framework Method'' to assist with interpretation of the data. Results: Data analysis revealed 11 categories distributed among the 3 themes ``acceptability,'' ``satisfaction,'' and ``performance.'' Patients were willing to accept the app as part of treatment when it was easy to use, when it benefited the patient, and when the physical therapist instructed the patient in its use. Satisfaction with the app was determined by users' perceived support from the app when exercising at home and the perceived increase in adherence. The video and text instructions, reminder functions, and self-monitor functions were considered the most important aspects for performance during treatment. The patients did not view the Physitrack app as a replacement for the physical therapist and relied on their therapist for instructions and support when needed. Conclusions: Patients who use an app to support home-based exercise as part of treatment are accepting of the app when it is easy to use, when it benefits the patient, and when the therapist instructs the patient in its use. Physical therapists using an app to support home-based exercise can use the findings from this study to effectively support their patients when exercising at home during treatment. ", doi="10.2196/35316", url="https://humanfactors.jmir.org/2022/3/e35316", url="http://www.ncbi.nlm.nih.gov/pubmed/36098993" } @Article{info:doi/10.2196/41152, author="Athanasiou, Alkinoos and Mitsopoulos, Konstantinos and Praftsiotis, Apostolos and Astaras, Alexander and Antoniou, Panagiotis and Pandria, Niki and Petronikolou, Vasileia and Kasimis, Konstantinos and Lyssas, George and Terzopoulos, Nikos and Fiska, Vasilki and Kartsidis, Panagiotis and Savvidis, Theodoros and Arvanitidis, Athanasios and Chasapis, Konstantinos and Moraitopoulos, Alexandros and Nizamis, Kostas and Kalfas, Anestis and Iakovidis, Paris and Apostolou, Thomas and Magras, Ioannis and Bamidis, Panagiotis", title="Neurorehabilitation Through Synergistic Man-Machine Interfaces Promoting Dormant Neuroplasticity in Spinal Cord Injury: Protocol for a Nonrandomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Sep", day="13", volume="11", number="9", pages="e41152", keywords="body-machine interface", keywords="brain-computer interface", keywords="neural rehabilitation", keywords="serious games", keywords="spinal cord injury", keywords="wearable robotics", abstract="Background: Spinal cord injury (SCI) constitutes a major sociomedical problem, impacting approximately 0.32-0.64 million people each year worldwide; particularly, it impacts young individuals, causing long-term, often irreversible disability. While effective rehabilitation of patients with SCI remains a significant challenge, novel neural engineering technologies have emerged to target and promote dormant neuroplasticity in the central nervous system. Objective: This study aims to develop, pilot test, and optimize a platform based on multiple immersive man-machine interfaces offering rich feedback, including (1) visual motor imagery training under high-density electroencephalographic recording, (2) mountable robotic arms controlled with a wireless brain-computer interface (BCI), (3) a body-machine interface (BMI) consisting of wearable robotics jacket and gloves in combination with a serious game (SG) application, and (4) an augmented reality module. The platform will be used to validate a self-paced neurorehabilitation intervention and to study cortical activity in chronic complete and incomplete SCI at the cervical spine. Methods: A 3-phase pilot study (clinical trial) was designed to evaluate the NeuroSuitUp platform, including patients with chronic cervical SCI with complete and incomplete injury aged over 14 years and age-/sex-matched healthy participants. Outcome measures include BCI control and performance in the BMI-SG module, as well as improvement of functional independence, while also monitoring neuropsychological parameters such as kinesthetic imagery, motivation, self-esteem, depression and anxiety, mental effort, discomfort, and perception of robotics. Participant enrollment into the main clinical trial is estimated to begin in January 2023 and end by December 2023. Results: A preliminary analysis of collected data during pilot testing of BMI-SG by healthy participants showed that the platform was easy to use, caused no discomfort, and the robotics were perceived positively by the participants. Analysis of results from the main clinical trial will begin as recruitment progresses and findings from the complete analysis of results are expected in early 2024. Conclusions: Chronic SCI is characterized by irreversible disability impacting functional independence. NeuroSuitUp could provide a valuable complementary platform for training in immersive rehabilitation methods to promote dormant neural plasticity. Trial Registration: ClinicalTrials.gov NCT05465486; https://clinicaltrials.gov/ct2/show/NCT05465486 International Registered Report Identifier (IRRID): PRR1-10.2196/41152 ", doi="10.2196/41152", url="https://www.researchprotocols.org/2022/9/e41152", url="http://www.ncbi.nlm.nih.gov/pubmed/36099009" } @Article{info:doi/10.2196/36288, author="Kalron, Alon and Frid, Lior and Fonkatz, Iliya and Menascu, Shay and Dolev, Mark and Magalashvili, David and Achiron, Anat", title="The Design, Development, and Testing of a Virtual Reality Device for Upper Limb Training in People With Multiple Sclerosis: Single-Center Feasibility Study", journal="JMIR Serious Games", year="2022", month="Sep", day="12", volume="10", number="3", pages="e36288", keywords="virtual reality", keywords="rehabilitation", keywords="feasibility", keywords="upper limb", keywords="multiple sclerosis", abstract="Background: Multiple sclerosis (MS) is a common nontraumatic, neurological, disabling disease that often presents with upper limb dysfunction. Exercise training has resulted in improvement for patients; however, there can be a lack of compliance due to access because of location and lack of MS experts. Virtual reality (VR) is a promising technology that can offer exercise therapy/rehabilitation at a distance. This type of remote training can be motivational and effective for patients with MS and can improve range of motion and muscle strength for those with upper limb dysfunction. Objective: The aim of this study is to evaluate the safety and feasibility of the XRHealth software and the Oculus Rift Station for patients with MS with upper limb motor dysfunction. Methods: A single-center, prospective, feasibility study was conducted with patients with MS who had upper limb motor dysfunction. Patients participated in a single 45-minute digital environment session with VR and completed a questionnaire about the quality of the training and fatigability. The clinician also completed a questionnaire to evaluate the suitability and safety of the training. Results: Overall, 30 patients were enrolled between the ages of 20 and 81 years. Patients reported that the training sessions within the digital environment were helpful, challenging, fun, and simple to understand, and that they would be willing to repeat the sessions again. The physical therapist that oversaw the patients reported that the training was suitable for 87\% (n=26) of the patients. Anticipated adverse events were fatigue, temporary dizziness, and temporary nausea. The operator complications included that the cable of the head-mounted display interrupted the training (n=2, 7\%) and fatigue that caused cessation of the VR training session (n=2, 7\%). No serious adverse events were reported. Conclusions: These preliminary results demonstrated that the use of the XRHealth software and Oculus Rift Station platform is feasible, safe, and engaging for patients, and has the potential to improve the functionality of the upper limbs in patients with MS. This study provides support for future studies of implementing a series of training sessions with virtual reality in a home-based environment. ", doi="10.2196/36288", url="https://games.jmir.org/2022/3/e36288", url="http://www.ncbi.nlm.nih.gov/pubmed/36094809" } @Article{info:doi/10.2196/37229, author="Tsakanikas, Vassilios and Gatsios, Dimitris and Pardalis, Athanasios and Tsiouris, M. Kostas and Georga, Eleni and Bamiou, Doris-Eva and Pavlou, Marousa and Nikitas, Christos and Kikidis, Dimitrios and Walz, Isabelle and Maurer, Christoph and Fotiadis, Dimitrios", title="Automated Assessment of Balance Rehabilitation Exercises With a Data-Driven Scoring Model: Algorithm Development and Validation Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="31", volume="9", number="3", pages="e37229", keywords="balance rehabilitation exercises", keywords="scoring model", keywords="exercise evaluation", keywords="persuasive coaching system", abstract="Background: Balance rehabilitation programs represent the most common treatments for balance disorders. Nonetheless, lack of resources and lack of highly expert physiotherapists are barriers for patients to undergo individualized rehabilitation sessions. Therefore, balance rehabilitation programs are often transferred to the home environment, with a considerable risk of the patient misperforming the exercises or failing to follow the program at all. Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance involves several modules, from rehabilitation program management to augmented reality coach presentation. Objective: The aim of this study was to design, implement, test, and evaluate a scoring model for the accurate assessment of balance rehabilitation exercises, based on data-driven techniques. Methods: The data-driven scoring module is based on an extensive data set (approximately 1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. It can be used as a training and testing data set for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. In that direction, for creating the data set, 2 independent experts monitored (in the clinic) 19 patients performing 1313 balance rehabilitation exercises and scored their performance based on a predefined scoring rubric. On the collected data, preprocessing, data cleansing, and normalization techniques were applied before deploying feature selection techniques. Finally, a wide set of ML algorithms, like random forests and neural networks, were used to identify the most suitable model for each scoring component. Results: The results of the trained model improved the performance of the scoring module in terms of more accurate assessment of a performed exercise, when compared with a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9\% for sitting exercises, 20.8\% for standing exercises, and 26.8\% for walking exercises). Finally, the resulting performance of the model resembled the threshold of the interobserver variability, enabling trustworthy usage of the scoring module in the closed-loop chain of the Holobalance coaching system. Conclusions: The proposed set of ML models can effectively score the balance rehabilitation exercises of the Holobalance system. The models had similar accuracy in terms of Cohen kappa analysis, with interobserver variability, enabling the scoring module to infer the score of an exercise based on the collected signals from sensing devices. More specifically, for sitting exercises, the scoring model had high classification accuracy, ranging from 0.86 to 0.90. Similarly, for standing exercises, the classification accuracy ranged from 0.85 to 0.92, while for walking exercises, it ranged from 0.81 to 0.90. Trial Registration: ClinicalTrials.gov NCT04053829; https://clinicaltrials.gov/ct2/show/NCT04053829 ", doi="10.2196/37229", url="https://rehab.jmir.org/2022/3/e37229", url="http://www.ncbi.nlm.nih.gov/pubmed/36044258" } @Article{info:doi/10.2196/35743, author="Fioratti, Iuri and Miyamoto, Cristiane Gisela and Fandim, Vitorino Junior and Ribeiro, Pontes Camila Pereira and Batista, Domingues Geovana and Freitas, Evangelista Gabriella and Palomo, Santos Andressa and Reis, dos Felipe Jos{\'e} Jandr{\'e} and Costa, Pena Leonardo Oliveira and Maher, G. Christopher and Saragiotto, Tirotti Bruno", title="Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program", journal="JMIR Form Res", year="2022", month="Aug", day="30", volume="6", number="8", pages="e35743", keywords="telerehabilitation", keywords="musculoskeletal pain", keywords="implementation science", keywords="feasibility study", keywords="chronic pain", keywords="pain", keywords="pilot study", keywords="eHealth", keywords="exercise", keywords="telehealth", keywords="self-management", abstract="Background: Internet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation. Objective: This study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet. Methods: The study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients' perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed. Results: In total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US \$278.30 per patient in the intervention group and US \$141.52 per patient in the control group. No adverse events were reported during the intervention period. Conclusions: We found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users' implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe. Trial Registration: ClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439 ", doi="10.2196/35743", url="https://formative.jmir.org/2022/8/e35743", url="http://www.ncbi.nlm.nih.gov/pubmed/35776863" } @Article{info:doi/10.2196/38689, author="Alfakir, Abdalrahman and Arrowsmith, Colin and Burns, David and Razmjou, Helen and Hardisty, Michael and Whyne, Cari", title="Detection of Low Back Physiotherapy Exercises With Inertial Sensors and Machine Learning: Algorithm Development and Validation", journal="JMIR Rehabil Assist Technol", year="2022", month="Aug", day="23", volume="9", number="3", pages="e38689", keywords="low back pain", keywords="rehabilitation", keywords="wearables", keywords="inertial measurement units", keywords="machine learning", keywords="activity recognition", abstract="Background: Physiotherapy is a critical element in the successful conservative management of low back pain (LBP). A gold standard for quantitatively measuring physiotherapy participation is crucial to understanding physiotherapy adherence in managing recovery from LBP. Objective: This study aimed to develop and evaluate a system with wearable inertial sensors to objectively detect the performance of unsupervised exercises for LBP comprising movement in multiple planes and sitting postures. Methods: A quantitative classification design was used within a machine learning framework to detect exercise performance and posture in a cohort of healthy participants. A set of 8 inertial sensors were placed on the participants, and data were acquired as they performed 7 McKenzie low back exercises and 3 sitting posture positions. Engineered time series features were extracted from the data and used to train 9 models by using a 6-fold cross-validation approach, from which the best 2 models were selected for further study. In addition, a convolutional neural network was trained directly on the time series data. A feature importance analysis was performed to identify sensor locations and channels that contributed the most to the models. Finally, a subset of sensor locations and channels was included in a hyperparameter grid search to identify the optimal sensor configuration and best performing algorithms for exercise and posture classification. The final models were evaluated using the F1 score in a 10-fold cross-validation approach. Results: In total, 19 healthy adults with no history of LBP each completed at least one full session of exercises and postures. Random forest and XGBoost (extreme gradient boosting) models performed the best out of the initial set of 9 engineered feature models. The optimal hardware configuration was identified as a 3-sensor setup---lower back, left thigh, and right ankle sensors with acceleration, gyroscope, and magnetometer channels. The XGBoost model achieved the highest exercise (F1 score: mean 0.94, SD 0.03) and posture (F1 score: mean 0.90, SD 0.11) classification scores. The convolutional neural network achieved similar results with the same sensor locations, using only the accelerometer and gyroscope channels for exercise classification (F1 score: mean 0.94, SD 0.02) and the accelerometer channel alone for posture classification (F1 score: mean 0.88, SD 0.07). Conclusions: This study demonstrates the potential of a 3-sensor lower body wearable solution (eg, smart pants) that can identify exercises in multiple planes and proper sitting postures, which is suitable for the treatment of LBP. This technology has the potential to improve the effectiveness of LBP rehabilitation by facilitating quantitative feedback, early problem diagnosis, and possible remote monitoring. ", doi="10.2196/38689", url="https://rehab.jmir.org/2022/3/e38689", url="http://www.ncbi.nlm.nih.gov/pubmed/35998014" } @Article{info:doi/10.2196/40708, author="Lai, Byron and Davis, Drew and Young, Raven and Kimani-Swanson, Erin and Wozow, Cynthia and Wen, Huacong and Kim, Yumi and Wilroy, Jereme and Rimmer, James", title="The Effects of Virtual Reality Tele-exergaming on Cardiometabolic Indicators of Health Among Youth With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Aug", day="17", volume="11", number="8", pages="e40708", keywords="disability", keywords="physical therapy", keywords="adapted physical activity", keywords="physical activity", keywords="active video gaming", abstract="Background: Youth with cerebral palsy do not have enjoyable, accessible, and scalable exercise options that can empower them to independently maintain their cardiometabolic health. Objective: The primary aim is to examine the preliminary efficacy of a 12-week home-based virtual reality tele-exergaming intervention on several indicators of cardiometabolic health in youth with cerebral palsy compared to the wait list control. A secondary aim is to describe feasibility metrics, namely, recruitment, retention, and adherence rates; perceived enjoyment; intervention safety; and management issues. The tertiary aim is to generate a theory that reveals critical behavioral mechanisms of adherence to tele-exergaming. Methods: In this parallel group design randomized controlled trial, 34 inactive youths with cerebral palsy are randomly allocated to one of two groups: a group that immediately receives 12 weeks of virtual reality exergaming with tele--physical education or a wait list control group that undergoes their habitual activity for 12 weeks. Participants are recruited from a Children's Hospital and community network. At baseline (week 0), week 6, and week 12, high sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, cholesterol, and pressure are measured by the youth and a caregiver at home using a blood spot test kit and blood pressure cuff. They will also self-measure their lung function and body weight using a peak flow meter and bathroom scale, respectively. Collections are supervised by research staff via videoconference. Changes in outcomes are compared between and within groups using exploratory statistical analyses and descriptive statistics. At postintervention or dropout, participants will undergo semistructured interviews to identify behavioral mechanisms that underly participation. Results: Recruitment procedures started in June 2022. All data are expected to be collected by October 2023. Full trial results are expected to be published by February 2024. Secondary analyses of data will be subsequently published. Conclusions: This trial tests an innovative serious exergaming virtual reality program that includes a completely remote enrollment, assessment, and intervention tele-protocol. The knowledge obtained will inform the development of a larger effectiveness trial for improving the health and well-being of youth with cerebral palsy. Trial Registration: ClinicalTrials.gov NCT05336227; https://clinicaltrials.gov/ct2/show/NCT05336227 International Registered Report Identifier (IRRID): PRR1-10.2196/40708 ", doi="10.2196/40708", url="https://www.researchprotocols.org/2022/8/e40708", url="http://www.ncbi.nlm.nih.gov/pubmed/35976192" } @Article{info:doi/10.2196/33255, author="Terzulli, Claire and Melchior, Meggane and Goffin, Laurent and Faisan, Sylvain and Gianesini, Coralie and Graff, Denis and Dufour, Andr{\'e} and Laroche, Edouard and Chauvin, Chlo{\'e} and Poisbeau, Pierrick", title="Effect of Virtual Reality Hypnosis on Pain Threshold and Neurophysiological and Autonomic Biomarkers in Healthy Volunteers: Prospective Randomized Crossover Study", journal="J Med Internet Res", year="2022", month="Jul", day="29", volume="24", number="7", pages="e33255", keywords="virtual reality", keywords="hypnosis", keywords="pain", keywords="analgesia", keywords="autonomic changes", keywords="thermal pain", keywords="physiological", keywords="nervous system", keywords="heat pain", abstract="Background: Virtual reality hypnosis (VRH) is a promising tool to reduce pain. However, the benefits of VRH on pain perception and on the physiological expression of pain require further investigation. Objective: In this study, we characterized the effects of VRH on the heat pain threshold among adult healthy volunteers while monitoring several physiological and autonomic functions. Methods: Sixty healthy volunteers were prospectively included to receive nociceptive stimulations. The first set of thermal stimuli consisted of 20 stimulations at 60{\textdegree}C (duration 500 milliseconds) to trigger contact heat evoked potentials (CHEPs). The second set of thermal stimuli consisted of ramps (1{\textdegree}C/second) to determine the heat pain threshold of the participants. Electrocardiogram, skin conductance responses, respiration rate, as well as the analgesia nociception index were also recorded throughout the experiment. Results: Data from 58 participants were analyzed. There was a small but significant increase in pain threshold in VRH (50.19{\textdegree}C, SD 1.98{\textdegree}C) compared to that in the control condition (mean 49.45{\textdegree}C, SD 1.87; P<.001, Wilcoxon matched-pairs signed-rank test; Cohen d=0.38). No significant effect of VRH on CHEPs and heart rate variability parameters was observed (all P>0.5; n=22 and n=52, respectively). During VRH, participants exhibited a clear reduction in their autonomic sympathetic tone, as shown by the lower number of nonspecific skin conductance peak responses (P<.001, two-way analysis of variance; n=39) and by an increase in the analgesia nociception index (P<.001, paired t-test; n=40). Conclusions: The results obtained in this study support the idea that VRH administration is effective at increasing heat pain thresholds and impacts autonomic functions among healthy volunteers. As a nonpharmacological intervention, VRH has beneficial action on acute experimental heat pain. This beneficial action will need to be evaluated for the treatment of other types of pain, including chronic pain. ", doi="10.2196/33255", url="https://www.jmir.org/2022/7/e33255", url="http://www.ncbi.nlm.nih.gov/pubmed/35904872" } @Article{info:doi/10.2196/40553, author="Jafarian, Fahimeh-Sadat and Jafari-Harandi, Mahmonir and Yeowell, Gillian and Sadeghi-Demneh, Ebrahim", title="The Efficacy of Lumbar Support on Pain, Disability, and Motor Control in Women With Postpartum Pelvic Girdle Pain: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jul", day="20", volume="11", number="7", pages="e40553", keywords="sacroiliac joint", keywords="pain", keywords="disability", keywords="motor control", keywords="lumbosacral orthosis", keywords="postpartum", abstract="Background: Pregnancy-related posterior pelvic girdle pain (PPGP) is one of the most important clinical manifestations of postpartum back pain. Those affected often complain of discomfort during daily activities. It is hypothesized that altered motor control is associated with perceived pain. Pelvic support can regulate possible underlying altered motor control mechanisms and decrease pain. However, the influence of a lumbosacral orthosis, which is broader support that allows for a wider contact area and more skin sensory stimulation to restore proper motor function, has not yet been investigated in women with postpartum PPGP. Objective: This study investigates the efficacy of broader lumbar support and narrower pelvic support on pain, proprioception, disability, and muscle strength in women with pregnancy-related PPGP. Methods: This study will be a single-center, 3-armed, participant-blinded, randomized controlled trial. In total, 84 women diagnosed with pregnancy-related PPGP will be recruited and randomly assigned into 3 groups. Intervention groups A and B will receive pelvic and lumbar supports, respectively. Group C (control) will receive only a patient education leaflet containing advice on strengthening exercises, comfortable positions, and other practical information. The study outcomes are pain, effort score during the active straight leg raising test, maximum isometric hip flexion force, maximum isometric hip external rotation force, maximum isometric trunk rotation force, and joint position reproduction of hip abduction. The study outcomes will be measured at 4 time points: baseline (T1), immediately after the intervention (T2), 4 weeks following interventions began (at this time, the intervention period is completed) (T3), and 1 week after discontinuing the interventions (T4) to evaluate the possible lasting effects of wearing supports. Multivariate analysis of variance will be used to test between- and within-group differences. Results: Recruitment for this study will be started in summer 2022 and is expected to be completed by the end of fall 2022. Conclusions: This study will examine the efficacy of broader lumbar support as an early rehabilitative treatment for women receiving postpartum posterior pelvic pain support compared to those receiving a narrower pelvic support. We expect the broader lumbar support to impact pain management and disability better than the current narrower pelvic belt. Long-term follow-up studies will help determine whether such lumbosacral orthosis reduces pain and improves daily activities in women with pregnancy-related PPGP. Trial Registration: Iranian Registry of Clinical Trials IRCT20150210021034N11; https://www.irct.ir/trial/54808 International Registered Report Identifier (IRRID): PRR1-10.2196/40553 ", doi="10.2196/40553", url="https://www.researchprotocols.org/2022/7/e40553", url="http://www.ncbi.nlm.nih.gov/pubmed/35857366" } @Article{info:doi/10.2196/38553, author="Dennett, M. Amy and Harding, E. Katherine and Peiris, L. Casey and Shields, Nora and Barton, Christian and Lynch, Lauren and Parente, Phillip and Lim, David and Taylor, F. Nicholas", title="Efficacy of Group Exercise--Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jul", day="18", volume="11", number="7", pages="e38553", keywords="telehealth", keywords="exercise", keywords="telerehabilitation", keywords="physical activity", keywords="supportive care", keywords="cancer", abstract="Background: Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise--based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective: We aimed to evaluate the efficacy of a group exercise--based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods: A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results: The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions: This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr International Registered Report Identifier (IRRID): PRR1-10.2196/38553 ", doi="10.2196/38553", url="https://www.researchprotocols.org/2022/7/e38553", url="http://www.ncbi.nlm.nih.gov/pubmed/35849441" } @Article{info:doi/10.2196/38442, author="Russell Esposito, Elizabeth and Farrokhi, Shawn and Shuman, R. Benjamin and Sessoms, H. Pinata and Szymanek, Eliza and Hoppes, W. Carrie and Bechard, Laura and King, David and Fraser, J. John", title="Uneven Treadmill Training for Rehabilitation of Lateral Ankle Sprains and Chronic Ankle Instability: Protocol for a Pragmatic Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jun", day="22", volume="11", number="6", pages="e38442", keywords="military personnel", keywords="ankle injuries", keywords="rehabilitation", keywords="recovery of function", keywords="secondary prevention", keywords="ankle sprain", keywords="treadmill", abstract="Background: Lateral ankle sprains (LASs) are common injuries among military service members. Approximately 40\% of individuals with an LAS progress to develop chronic ankle instability (CAI), a condition that results in substantial mechanical and neurophysiological impairment and activity limitation. Since proprioceptive and balance training improve functional outcomes and prevent secondary injury following LAS, they are recommended in clinical practice. Uneven treadmills are an innovative modality that challenge the sensorimotor system while performing an ecologically valid task simulating environments frequently encountered by service members with LAS and CAI. Objective: The aim of this study is to evaluate whether the inclusion of uneven treadmill training in standard rehabilitation can improve clinical, functional, biomechanical, and patient-reported outcomes compared with the standard of care alone in service members with LAS and CAI. The prophylactic effects of treatment on secondary injury and identification of any contributing or mediating factors that influence outcomes following treatment will also be evaluated. We hypothesize that service members receiving uneven treadmill training will demonstrate greater improvements in clinical and instrumented measures of impairment, patient-reported function, and lower risk of injury recurrence than the control group immediately post and 18 months following treatment. Methods: A multisite, parallel randomized clinical trial will be performed among service members aged 18-49 years being treated for LAS and CAI in military treatment facilities in the United States. Participants randomly assigned and allocated to receive the experimental intervention will be provided up to 12 sessions of training on an uneven terrain treadmill over a 6-week treatment course to supplement standard rehabilitation care. Treatment intensity of the rehabilitation exercises and treadmill training will be progressed on the basis of patient-perceived intensity and treatment responses. Outcome measures will include patient-reported outcomes, functional assessments, performance measures, and biomechanical measures. Investigators collecting outcome measures will be blinded to treatment allocation. Reinjury rates and patient-reported outcomes of function will be tracked over 18 months following treatment. Results: The project was funded in September 2020. Patient recruitment began in November 2021, with 3 participants enrolled as of February 2022. Dissemination of the main study findings is anticipated in 2024. Conclusions: This study will assess the impact of an innovative uneven-terrain treadmill on treatment outcomes in the rehabilitation of service members with LAS and CAI. The results of this study will be used to inform rehabilitation practices and to potentially improve functional outcomes and secondary prevention in this patient population. Trial Registration: ClinicalTrials.gov NCT04999904; https://clinicaltrials.gov/ct2/show/NCT04999904?term=NCT04999904 International Registered Report Identifier (IRRID): DERR1-10.2196/38442 ", doi="10.2196/38442", url="https://www.researchprotocols.org/2022/6/e38442", url="http://www.ncbi.nlm.nih.gov/pubmed/35731551" } @Article{info:doi/10.2196/38084, author="H{\"o}rder, Helena and Nero, H{\aa}kan and Misini Ignjatovic, Majda and Kiadaliri, Ali and Lohmander, Stefan L. and Dahlberg, E. Leif and Abbott, Allan", title="Digitally Delivered Exercise and Education Treatment Program for Low Back Pain: Longitudinal Observational Cohort Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Jun", day="21", volume="9", number="2", pages="e38084", keywords="low back pain", keywords="telehealth", keywords="physiotherapy", keywords="digital care", keywords="exercise", keywords="rehabilitation", keywords="back pain", keywords="pain management", keywords="telemedicine", keywords="digital therapy", keywords="chronic pain", keywords="health outcome", abstract="Background: Exercise and education is recommended as first-line treatment by evidence-based, international guidelines for low back pain (LBP). Despite consensus regarding the treatment, there is a gap between guidelines and what is offered to patients. Digital LBP treatments are an emerging way of delivering first-line treatment. Objective: The aim of this study is to evaluate outcomes after participation in a 3-month digitally delivered treatment program for individuals with subacute or chronic LBP. Methods: We analyzed data from 2593 consecutively recruited participants in a digitally delivered treatment program, available via the national health care system in Sweden. The program consists of video-instructed and progressive adaptable exercises, education through text lessons, and a chat and video function connecting participants with a personal physiotherapist. The primary outcome was mean change and proportion reaching a minimal clinically important change (MCIC) for LBP (2 points or 30\% decrease) assessed with the numerical rating scale (average pain during the past week, discrete boxes, 0-10, best to worst). Secondary outcomes were mean change and proportion reaching MCIC (10 points or 30\%) in disability, assessed with the Oswestry Disability Index (ODI; 0-100, best to worst) and a question on patient acceptable symptom state (PASS). Results: The mean participant age was 63 years, 73.85\% (1915/2593) were female, 54.72\% (1419/2593) had higher education, 50.56\% (1311/2593) were retired, and the mean BMI was 26.5 kg/m2. Participants completed on average 84\% of the prescribed exercises and lessons, with an adherence of ?80\% in 69.26\% (1796/2593) and ?90\% in 50.13\% (1300/2593) of the participants.Mean reduction in pain from baseline to 3 months was 1.7 (95\% CI --1.8 to --1.6), corresponding to a 35\% relative change. MCIC was reached by 58.50\% (1517/2593) of participants. ODI decreased 4 points (95\% CI --4.5 to --3.7), and 36.48\% (946/2593) reached an MCIC. A change from no to yes in PASS was seen in 30.35\% (787/2593) of participants.Multivariable analysis showed positive associations between reaching an MCIC in pain and high baseline pain (odds ratio [OR] 1.9, 95\% CI 1.6-2.1), adherence (OR 1.5, 95\% CI 1.3-1.8), and motivation (OR 1.2, 95\% CI 1.0-1.5), while we found negative associations for wish for surgery (OR 0.6, 95\% CI 0.5-0.9) and pain in other joints (OR 0.9, 95\% CI 0.7-0.9). We found no associations between sociodemographic characteristics and pain reduction. Conclusions: Participants in this digitally delivered treatment for LBP had reduced pain at 3-month follow-up, and 58.50\% (1517/2593) reported an MCIC in pain. Our findings suggest that digital treatment programs can reduce pain at clinically important levels for people with high adherence to treatment but that those with such severe LBP problems that they wish to undergo surgery may benefit from additional support. Trial Registration: ClinicalTrials.gov NCT05226156; https://clinicaltrials.gov/ct2/show/NCT05226156 ", doi="10.2196/38084", url="https://rehab.jmir.org/2022/2/e38084", url="http://www.ncbi.nlm.nih.gov/pubmed/35727622" } @Article{info:doi/10.2196/35365, author="Thorup, Brun Charlotte and Villadsen, Anne and Andreasen, Jesper Jan and Aar{\o}e, Jens and Andreasen, Jane and Brocki, Cristina Barbara", title="Perspectives on Participation in a Feasibility Study on Exercise-Based Cardiac Telerehabilitation After Transcatheter Aortic Valve Implantation: Qualitative Interview Study Among Patients and Health Professionals", journal="JMIR Form Res", year="2022", month="Jun", day="20", volume="6", number="6", pages="e35365", keywords="transcatheter aortic valve implantation", keywords="aortic valve", keywords="implant", keywords="TAVI", keywords="telerehabilitation", keywords="rehabilitation", keywords="aortic stenosis", keywords="patients' perspective", keywords="older people", keywords="elder", keywords="aged", keywords="geriatric", keywords="gerontology", keywords="patient experience", keywords="user experience", keywords="health professional experience", keywords="physician experience", keywords="telehealth", keywords="older adult", keywords="telemedicine", keywords="cardiac", keywords="cardiology", keywords="heart", keywords="perspective", keywords="home-based", keywords="exercise", keywords="activity tracker", keywords="physical activity", keywords="mHealth", keywords="mobile health", keywords="fitness", abstract="Background: Aortic valve stenosis affects approximately half of people aged ?85 years, and the recommended surgical treatment for older patients is transcatheter aortic valve implantation (TAVI). Despite strong evidence for its advantages, low attendance rate in cardiac rehabilitation is observed among patients after TAVI. Cardiac telerehabilitation (CTR) has proven comparable with center-based rehabilitation; however, no study has investigated CTR targeting patients after TAVI. On the basis of participatory design, an exercise-based CTR program (TeleTAVI) was developed, which included a web-based session with a cardiac nurse, a tablet containing an informative website, an activity tracker, and supervised home-based exercise sessions that follow the national recommendations for cardiac rehabilitation. Objective: This study aims to explore patients' and health professionals' experiences with using health technologies and participating in the exercise-based CTR program, TeleTAVI. Methods: This study is a part of a feasibility study and will only report patients' and health professionals' experiences of being a part of TeleTAVI. A total of 11 qualitative interviews were conducted using a semistructured interview guide (n=7, 64\% patients and n=4, 36\% health professionals). Patient interviews were conducted after 8 weeks of participation in TeleTAVI, and interviews with health professionals were conducted after the end of the program. The analysis was conducted as inductive content analysis to create a condensed meaning presented as themes. Results: Reticence toward using the website was evident with reduced curiosity to explore it, and reduced benefit from using the activity tracker was observed, as the patients' technical competencies were challenged. This was also found when using the tablet for web-based training sessions, leading to patients feeling worried before the training, as they anticipated technical problems. Disadvantages of the TeleTAVI program were technical problems and inability to use hands-on guidance with the patients. However, both physiotherapists and patients reported a feeling of improvement in patients' physical fitness. The home training created a feeling of safety, supported adherence, and made individualization possible, which the patients valued. A good relationship and continuity in the contact with health professionals seemed very important for the patients and affected their positive attitude toward the program. Conclusions: The home-based nature of the TeleTAVI program seems to provide the opportunity to support individualization, autonomy, independence, and adherence to physical training in addition to improvement in physical capability in older patients. Despite technological challenges, basing the relationship between the health professionals and patients on continuity may be beneficial for patients. Prehabilitation may also be considered, as it may create familiarity toward technology and adherence to the training. ", doi="10.2196/35365", url="https://formative.jmir.org/2022/6/e35365", url="http://www.ncbi.nlm.nih.gov/pubmed/35723925" } @Article{info:doi/10.2196/37836, author="Krese, A. Kelly and Donnelly, Z. Kyla and Etingen, Bella and Bender Pape, L. Theresa and Chaudhuri, Sarmistha and Aaronson, L. Alexandra and Shah, P. Rachana and Bhaumik, K. Dulal and Billups, Andrea and Bedo, Sabrina and Wanicek-Squeo, Terese Mary and Bobra, Sonia and Herrold, A. Amy", title="Feasibility of a Combined Neuromodulation and Yoga Intervention for Mild Traumatic Brain Injury and Chronic Pain: Protocol for an Open-label Pilot Trial", journal="JMIR Res Protoc", year="2022", month="Jun", day="15", volume="11", number="6", pages="e37836", keywords="concussion", keywords="mild traumatic brain injury", keywords="chronic pain", keywords="neuromodulation", keywords="transcranial magnetic stimulation", abstract="Background: Mild traumatic brain injury (mTBI) and chronic pain often co-occur and worsen rehabilitation outcomes. There is a need for improved multimodal nonpharmacologic treatments that could improve outcomes for both conditions. Yoga is a promising activity-based intervention for mTBI and chronic pain, and neuromodulation through transcranial magnetic stimulation is a promising noninvasive, nonpharmacological treatment for mTBI and chronic pain. Intermittent theta burst stimulation (iTBS) is a type of patterned, excitatory transcranial magnetic stimulation. iTBS can induce a window of neuroplasticity, making it ideally suited to boost the effects of treatments provided after it. Thus, iTBS may magnify the impacts of subsequently delivered interventions as compared to delivering those interventions alone and accordingly boost their impact on outcomes. Objective: The aim of this study is to (1) develop a combined iTBS+yoga intervention for mTBI and chronic pain, (2) assess the intervention's feasibility and acceptability, and (3) gather preliminary clinical outcome data on quality of life, function, and pain that will guide future studies. Methods: This is a mixed methods, pilot, open-labeled, within-subject intervention study. We will enroll 20 US military veteran participants. The combined iTBS+yoga intervention will be provided in small group settings once a week for 6 weeks. The yoga intervention will follow the LoveYourBrain yoga protocol---specifically developed for individuals with TBI. iTBS will be administered immediately prior to the LoveYourBrain yoga session. We will collect preliminary quantitative outcome data before and after the intervention related to quality of life (TBI-quality of life), function (Mayo-Portland Adaptability Index), and pain (Brief Pain Inventory) to inform larger studies. We will collect qualitative data via semistructured interviews focused on intervention acceptability after completion of the intervention. Results: This study protocol was approved by Edward Hines Jr Veterans Administration Hospital Institutional Review Board (Hines IRB 1573116-4) and was prospectively registered on ClinicalTrials.gov (NCT04517604). This study includes a Food and Drug Administration Investigational Device Exemption (IDE: G200195). A 2-year research plan timeline was developed. As of March 2022, a total of 6 veterans have enrolled in the study. Data collection is ongoing and will be completed by November 2022. We expect the results of this study to be available by October 2024. Conclusions: We will be able to provide preliminary evidence of safety, feasibility, and acceptability of a novel combined iTBS and yoga intervention for mTBI and chronic pain---conditions with unmet treatment needs. Trial Registration: ClinicalTrials.gov NCT04517604; https://www.clinicaltrials.gov/ct2/show/NCT04517604 International Registered Report Identifier (IRRID): DERR1-10.2196/37836 ", doi="10.2196/37836", url="https://www.researchprotocols.org/2022/6/e37836", url="http://www.ncbi.nlm.nih.gov/pubmed/35704372" } @Article{info:doi/10.2196/29830, author="Anwar, Naveed and Karimi, Hossein and Ahmad, Ashfaq and Gilani, Amir Syed and Khalid, Kehkshan and Aslam, Sohaib Ahmed and Hanif, Asif", title="Virtual Reality Training Using Nintendo Wii Games for Patients With Stroke: Randomized Controlled Trial", journal="JMIR Serious Games", year="2022", month="Jun", day="13", volume="10", number="2", pages="e29830", keywords="stroke", keywords="virtual reality", keywords="Fugl-Meyer score", keywords="rehabilitation", keywords="training", keywords="physical therapy", keywords="therapy", keywords="balance", keywords="function", keywords="randomized controlled trial", abstract="Background: Stroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial. Objective: The aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke. Methods: It was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22. Results: The trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted. Conclusions: VR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability. Trial Registration: Iranian Registry of Clinical Trials RCT20190715044216N1; https://www.irct.ir/user/trial/40898/view ", doi="10.2196/29830", url="https://games.jmir.org/2022/2/e29830", url="http://www.ncbi.nlm.nih.gov/pubmed/35699989" } @Article{info:doi/10.2196/29936, author="Lambert, Genevieve and Drummond, Kenneth and Tahasildar, Bhagya and Carli, Francesco", title="Virtual Prehabilitation in Patients With Cancer Undergoing Surgery During the COVID-19 Pandemic: Protocol for a Prospective Feasibility Study", journal="JMIR Res Protoc", year="2022", month="May", day="6", volume="11", number="5", pages="e29936", keywords="prehabilitation", keywords="telehealth", keywords="functional capacity", keywords="cancer care", keywords="exercise", keywords="malnutrition", keywords="psychosocial support", abstract="Background: Since the beginning of the COVID-19 pandemic, preoperative care, also termed prehabilitation, has become increasingly relevant due to the decreasing functional and psychosocial health of patients with cancer, which is a result of the pandemic restrictions. Concurrently, access to telehealth has improved; telehealth comprises all remote care delivery facilitated by information technologies (ie, virtually). Objective: The aim of this protocol is to describe the rationale and methodology for a major trial investigating the feasibility and safety of multimodal virtual prehabilitation services (ie, teleprehabilitation). Methods: This single-arm feasibility trial aims to recruit 100 patients with cancer to receive teleprehabilitation throughout their preoperative period. The inclusion criteria are as follows: (1) 18 years of age or older, (2) scheduled for elective cancer surgery and referred by a surgeon, (3) medically cleared by the referring physician to engage in physical activity, and (4) have a good comprehension of the English or French language. Feasibility will be assessed by documenting recruitment, adherence, and retention rates, in addition to patients' motives for not participating in the trial, low participation, or discontinuation. The secondary outcome of safety will be assessed by reporting program-related adverse events. Results: The Montreal General Hospital Foundation funded the project in August 2020. The protocol was then approved by the Research Ethics Board of the McGill University Health Centre in January 2021 (ID No. 2021-6730). The first patient was recruited in March 2021, and recruitment is expected to end in September 2022. As of March 2022, 36 patients have been recruited, including 24 who have completed their participation. No adverse events have been reported. Data collection is expected to conclude in November 2022. Data analysis will be performed, and the results will be published by the beginning of 2023. Conclusions: This trial will provide guidance on the use of telehealth in the administration of prehabilitation services. The trial will provide a large amount of information that will respond to gaps in the literature, as there are minimal reports on the use of telehealth rehabilitation and prehabilitation services among elderly populations and in acute contexts, such as the preoperative period. Trial Registration: ClinicalTrials.gov NCT0479956; https://clinicaltrials.gov/ct2/show/NCT04799561 International Registered Report Identifier (IRRID): DERR1-10.2196/29936 ", doi="10.2196/29936", url="https://www.researchprotocols.org/2022/5/e29936", url="http://www.ncbi.nlm.nih.gov/pubmed/35522464" } @Article{info:doi/10.2196/34543, author="Rian, Torbj{\o}rn and Sand, Kari and Skogvoll, Eirik and Klepstad, P{\aa}l and Wik, S. Tina", title="A Web-Based Communication Tool for Postoperative Follow-up and Pain Assessment at Home After Primary Knee Arthroplasty: Feasibility and Usability Study", journal="JMIR Form Res", year="2022", month="Apr", day="28", volume="6", number="4", pages="e34543", keywords="feasibility studies", keywords="postoperative follow-up", keywords="primary knee arthroplasty, pain assessment", keywords="mobile application", keywords="pain treatment", keywords="follow-up at home", abstract="Background: We report the use of an electronic tool, Eir (Eir Solutions AS, Norway), for symptom registration at home after knee arthroplasty. This electronic tool was used in a randomized controlled trial (RCT) comparing 3 different analgesic regimens with respect to postoperative pain and side effects. Objective: The aim of this substudy was to investigate this electronic tool for symptom registrations at home with respect to usability (ie, how easy it was to use) and feasibility (ie, how well the tool served its purpose). Methods: To assess the tool's usability, all participants were invited to fill out the 10-item System Usability Scale (SUS) after using the tool for 8 days. To assess feasibility, data regarding the participants' ability to use the tool with or without assistance or reminders were collected qualitatively on a daily basis during the study period. Results: A total of 134 patients completed the RCT. Data concerning feasibility of the web-based tool were collected from all 134 patients. The SUS was completed by 119 of the 134 patients; 70.2\% (94/134) of the patients managed to use the tool at home without any technical support. All technical challenges were related to the login procedure or internet access. The mean SUS score was 89.6 (median 92.5; range 22.5-100). Conclusions: This study showed high feasibility and high usability of the Eir web tool. The received reports gave the necessary information needed for both research data and clinical follow-up. Trial Registration: ClinicalTrials.gov NCT02604446; https://www.clinicaltrials.gov/ct2/show/NCT02604446 ", doi="10.2196/34543", url="https://formative.jmir.org/2022/4/e34543", url="http://www.ncbi.nlm.nih.gov/pubmed/35482392" } @Article{info:doi/10.2196/26990, author="Burdea, Grigore and Kim, Nam and Polistico, Kevin and Kadaru, Ashwin and Grampurohit, Namrata and Hundal, Jasdeep and Pollack, Simcha", title="Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports", journal="JMIR Rehabil Assist Technol", year="2022", month="Apr", day="13", volume="9", number="2", pages="e26990", keywords="subacute stroke", keywords="virtual reality", keywords="gamification", keywords="therapeutic game controller", keywords="integrative rehabilitation", keywords="BrightArm Duo", keywords="BrightArm Compact", keywords="upper extremity", keywords="cognition", keywords="depression", abstract="Background: BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. Objective: The aim of this study is to design and test a robotic rehabilitation table--based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. Methods: A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. Results: The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225\% and 100\% increase), grasp strength (27\% and 16\% increase), and pinch strength (31\% and 15\% increase). The shoulder flexion range increased by 17\% and 18\% and elbow supination range by 75\% and 58\%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). Conclusions: The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. Trial Registration: ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170 ", doi="10.2196/26990", url="https://rehab.jmir.org/2022/2/e26990", url="http://www.ncbi.nlm.nih.gov/pubmed/35416787" } @Article{info:doi/10.2196/34822, author="Shore, Josh and Nalder, Emily and Hutchison, Michael and Reed, Nick and Hunt, Anne", title="Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development", journal="JMIR Pediatr Parent", year="2022", month="Apr", day="4", volume="5", number="2", pages="e34822", keywords="concussion", keywords="pediatrics", keywords="active rehabilitation", keywords="telehealth", keywords="exercise", keywords="mobile phone", abstract="Background: Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective: This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods: The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results: Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion \& You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions: The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach. ", doi="10.2196/34822", url="https://pediatrics.jmir.org/2022/2/e34822", url="http://www.ncbi.nlm.nih.gov/pubmed/35377326" } @Article{info:doi/10.2196/26825, author="R{\"o}hling, Marie Hanna and Althoff, Patrik and Arsenova, Radina and Drebinger, Daniel and Gigengack, Norman and Chorschew, Anna and Kroneberg, Daniel and R{\"o}nnefarth, Maria and Ellermeyer, Tobias and Rosenkranz, Cath{\'e}rine Sina and Heesen, Christoph and Behnia, Behnoush and Hirano, Shigeki and Kuwabara, Satoshi and Paul, Friedemann and Brandt, Ulrich Alexander and Schmitz-H{\"u}bsch, Tanja", title="Proposal for Post Hoc Quality Control in Instrumented Motion Analysis Using Markerless Motion Capture: Development and Usability Study", journal="JMIR Hum Factors", year="2022", month="Apr", day="1", volume="9", number="2", pages="e26825", keywords="instrumented motion analysis", keywords="markerless motion capture", keywords="visual perceptive computing", keywords="quality control", keywords="quality reporting", keywords="gait analysis", abstract="Background: Instrumented assessment of motor symptoms has emerged as a promising extension to the clinical assessment of several movement disorders. The use of mobile and inexpensive technologies such as some markerless motion capture technologies is especially promising for large-scale application but has not transitioned into clinical routine to date. A crucial step on this path is to implement standardized, clinically applicable tools that identify and control for quality concerns. Objective: The main goal of this study comprises the development of a systematic quality control (QC) procedure for data collected with markerless motion capture technology and its experimental implementation to identify specific quality concerns and thereby rate the usability of recordings. Methods: We developed a post hoc QC pipeline that was evaluated using a large set of short motor task recordings of healthy controls (2010 recordings from 162 subjects) and people with multiple sclerosis (2682 recordings from 187 subjects). For each of these recordings, 2 raters independently applied the pipeline. They provided overall usability decisions and identified technical and performance-related quality concerns, which yielded respective proportions of their occurrence as a main result. Results: The approach developed here has proven user-friendly and applicable on a large scale. Raters' decisions on recording usability were concordant in 71.5\%-92.3\% of cases, depending on the motor task. Furthermore, 39.6\%-85.1\% of recordings were concordantly rated as being of satisfactory quality whereas in 5.0\%-26.3\%, both raters agreed to discard the recording. Conclusions: We present a QC pipeline that seems feasible and useful for instant quality screening in the clinical setting. Results confirm the need of QC despite using standard test setups, testing protocols, and operator training for the employed system and by extension, for other task-based motor assessment technologies. Results of the QC process can be used to clean existing data sets, optimize quality assurance measures, as well as foster the development of automated QC approaches and therefore improve the overall reliability of kinematic data sets. ", doi="10.2196/26825", url="https://humanfactors.jmir.org/2022/2/e26825", url="http://www.ncbi.nlm.nih.gov/pubmed/35363150" } @Article{info:doi/10.2196/26827, author="Patel, I. Darpan and Gonzalez, Angela and Moon, Crisann and Serra, Monica and Bridges, Blake Preston and Hughes, Daniel and Clarke, Geoffrey and Kilpela, Lisa and Jiwani, Rozmin and Musi, Nicolas", title="Exercise and Creatine Supplementation to Augment the Adaptation of Exercise Training Among Breast Cancer Survivors Completing Chemotherapy: Protocol for an Open-label Randomized Controlled Trial (the THRIVE Study)", journal="JMIR Res Protoc", year="2022", month="Apr", day="1", volume="11", number="4", pages="e26827", keywords="rehabilitation", keywords="supplements", keywords="resistant exercise", keywords="oncology", keywords="quality of life", keywords="doxorubicin", abstract="Background: In breast cancer survivors, chemotherapy-induced muscle loss has been shown to be attenuated with structured resistance exercise. Creatine supplementation can increase bioenergetics in skeletal muscle, which helps to improve overall strength and endurance and reduce muscular fatigue. Therefore, we hypothesize that adding creatinine supplementation to exercise training will accelerate improvements in strength, endurance, and bioenergetics in breast cancer survivors. Objective: The primary objective is to determine the effects of combining creatine supplementation with exercise on modulating strength and physical function in breast cancer survivors by comparing these effects to those of exercise alone. The secondary objectives are to determine if creatine supplementation and exercise can increase the intramuscular storage of creatine and improve body composition by comparing this intervention to exercise alone. Methods: We aim to test our hypothesis by conducting an open-label randomized controlled trial of 30 breast cancer survivors who have completed chemotherapy within 6 months of enrollment. Eligible participants will be equally randomized (1:1) to either a creatine and exercise group or an exercise-only group for this 12-week intervention. Individuals who are randomized to receive creatine will be initially dosed at 20 g per day for 7 days to boost the availability of creatine systemically. Thereafter, the dose will be reduced to 5 g per day for maintenance throughout the duration of the 12-week protocol. All participants will engage in 3 center-based exercise sessions, which will involve completing 3 sets of 8 to 12 repetitions on chest press, leg press, seated row, shoulder press, leg extension, and leg curl machines. The primary outcomes will include changes in strength, body composition, and physical function in breast cancer survivors. The secondary outcomes will be intramuscular concentrations of creatine and adenosine triphosphate in the vastus lateralis, midthigh cross-sectional area, and quality of life. Results: As of October 2021, a total of 9 patients have been enrolled into the study. No unexpected adverse events have been reported. Conclusions: Creatine is being studied as a potential agent for improving strength, endurance, and bioenergetics in breast cancer survivors following chemotherapy. The findings from our trial may have future implications for supporting breast cancer survivors in reversing the muscle loss experienced during chemotherapy and improving their physical function and quality of life. Trial Registration: ClinicalTrials.gov NCT04207359; https://clinicaltrials.gov/ct2/show/NCT04207359 International Registered Report Identifier (IRRID): PRR1-10.2196/26827 ", doi="10.2196/26827", url="https://www.researchprotocols.org/2022/4/e26827", url="http://www.ncbi.nlm.nih.gov/pubmed/35363152" } @Article{info:doi/10.2196/35700, author="Rozenberg, Dmitry and Santa Mina, Daniel and Nourouzpour, Sahar and Camacho Perez, Encarna and Stewart, Lyn Brooke and Wickerson, Lisa and Tsien, Cynthia and Selzner, Nazia and Shore, Josh and Aversa, Meghan and Woo, Minna and Holdsworth, Sandra and Prevost, Karina and Park, Jeff and Azhie, Amirhossein and Huszti, Ella and McLeod, Elizabeth and Dales, Sarah and Bhat, Mamatha", title="Feasibility of a Home-Based Exercise Program for Managing Posttransplant Metabolic Syndrome in Lung and Liver Transplant Recipients: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Mar", day="23", volume="11", number="3", pages="e35700", keywords="lung transplant", keywords="liver transplant", keywords="posttransplant metabolic syndrome", keywords="exercise training", keywords="randomized controlled trial", keywords="pilot study", abstract="Background: Posttransplant metabolic syndrome (PTMS) is a common contributor to morbidity and mortality among solid organ transplant recipients in the late posttransplant period (?1 year). Patients diagnosed with PTMS are at a higher risk of cardiovascular disease and frequently experience decreased physical function and health-related quality of life (HRQL). Studies in the early posttransplant period (<1 year) have shown the benefits of facility-based exercise training on physical function and HRQL, but have not evaluated the effects on metabolic risk factors. It remains unclear whether home-based exercise programs are feasible and can be delivered at a sufficient exercise dose to have effects on PTMS. This protocol outlines the methodology of a randomized controlled trial of a partly supervised home-based exercise program in lung transplant (LTx) and orthotopic liver transplant (OLT) recipients. Objective: This study aims to evaluate the feasibility (ie, recruitment rate, program adherence, attrition, safety, and participant satisfaction) of a 12-week individualized, home-based aerobic and resistance training program in LTx and OLT recipients initiated 12 to 18 months after transplantation, and to assess estimates of intervention efficacy on metabolic risk factors, exercise self-efficacy, and HRQL. Methods: In total, 20 LTx and 20 OLT recipients with ?2 cardiometabolic risk factors at 12 to 18 months after transplantation will be randomized to an intervention (home-based exercise training) or control group. The intervention group will receive an individualized exercise prescription comprising aerobic and resistance training, 3 to 5 times a week for 12 weeks. Participants will meet on a weekly basis (via videoconference) with a qualified exercise professional who will supervise exercise progression, provide support, and support exercise self-efficacy. Participants in both study groups will receive a counseling session on healthy eating with a dietitian at the beginning of the intervention. For the primary aim, feasibility will be assessed through recruitment rate, program adherence, satisfaction, attrition, and safety parameters. Secondary outcomes will be measured at baseline and 12 weeks, including assessments of metabolic risk factors (ie, insulin resistance, abdominal obesity, blood pressure, and cholesterol), HRQL, and exercise self-efficacy. Descriptive statistics will be used to summarize program feasibility and effect estimates (means and 95\% CIs) for sample size calculations in future trials. Results: Enrollment started in July 2021. It is estimated that the study period will be 18 months, with data collection to be completed by December 2022. Conclusions: A partly supervised home-based, individually tailored exercise program that promotes aerobic and resistance training and exercise self-efficacy may be an important intervention for improving the metabolic profile of LTx and OLT recipients with cardiometabolic risk factors. Thus, characterizing the feasibility and effect estimates of home-based exercise constitutes the first step in developing future clinical trials designed to reduce the high morbidity associated with PTMS. Trial Registration: ClinicalTrials.gov NCT04965142; https://clinicaltrials.gov/ct2/show/NCT04965142 International Registered Report Identifier (IRRID): DERR1-10.2196/35700 ", doi="10.2196/35700", url="https://www.researchprotocols.org/2022/3/e35700", url="http://www.ncbi.nlm.nih.gov/pubmed/35319467" } @Article{info:doi/10.2196/30366, author="Wiskerke, Evelyne and Kool, Jan and Hilfiker, Roger and Sattelmayer, Martin Karl and Verheyden, Geert", title="Determining the Optimal Virtual Reality Exergame Approach for Balance Therapy in Persons With Neurological Disorders Using a Rasch Analysis: Longitudinal Observational Study", journal="JMIR Serious Games", year="2022", month="Mar", day="22", volume="10", number="1", pages="e30366", keywords="digital therapeutics", keywords="virtual reality", keywords="exergaming", keywords="balance", keywords="stroke", keywords="multiple sclerosis", keywords="neurorehabilitation", keywords="Rasch analysis", abstract="Background: Virtual reality (VR) exergames have gained popularity in the rehabilitation of persons with neurological disorders as an add-on therapy to increase intensity of training. Intensity is strongly dependent on the motivation of the patient. Motivation can be increased by delivering variation within training and challenging exercises. However, patients are often underchallenged, as exergame difficulty often does not match the patient's ability. A Rasch analysis can establish hierarchy of exergame items in order to assist the delivery of patient-centered therapy. Objective: The aim of this study was to apply the Rasch model to create a hierarchical order of existing VR balance exergames and to relate these exergames to the abilities of persons with neurological disorders, in order to deliver challenge and variation. Methods: A total of 30 persons with stroke and 51 persons with multiple sclerosis (MS) were included in the study. All participants performed a training program, lasting 3 weeks for persons with MS and 4 weeks for persons with stroke, in which they performed VR balance exergames with a movement recognition--based system (MindMotion GO; MindMaze SA). VR exercise scores, Berg Balance Scale scores, and clinical descriptive data were collected. Berg Balance Scale and device scores were analyzed with the Rasch model using a repeated-measures approach to examine whether the distribution of exercise scores fitted the Rasch model. Secondly, a person-item map was created to show the hierarchy of exercise difficulty and person ability. Results: Participants completed a selection of 56 balance exercises (ie, items), which consisted of a combination of various balance tasks and levels (ie, exercises). Using repeated measures, this resulted in a count of 785 observations. Analysis showed strong evidence for unidimensionality of the data. A total of 47 exercises (ie, items) had a sufficiently good fit to the Rasch model. Six items showed underfit, with outfit mean square values above 1.5. One item showed underfit but was kept in the analysis. Three items had negative point-biserial correlations. The final model consisted of 47 exercises, which were provided for persons with low to moderate balance ability. Conclusions: The VR exercises sufficiently fitted the Rasch model and resulted in a hierarchical order of VR balance exercises for persons with stroke and MS with low to moderate balance ability. In combination with the Berg Balance Scale, the results can guide clinical decision-making in the selection of patient-focused VR balance exercises. Trial Registration: ClinicalTrials.gov NCT03993275; https://clinicaltrials.gov/ct2/show/NCT03993275 ", doi="10.2196/30366", url="https://games.jmir.org/2022/1/e30366", url="http://www.ncbi.nlm.nih.gov/pubmed/35315785" } @Article{info:doi/10.2196/33609, author="Agnew, R. Jonathon M. and Hanratty, E. Catherine and McVeigh, G. Joseph and Nugent, Chris and Kerr, P. Daniel", title="An Investigation Into the Use of mHealth in Musculoskeletal Physiotherapy: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="11", volume="9", number="1", pages="e33609", keywords="physiotherapy", keywords="musculoskeletal", keywords="mHealth", keywords="rehabilitation", keywords="scoping review", keywords="mobile phone", abstract="Background: Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. Objective: The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. Methods: A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. Results: Of the 1393 studies, 28 (2.01\%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18\%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50\%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. Conclusions: mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available. ", doi="10.2196/33609", url="https://rehab.jmir.org/2022/1/e33609", url="http://www.ncbi.nlm.nih.gov/pubmed/35275089" } @Article{info:doi/10.2196/28875, author="Chaplin, Emma and Barnes, Amy and Newby, Chris and Houchen-Wolloff, Linzy and Singh, J. Sally", title="Comparison of the Impact of Conventional and Web-Based Pulmonary Rehabilitation on Physical Activity in Patients With Chronic Obstructive Pulmonary Disease: Exploratory Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="10", volume="9", number="1", pages="e28875", keywords="SPACE for COPD", keywords="internet", keywords="web-based", keywords="chronic obstructive pulmonary disease", keywords="pulmonary rehabilitation", keywords="physical activity", keywords="exercise", keywords="chronic disease", keywords="COPD", keywords="rehabilitation", abstract="Background: Pulmonary Rehabilitation (PR) increases exercise capacity, with less clear evidence regarding physical activity (PA). The World Health Organization recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA per week to reduce the risks of chronic disease. Objective: The objective of this study was to assess the effectiveness of conventional PR versus web-based PR with respect to changes in PA. Methods: Patients with COPD were randomized to either conventional PR classes (n=51) or a web-based PR program (n=52) for 7 weeks in a feasibility study. Accelerometers (Sensewear) were worn before and after the intervention, and PA was measured as steps per day and mean bouts of moderate activity for ?2, ?5, ?10, and ?20 minutes. Measures were derived for patients with ?8 hours of data per day for ?4 days, using the R package for statistical analysis. Variables were explored to examine their relationships with bouts of activity. Results: Baseline characteristics did not differ significantly between groups. Complete PA data were available for the groups receiving web-based (n=20) and conventional (n=34) PR interventions. The web-based PR group demonstrated a nonsignificant increase in the number of steps per day, which mainly comprised short bouts of moderate to vigorous intensity PA when compared to the conventional PR group (P=.20). The conventional PR group demonstrated increased 20-minute bouts of PA by 49.1\%, although this was not significant (P=.07). At baseline, age (r=--0.21, P=.04), BMI (r=--0.311, P=.004), and FEV1 (forced expiratory volume in 1 second; \% predicted; r=--0.248, P=.048) were significantly correlated with 10-minute bouts of PA; however, this was not observed post intervention. Conclusions: The analysis revealed a nonsignificant difference in the pattern of PA between groups receiving conventional vs web-based PR---the former being associated with an increase in 20-minute bouts, while the latter having demonstrated an increase in the number of steps per day. There appears to be a differing response emerging between the two interventions. Trial Registration: International Clinical Trials Registry ISRCTN03142263; https://tinyurl.com/y4dmfyrb ", doi="10.2196/28875", url="https://rehab.jmir.org/2022/1/e28875", url="http://www.ncbi.nlm.nih.gov/pubmed/35266871" } @Article{info:doi/10.2196/32457, author="Haladay, Douglas and Ditwiler, Edgeworth Rebecca and Klein, B. Aimee and Miro, Rebecca and Lazinski, Matthew and Swisher, Lee Laura and Beckstead, Jason and Wolfson, Jay and Hardwick, Dustin", title="Goal Attainment Scaling in Outpatient Physical Therapy for Chronic Low Back Pain: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2022", month="Mar", day="7", volume="11", number="3", pages="e32457", keywords="goal attainment scaling", keywords="goal setting", keywords="low back pain", keywords="chronic pain", keywords="physical therapy", keywords="patient engagement", keywords="adherence", keywords="rehabilitation", keywords="physical therapist", abstract="Background: Patient engagement in decisions regarding their health care may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their health care, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in health care decisions. Physical therapy goals are often generated by health care providers based on subjective information or standardized, fixed-item, patient-reported outcome measures. However, these outcome measures may not fully reveal the activity and participation limitations of individual patients. Goal attainment scaling (GAS) is a patient-centered approach that allows patients to set meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various populations, there is limited evidence in the United States on utilizing GAS in physical therapy for patients with chronic low back pain (LBP). Objective: The purpose of this paper is to describe the protocol for a study to (1) develop a way to apply GAS procedures for physical therapists treating patients with chronic LBP in the United States and (2) test the feasibility of applying GAS procedures for chronic LBP in an outpatient physical therapy setting. Methods: This study used a mixed methods design with 2 phases: qualitative and quantitative. The qualitative phase of the study employed focus groups of patients with chronic LBP to identify an inventory of goals that were important and measurable. A series of prompts was developed from this inventory to assist physical therapists in collaboratively establishing goals with patients in a clinical setting. The quantitative phase of the study pilot-tested the inventory developed in the qualitative phase in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We also plan to compare how well GAS reveals change over time relative to traditional, fixed-item, patient-reported measures. Results: Phase 1 data collection was completed in June 2020, while data collection for phase 2 was performed between March 2021 and December 2021. We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and that it will demonstrate clinically important changes in patients with chronic LBP. Conclusions: GAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in real-world physical therapy for chronic LBP in a clinical setting. Due to unique time and productivity constraints, for GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in a clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful changes in patient outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/32457 ", doi="10.2196/32457", url="https://www.researchprotocols.org/2022/3/e32457", url="http://www.ncbi.nlm.nih.gov/pubmed/35254282" } @Article{info:doi/10.2196/31504, author="Meyer, Amanda and Hrdlicka, Charles Henry and Cutler, Erica and Hellstrand, Jill and Meise, Emily and Rudolf, Kaitlyn and Grevelding, Pete and Nankin, Matthew", title="A Novel Body Weight--Supported Postural Perturbation Module for Gait and Balance Rehabilitation After Stroke: Preliminary Evaluation Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="1", volume="9", number="1", pages="e31504", keywords="stroke rehabilitation", keywords="postural balance", keywords="gait and ambulation", keywords="balance perturbation", keywords="postural perturbation", keywords="body weight support system", keywords="occupational therapy", keywords="physical therapy", keywords="long-term acute care hospital, Berg Balance Scale", keywords="Activities-Specific Balance Confidence Scale", abstract="Background: Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. Objective: This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. Methods: This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. Results: The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95\% (SD 43.78\%) and that for the BWSS control sample (n=15) was 53.29\% (SD 24.13\%). These values were greater than those for the standard of care group (n=30; mean 28.31\%, SD 17.25\%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). Conclusions: Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. Trial Registration: ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161 ", doi="10.2196/31504", url="https://rehab.jmir.org/2022/1/e31504", url="http://www.ncbi.nlm.nih.gov/pubmed/35080495" } @Article{info:doi/10.2196/31675, author="Koppenaal, Tjarco and Pisters, F. Martijn and Kloek, JJ Corelien and Arensman, M. Remco and Ostelo, WJG Raymond and Veenhof, Cindy", title="The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Feb", day="25", volume="24", number="2", pages="e31675", keywords="eHealth", keywords="nonspecific low back pain", keywords="physiotherapy", keywords="blended care", keywords="mobile phone", abstract="Background: Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients' self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients' physical functioning. Objective: This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods: The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ?18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients' risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results: Both the stratified blended physiotherapy group (104/208, 50\%) and the face-to-face physiotherapy group (104/208, 50\%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference ?1.96, 95\% CI ?4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3\%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference ?16.39, 95\% CI ?27.98 to ?4.79) and several secondary outcomes. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy. Trial Registration: ISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203 International Registered Report Identifier (IRRID): RR2-10.1186/s12891-020-3174-z ", doi="10.2196/31675", url="https://www.jmir.org/2022/2/e31675", url="http://www.ncbi.nlm.nih.gov/pubmed/35212635" } @Article{info:doi/10.2196/31020, author="Garc{\'i}a-Mu{\~n}oz, Cristina and Cort{\'e}s-Vega, Mar{\'i}a-Dolores and Hern{\'a}ndez-Rodr{\'i}guez, Juan-Carlos and Fern{\'a}ndez-Segu{\'i}n, M. Lourdes and Escobio-Prieto, Isabel and Casuso-Holgado, Jes{\'u}s Mar{\'i}a", title="Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report", journal="JMIR Serious Games", year="2022", month="Feb", day="16", volume="10", number="1", pages="e31020", keywords="immersive virtual reality", keywords="vestibular rehabilitation", keywords="multiple sclerosis", keywords="exergames", abstract="Background: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16\% in the physical health area at T2; 33.56\% in the mental health area at T2). The patient rated the usability of the system as 90\%, based on the System Usability Scale, and gave the system a grade of A. Conclusions: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation. ", doi="10.2196/31020", url="https://games.jmir.org/2022/1/e31020", url="http://www.ncbi.nlm.nih.gov/pubmed/34766551" } @Article{info:doi/10.2196/27597, author="Barak Ventura, Roni and Stewart Hughes, Kora and Nov, Oded and Raghavan, Preeti and Ruiz Mar{\'i}n, Manuel and Porfiri, Maurizio", title="Data-Driven Classification of Human Movements in Virtual Reality--Based Serious Games: Preclinical Rehabilitation Study in Citizen Science", journal="JMIR Serious Games", year="2022", month="Feb", day="10", volume="10", number="1", pages="e27597", keywords="motion analysis", keywords="principal component analysis", keywords="telerehabilitation", keywords="virtual reality", abstract="Background: Sustained engagement is essential for the success of telerehabilitation programs. However, patients' lack of motivation and adherence could undermine these goals. To overcome this challenge, physical exercises have often been gamified. Building on the advantages of serious games, we propose a citizen science--based approach in which patients perform scientific tasks by using interactive interfaces and help advance scientific causes of their choice. This approach capitalizes on human intellect and benevolence while promoting learning. To further enhance engagement, we propose performing citizen science activities in immersive media, such as virtual reality (VR). Objective: This study aims to present a novel methodology to facilitate the remote identification and classification of human movements for the automatic assessment of motor performance in telerehabilitation. The data-driven approach is presented in the context of a citizen science software dedicated to bimanual training in VR. Specifically, users interact with the interface and make contributions to an environmental citizen science project while moving both arms in concert. Methods: In all, 9 healthy individuals interacted with the citizen science software by using a commercial VR gaming device. The software included a calibration phase to evaluate the users' range of motion along the 3 anatomical planes of motion and to adapt the sensitivity of the software's response to their movements. During calibration, the time series of the users' movements were recorded by the sensors embedded in the device. We performed principal component analysis to identify salient features of movements and then applied a bagged trees ensemble classifier to classify the movements. Results: The classification achieved high performance, reaching 99.9\% accuracy. Among the movements, elbow flexion was the most accurately classified movement (99.2\%), and horizontal shoulder abduction to the right side of the body was the most misclassified movement (98.8\%). Conclusions: Coordinated bimanual movements in VR can be classified with high accuracy. Our findings lay the foundation for the development of motion analysis algorithms in VR-mediated telerehabilitation. ", doi="10.2196/27597", url="https://games.jmir.org/2022/1/e27597", url="http://www.ncbi.nlm.nih.gov/pubmed/35142629" } @Article{info:doi/10.2196/29230, author="Nweke, Martins and Mshunqane, Nombeko and Govender, Nalini and Akinpelu, Aderonke and Ogunniyi, Adesola", title="Aerobic Exercise in HIV-Associated Neurocognitive Disorders: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jan", day="31", volume="11", number="1", pages="e29230", keywords="HIV", keywords="neurocognitive disorder", keywords="exercise", keywords="rehabilitation", keywords="quality of life", keywords="activity limitation", abstract="Background: Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. Objective: This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Methods: At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. Results: This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60\% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. Conclusions: This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Trial Registration: Pan African Clinical Trials Registry PACTR202009483415745; https://tinyurl.com/2p97zpu9 International Registered Report Identifier (IRRID): PRR1-10.2196/29230 ", doi="10.2196/29230", url="https://www.researchprotocols.org/2022/1/e29230", url="http://www.ncbi.nlm.nih.gov/pubmed/35099405" } @Article{info:doi/10.2196/27637, author="Hoevenaars, Dirk and Yocarini, E. Iris and Paraschiakos, Stylianos and Holla, M. Jasmijn F. and de Groot, Sonja and Kraaij, Wessel and Janssen, J. Thomas W.", title="Accuracy of Heart Rate Measurement by the Fitbit Charge 2 During Wheelchair Activities in People With Spinal Cord Injury: Instrument Validation Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Jan", day="19", volume="9", number="1", pages="e27637", keywords="Fitbit Charge 2", keywords="heart rate", keywords="accuracy", keywords="photoplethysmography", keywords="spinal cord injury", abstract="Background: Heart rate (HR) is an important and commonly measured physiological parameter in wearables. HR is often measured at the wrist with the photoplethysmography (PPG) technique, which determines HR based on blood volume changes, and is therefore influenced by blood pressure. In individuals with spinal cord injury (SCI), blood pressure control is often altered and could therefore influence HR accuracy measured by the PPG technique. Objective: The objective of this study is to investigate the HR accuracy measured with the PPG technique with a Fitbit Charge 2 (Fitbit Inc) in wheelchair users with SCI, how the activity intensity affects the HR accuracy, and whether this HR accuracy is affected by lesion level. Methods: The HR of participants with (38/48, 79\%) and without (10/48, 21\%) SCI was measured during 11 wheelchair activities and a 30-minute strength exercise block. In addition, a 5-minute seated rest period was measured in people with SCI. HR was measured with a Fitbit Charge 2, which was compared with the HR measured by a Polar H7 HR monitor used as a reference device. Participants were grouped into 4 groups---the no SCI group and based on lesion level into the T1 (cervical) group. Mean absolute percentage error (MAPE) and concordance correlation coefficient were determined for each group for each activity type, that is, rest, wheelchair activities, and strength exercise. Results: With an overall MAPEall lesions of 12.99\%, the accuracy fell below the standard acceptable MAPE of --10\% to +10\% with a moderate agreement (concordance correlation coefficient=0.577). The HR accuracy of Fitbit Charge 2 seems to be reduced in those with cervical lesion level in all activities (MAPEno SCI=8.09\%; MAPET1=20.43\%). The accuracy of the Fitbit Charge 2 decreased with increasing intensity in all lesions (MAPErest=6.5\%, MAPEactivity=12.97\%, and MAPEstrength=14.2\%). Conclusions: HR measured with the PPG technique showed lower accuracy in people with SCI than in those without SCI. The accuracy was just above the acceptable level in people with paraplegia, whereas in people with tetraplegia, a worse accuracy was found. The accuracy seemed to worsen with increasing intensities. Therefore, high-intensity HR data, especially in people with cervical lesions, should be used with caution. ", doi="10.2196/27637", url="https://rehab.jmir.org/2022/1/e27637", url="http://www.ncbi.nlm.nih.gov/pubmed/35044306" } @Article{info:doi/10.2196/33130, author="Dennett, Amy and Harding, E. Katherine and Reimert, Jacoba and Morris, Rebecca and Parente, Phillip and Taylor, F. Nicholas", title="Telerehabilitation's Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation", journal="JMIR Cancer", year="2021", month="Dec", day="21", volume="7", number="4", pages="e33130", keywords="telehealth", keywords="exercise", keywords="telerehabilitation", keywords="physical activity", keywords="supportive care", keywords="COVID-19", keywords="feasibility", keywords="cancer", keywords="cancer survivor", keywords="evaluation", keywords="rehabilitation", keywords="impact", keywords="development", keywords="implementation", abstract="Background: Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. Objective: Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. Methods: A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. Results: The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82\%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80\% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29\%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus \$1104 (US \$790). Conclusions: Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation. ", doi="10.2196/33130", url="https://cancer.jmir.org/2021/4/e33130", url="http://www.ncbi.nlm.nih.gov/pubmed/34854817" } @Article{info:doi/10.2196/30985, author="Vinolo Gil, Jesus Maria and Gonzalez-Medina, Gloria and Lucena-Anton, David and Perez-Cabezas, Veronica and Ruiz-Molinero, Carmen Mar{\'i}a Del and Mart{\'i}n-Valero, Roc{\'i}o", title="Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis", journal="JMIR Serious Games", year="2021", month="Dec", day="15", volume="9", number="4", pages="e30985", keywords="augmented reality", keywords="physical therapy", keywords="rehabilitation", keywords="functionality", abstract="Background: Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective: This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods: A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta?Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation. The Cochrane Collaboration tool was used to evaluate the risk of bias. Results: In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36\%) contributed information to the meta-analysis. Overall, 64\% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95\% CI ?0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change ?1.211, 95\% CI ?3.2005 to 0.7768; z=?1.194; P=.23). Conclusions: AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020180766; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=180766 ", doi="10.2196/30985", url="https://games.jmir.org/2021/4/e30985", url="http://www.ncbi.nlm.nih.gov/pubmed/34914611" } @Article{info:doi/10.2196/29047, author="Merolli, Mark and Francis, J. Jill and Vallance, Patrick and Bennell, L. Kim and Malliaras, Peter and Hinman, S. Rana", title="Patient-Facing Mobile Apps to Support Physiotherapy Care: Protocol for a Systematic Review of Apps Within App Stores", journal="JMIR Res Protoc", year="2021", month="Dec", day="9", volume="10", number="12", pages="e29047", keywords="physiotherapy", keywords="physical therapy", keywords="digital health intervention", keywords="mobile app", keywords="eHealth", keywords="behavior change technique", keywords="behavior change", keywords="exercise", keywords="digital health", keywords="mHealth", abstract="Background: Care delivered by physiotherapists aims to facilitate engagement in positive health behaviors by patients (eg, adherence to exercise). However, research suggests that behavioral interventions are frequently omitted from care. Hence, better understanding of strategies that can be used by physiotherapists to support patients to engage in positive behaviors is important and likely to optimize outcomes. Digital health interventions delivered via mobile apps are garnering attention for their ability to support behavior change. They have potential to incorporate numerous behavior change techniques (BCTs) to support goals of physiotherapy care, including but not limited to self-monitoring, goal setting, and prompts/alerts. Despite their potential to support physiotherapy care, much is still unknown about what apps are available to consumers, the BCTs they use, their quality, and their potential to change behaviors. Objective: The primary aim of this study is to systematically review the mobile apps available in app stores that are intended for use by patients to support physiotherapy care, including the BCTs within these apps. The secondary aims are to evaluate the quality and behavior change potential of these apps. Methods: A systematic review of mobile apps in app stores will be undertaken. This will be guided by recommendations for systematic reviews in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement but adapted to suit our app store search, consistent with similar systematic reviews of apps published in the Journal of Medical Internet Research. Apple Store and Google Play will be searched with a two-step search strategy, using terms relevant to physiotherapy, physiotherapists, and common physiotherapy care. Key eligibility criteria will include apps that are intended for use by patients and are self-contained or stand-alone without the need of additional wearable devices or other add-ons. Included apps will be coded for BCTs and rated for quality using the Mobile Application Rating Scale (MARS) and for potential to change behavior using the App Behavior Change Scale (ABACUS). Results: App store search and screening are expected to be completed in 2021. Data extraction and quality appraisal are expected to commence by November 2021. The study results are expected to be published in a subsequent?paper in 2022. Conclusions: Knowledge gained from this review will support clinical practice and inform research by providing a greater understanding of the quality of currently available mobile apps and their potential to support patient behavior change goals of physiotherapy care. International Registered Report Identifier (IRRID): PRR1-10.2196/29047 ", doi="10.2196/29047", url="https://www.researchprotocols.org/2021/12/e29047", url="http://www.ncbi.nlm.nih.gov/pubmed/34889767" } @Article{info:doi/10.2196/18972, author="Maier, Andr{\'e} and Eicher, Cornelia and Kiselev, Joern and Klebbe, Robert and Greu{\`e}l, Marius and Kettemann, Dagmar and Gaudlitz, Marcel and Walter, Bertram and Oleimeulen, Ursula and M{\"u}nch, Christoph and Meyer, Thomas and Spittel, Susanne", title="Acceptance of Enhanced Robotic Assistance Systems in People With Amyotrophic Lateral Sclerosis--Associated Motor Impairment: Observational Online Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Dec", day="6", volume="8", number="4", pages="e18972", keywords="amyotrophic lateral sclerosis", keywords="assistive robotics", keywords="technology commitment", keywords="robotic arm assistance", abstract="Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by a progressive paresis of the extremities and the loss of manual functioning. Due to the severe functional impairment that the disease entails, ALS requires the provision of comprehensive nursing care and a complex set of assistive technology devices. To relieve caregivers and promote autonomy of people with ALS, robotic assistance systems are being developed. This trial aims to evaluate the acceptance of technology, in general, and of robotic arm assistance among people with ALS in order to lay the groundwork for the development of a semiautomatic robotic arm that can be controlled by humans via a multimodal user interface and that will allow users to handle objects and attend to their own bodies. Objective: The aim of this study was to perform a systematic analysis of technology commitment and acceptance of robotic assistance systems from the perspective of physically limited people living with ALS. Methods: The investigation was conducted as a study of a prospective cohort. Participants were only included if they had received a medical diagnosis of ALS. Data collection took place via an online questionnaire on the Ambulanzpartner Soziotechnologie internet platform. Technological commitment was measured using the Neyer short scale. Furthermore, a multidimensional questionnaire was specially developed to analyze participant acceptance of robotic arm assistance: the Acceptance Measure of Robotic Arm Assistance (AMRAA). This questionnaire was accompanied by a video introducing the robot arm. ALS severity was ascertained using the ALS Functional Rating Scale--Extended (ALSFRS-EX). Results: A total of 268 people with ALS participated in the survey. Two-thirds of the participants were male. The overall mean ALS severity score was 42.9 (SD 11.7) points out of 60 on the ALSFRS-EX, with the most relevant restrictions on arms and legs (<60\% of normal functioning). Technological commitment ranked high, with the top third scoring 47.2 points out of 60. Younger participants and males showed significantly higher values. The AMRAA score was, again, significantly higher among younger participants. However, the gender difference within the overall cohort was not significant. The more limited the arm functioning of participants according to the ALSFRS-EX subscale, the higher the acceptance rate of robotic assistance. This relationship proved significant. Conclusions: People with ALS display high technological commitment and feel positive about using technological assistance systems. In our study, younger participants were more open to technology use, in general, and robotic assistance, in particular. Self-appraisal of technology acceptance, competence, and control conviction were generally higher among men. However, any presumed gender difference vanished when users were asked to rate the anticipated usefulness of the technology, in particular the robotic arm. The acceptance was also reflected in users' increased willingness to use a robotic arm as the functionality of their own arms decreased. From the perspective of people with ALS, robotic assistance systems are critical to promoting individual autonomy. Another key consideration in the development of future assistive technologies should be the reduction of caregiver burden. Trial Registration: German Clinical Trials Register DRKS00012803; https://tinyurl.com/w9yzduhd ", doi="10.2196/18972", url="https://rehab.jmir.org/2021/4/e18972", url="http://www.ncbi.nlm.nih.gov/pubmed/34874891" } @Article{info:doi/10.2196/30378, author="Jorge, Serafim Ana Elisa and Bennell, Louise Kim and Kimp, Jared Alexander and Campbell, Kate Penny and Hinman, Shane Rana", title="An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data", journal="JMIR Med Educ", year="2021", month="Dec", day="1", volume="7", number="4", pages="e30378", keywords="osteoarthritis", keywords="knee", keywords="physiotherapy", keywords="exercise", keywords="e-learning", keywords="telehealth", keywords="pain", keywords="education", keywords="implementation", keywords="evaluation", keywords="professional development", keywords="rehabilitation", abstract="Background: The COVID-19 pandemic necessitated clinicians to transition to telehealth, often with little preparation or training. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules were developed to upskill physiotherapists in management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the e-learning modules are perceived by physiotherapists as effective when they are part of a comprehensive training program for a clinical trial. However, the effectiveness of the modules on their own in a real-world setting is unknown. Objective: This study aims to evaluate the reach, effectiveness, adoption, and implementation of PEAK e-learning modules. Methods: This longitudinal study was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators, and health care students who registered for access to the modules between April 1 and November 30, 2020. Reach was evaluated by outcomes (countries, referral sources, and attrition) extracted from registration data and embedded within precourse surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with videoconferencing; likelihood of using education, strengthening exercise, and physical activity in a treatment plan for knee OA; usefulness of modules) measured using a 10-point numeric rating scale (NRS; score range from 1=not confident or likely or useful at all to 10=extremely confident or likely or useful) in pre- and postcourse (on completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to the use of learning and usefulness of program elements (measured via a 4-point Likert scale, from not at all useful to extremely useful) in a survey administered 4 months after module completion. Results: Broad reach was achieved, with 6720 people from 97 countries registering for access. Among registrants, there were high levels of attrition, with 36.65\% (2463/6720) commencing the program and precourse survey and 19.61\% (1318/6720) completing all modules and the postcourse survey. The program was effective. Learners who completed the modules demonstrated increased confidence with videoconferencing (mean change 3.1, 95\% CI 3.0-3.3 NRS units) and increased likelihood of using education, strengthening and physical activity in a knee OA treatment plan, compared to precourse. Adoption and implementation of learning (n=149 respondents) occurred at 4 months. More than half of the respondents used their learning to structure in-person consultations with patients (80/142, 56.3\%) and patient information booklets in their clinical practice (75/142, 52.8\%). Conclusions: Findings provide evidence of the reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting among physiotherapists. The e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via videoconferencing. Attrition across the e-learning program highlights the challenges of keeping learners engaged in self-directed web-based learning. ", doi="10.2196/30378", url="https://mededu.jmir.org/2021/4/e30378", url="http://www.ncbi.nlm.nih.gov/pubmed/34587585" } @Article{info:doi/10.2196/29712, author="Ochmann, T. David and Philippi, A. Keito F. and Zeier, Peter and Sandner, Magdalena and Hillen, Barlo and Neuberger, I. Elmo W. and Ruiz de Azua, Inigo and Lieb, Klaus and Wessa, Mich{\`e}le and Lutz, Beat and Simon, Perikles and Brahmer, Alexandra", title="Association of Innate and Acquired Aerobic Capacity With Resilience in Healthy Adults: Protocol for a Randomized Controlled Trial of an 8-Week Web-Based Physical Exercise Intervention", journal="JMIR Res Protoc", year="2021", month="Nov", day="29", volume="10", number="11", pages="e29712", keywords="stress resilience", keywords="eHealth", keywords="aerobic capacity", keywords="peak oxygen uptake", keywords="cortisol", keywords="kynurenic acid", keywords="endocannabinoids", abstract="Background: Physical activity alleviates chronic stress. The latest research suggests a relationship between resilience and physical fitness. Beneficial adaptations of the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, endocannabinoid system, and tryptophan pathway, which are induced by an active lifestyle, are considered to be conducive to resilience. However, detailed knowledge on the molecular link between the effects of acute and chronic physical exercise and improved resilience to stress in humans is missing. Moreover, the relationship between innate and acquired aerobic capacity and resilience is poorly understood. Objective: The aim of this study is to implement a human exercise intervention trial addressing the following main hypotheses: a high innate aerobic capacity is associated with high resilience to stress, and web-based physical exercise training improves aerobic capacity of physically inactive adults, which is accompanied by improved resilience. In this setting, we will analyze the relationship between resilience parameters and innate and acquired aerobic capacity as well as circulating signaling molecules. Methods: A total of 70 healthy, physically inactive (<150 minutes/week of physical activity) adults (aged 18-45 years) will be randomly assigned to an intervention or control group. Participants in the intervention group will receive weekly training using progressive endurance and interval running adapted individually to their remotely supervised home training performance via web-based coach support. A standardized incremental treadmill exercise test will be performed before and after the intervention period of 8 weeks to determine the innate and acquired aerobic capacity (peak oxygen uptake). Before and after the intervention, psychological tests and questionnaires that characterize parameters implicated in resilience will be applied. Blood and saliva will be sampled for the analysis of cortisol, lactate, endocannabinoids, catecholamines, kynurenic acid, and further circulating signal transducers. Statistical analysis will provide comprehensive knowledge on the relationship between aerobic capacity and resilience, as well as the capacity of peripheral factors to mediate the promoting effects of exercise on resilience. Results: The study was registered in October 2019, and enrollment began in September 2019. Of the 161 participants who were initially screened via a telephone survey, 43 (26.7\%) fulfilled the inclusion criteria and were included in the study. Among the 55\% (17/31) of participants in the intervention group and 45\% (14/31) of participants in the control group who completed the study, no serious adverse incidents were reported. Of 43 participants, 4 (9\%) withdrew during the program (for individual reasons) and 8 (19\%) have not yet participated in the program; moreover, further study recruitment was paused for an indeterminate amount of time because of the COVID-19 pandemic. Conclusions: Our study aims to further define the physiological characteristics of human resilience, and it may offer novel approaches for the prevention and therapy of mental disorders via an exercise prescription. International Registered Report Identifier (IRRID): DERR1-10.2196/29712 ", doi="10.2196/29712", url="https://www.researchprotocols.org/2021/11/e29712", url="http://www.ncbi.nlm.nih.gov/pubmed/34847062" } @Article{info:doi/10.2196/33589, author="Cabral, F. Danylo and Hinchman, A. Carrie and Nunez, Christina and Rice, Jordyn and Loewenstein, A. David and Cahalin, P. Lawrence and Rundek, Tatjana and Pascual-Leone, Alvaro and Gomes-Osman, Joyce", title="Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study", journal="JMIR Res Protoc", year="2021", month="Nov", day="23", volume="10", number="11", pages="e33589", keywords="exercise", keywords="neuroplasticity", keywords="cognition", keywords="brain health", keywords="cardiorespiratory fitness", keywords="cardiovascular function", keywords="trophic factors", keywords="telehealth", keywords="aging adult", abstract="Background: Extensive evidence supports a link between aerobic exercise and cognitive improvements in aging adults. A major limitation with existing research is the high variability in cognitive response to exercise. Our incomplete understanding of the mechanisms that influence this variability and the low adherence to exercise are critical knowledge gaps and major barriers for the systematic implementation of exercise for promoting cognitive health in aging. Objective: We aimed to provide an in-person and remotely delivered intervention study protocol with the main goal of informing the knowledge gap on the mechanistic action of exercise on the brain by characterizing important mechanisms of neuroplasticity, cardiorespiratory fitness response, and genetics proposed to underlie cognitive response to exercise. Methods: This is an open-label, 2-month, interventional study protocol in neurologically healthy sedentary adults. This study was delivered fully in-person and in remote options. Participants underwent a total of 30 sessions, including the screening session, 3 pretest (baseline) assessments, 24 moderate-to-vigorous aerobic exercise sessions, and 3 posttest assessments. We recruited participants aged 55 years and above, sedentary, and cognitively healthy. Primary outcomes were neuroplasticity, cognitive function, and cardiorespiratory fitness. Secondary outcomes included genetic factors, endothelium function, functional mobility and postural control, exercise questionnaires, depression, and sleep. We also explored study feasibility, exercise adherence, technology adaptability, and compliance of both in-person and remote protocols. Results: The recruitment phase and data collection of this study have concluded. Results are expected to be published by the end of 2021 or in early 2022. Conclusions: The data generated in these studies will introduce tangible parameters to guide the development of personalized exercise prescription models for maximal cognitive benefit in aging adults. Successful completion of the specific aims will enable researchers to acquire the appropriate expertise to design and conduct studies by testing personalized exercise interventions in person and remotely delivered, likely to be more effective at promoting cognitive health in aging adults. Trial Registration: ClinicalTrials.gov NCT03804528; http://clinicaltrials.gov/ct2/show/NCT03804528 International Registered Report Identifier (IRRID): RR1-10.2196/33589 ", doi="10.2196/33589", url="https://www.researchprotocols.org/2021/11/e33589", url="http://www.ncbi.nlm.nih.gov/pubmed/34817393" } @Article{info:doi/10.2196/26612, author="Lewkowicz, Daniel and Slosarek, Tamara and Wernicke, Sarah and Winne, Antonia and Wohlbrandt, M. Attila and Bottinger, Erwin", title="Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="19", volume="8", number="4", pages="e26612", keywords="digital therapeutic care", keywords="decision support interventions", keywords="low back pain", keywords="behavior change techniques", keywords="back", keywords="orthopedic", keywords="systematic review", keywords="digital therapy", keywords="decision support", keywords="mobile phone", abstract="Background: Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective: This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods: We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results: We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50\%) were RCTs and 6 (50\%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67\% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions: This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants' ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs. ", doi="10.2196/26612", url="https://rehab.jmir.org/2021/4/e26612", url="http://www.ncbi.nlm.nih.gov/pubmed/34807837" } @Article{info:doi/10.2196/33027, author="Strubbia, Carla and Levack, MM William and Grainger, Rebecca and Takahashi, Kayoko and Tomori, Kounosuke", title="Use of an iPad App (Aid for Decision-making in Occupational Choice) for Collaborative Goal Setting in Interprofessional Rehabilitation: Qualitative Descriptive Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="18", volume="8", number="4", pages="e33027", keywords="rehabilitation", keywords="goals", keywords="digital technology", keywords="mobile health", keywords="mobile phone", abstract="Background: Goal setting is a key part of the rehabilitation process. The use of technology and electronic tools such as smartphone apps and websites has been suggested as a way of improving the engagement of users in meaningful goal setting and facilitating shared decision-making between patients and health professionals. Objective: This study aims to describe experiences of health professionals and patients in the use of the English language version of the iPad app Aid for Decision-making in Occupational Choice (ADOC) to facilitate collaborative goal setting in rehabilitation. Methods: We recruited participants from 3 acute and postacute care rehabilitation wards in both public and private organizations in New Zealand. Participants were registered allied health professionals, including physiotherapists, occupational therapists, and speech-language therapists, who engage in goal setting as part of their normal work, and their adult patients. We collected data via semistructured interviews to gather information about the experiences of the participants in the use of ADOC for goal setting. Data were analyzed with thematic analysis. Results: A total of 8 health professionals and 8 patients participated in the study. Six main themes emerged from the data: changing patients' perspective on what is possible, changing health professionals' perspective on what is important, facilitating shared decision-making, lack of guides for users, logistic and organizational barriers, and app-related and technical issues. Conclusions: Health professionals and patients found ADOC to be a valuable tool when setting shared rehabilitation goals. The use of ADOC promoted a patient-centered approach that empowered patients to engage in collaborative goal setting. The technological limitations of the app that negatively impacted experiences can be addressed in the future implementation of ADOC in rehabilitation settings. ", doi="10.2196/33027", url="https://rehab.jmir.org/2021/4/e33027", url="http://www.ncbi.nlm.nih.gov/pubmed/34792475" } @Article{info:doi/10.2196/29799, author="Wilroy, Jereme and Lai, Byron and Currie, Madison and Young, Hui-Ju and Thirumalai, Mohanraj and Mehta, Tapan and Giannone, John and Rimmer, James", title="Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study", journal="JMIR Form Res", year="2021", month="Nov", day="18", volume="5", number="11", pages="e29799", keywords="telehealth", keywords="disability", keywords="COVID-19", keywords="exercise", keywords="assessments", keywords="feasibility", keywords="mHealth", keywords="teleassessment", keywords="mobility impairment", keywords="home exercise", keywords="participation", keywords="physical disabilities", abstract="Background: The Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) initiative is a large randomized controlled study that aims to overcome logistical barriers to exercise via telehealth for people with physical disabilities. However, at the start of the COVID-19 pandemic, enrollment was halted due to limited operations at the testing site, which included no onsite visits that involved participant data collection. In response to the limited operations, a modified data collection protocol was developed for virtual enrollment of study participants. Objective: This paper presents feasibility data on using teleassessments to enroll people with mobility impairment into a home-based exercise trial. Methods: The modified protocol replaced onsite enrollment and data collection visits with teleassessments using a computer tablet and testing equipment that was shipped to the participants' home address prior to the synchronous teleassessments conducted by an exercise physiologist through Zoom. The participants were mailed a teleassessment toolkit that included a digital blood pressure cuff, spirometer, hand dynamometer, mini disc cone, and measuring tape (to complete standardized testing). The teleassessment measures included resting blood pressure and heart rate, forced vital capacity, grip strength, Five Times Sit to Stand, and Timed Up and Go. Feasibility metrics included technological effectiveness, efficiency, and safety. The technological effectiveness of the telehealth assessment was determined by the percentage of sessions completed without technical issues with ?90\% criteria set a priori. Efficiency was measured by a session duration of ?2 hours. Safety was measured by the number of adverse events related to the teleassessments reported. Results: Data from 36 participants were included in this feasibility study, and 34 (94\%) participants completed all teleassessments without technical issues. For efficiency, the teleassessment sessions were completed in a mean time of 65 minutes and a maximum session length of 110 minutes. There were no adverse events reported to indicate concerns with the safety of teleassessments. Conclusions: The modified teleassessment protocol, in response to COVID-19 restrictions, may be a feasible process for enrolling adults with mobility impairment into a home exercise trial who otherwise would have not been able to participate. Trial Registration: ClinicalTrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 ", doi="10.2196/29799", url="https://formative.jmir.org/2021/11/e29799", url="http://www.ncbi.nlm.nih.gov/pubmed/34792477" } @Article{info:doi/10.2196/27087, author="Soulard, Julie and Vaillant, Jacques and Baillet, Athan and Gaudin, Philippe and Vuillerme, Nicolas", title="Gait and Axial Spondyloarthritis: Comparative Gait Analysis Study Using Foot-Worn Inertial Sensors", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="9", volume="9", number="11", pages="e27087", keywords="ankylosing spondylitis", keywords="spondyloarthritis", keywords="gait", keywords="locomotion", keywords="pain", keywords="mobility", keywords="spatiotemporal", keywords="digital health", keywords="sensors", abstract="Background: Axial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice. Objective: This study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate. Methods: A total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms--1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground). Results: Age, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17). Conclusions: Gait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine. Trial Registration: ClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212 International Registered Report Identifier (IRRID): RR2-10.1007/s00296-019-04396-4 ", doi="10.2196/27087", url="https://mhealth.jmir.org/2021/11/e27087", url="http://www.ncbi.nlm.nih.gov/pubmed/34751663" } @Article{info:doi/10.2196/25453, author="Jain, Deeptee and Norman, Kevin and Werner, Zachary and Makovoz, Bar and Baker, Turner and Huber, Stephan", title="Using Postmarket Surveillance to Assess Safety-Related Events in a Digital Rehabilitation App (Kaia App): Observational Study", journal="JMIR Hum Factors", year="2021", month="Nov", day="9", volume="8", number="4", pages="e25453", keywords="lower back pain", keywords="digital therapeutics", keywords="adverse event", keywords="pain", keywords="safety", keywords="digital health", keywords="multidisciplinary pain treatment", abstract="Background: Low back pain (LBP) affects nearly 4 out of 5 individuals during their lifetime and is the leading cause of disability globally. Digital therapeutics are emerging as effective treatment options for individuals experiencing LBP. Despite the growth of evidence demonstrating the benefits of these therapeutics in reducing LBP and improving functional outcomes, little data has been systematically collected on their safety profiles. Objective: This study aims to evaluate the safety profile of a multidisciplinary digital therapeutic for LBP, the Kaia App, by performing a comprehensive assessment of reported adverse events (AEs) by users as captured by a standardized process for postmarket surveillance. Methods: All users of a multidisciplinary digital app that includes physiotherapy, mindfulness techniques, and education for LBP (Kaia App) from 2018 to 2019 were included. Relevant messages sent by users via the app were collected according to a standard operating procedure regulating postmarket surveillance of the device. These messages were then analyzed to determine if they described an adverse event (AE). Messages describing an AE were then categorized based on the type of AE, its seriousness, and its relatedness to the app, and they were described by numerical counts. User demographics, including age and gender, and data on app use were collected and evaluated to determine if they were risk factors for increased AE reporting. Results: Of the 138,337 active users of the Kaia App, 125 (0.09\%) reported at least one AE. Users reported 0.00014 AEs per active day on the app. The most common nonserious AE reported was increased pain. Other nonserious AEs reported included muscle issues, unpleasant sensations, headache, dizziness, and sleep disturbances. One serious AE, a surgery, was reported. Details of the event and its connection to the intervention were not obtainable, as the user did not provide more information when asked to do so; therefore, it was considered to be possibly related to the intervention. There was no relationship between gender and AE reporting (P>.99). Users aged 25 to 34 years had reduced odds (odds ratio [OR] 0.31, 95\% CI 0.08-0.95; P=.03) of reporting AEs, while users aged 55 to 65 years (OR 2.53, 95\% CI 1.36-4.84, P=.002) and ?75 years (OR 4.36, 95\% CI 1.07-13.26; P=.02) had increased odds. AEs were most frequently reported by users who had 0 to 99 active days on the app, and less frequently reported by users with more active days on the app. Conclusions: This study on the Kaia App provides the first comprehensive assessment of reported AEs associated with real-world use of digital therapeutics for lower back pain. The overall rate of reported AEs was very low, but significant reporting bias is likely to be present. The AEs reported were generally consistent with those described for in-person therapies for LBP. ", doi="10.2196/25453", url="https://humanfactors.jmir.org/2021/4/e25453", url="http://www.ncbi.nlm.nih.gov/pubmed/34751664" } @Article{info:doi/10.2196/28634, author="Herkert, Cyrille and Graat-Verboom, Lidwien and Gilsing-Fernhout, Judith and Schols, Manon and Kemps, Clemens Hareld Marijn", title="Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study", journal="JMIR Form Res", year="2021", month="Nov", day="9", volume="5", number="11", pages="e28634", keywords="home-based exercise", keywords="cardiac diseases", keywords="pulmonary diseases", keywords="comorbidities", keywords="elderly", abstract="Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50\% (5/10) were men. Of the 10 participants, 9 (90\%) completed the 8-week program. Median adherence to the exercise prescription was 75\% (IQR 37\%-88\%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86\%, IQR 51\%-100\%, and final 2 weeks: 57\%, IQR 8\%-75\%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44\%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 ", doi="10.2196/28634", url="https://formative.jmir.org/2021/11/e28634", url="http://www.ncbi.nlm.nih.gov/pubmed/34751655" } @Article{info:doi/10.2196/16864, author="Anttila, Marjo-Riitta and Soderlund, Anne and Paajanen, Teemu and Kivist{\"o}, Heikki and Kokko, Katja and Sj{\"o}gren, Tuulikki", title="Biopsychosocial Profiles of Patients With Cardiac Disease in Remote Rehabilitation Processes: Mixed Methods Grounded Theory Approach", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="3", volume="8", number="4", pages="e16864", keywords="coronary disease", keywords="experience", keywords="biopsychosocial model", keywords="digital cardiac rehabilitation", keywords="mixed methods grounded theory", keywords="web-based program", keywords="physical activity", keywords="self-efficacy", keywords="quality of life", abstract="Background: Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): feeling outsider, being uninterested, reflecting benefit, and enthusiastic using. Objective: This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation. Methods: Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a t test, or nonparametric tests---Mann--Whitney and Kruskal--Wallis tests---to compare the 4 e-usage groups---feeling outsider, being uninterested, reflecting benefit, and enthusiastic using---in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory. Results: The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95\% CI 1.0-27.5; P=.03) and lower for physical fitness (MD ?0.72; 95\% CI ?1.4 to ?0.06; P=.03) in the being uninterested group than in the enthusiastic using group. The feeling outsider group had lower physical fitness (MD ?55.8; 95\% CI ?110.7 to ?0.92; P=.047) than the enthusiastic using group. For psychosocial variables, such as the degree of self-determination in exercise (MD ?7.3; 95\% CI ?13.5 to ?1.1; P=.02), the being uninterested group had lower values than the enthusiastic using group. Social variables such as performing guided tasks in the program (P=.03) and communicating via messages (P=.03) were lower in the feeling outsider group than in the enthusiastic using group. The feeling outsider and being uninterested groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the being uninterested group were interested in tracking their physical activity. The reflecting benefit and enthusiastic using groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the enthusiastic using group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as building self-awareness, increasing engagement, maintaining a healthy lifestyle balance, and strengthening self-confidence. Conclusions: The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles. ", doi="10.2196/16864", url="https://rehab.jmir.org/2021/4/e16864", url="http://www.ncbi.nlm.nih.gov/pubmed/34730548" } @Article{info:doi/10.2196/30768, author="Nelligan, K. Rachel and Hinman, S. Rana and McManus, Fiona and Lamb, E. Karen and Bennell, L. Kim", title="Moderators of the Effect of a Self-directed Digitally Delivered Exercise Program for People With Knee Osteoarthritis: Exploratory Analysis of a Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Oct", day="29", volume="23", number="10", pages="e30768", keywords="digital", keywords="text messaging", keywords="exercise", keywords="moderators", keywords="osteoarthritis", keywords="RCT", keywords="clinical trial", keywords="subgroups", keywords="pain", keywords="function", keywords="knee osteoarthritis", keywords="rehabilitation", keywords="digital health", abstract="Background: A 24-week self-directed digitally delivered intervention was found to improve pain and function in people with knee osteoarthritis (OA). However, it is possible that this intervention may be better suited to certain subgroups of people with knee OA compared to others. Objective: The aim of this study was to explore whether certain individual baseline characteristics moderate the effects of a self-directed digitally delivered intervention on changes in pain and function over 24 weeks in people with knee OA. Methods: An exploratory analysis was conducted on data from a randomized controlled trial involving 206 people with a clinical diagnosis of knee OA. This trial compared a self-directed digitally delivered intervention comprising of web-based education, exercise, and physical activity program supported by automated exercise behavior change mobile phone text messages to web-based education alone (control). The primary outcomes were changes in overall knee pain (assessed on an 11-point numerical rating scale) and physical function (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale [WOMAC]) at 24 weeks. Five baseline patient characteristics were selected as the potential moderators: (1) number of comorbidities, (2) number of other painful joints, (3) pain self-efficacy, (4) exercise self-efficacy, and (5) self-perceived importance of exercise. Separate linear regression models for each primary outcome and each potential moderator were fit, including treatment group, moderator, and interaction between treatment group and moderator, adjusting for the outcome at baseline. Results: There was evidence that pain self-efficacy moderated the effect of the intervention on physical function compared to the control at 24 weeks (interaction P=.02). Posthoc assessment of the mean change in WOMAC function by treatment arm showed that each 1-unit increase in baseline pain self-efficacy was associated with a 1.52 (95\% CI 0.27 to 2.78) unit improvement in the control group. In contrast, a reduction of 0.62 (95\% CI --1.93 to 0.68) units was observed in the intervention group with each unit increase in pain self-efficacy. There was only weak evidence that pain self-efficacy moderated the effect of the intervention on pain and that number of comorbidities, number of other painful joints, exercise self-efficacy, or exercise importance moderated the effect of the intervention on pain or function. Conclusions: With the exception of pain self-efficacy, which moderated changes in function but not pain, we found limited evidence that our selected baseline patient characteristics moderated intervention outcomes. This indicates that people with a range of baseline characteristics respond similarly to the unsupervised digitally delivered exercise intervention. As these findings are exploratory in nature, they require confirmation in future studies. ", doi="10.2196/30768", url="https://www.jmir.org/2021/10/e30768", url="http://www.ncbi.nlm.nih.gov/pubmed/34714252" } @Article{info:doi/10.2196/28124, author="Haglo, H{\aa}vard and Wang, Eivind and Berg, Kristian Ole and Hoff, Jan and Helgerud, Jan", title="Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="21", volume="9", number="10", pages="e28124", keywords="VO2max", keywords="maximal oxygen uptake", keywords="mobile app", keywords="cardiovascular health", keywords="quality of life", keywords="endurance training", abstract="Background: Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding. Objective: This study sought to investigate if self-administered 4{\texttimes}4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4{\texttimes}4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL). Methods: Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4{\texttimes}4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85\% to 95\% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period. Results: VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected. Conclusions: High-intensity 4{\texttimes}4-min interval training increased VO2max and HRQoL, contributing to patients' reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population. Trial Registration: ClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528 ", doi="10.2196/28124", url="https://mhealth.jmir.org/2021/10/e28124", url="http://www.ncbi.nlm.nih.gov/pubmed/34673536" } @Article{info:doi/10.2196/31855, author="Giggins, M. Oonagh and Doyle, Julie and Smith, Suzanne and Moran, Orla and Gavin, Shane and Sojan, Nisanth and Boyle, Gordon", title="Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="7", volume="10", number="10", pages="e31855", keywords="cardiac rehabilitation", keywords="exercise", keywords="cardiovascular disease", keywords="virtual rehabilitation", keywords="digital health", keywords="self-management", keywords="pilot study", keywords="platform", keywords="feasibility", abstract="Background: Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. Objective: The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering -- Cardiac Rehabilitation (ECME-CR) platform. Methods: A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. Results: Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. Conclusions: This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. International Registered Report Identifier (IRRID): PRR1-10.2196/31855 ", doi="10.2196/31855", url="https://www.researchprotocols.org/2021/10/e31855", url="http://www.ncbi.nlm.nih.gov/pubmed/34617908" } @Article{info:doi/10.2196/32085, author="McLaren, Ruth and Smith, F. Paul and Lord, Sue and Kaur, Kamal Preet and Zheng, Yiwen and Taylor, Denise", title="Noisy Galvanic Vestibular Stimulation Combined With a Multisensory Balance Program?in Older Adults With Moderate to High Fall Risk: Protocol for a Feasibility Study for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="5", volume="10", number="10", pages="e32085", keywords="older adult", keywords="balance", keywords="rehabilitation", keywords="noisy galvanic vestibular stimulation", keywords="nGVS", keywords="brain stimulation", abstract="Background: Reduced mobility and falls are common among older adults. Balance retraining programs are effective in reducing falls and in improving balance and mobility. Noisy galvanic vestibular stimulation is a low-level electrical stimulation used to reduce the threshold for the firing of vestibular neurons via a mechanism of stochastic resonance. Objective: This study aims to determine the feasibility of using noisy galvanic vestibular stimulation to augment a balance training program for older adults at risk of falls. We hypothesize that noisy galvanic vestibular stimulation will enhance the effects of balance retraining in older adults at risk of falls Methods: In this 3-armed randomized controlled trial, community dwelling older adults at risk of falling will be randomly assigned to a noisy galvanic vestibular stimulation plus balance program (noisy galvanic vestibular stimulation group), sham plus balance program (sham group), or a no treatment group (control). Participants will attend the exercise group twice a week for 8 weeks with assessment of balance and gait pretreatment, posttreatment, and at 3 months postintervention. Primary outcome measures include postural sway, measured by center of pressure velocity, area and root mean square, and gait parameters such as speed, step width, step variability, and double support time. Spatial memory will also be measured using the triangle completion task and the 4 Mountains Test. Results: Recruitment began in November 2020. Data collection and analysis are expected to be completed by December 2022. Conclusions: This study will evaluate the feasibility of using noisy galvanic vestibular stimulation alongside balance retraining in older adults at risk of falls and will inform the design of a fully powered randomized controlled trial. Trial Registration: New Zealand Clinical Trials Registry (ACTRN12620001172998); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379944 International Registered Report Identifier (IRRID): DERR1-10.2196/32085 ", doi="10.2196/32085", url="https://www.researchprotocols.org/2021/10/e32085", url="http://www.ncbi.nlm.nih.gov/pubmed/34609323" } @Article{info:doi/10.2196/30725, author="Itoh, Hidetaka and Amiya, Eisuke and Narita, Koichi and Shimbo, Mai and Taya, Masanobu and Komuro, Issei and Hasegawa, Takashi and Makita, Shigeru and Kimura, Yutaka", title="Efficacy and Safety of Remote Cardiac Rehabilitation in the Recovery Phase of Cardiovascular Diseases: Protocol for a Multicenter, Nonrandomized, Single-Arm, Interventional Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="4", volume="10", number="10", pages="e30725", keywords="cardiac rehabilitation", keywords="remote system", keywords="e-learning", keywords="exercise capacity", keywords="rehabilitation", keywords="cardiovascular disease", keywords="monitoring system", keywords="disease prevention", keywords="cardiology", abstract="Background: Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. Objective: This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. Methods: Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. Results: The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. Conclusions: The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. Trial Registration: University Hospital Medical Information Network---Clinical Trials Registry UMIN--CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000048983 International Registered Report Identifier (IRRID): DERR1-10.2196/30725 ", doi="10.2196/30725", url="https://www.researchprotocols.org/2021/10/e30725", url="http://www.ncbi.nlm.nih.gov/pubmed/34407925" } @Article{info:doi/10.2196/27535, author="Anan, Tomomi and Kajiki, Shigeyuki and Oka, Hiroyuki and Fujii, Tomoko and Kawamata, Kayo and Mori, Koji and Matsudaira, Ko", title="Effects of an Artificial Intelligence--Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Sep", day="24", volume="9", number="9", pages="e27535", keywords="neck pain", keywords="shoulder pain", keywords="shoulder stiffness", keywords="low back pain", keywords="musculoskeletal symptoms", keywords="digital intervention", keywords="mobile app", keywords="mHealth", keywords="eHealth", keywords="digital health", keywords="mobile phone", abstract="Background: Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. Objective: This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)--assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants' adherence to exercises. Methods: We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone's chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). Results: We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92\% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95\% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75\%) out of 48 participants in the intervention group and 3 (7\%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95\% CI 11.25-164.28; P<.001). Conclusions: This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. Trial Registration: University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000038307. ", doi="10.2196/27535", url="https://mhealth.jmir.org/2021/9/e27535", url="http://www.ncbi.nlm.nih.gov/pubmed/34559054" } @Article{info:doi/10.2196/22818, author="Smith-Turchyn, Jenna and Adams, C. Scott and Sabiston, M. Catherine", title="Testing of a Self-administered 6-Minute Walk Test Using Technology: Usability, Reliability and Validity Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Sep", day="23", volume="8", number="3", pages="e22818", keywords="exercise", keywords="physical activity", keywords="usability testing", keywords="applications", keywords="mobile phone", abstract="Background: The need to attend a medically supervised hospital- or clinic-based appointment is a well-recognized barrier to exercise participation. The development of reliable and accurate home-based functional tests has the potential to decrease the burden on the health care system while enabling support, information, and assessment. Objective: This study aims to explore the usability (ie, acceptability, satisfaction, accuracy, and practicality) of the EasyMeasure app to self-administer the 6-minute walk test (6MWT) in young, healthy adults and determine parallel form reliability and construct validity of conducting a self-administered 6MWT using technology. Methods: We used a usability study design. English-speaking, undergraduate university students who had access to an iPhone or iPad device running iOS 10 or later and self-reported ability to walk for 6 minutes were recruited for this study. Consenting participants were randomized to either a standard 6MWT group (ie, supervised without the use of the app) or a technology 6MWT group (ie, unsupervised with the app to mimic independent implementation of the test). All participants performed a maximal treadmill test. Participants in the 6MWT group completed the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire and a satisfaction questionnaire after completing the assessment. Parallel form reliability of the 6MWT using technology was analyzed by comparing participant self-administered scores and assessor scores using Pearson correlation coefficients across and between trials. Construct validity was assessed by comparing participant 6MWT scores (both standard and using technology) with maximum treadmill test variables (peak oxygen uptake and ventilatory threshold [VT]). Results: In total, 20 university students consented to participate in the study. All but 2 participants (8/10, 80\%) in the technology 6MWT group had deviations that prevented them from accurately conducting the 6MWT using the app, and none of the participants were able to successfully score the 6MWT. However, a significantly strong correlation was found (r=.834; P=.003) when comparing participants' scores for the 6MWT using technology with the assessors' scores. No significant correlations were found between maximal treadmill test peak oxygen uptake scores and 6MWT prediction equations using standard 6MWT scores (equation 1: r=0.119; P=.78; equation 2: r=0.095; P=.82; equation 3: r=0.119; P=.78); however, standard 6MWT scores were significantly correlated with VT values (r=0.810; P=.02). The calculated submaximal treadmill scores and assessor 6MWT scores using technology also demonstrated a significant correlation (r=0.661; P=.04). Conclusions: This study demonstrated significant usability concerns regarding the accuracy of a self-administered 6MWT using the EasyMeasure app. However, the strong and significant correlation between the 6MWT and VT values demonstrates the potential of the 6MWT to measure functional capacity for community-based exercise screening and patient monitoring. ", doi="10.2196/22818", url="https://rehab.jmir.org/2021/3/e22818", url="http://www.ncbi.nlm.nih.gov/pubmed/34554105" } @Article{info:doi/10.2196/27602, author="Chamorro-Moriana, Gema and Sevillano, Luis Jose and Perez-Cabezas, V.", title="Versatile GCH Control Software for Correction of Loads Applied to Forearm Crutches During Gait Recovery Through Technological Feedback: Development and Implementation Study", journal="J Med Internet Res", year="2021", month="Sep", day="22", volume="23", number="9", pages="e27602", keywords="control and monitoring software", keywords="feedback technology", keywords="motor control", keywords="gait", keywords="crutches", keywords="assisted gait for partial weight-bearing", keywords="functional recovery of the gait", keywords="unloading of lower limb musculoskeletal injury", keywords="rehabilitation", keywords="physical therapy", keywords="lower limb", keywords="injury", keywords="injuries", abstract="Background: Measuring weight bearing is an essential aspect of clinical care for lower limb injuries such as sprains or meniscopathy surgeries. This care often involves the use of forearm crutches for partial loads progressing to full loads. Therefore, feasible methods of load monitoring for daily clinical use are needed. Objective: The main objective of this study was to design an innovative multifunctional desktop load-measuring software that complements GCH System 2.0--instrumented forearm crutches and monitors the applied loads, displaying real-time graphical and numerical information, and enabling the correction of inaccuracies through feedback technology during assisted gait. The secondary objective was to perform a preliminary implementation trial. Methods: The software was designed for indoor use (clinics/laboratories). This software translates the crutch sensor signal in millivolts into force units, records and analyzes data (10-80 Hz), and provides real-time effective curves of the loads exerted on crutches. It covers numerous types of extrinsic feedback, including visual, acoustic (verbal/beeps), concurrent, terminal, and descriptive feedback, and includes a clinical and research use database. An observational descriptive pilot study was performed with 10 healthy subjects experienced in bilateral assisted gait. The Wilcoxon matched-pairs signed-rank test was used to evaluate the load accuracy evolution of each subject (ie, changes in the loads exerted on crutches for each support) among various walks, which was interpreted at the 95\% confidence level. Results: GCH Control Software was developed as a multifunctional desktop tool complementing GCH System 2.0--instrumented forearm crutches. The pilot implementation of the feedback mechanism observed 96/100 load errors at baseline (walk 0, no feedback) with 7/10 subjects exhibiting crutch overloading. Errors ranged from 61.09\% to 203.98\%, demonstrating heterogeneity. The double-bar feedback found 54/100 errors in walk 1, 28/100 in walk 2, and 14/100 in walk 3. The first walk with double-bar feedback (walk 1) began with errors similar to the baseline walk, generally followed by attempts at correction. The Wilcoxon matched-pairs signed-rank test used to evaluate each subject's progress showed that all participants steadily improved the accuracy of the loads applied to the crutches. In particular, Subject 9 required extra feedback with two single-bar walks to focus on the total load. The participants also corrected the load balance between crutches and fluency errors. Three subjects made one error of load balance and one subject made six fluctuation errors during the three double-bar walks. The latter subject performed additional feedback with two balance-bar walks to focus on the load balance. Conclusions: GCH Control Software proved to be useful for monitoring the loads exerted on forearm crutches, providing a variety of feedback for correcting load accuracy, load balance between crutches, and fluency. The findings of the complementary implementation were satisfactory, although clinical trials with larger samples are needed to assess the efficacy of the different feedback mechanisms and to select the best alternatives in each case. ", doi="10.2196/27602", url="https://www.jmir.org/2021/9/e27602", url="http://www.ncbi.nlm.nih.gov/pubmed/34550073" } @Article{info:doi/10.2196/21906, author="Tuttle, Katherine and Kelemen, Arpad and Liang, Yulan", title="Use of Smartphone Apps for Improving Physical Function Capacity in Cardiac Patient Rehabilitation: Systematic Review", journal="JMIRx Med", year="2021", month="Sep", day="17", volume="2", number="3", pages="e21906", keywords="cardiac rehabilitation", keywords="physical capacity", keywords="exercise", keywords="smartphone apps", abstract="Background: Cardiac rehabilitation (CR) is an evidence-based approach for preventing secondary cardiac events. Smartphone apps are starting to be used in CR to give patients real-time feedback on their health, connect them remotely with their medical team, and allow them to perform their rehabilitation at home. The use of smartphone apps is becoming omnipresent and has real potential in impacting patients in need of CR. Objective: This paper provides critical examinations and summaries of existing research studies with an in-depth analysis of not only the individual studies but also the larger patterns that have emerged with smartphone apps in CR as well as their significance for practice change. Methods: A systematic review was conducted through broad database searches that focused on evaluating randomized controlled trials, in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) expectations. A total of 43 articles were evaluated, and 6 were chosen for this review. The dates of the articles ranged from 2014-2020, and the studies focused on the population of cardiac outpatients who needed CR after suffering a cardiac event, with interventions using a smartphone that incorporated the CR standards of the American Heart Association. The outcomes measured were directed at focusing on improved exercise function capacity, valued at a significance level of P<.05, for improved 6-minute walk test (6MWT) and peak oxygen uptake (PVO2) results. Results: In the evaluated articles, the results were inconsistent for significant positive effects of CR smartphone apps on cardiac patients' physical function capacity in terms of the 6MWT and PVO2 when using a smartphone app to aid in CR. Conclusions: Because evidence in the literature suggests nonhomogeneous results for successful use of smartphone apps in CR, it is crucial to investigate the potential reasons for this inconsistency. An important observation from this systematic review is that smartphone apps used in CR have better clinical outcomes related to physical function capacity if the app automatically records information or provides real-time feedback to participants about their progress, compared to apps that only educate and encourage use while requiring the participant to manually log their CR activities. Additional factors to consider during these studies include the starting health of the patients, the sample sizes, and the specific components of CR that the smartphone apps are using. Overall, more clinical trials are needed that implement smartphone apps with these factors in mind, while placing stronger emphasis on using biosensing capabilities that can automatically log results and send them to providers on a real-time dashboard. ", doi="10.2196/21906", url="https://med.jmirx.org/2021/3/e21906", url="http://www.ncbi.nlm.nih.gov/pubmed/37725554" } @Article{info:doi/10.2196/26982, author="Meinke, Anita and Peters, Rick and Knols, Ruud and Karlen, Walter and Swanenburg, Jaap", title="Exergaming Using Postural Feedback From Wearable Sensors and Exercise Therapy to Improve Postural Balance in People With Nonspecific Low Back Pain: Protocol for a Factorial Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Aug", day="26", volume="10", number="8", pages="e26982", keywords="low back pain", keywords="exercise therapy", keywords="postural balance", keywords="postural feedback", keywords="motor control", keywords="fear of movement", keywords="exergame", keywords="randomized controlled trial", keywords="physical activity", keywords="smartphone", keywords="sensors", keywords="activity tracker", keywords="mobile phone", abstract="Background: Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP. Objective: This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP. Methods: The study was an assessor-blinded 2{\texttimes}2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet. Results: The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check. Conclusions: Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/26982 ", doi="10.2196/26982", url="https://www.researchprotocols.org/2021/8/e26982", url="http://www.ncbi.nlm.nih.gov/pubmed/34435954" } @Article{info:doi/10.2196/24665, author="Lapierre, Nolwenn and Um Din, Nathavy and Igout, Manuella and Chevrier, Jo{\"e}l and Belmin, Jo{\"e}l", title="Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="26", volume="10", number="8", pages="e24665", keywords="older adult", keywords="fall", keywords="fear of falling", keywords="exergame", keywords="randomized controlled trial", keywords="psychomotor therapy", keywords="rehabilitation", keywords="fear", keywords="risk", keywords="elderly", keywords="protocol", keywords="therapy", abstract="Background: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results: The protocol (2019-11-22) has been approved by the Comit{\'e} de Protection des Personnes Nord-Ouest I--Universit{\'e} de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID): DERR1-10.2196/24665 ", doi="10.2196/24665", url="https://www.researchprotocols.org/2021/8/e24665", url="http://www.ncbi.nlm.nih.gov/pubmed/34435968" } @Article{info:doi/10.2196/24015, author="Kraaijkamp, M. Jules J. and van Dam van Isselt, F. El{\'e}onore and Persoon, Anke and Versluis, Anke and Chavannes, H. Niels and Achterberg, P. Wilco", title="eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability", journal="J Med Internet Res", year="2021", month="Aug", day="19", volume="23", number="8", pages="e24015", keywords="geriatric rehabilitation", keywords="eHealth", keywords="mHealth", keywords="digital health", keywords="effectiveness", keywords="feasibility", keywords="usability", keywords="systematic review", abstract="Background: eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. Objective: The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. Methods: We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ?70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. Results: In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38\%) found eHealth was at least as effective as non-eHealth interventions (56\% of the 27 studies with a control group), 11 studies (41\%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4\%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94\%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18\%). Of 40 studies, 4 (10\%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. Conclusions: eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation. ", doi="10.2196/24015", url="https://www.jmir.org/2021/8/e24015", url="http://www.ncbi.nlm.nih.gov/pubmed/34420918" } @Article{info:doi/10.2196/30239, author="Motz, Victoria and Faust, Alison and Dahmus, Jessica and Stern, Benjamin and Soriano, Christopher and Stine, G. Jonathan", title="Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study", journal="JMIR Form Res", year="2021", month="Aug", day="17", volume="5", number="8", pages="e30239", keywords="physical activity", keywords="fatty liver", keywords="telemedicine", keywords="liver", keywords="nonalcoholic fatty liver disease", keywords="liver disease", keywords="fatty liver disease", keywords="aerobic training", keywords="telehealth", keywords="fitness", keywords="feasibility", keywords="steatohepatitis", abstract="Background: Most patients with nonalcoholic fatty liver disease (NAFLD) are physically inactive despite the well-known benefits of physical activity. Telehealth offers promise as a novel way to deliver an exercise training program and increase physical activity. However, the feasibility, safety, and efficacy of telehealth-based exercise programs is unknown in patients with NAFLD. Objective: The aim of this study was to determine the feasibility of a directly supervised exercise training program delivered exclusively with telehealth to patients with nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD. Methods: In response to COVID-19 research restrictions, we adapted an existing clinical trial and delivered 20 weeks of moderate-intensity aerobic training 5 days a week under real-time direct supervision using an audio--visual telehealth platform. Aerobic training was completed by walking outdoors or using a home treadmill. Fitness activity trackers with heart rate monitors ensured exercise was completed at the prescribed intensity with real-time feedback from an exercise physiologist. Results: Three female patients with biopsy-proven NASH were enrolled with a mean age of 52 (SD 14) years. The mean body mass index was 31.9 (SD 5.1) kg/m2. All patients had metabolic syndrome. All patients completed over 80\% of exercise sessions (mean 84\% [SD 3\%]) and no adverse events occurred. Body weight (mean --5.1\% [SD 3.7\%]), body fat (mean --4.4\% [SD 2.3\%]), and waist circumference (mean --1.3 in. [SD 1.6 in.]) all improved with exercise. The mean relative reduction in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was 35.1\% (SD 8.8\%). Mean reductions in hemoglobin A1c and Homeostatic Model Assessment for Insulin Resistance were also observed (--0.5\% [SD 0.2\%] and --4.0 [SD 1.2], respectively). The mean peak oxygen consumption (VO2peak) improved by 9.9 (SD 6.6) mL/kg/min. Conclusions: This proof-of-concept study found that supervised exercise training delivered via telehealth is feasible and safe in patients with NASH. Telehealth-based exercise training also appears to be highly efficacious in patients with NASH, but this will need to be confirmed by future large-scale trials. Trial Registration: ClinicalTrials.gov NCT03518294; https://clinicaltrials.gov/ct2/show/NCT03518294 ", doi="10.2196/30239", url="https://formative.jmir.org/2021/8/e30239", url="http://www.ncbi.nlm.nih.gov/pubmed/34402795" } @Article{info:doi/10.2196/28400, author="Kwan, Cho Rick Yiu and Liu, Wa Justina Yat and Fong, Kuen Kenneth Nai and Qin, Jing and Leung, Kwok-Yuen Philip and Sin, Kan Olive Suk and Hon, Yuen Pik and Suen, W. Lydia and Tse, Man-Kei and Lai, KY Claudia", title="Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial", journal="JMIR Serious Games", year="2021", month="Aug", day="6", volume="9", number="3", pages="e28400", keywords="virtual reality", keywords="motor-cognitive training", keywords="cognitive frailty", keywords="game", keywords="feasibility", keywords="VR", keywords="training", keywords="older adults", keywords="frail", keywords="pilot study", keywords="randomized controlled trial", abstract="Background: Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments. Objective: We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty. Methods: A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ?60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed. Results: Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=--2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=--1.19, P=.24). The reduction in physical frailty in the intervention group (Z=--1.73, P=.08) was similar to that in the control group (Z=--1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=--0.16, P=.11) and greater in the control group (Z=--2.52, P=.01). The recruitment rate was acceptable (17/33, 52\%). Both groups had a 100\% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11\%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25\%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group. Conclusions: This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty. Trial Registration: ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216 ", doi="10.2196/28400", url="https://games.jmir.org/2021/3/e28400", url="http://www.ncbi.nlm.nih.gov/pubmed/34383662" } @Article{info:doi/10.2196/26235, author="Pettersson, Beatrice and Janols, Rebecka and Wiklund, Maria and Lundin-Olsson, Lillemor and Sandlund, Marlene", title="Older Adults' Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory", journal="J Med Internet Res", year="2021", month="Jul", day="30", volume="23", number="7", pages="e26235", keywords="accidental falls", keywords="aged", keywords="exercise", keywords="qualitative research", keywords="eHealth", keywords="self-management", keywords="fall prevention", keywords="behavior change", keywords="self-determination theory", keywords="classification of motivation and behavior change techniques", abstract="Background: Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory. Objective: This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users. Methods: The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers,smartphones, and tablets, and was fully self-managed. Results: In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants' competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program. Conclusions: In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants' experiences, a proposed addition to the classification system used as an analytical matrix has been presented. Trial Registration: ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849 ", doi="10.2196/26235", url="https://www.jmir.org/2021/7/e26235", url="http://www.ncbi.nlm.nih.gov/pubmed/34328438" } @Article{info:doi/10.2196/26658, author="Biebl, Theresia Johanna and Rykala, Marzena and Strobel, Maximilian and Kaur Bollinger, Pawandeep and Ulm, Bernhard and Kraft, Eduard and Huber, Stephan and Lorenz, Andreas", title="App-Based Feedback for Rehabilitation Exercise Correction in Patients With Knee or Hip Osteoarthritis: Prospective Cohort Study", journal="J Med Internet Res", year="2021", month="Jul", day="13", volume="23", number="7", pages="e26658", keywords="mHealth", keywords="digital health", keywords="digital rehabilitation", keywords="machine learning", keywords="smartphone", keywords="osteoarthritis", keywords="exercise therapy", abstract="Background: The use of digital therapeutic solutions for rehabilitation of conditions such as osteoarthritis provides scalable access to rehabilitation. Few validated technological solutions exist to ensure supervision of users while they exercise at home. Motion Coach (Kaia Health GmbH) provides audiovisual feedback on exercise execution in real time on conventional smartphones. Objective: We hypothesized that the interrater agreement between physiotherapists and Motion Coach would be noninferior to physiotherapists' interrater agreement for exercise evaluations in a cohort with osteoarthritis. Methods: Patients diagnosed with osteoarthritis of the knee or hip were recruited at a university hospital to perform a set of 6 exercises. Agreement between Motion Coach and 2 physiotherapists' corrections for segments of the exercises were compared using Cohen $\kappa$ and percent agreement. Results: Participants (n=24) were enrolled and evaluated. There were no significant differences between interrater agreements (Motion Coach app vs physiotherapists: percent agreement 0.828; physiotherapist 1 vs physiotherapist 2: percent agreement 0.833; P<.001). Age (70 years or under, older than 70 years), gender (male, female), or BMI (30 kg/m2 or under, greater than 30 kg/m2) subgroup analysis revealed no detectable difference in interrater agreement. There was no detectable difference in levels of interrater agreement between Motion Coach vs physiotherapists and between physiotherapists in any of the 6 exercises. Conclusions: The results demonstrated that Motion Coach is noninferior to physiotherapist evaluations. Interrater agreement did not differ between 2 physiotherapists or between physiotherapists and the Motion Coach app. This finding was valid for all investigated exercises and subgroups. These results confirm the ability of Motion Coach to detect user form during exercise and provide valid feedback to users with musculoskeletal disorders. ", doi="10.2196/26658", url="https://www.jmir.org/2021/7/e26658", url="http://www.ncbi.nlm.nih.gov/pubmed/34255677" } @Article{info:doi/10.2196/18130, author="Ding, Y. Eric and Erskine, Nathaniel and Stut, Wim and McManus, D. David and Peterson, Amy and Wang, Ziyue and Escobar Valle, Jorge and Albuquerque, Daniella and Alonso, Alvaro and Botkin, F. Naomi and Pack, R. Quinn", title="MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study", journal="JMIR Hum Factors", year="2021", month="Jul", day="8", volume="8", number="3", pages="e18130", keywords="cardiac rehabilitation", keywords="telerehabilitation", keywords="health watch", keywords="mHealth", keywords="exercise", abstract="Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch--informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33\%) were women, and 6 (33\%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86\% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch--based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. ", doi="10.2196/18130", url="https://humanfactors.jmir.org/2021/3/e18130", url="http://www.ncbi.nlm.nih.gov/pubmed/34255660" } @Article{info:doi/10.2196/27064, author="Gagnon, Marianne and Marino Merlo, Gabriela and Yap, Rita and Collins, Jessica and Elfassy, Caroline and Sawatzky, Bonita and Marsh, Jacquelyn and Hamdy, Reggie and Veilleux, Louis-Nicolas and Dahan-Oliel, No{\'e}mi", title="Using Telerehabilitation to Deliver a Home Exercise Program to Youth With Arthrogryposis: Single Cohort Pilot Study", journal="J Med Internet Res", year="2021", month="Jul", day="6", volume="23", number="7", pages="e27064", keywords="telerehabilitation", keywords="teleassessment", keywords="arthrogryposis multiplex congenita", keywords="physical therapy", keywords="occupational therapy", abstract="Background: Arthrogryposis multiplex congenita (AMC) is characterized by joint contractures and muscle weakness, which limit daily activities. Youths with AMC require frequent physical therapeutic follow-ups to limit the recurrence of contractures and maintain range of motion (ROM) and muscle strength; however, access to specialized care may be limited because of geographical distance. Telerehabilitation can offer a potential solution for delivering frequent follow-ups for youth with AMC, but research on the use of telerehabilitation in children with musculoskeletal disorders is scarce. Objective: The study aims to evaluate the feasibility of delivering a home exercise program (HEP) by using telerehabilitation for youth with AMC. We also aim to explore the effectiveness of the HEP as a secondary aim. Methods: Youths aged between 8 and 21 years with AMC were recruited at the Shriners Hospitals for Children--Canada. The participants completed baseline and post-HEP questionnaires (the Physical Activity Questionnaire for Adolescents, Pediatrics Outcomes Data Collection Instrument, and Adolescent and Pediatric Pain Tool), and clinicians assessed their active ROM using a virtual goniometer. Clinicians used the Goal Attainment Scale with the participants to identify individualized goals to develop a 12-week HEP and assess the achievement of these goals. Follow-ups were conducted every 3 weeks to adjust the HEP. Data on withdrawal rates and compliance to the HEP and follow-ups were collected to assess the feasibility of this approach. The interrater reliability of using a virtual goniometer was assessed using the intraclass correlation coefficient and associated 95\% CI. Nonparametric tests were used to evaluate feasibility and explore the effectiveness of the HEP. Results: Of the 11 youths who were recruited, 7 (median age: 16.9 years) completed the HEP. Of the 47 appointments scheduled, 5 had to be rescheduled in ?24 hours. The participants performed their HEP 2.04 times per week (95\% CI 1.25-4.08) and reported good satisfaction with the approach. A general intraclass correlation coefficient of 0.985 (95\% CI 0.980-0.989) was found for the web-based ROM measurement. Individualized goals were related to pain management; endurance in writing, standing, or walking; sports; and daily activities. In total, 12 of the 15 goals set with the participants were achieved. Statistically significant improvements were observed in the pain and comfort domain of the Pediatrics Outcomes Data Collection Instrument (preintervention: median 71; 95\% CI 34-100; postintervention: median 85; 95\% CI 49-100; P=.08) and Physical Activity Questionnaire for Adolescents (preintervention: median 1.62; 95\% CI 1.00-2.82; postintervention: median 2.32; 95\% CI 1.00-3.45; P=.046). Conclusions: The remote delivery of an HEP for youth with AMC is feasible. Promising results were found for the effectiveness of the HEP in helping youths with AMC to achieve their goals. The next step will be to assess the effectiveness of this exercise intervention in a randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.2196/18688 ", doi="10.2196/27064", url="https://www.jmir.org/2021/7/e27064", url="http://www.ncbi.nlm.nih.gov/pubmed/34255680" } @Article{info:doi/10.2196/20299, author="Hakala, Sanna and Kivist{\"o}, Heikki and Paajanen, Teemu and Kankainen, Annaliisa and Anttila, Marjo-Riitta and Heinonen, Ari and Sj{\"o}gren, Tuulikki", title="Effectiveness of Distance Technology in Promoting Physical Activity in Cardiovascular Disease Rehabilitation: Cluster Randomized Controlled Trial, A Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Jun", day="18", volume="8", number="2", pages="e20299", keywords="cardiac rehabilitation", keywords="rehabilitation", keywords="cardiovascular diseases", keywords="technology", keywords="exercise", keywords="randomized controlled trial", keywords="clinical trial", abstract="Background: Physical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied. Objective: The aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology--based treatment in 12 months of cardiac rehabilitation. Methods: The cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire. Results: During the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95\% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95\% CI --90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95\% CI --585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD --87.9 minutes per week, 95\% CI --379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95\% CI --75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95\% CI --2099.6 to 3833.9; P=.55). Conclusions: The use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods. Trial Registration: ISRCTN Registry ISRCTN61225589; https://doi.org/10.1186/ISRCTN61225589 ", doi="10.2196/20299", url="https://rehab.jmir.org/2021/2/e20299", url="http://www.ncbi.nlm.nih.gov/pubmed/34142970" } @Article{info:doi/10.2196/25569, author="Lambert, Genevieve and Alos, Nathalie and Bernier, Pascal and Laverdi{\`e}re, Caroline and Kairy, Dahlia and Drummond, Kenneth and Dahan-Oliel, No{\'e}mi and Lemay, Martin and Veilleux, Louis-Nicolas", title="Home-Based Telehealth Exercise Intervention in Early-On Survivors of Childhood Acute Lymphoblastic Leukemia: Feasibility Study", journal="JMIR Cancer", year="2021", month="Jun", day="16", volume="7", number="2", pages="e25569", keywords="exercise therapy", keywords="rehabilitation", keywords="acute lymphoblastic leukemia", keywords="intervention study", keywords="telehealth", keywords="mobile phone", abstract="Background: Acute lymphoblastic leukemia is the most common type of pediatric cancer. Acute lymphoblastic leukemia causes an altered bone mineral homeostasis state, which can contribute to osteopenia, and bone fractures, most commonly vertebral fractures. With the increasing number of childhood cancer survivors, late adverse effects such as musculoskeletal comorbidities are often reported and are further influenced by inactive lifestyle habits. Physical activity has been shown to increase the mechanical workload of the bone, mitigating bone impairment in other cancer-specific populations. Objective: This interventional pilot study aims to investigate the use of telehealth to deliver a home-based exercise intervention for early-on survivors of bone marrow--related hematological malignancies and to assess its impact on survivors' musculoskeletal and functional health. Methods: We aimed to recruit a group of 12 early-on survivors of acute lymphoblastic leukemia, within 6 months to 5 years of treatment, to participate in and complete the proposed telehealth intervention with a parent. The 16-week intervention included 40 potential home-based physical activity interventions supervised by a kinesiologist through a telehealth internet platform, with monthly progression. Patients were recruited to the cohort if they were able to participate in the intervention during the first month (minimum 12 weeks of intervention). Evaluation before and after the intervention protocol highlighted differences in functional capacities and musculoskeletal health of patients using mechanography, peripheral quantitative computed tomography, 6-minute walk test, and grip force test. Results: The recruitment rate for the intervention was low (12/57, 21\% of contacted patients). Of 12 patients, 3 were excluded (1=relapse, 1=failure to meet technical requirements, and 1=abandoned). The 9 patients who completed the intervention (6 girls; mean age 10.93, SD 2.83 years; mean BMI 21.58, SD 6.55 kg/m2; mean time since treatment completion 36.67, SD 16.37 months) had a mean adherence of 89\% and a completion rate of 75\%. In addition, these patients showed functional improvements in lower limb muscle force and power as well as in the 6-minute walk test distance. Participants also showed improved bone health after the intervention on the following parameters: bone mineral content, stress-strain index, total and cortical cross-sectional area at the 14\% site (P=.03, P=.01, P=.01, and P=.001, respectively) and 38\% site of the tibia (P=.003, P=.04, P=.001, and P=.003, respectively). Conclusions: High adherence and participation rates suggest that telehealth is a feasible method to deliver exercise interventions to young early-on survivors of acute lymphoblastic leukemia. The proposed intervention seems promising in providing benefits to patients' functional performance and bone health, but a large-scale study is needed to confirm this assumption. ", doi="10.2196/25569", url="https://cancer.jmir.org/2021/2/e25569", url="http://www.ncbi.nlm.nih.gov/pubmed/34132645" } @Article{info:doi/10.2196/21728, author="Houchen-Wolloff, Linzy and Orme, Mark and Barradell, Amy and Clinch, Lisa and Chaplin, Emma and Gardiner, Nikki and Singh, J. Sally", title="Web-Based Self-management Program (SPACE for COPD) for Individuals Hospitalized With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Nonrandomized Feasibility Trial of Acceptability", journal="JMIR Mhealth Uhealth", year="2021", month="Jun", day="11", volume="9", number="6", pages="e21728", keywords="COPD", keywords="telehealth", keywords="digital health", keywords="internet", keywords="rehabilitation", keywords="quantitative", keywords="qualitative", keywords="exercise", abstract="Background: Hospital admissions due to the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are costly for individuals and health services. Pulmonary rehabilitation (PR) is known to reduce hospital readmissions when delivered after hospitalization, but the uptake and completion of PR following hospitalization remains poor (<10\% of those eligible in the UK audit data). A web-based platform of the SPACE (Self-management Program of Activity Coping and Education) for COPD (chronic obstructive pulmonary disease) has previously shown promising results in patients with stable COPD but has not been tested following an AECOPD. Objective: This study aims to assess the feasibility and acceptability of a web-based self-management program. Methods: A nonrandomized feasibility study for patients with confirmed AECOPD who were deemed web literate was conducted. All patients consented during their hospitalization and received access to the website following discharge in addition to usual care. The program aims to facilitate patients to better understand and manage their condition through education and home-based exercises. Participants were asked to complete the Bristol COPD Knowledge Questionnaire at baseline and after 6 months. A total of 14 participants were also interviewed (n=8 completers; n=6 noncompleters) regarding their experiences with the web-based program and trial. The interviews were analyzed using thematic analysis. Results: In total, 2080 patients were screened for eligibility, of which 100 patients (age: mean 71.2 years, SD 9.3 years; male: 55/100, 55\%; forced expiratory volume in 1 second/forced vital capacity ratio: mean 0.46, SD 0.14; pack-years: mean 50.2, SD 31.0; current smokers: 35/100, 35\%) were recruited (4.8\% of those screened). The main reason for ineligibility was a lack of web literacy (1366/1980, 68.98\%). In total, 18\% (18/100) of patients had completed the web program by 6 months, with others still registered in the program (27/100, 27\%), and more than half did not register (55/100, 55\%). There was a mean change in Bristol COPD Knowledge Questionnaire scores at 6 months of 7.8 (SD 10.2) points. Qualitative interviews identified three main themes: preparing for, engagement with, and benefits of the study and program. A total of 57\% (57/100) accepted a referral to PR on discharge and 19\% (19/100) had completed the program after 6 months. Conclusions: On the basis of the challenges of recruiting, retaining, and engaging participants in a web-based self-management program, it is not a feasible approach to roll out widely. This study acknowledges that this is a challenging time for patients with an AECOPD to engage in exercise and self-management education. However, for patients who were able to engage in such an intervention, the completion rate of PR was double the previous audit estimates from the United Kingdom, disease knowledge improved, and the intervention was of value to patients. Trial Registration: ISRCTN Registry 13081008; https://www.isrctn.com/ISRCTN13081008 ", doi="10.2196/21728", url="https://mhealth.jmir.org/2021/6/e21728", url="http://www.ncbi.nlm.nih.gov/pubmed/34114960" } @Article{info:doi/10.2196/24276, author="Ochoa, Christa and Cole, Maria and Froehlich-Grobe, Katherine", title="Feasibility of an Internet-Based Intervention to Promote Exercise for People With Spinal Cord Injury: Observational Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Jun", day="9", volume="8", number="2", pages="e24276", keywords="spinal cord injury", keywords="lifestyle intervention", keywords="physical activity", keywords="health promotion", keywords="eHealth", abstract="Background: People with spinal cord injury (SCI) are less likely to be physically active and have higher chronic disease risk than those in the general population due to physical and metabolic changes that occur postinjury. Few studies have investigated approaches to promote increased physical activity (PA) for people with SCI despite evidence that they face unique barriers, including lack of accessible transportation and exercise equipment. To address these obstacles, we adapted an evidence-based phone-delivered intervention that promoted increased PA among people with SCI into a web-based platform, titled the Workout on Wheels internet intervention (WOWii). The adapted program provides participants with weekly skill-building information and activities, basic exercise equipment, and ongoing support through weekly group videoconferencing. Objective: This pilot study was conducted to assess the feasibility of using a web-based and virtual format to deliver the WOWii program in a randomized controlled trial. Methods: We assessed the feasibility of the web-based program by delivering an abbreviated, 4-week version to 10 participants with SCI. Rates of weekly videoconference attendance, activity completion, and exercise activity as tracked by an arm-based activity monitor were recorded for all participants. Results: Participants averaged 3.3 of 4 (83\%) weekly group videoconferences attended, 3.4 of 4 (85\%) web-based module activities completed, and 2.3 of 4 (58\%) weeks of using the arm-based activity monitor. The majority of the sample (9/10, 90\%) synced their arm-based PA monitor at least once, and overall engagement as an average of each component across the 4 weeks was 75\%. Conclusions: The intervention had sufficiently high levels of engagement to be used in a full randomized controlled trial to test its effectiveness in improving levels of PA among people with SCI. The knowledge we gained from this pilot study informed improvements that were made in the full randomized controlled trial. ", doi="10.2196/24276", url="https://rehab.jmir.org/2021/2/e24276", url="http://www.ncbi.nlm.nih.gov/pubmed/34106086" } @Article{info:doi/10.2196/24076, author="Stork, Jordan Matthew and Bell, Gordon Ethan and Jung, Elizabeth Mary", title="Examining the Impact of a Mobile Health App on Functional Movement and Physical Fitness: Pilot Pragmatic Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="May", day="28", volume="9", number="5", pages="e24076", keywords="mHealth", keywords="functional movement", keywords="flexibility", keywords="strength", keywords="cardiovascular fitness", abstract="Background: Numerous mobile apps available for download are geared toward health and fitness; however, limited research has evaluated the real-world effectiveness of such apps. The movr app is a mobile health app designed to enhance physical functioning by prescribing functional movement training based on individualized movement assessments. The influence of the movr app on functional movement and physical fitness (flexibility, strength, and cardiovascular fitness) has not yet been established empirically. Objective: This study aims to examine the real-world impact of the movr app on functional movement, flexibility, strength, and cardiovascular fitness. Methods: A total of 48 healthy adults (24 women and 24 men; mean age 24, SD 5 years) completed an 8-week pilot pragmatic randomized controlled trial in which they were randomly assigned to either 8-week use of the movr app (n=24) or 8-week waitlist control (n=24). Measures of functional movement (Functional Movement Screen [FMS]), strength (push-ups, handgrip strength, and countermovement jump), flexibility (shoulder flexibility, sit and reach, active straight leg raise [ASLR], and half-kneeling dorsiflexion), and cardiovascular fitness (maximal oxygen uptake []) were collected at baseline and the 8-week follow-up. Results: Repeated measures analyses of variance revealed significant group-by-time interactions for the 100-point FMS (P<.001), shoulder flexibility (P=.01), ASLR (P=.001), half-kneeling dorsiflexion (P<.001), and push-up tests (P=.03). Pairwise comparisons showed that FMS scores increased from pre- to postintervention for those in the movr group (P<.001) and significantly decreased for those in the control group (P=.04). For shoulder flexibility, ASLR, half-kneeling dorsiflexion, and push-up tests, improvements from pre- to postintervention were found in the movr group (all values of P<.05) but not in the control group (all values of P>.05). There were no changes in the sit and reach or handgrip strength test scores for either group (all values of P>.05). A significant main effect of time was found for the countermovement jump (P=.02), such that scores decreased from pre- to postintervention in the control group (P=.02) but not in the movr group (P=.38). Finally, a significant group-by-time interaction was found for (P=.001), revealing that scores decreased pre- to postintervention in the control group (P<.001), but not in the movr group (P=.54). Conclusions: The findings revealed that movr improved indices of functional movement (FMS), flexibility (shoulder, ASLR, and dorsiflexion), and muscular endurance (push-ups) over an 8-week period compared with the control group while maintaining handgrip strength, lower body power (countermovement jump), and cardiovascular fitness (). Thus, this study provides initial evidence of the effectiveness of the movr app for enhancing functional movement and physical fitness among healthy adults. Trial Registration: ClinicalTrials.gov NCT04865666; https://clinicaltrials.gov/ct2/show/NCT04865666 ", doi="10.2196/24076", url="https://mhealth.jmir.org/2021/5/e24076", url="http://www.ncbi.nlm.nih.gov/pubmed/34047704" } @Article{info:doi/10.2196/28210, author="Lai, Byron and Powell, Maegen and Clement, Grace Anne and Davis, Drew and Swanson-Kimani, Erin and Hayes, Leslie", title="Examining the Feasibility of Early Mobilization With Virtual Reality Gaming Using Head-Mounted Display and Adaptive Software With Adolescents in the Pediatric Intensive Care Unit: Case Report", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="27", volume="8", number="2", pages="e28210", keywords="physical activity", keywords="active video gaming", keywords="exergaming", keywords="early mobility", keywords="rehabilitation", abstract="Background: Early rehabilitative mobilization for adolescents is safe and feasible. However, there is a lack of published rehabilitation strategies and treatments that can maximize engagement and outcomes among adolescents in the pediatric intensive care unit (PICU). Virtual reality (VR) gaming using a head-mounted display (HMD) and adaptive software can allow active and nonactive gameplay at the bedside for people with limited arm mobility, making it a potentially inclusive and enjoyable treatment modality for adolescents in the PICU. Objective: The purpose of this brief case study is to report on the preliminary feasibility of incorporating adaptive VR gaming using an HMD with 2 adolescents who received early mobility treatment within the PICU. Methods: This study was a mini-ethnographic investigation of 2 adolescents (a 15-year-old male and a 13-year old male) in the PICU who underwent VR gaming sessions as part of their early mobilization care, using an Oculus Rift HMD and adaptive software (WalkinVR) that promoted full gameplay in bed. The Rift was plugged into a gaming laptop that was set up on a table within the patient's room before each session. The intervention was delivered by an adapted exercise professional and supervised by a physical therapist. Patients had access to a variety of active games (eg, boxing, rhythmic movement to music, and exploratory adventure) and nonactive games (eg, racing and narrative adventure). Gaming sessions were scheduled between usual care, when tolerable and requested by the participant. The interventionist and therapists took audio-recorded and written notes after completing each gaming session. These data were analyzed and presented in a narrative format from the perspective of the research team. Results: Case 1 participated in 4 gaming sessions, with an average of 18 minutes (SD 11) per session. Case 2 participated in 2 sessions, with an average of 35 minutes (SD 7) per session. Both cases were capable of performing active gaming at a moderate level of exercise intensity, as indicated by their heart rate. However, their health and symptoms fluctuated on a daily basis, which prompted the gameplay of adventure or nonactive games. Gameplay appeared to improve participants' affect and alertness and motivate them to be more engaged in early mobilization therapy. Gameplay without the WalkinVR software caused several usability issues. There were no serious adverse events, but both cases experienced symptoms based on their condition. Conclusions: The findings of this study suggest that VR gaming with HMDs and adaptive software is likely a feasible supplement to usual care for adolescents within the PICU, and these findings warrant further investigation. Recommendations for future studies aimed at incorporating VR gaming during early mobilization are presented herein. ", doi="10.2196/28210", url="https://rehab.jmir.org/2021/2/e28210", url="http://www.ncbi.nlm.nih.gov/pubmed/34042602" } @Article{info:doi/10.2196/25556, author="Gao, Yang and Zhong, D. Linda L. and Quach, Binh and Davies, Bruce and Ash, I. Garrett and Lin, Zhi-Xiu and Feng, Yibin and Lau, M. Benson W. and Wagner, D. Peter and Yang, Xian and Guo, Yike and Jia, Wei and Bian, Zhaoxiang and Baker, S. Julien", title="COVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study", journal="JMIR Res Protoc", year="2021", month="May", day="26", volume="10", number="5", pages="e25556", keywords="COVID-19", keywords="rehabilitation", keywords="cardiorespiratory exercise", keywords="Chinese medicine", abstract="Background: Recent studies have revealed that many discharged patients with COVID-19 experience ongoing symptoms months later. Rehabilitation interventions can help address the consequences of COVID-19, including medical, physical, cognitive, and psychological problems. To our knowledge, no studies have investigated the effects of rehabilitation following discharge from hospital for patients with COVID-19. Objective: The specific aims of this project are to investigate the effects of a 12-week exercise program on pulmonary fibrosis in patients recovering from COVID-19. A further aim will be to examine how Chinese herbal medicines as well as the gut microbiome and its metabolites regulate immune function and possibly autoimmune deficiency in the rehabilitation process. Methods: In this triple-blinded, randomized, parallel-group, controlled clinical trial, we will recruit adult patients with COVID-19 who have been discharged from hospital in Hong Kong and are experiencing impaired lung function and pulmonary function. A total of 172 eligible patients will be randomized into four equal groups: (1) cardiorespiratory exercise plus Chinese herbal medicines group, (2) cardiorespiratory exercise only group, (3) Chinese herbal medicines only group, and (4) waiting list group (in which participants will receive Chinese herbal medicines after 24 weeks). These treatments will be administered for 12 weeks, with a 12-week follow-up period. Primary outcomes include dyspnea, fatigue, lung function, pulmonary function, blood oxygen levels, immune function, blood coagulation, and related blood biochemistry. Measurements will be recorded prior to initiating the above treatments and repeated at the 13th and 25th weeks of the study. The primary analysis is aimed at comparing the outcomes between groups throughout the study period with an $\alpha$ level of .05 (two-tailed). Results: The trial has been approved by the university ethics committee following the Declaration of Helsinki (approval number: REC/19-20/0504) in 2020. The trial has been recruiting patients. The data collection will be completed in 24 months, from January 1, 2021, to December 31, 2022. Conclusions: Given that COVID-19 and its sequelae would persist in human populations, important findings from this study would provide valuable insights into the mechanisms and processes of COVID-19 rehabilitation. Trial Registration: ClinicalTrials.gov NCT04572360; https://clinicaltrials.gov/ct2/show/NCT04572360 International Registered Report Identifier (IRRID): PRR1-10.2196/25556 ", doi="10.2196/25556", url="https://www.researchprotocols.org/2021/5/e25556", url="http://www.ncbi.nlm.nih.gov/pubmed/33970864" } @Article{info:doi/10.2196/28221, author="Sun, Ting and Xu, Yang and Xie, Hui and Ma, Zuchang and Wang, Yu", title="Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers: Pretest--Posttest Study", journal="J Med Internet Res", year="2021", month="May", day="24", volume="23", number="5", pages="e28221", keywords="exercise prescription", keywords="cardiovascular function", keywords="body composition", keywords="bone mineral density", keywords="physical fitness", abstract="Background: A scientific, personalized, and quantitative exercise prescription that has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease is highly recommended. However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (eg, prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalized prescription is thus worth exploring. Objective: The aim of this study was to investigate whether a year-long cloud platform--based and intelligent personalized exercise prescription intervention could improve Chinese middle-aged and older adult community dwellers' health outcomes. Methods: A total of 177 participants (aged 52-85 years; mean 67.93, SD 7.05) were recruited from 2 Chinese community health service centers in Anhui Province, China. The exercise intervention was delivered over 12 months with a single-group pretest--posttest design. After being assessed in terms of physical activity, health-related lifestyle, history of chronic diseases and drug use, family history of disease and cardiovascular function, body composition, bone mineral density, and physical fitness through an eHealth promotion system, participants with relative contraindications for exercise were personally prescribed the health care exercise mode by an intelligent system, while those without relative contraindication and who had a regular exercise habit were prescribed the scientific fitness mode. Paired t tests were used for the analysis. Results: A total of 97 participants were classified into the health care mode, and the remaining 80 participants were assigned to the scientific fitness mode. Significant changes in heart rate (mean difference [MD] 2.97; 95\% CI 1.1-4.84; P=.002), subendocardial viability ratio (MD --0.13; CI: --1.19 to --0.63; P<.001), weight (MD 0.99; CI 0.29-1.69; P=.006), BMI (MD 0.38; CI 0.11-0.64; P=.006), body fat rate (MD 0.88; CI 0.24-1.51; P=.007), fat mass (MD 0.92; CI 0.33-1.53; P=.003), and brachial-ankle pulse wave velocity (MD: --0.72; CI --1.17 to --0.27; P=.002) were observed among participants with the health care mode exercise prescriptions at the 12-month postintervention versus the baseline assessment, while no changes in systolic blood pressure, diastolic blood pressure, muscle mass, bone mineral density, t value, z value, balance, or ability were discerned. The results showed a functional decline in the physical fitness of both groups, including in handgrip strength (healthcare mode: MD 4.41; scientific fitness mode: MD 3.11), vital capacity (healthcare mode: MD 261.99; scientific fitness mode: MD 250.78), and agility (healthcare mode MD=--0.35; scientific fitness mode: MD=--0.39) with all P values <.001, except handgrip strength in the scientific fitness mode (P=.002). There were no significant differences in other parameters among participants with scientific fitness mode exercise prescriptions. Conclusions: The observations suggest that our exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings. ", doi="10.2196/28221", url="https://www.jmir.org/2021/5/e28221", url="http://www.ncbi.nlm.nih.gov/pubmed/34028359" } @Article{info:doi/10.2196/21924, author="Hendrickx, Roel and van der Avoird, Tim and Pilot, Peter and Kerkhoffs, Gino and Schotanus, Martijn", title="Exergaming as a Functional Test Battery in Patients Who Received Arthroscopic Ankle Arthrodesis: Cross-sectional Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="5", volume="8", number="2", pages="e21924", keywords="arthroscopic ankle arthrodesis", keywords="exergaming", keywords="functional test battery", keywords="exergames", keywords="serious games", keywords="ankle", keywords="function", keywords="game", keywords="exercise", keywords="physical activity", keywords="rehabilitation", keywords="gait", keywords="quality of care", abstract="Background: Recently, movement-based videogames (exergames) have gained popularity in improving the rehabilitation process after surgery. During exergaming, participants are physically challenged as the game component stimulates adherence to the training program. There is no literature on the effect of exergame training interventions in patients who received arthroscopic ankle arthrodesis. Objective: This pilot study assessed the potency of an existing exergaming tool for the rehabilitation program of patients who received arthroscopic ankle arthrodesis. Methods: A cross-sectional pilot study was performed, in which patients who received arthroscopic ankle arthrodesis (n=8) were subjected to an exergaming protocol. Gait analysis was performed with a treadmill system. A healthy age-matched control group (n=10) was used as the control group. Results: The patient group was capable of performing exergaming exercises and they showed no floor or ceiling effect. Only in case of the overall stability, the patient group performed significantly less better than the control group (P=.03). Gait analysis showed equal step length with increased external rotation of the affected limb. Conclusions: Exergaming seems to be a valuable tool for measuring the ability of patients who received AAA to perform activities of daily living and it has the potential to individualize rehabilitation programs. When exergaming is systematically integrated with patient-reported outcome measures and activity tracking, it has the potential to improve the quality of care. ", doi="10.2196/21924", url="https://rehab.jmir.org/2021/2/e21924", url="http://www.ncbi.nlm.nih.gov/pubmed/33949311" } @Article{info:doi/10.2196/27640, author="Chau, Hing Pui and Kwok, Jojo Yan Yan and Chan, Maggie Mee Kie and Kwan, Daniel Ka Yu and Wong, Lun Kam and Tang, Ho Ying and Chau, Peter Kan Lung and Lau, Matthew Sheung Wa and Yiu, Yannex Yan Yan and Kwong, Fanny Mei Yan and Lai, Thomas Wai Ting and Leung, Kit Mun", title="Feasibility, Acceptability, and Efficacy of Virtual Reality Training for Older Adults and People With Disabilities: Single-Arm Pre-Post Study", journal="J Med Internet Res", year="2021", month="May", day="4", volume="23", number="5", pages="e27640", keywords="virtual reality", keywords="rehabilitation", keywords="older adults, people with disabilities", keywords="evaluation", abstract="Background: Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design. Objective: This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities. Methods: A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games. Results: A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9\%) completed at least one follow-up. Additionally, 76.3\% (103/135) of the participants could attend at least 70\% of the proposed 18 sessions, and 72.5\% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4\% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort. Conclusions: A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients. ", doi="10.2196/27640", url="https://www.jmir.org/2021/5/e27640", url="http://www.ncbi.nlm.nih.gov/pubmed/33944795" } @Article{info:doi/10.2196/25872, author="Jones, E. Sarah and Campbell, K. Penny and Kimp, J. Alexander and Bennell, Kim and Foster, E. Nadine and Russell, Trevor and Hinman, S. Rana", title="Evaluation of a Novel e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis via Telehealth: Qualitative Study Nested in the PEAK (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis) Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Apr", day="30", volume="23", number="4", pages="e25872", keywords="osteoarthritis", keywords="knee", keywords="physiotherapy", keywords="exercise", keywords="e-learning", keywords="qualitative", keywords="telehealth", keywords="pain", keywords="education", abstract="Background: The delivery of physiotherapy via telehealth could provide more equitable access to services for patients. Videoconference-based telehealth has been shown to be an effective and acceptable mode of service delivery for exercise-based interventions for chronic knee pain; however, specific training in telehealth is required for physiotherapists to effectively and consistently deliver care using telehealth. The development and evaluation of training programs to upskill health care professionals in the management of osteoarthritis (OA) has also been identified as an important priority to improve OA care delivery. Objective: This study aims to explore physiotherapists' experiences with and perceptions of an e-learning program about best practice knee OA management (focused on a structured program of education, exercise, and physical activity) that includes telehealth delivery via videoconferencing. Methods: We conducted a qualitative study using individual semistructured telephone interviews, nested within the Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis randomized controlled trial, referred to as the PEAK trial. A total of 15 Australian physiotherapists from metropolitan and regional private practices were interviewed following the completion of an e-learning program. The PEAK trial e-learning program involved self-directed learning modules, a mock video consultation with a researcher (simulated patient), and 4 audited practice video consultations with pilot patients with chronic knee pain. Interviews were audio recorded and transcribed verbatim. Data were thematically analyzed. Results: A total of five themes (with associated subthemes) were identified: the experience of self-directed e-learning (physiotherapists were more familiar with in-person learning; however, they valued the comprehensive, self-paced web-based modules. Unwieldy technological features could be frustrating); practice makes perfect (physiotherapists benefited from the mock consultation with the researcher and practice sessions with pilot patients alongside individualized performance feedback, resulting in confidence and preparedness to implement new skills); the telehealth journey (although inexperienced with telehealth before training, physiotherapists were confident and able to deliver remote care following training; however, they still experienced some technological challenges); the whole package (the combination of self-directed learning modules, mock consultation, and practice consultations with pilot patients was felt to be an effective learning approach, and patient information booklets supported the training package); and impact on broader clinical practice (training consolidated and refined existing OA management skills and enabled a switch to telehealth when the COVID-19 pandemic affected in-person clinical care). Conclusions: Findings provide evidence for the perceived effectiveness and acceptability of an e-learning program to train physiotherapists (in the context of a clinical trial) on best practice knee OA management, including telehealth delivery via videoconferencing. The implementation of e-learning programs to upskill physiotherapists in telehealth appears to be warranted, given the increasing adoption of telehealth service models for the delivery of clinical care. ", doi="10.2196/25872", url="https://www.jmir.org/2021/4/e25872", url="http://www.ncbi.nlm.nih.gov/pubmed/33929326" } @Article{info:doi/10.2196/27826, author="Litrownik, Daniel and Gilliam, A. Elizabeth and Wayne, M. Peter and Richardson, R. Caroline and Kadri, Reema and Rist, M. Pamela and Moy, L. Marilyn and Yeh, Y. Gloria", title="Development of a Novel Intervention (Mindful Steps) to Promote Long-Term Walking Behavior in Chronic Cardiopulmonary Disease: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Apr", day="29", volume="10", number="4", pages="e27826", keywords="mind--body exercise", keywords="internet-mediated intervention", keywords="behavior change", keywords="physical activity", keywords="COPD", keywords="heart failure", abstract="Background: Despite current rehabilitation programs, long-term engagement in physical activity remains a significant challenge for patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). Novel strategies to promote physical activity in these populations are greatly needed. Emerging literature on the benefits of both mind--body interventions and web-based interventions provide the rationale for the development of the Mindful Steps intervention for increasing walking behavior. Objective: This study aims to develop a novel multimodal mind--body exercise intervention through adaptation of an existing web-based physical activity intervention and incorporation of mind--body exercise, and to pilot test the delivery of the new intervention, Mindful Steps, in a randomized controlled feasibility trial in older adults with COPD and/or HF. Methods: In phase 1, guided by a theoretical conceptual model and review of the literature on facilitators and barriers of physical activity in COPD and HF, we convened an expert panel of researchers, mind--body practitioners, and clinicians to inform development of the novel, multimodal intervention. In phase 2, we are conducting a pilot randomized controlled feasibility trial of the Mindful Steps intervention that includes in-person mind--body exercise classes, an educational website, online mind--body videos, and a pedometer with step-count feedback and goals to increase walking behavior in patients with COPD and/or HF. Outcomes include feasibility measures as well as patient-centered measures. Results: The study is currently ongoing. Phase 1 intervention development was completed in March 2019, and phase 2 data collection began in April 2019. Conclusions: Through the integration of components from a web-based physical activity intervention and mind--body exercise, we created a novel, multimodal program to impact long-term physical activity engagement for individuals with COPD and HF. This developmental work and pilot study will provide valuable information needed to design a future clinical trial assessing efficacy of this multimodal approach. Trial Registration: ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/ct2/show/NCT03003780 International Registered Report Identifier (IRRID): DERR1-10.2196/27826 ", doi="10.2196/27826", url="https://www.researchprotocols.org/2021/4/e27826", url="http://www.ncbi.nlm.nih.gov/pubmed/33913819" } @Article{info:doi/10.2196/25717, author="Bientzle, Martina and Restle, Anne and Kimmerle, Joachim", title="Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="21", volume="9", number="4", pages="e25717", keywords="smartphone use", keywords="phubbing", keywords="physiotherapy", keywords="smartphone", keywords="therapy", keywords="patients", keywords="therapists", keywords="therapeutic", keywords="treatment", abstract="Background: Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any purpose. This also applies to patients and therapists in treatment situations. Objective: The aim of this study was to investigate how purposeful smartphone use compared with recreational smartphone use (by a physiotherapist or by a patient) influenced the perception of a physiotherapeutic treatment situation. We examined the impact of smartphone use during a physiotherapy session on the perception of the physiotherapist, evaluation of attentiveness, and evaluation of smartphone use in physiotherapy in general. Methods: Members of various music and sports clubs were invited to participate in an online randomized controlled trial. Participants were randomly assigned to one of four conditions. They watched a video in which a physiotherapeutic treatment was shown and in which a smartphone was used or not used in the following four different ways: (1) therapeutically purposeful use, (2) recreational use by the physiotherapist (looking at the phone from time to time with no therapeutic purpose), (3) recreational use by the patient, and (4) no smartphone use (control condition). After watching the video, the participants indicated their perception of the physiotherapist's professional competence, social competence, and empathetic behavior. They also rated the physiotherapist's and patient's attentiveness and evaluated the usage of smartphones generally in physiotherapy. Results: The analysis included 118 participants (63 women and 55 men). When the physiotherapist used the smartphone in a purposeful way, the physiotherapist was perceived as more professionally competent (P=.007), socially competent (P=.03), and empathetic (P=.04) than if the physiotherapist used it with no therapeutic purpose. These effects occurred because recreational smartphone use by the physiotherapist was evaluated more negatively than the behavior in the control condition (professional competence: P=.001; social competence: P=.03; empathy: P=.04). Moreover, when the physiotherapist used the smartphone in a recreational way, the physiotherapist was perceived as being less attentive (P<.001). Likewise, when the patient used the smartphone in a recreational way, the patient was perceived as being less attentive (P<.001). Finally, smartphone use in physiotherapy was rated as more positive in general when the smartphone was used in a purposeful way compared with the conditions in which the physiotherapist or patient looked at the smartphone with no therapeutic purpose (P<.001). This positive evaluation occurred because purposeful use led to a more positive rating than no smartphone use (P<.001, R=0.42). Conclusions: Smartphones are only appropriate for therapists and patients if they are used directly for a therapeutic purpose. Otherwise, it is better not to use smartphones during treatment. Trial Registration: AsPredicted (aspredicted.org) \#24740; https://aspredicted.org/blind.php?x=vv532i ", doi="10.2196/25717", url="https://mhealth.jmir.org/2021/4/e25717", url="http://www.ncbi.nlm.nih.gov/pubmed/33881402" } @Article{info:doi/10.2196/20468, author="Park, G. Linda and Elnaggar, Abdelaziz and Lee, J. Sei and Merek, Stephanie and Hoffmann, J. Thomas and Von Oppenfeld, Julia and Ignacio, Nerissa and Whooley, A. Mary", title="Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Apr", day="16", volume="5", number="4", pages="e20468", keywords="physical activity", keywords="cardiac rehabilitation", keywords="digital health", keywords="mobile app", keywords="wearable device", keywords="mHealth", abstract="Background: Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective: The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23\% (14/60) were female; retention rate was 85\% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions: This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. Trial Registration: ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313 ", doi="10.2196/20468", url="https://formative.jmir.org/2021/4/e20468", url="http://www.ncbi.nlm.nih.gov/pubmed/33861204" } @Article{info:doi/10.2196/23882, author="Gulick, Victoria and Graves, Daniel and Ames, Shannon and Krishnamani, Parimala Pavitra", title="Effect of a Virtual Reality--Enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Apr", day="15", volume="23", number="4", pages="e23882", keywords="virtual reality", keywords="VR", keywords="cardiac rehabilitation", keywords="patient experience", keywords="patient education", keywords="outpatient therapy", keywords="exercise", abstract="Background: Cardiac rehabilitation (CR) is clinically proven to reduce morbidity and mortality; however, many eligible patients do not enroll in treatment. Furthermore, many enrolled patients do not complete their full course of treatment. This is greatly influenced by socioeconomic factors but is also because of patients' lack of understanding of the importance of their care and a lack of motivation to maintain attendance. Objective: This study aims to explore the potential benefits of virtual reality (VR) walking trails within CR treatment, specifically with regard to patient knowledge retention, satisfaction with treatment, and the overall attendance of treatment sessions. Methods: New CR patients were enrolled and randomized on a rolling basis to either the control group or intervention group. Intervention patients completed their time on the treadmill with VR walking trails, which included audio-recorded education, whereas control patients completed the standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing 6-minute walk test improvement. In addition, secondary outcomes of patients' cardiac knowledge and satisfaction were assessed via a computer-based questionnaire; patient adherence to the recommended number of sessions was also monitored. Cardiac knowledge assessment included a prerehabilitation education quiz, and the same quiz was repeated at patients' final visit and again at the 2-month follow-up. The satisfaction questionnaire was completed at the final visit. Results: Between January 2018 and May 2019, 72 patients were enrolled---41 in the intervention group and 31 in the control group. On the basis of the results of the prerehabilitation and postrehabilitation 6-minute walk test, no significant differences were observed between the intervention and control groups (P=.64). No statistical differences were observed between groups in terms of education (P=.86) or satisfaction (P=.32) at any time point. The control group had statistically more favorable rates of attendance, as determined by the risk group comparison (P=.02) and the comparison of the rates for completing the minimum number of sessions (P=.046), but no correlation was observed between the study group and reasons for ending treatment. Conclusions: Although no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, the qualitative information suggests that patients may have indeed enjoyed their experience with VR, even though quantitative satisfaction data did not capture this. Further considerations for how and when VR should be applied to CR are suggested in this paper. Trial Registration: ClinicalTrials.gov NCT03945201; https://clinicaltrials.gov/ct2/show/NCT03945201 ", doi="10.2196/23882", url="https://www.jmir.org/2021/4/e23882", url="http://www.ncbi.nlm.nih.gov/pubmed/33856355" } @Article{info:doi/10.2196/27336, author="Vanegas, Erik and Salazar, Yolocuauhtli and Igual, Ra{\'u}l and Plaza, Inmaculada", title="Force-Sensitive Mat for Vertical Jump Measurement to Assess Lower Limb Strength: Validity and Reliability Study", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="9", volume="9", number="4", pages="e27336", keywords="vertical jump", keywords="mHealth", keywords="mobile health", keywords="force-sensitive resistor", keywords="lower limb strength", keywords="leg strength", abstract="Background: Vertical jump height is widely used in health care and sports fields to assess muscle strength and power from lower limb muscle groups. Different approaches have been proposed for vertical jump height measurement. Some commonly used approaches need no sensor at all; however, these methods tend to overestimate the height reached by the subjects. There are also novel systems using different kind of sensors like force-sensitive resistors, capacitive sensors, and inertial measurement units, among others, to achieve more accurate measurements. Objective: The objective of this study is twofold. The first objective is to validate the functioning of a developed low-cost system able to measure vertical jump height. The second objective is to assess the effects on obtained measurements when the sampling frequency of the system is modified. Methods: The system developed in this study consists of a matrix of force-sensitive resistor sensors embedded in a mat with electronics that allow a full scan of the mat. This mat detects pressure exerted on it. The system calculates the jump height by using the flight-time formula, and the result is sent through Bluetooth to any mobile device or PC. Two different experiments were performed. In the first experiment, a total of 38 volunteers participated with the objective of validating the performance of the system against a high-speed camera used as reference (120 fps). In the second experiment, a total of 15 volunteers participated. Raw data were obtained in order to assess the effects of different sampling frequencies on the performance of the system with the same reference device. Different sampling frequencies were obtained by performing offline downsampling of the raw data. In both experiments, countermovement jump and countermovement jump with arm swing techniques were performed. Results: In the first experiment an overall mean relative error (MRE) of 1.98\% and a mean absolute error of 0.38 cm were obtained. Bland-Altman and correlation analyses were performed, obtaining a coefficient of determination equal to R2=.996. In the second experiment, sampling frequencies of 200 Hz, 100 Hz, and 66.6 Hz show similar performance with MRE below 3\%. Slower sampling frequencies show an exponential increase in MRE. On both experiments, when dividing jump trials in different heights reached, a decrease in MRE with higher height trials suggests that the precision of the proposed system increases as height reached increases. Conclusions: In the first experiment, we concluded that results between the proposed system and the reference are systematically the same. In the second experiment, the relevance of a sufficiently high sampling frequency is emphasized, especially for jump trials whose height is below 10 cm. For trials with heights above 30 cm, MRE decreases in general for all sampling frequencies, suggesting that at higher heights reached, the impact of high sampling frequencies is lesser. ", doi="10.2196/27336", url="https://mhealth.jmir.org/2021/4/e27336", url="http://www.ncbi.nlm.nih.gov/pubmed/33835040" } @Article{info:doi/10.2196/23822, author="Demers, Marika and Fung, Karen and Subramanian, K. Sandeep and Lemay, Martin and Robert, T. Maxime", title="Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review", journal="JMIR Serious Games", year="2021", month="Apr", day="7", volume="9", number="2", pages="e23822", keywords="virtual rehabilitation", keywords="upper limb", keywords="brain damage", keywords="feedback", keywords="active video games", keywords="learning", abstract="Background: Increasing evidence supports the use of virtual reality systems to improve upper limb motor functions in individuals with cerebral palsy. While virtual reality offers the possibility to include key components to promote motor learning, it remains unclear if and how motor learning principles are incorporated into the development of rehabilitation interventions using virtual reality. Objective: The objective of this study was to determine the extent to which motor learning principles are integrated into virtual reality interventions targeting upper limb function in individuals with cerebral palsy. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was performed in 10 databases using a combination of keywords related to cerebral palsy, virtual reality, video games, and rehabilitation. Studies were divided into 2 categories: commercial video game platforms and devices and custom virtual reality systems. Study quality was assessed using the modified Downs and Black checklist. Results: The initial search yielded 1497 publications. A total of 26 studies from 30 publications were included, with most studies classified as ``fair'' according to the modified Downs and Black checklist. The majority of studies provided enhanced feedback and variable practice and used functionally relevant and motivating virtual tasks. The dosage varied greatly (total training time ranged from 300 to 3360 minutes), with only 6 studies reporting the number of movement repetitions per session. The difficulty progression and the assessment of skills retention and transfer were poorly incorporated, especially for the commercial video games. Conclusions: Motor learning principles should be better integrated into the development of future virtual reality systems for optimal upper limb motor recovery in individuals with cerebral palsy. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020151982; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020151982 ", doi="10.2196/23822", url="https://games.jmir.org/2021/2/e23822", url="http://www.ncbi.nlm.nih.gov/pubmed/33825690" } @Article{info:doi/10.2196/21105, author="Kappattanavar, Mallikarjuna Arpita and Steckhan, Nico and Sachs, Philipp Jan and Freitas da Cruz, Harry and B{\"o}ttinger, Erwin and Arnrich, Bert", title="Monitoring of Sitting Postures With Sensor Networks in Controlled and Free-living Environments: Systematic Review", journal="JMIR Biomed Eng", year="2021", month="Mar", day="1", volume="6", number="1", pages="e21105", keywords="classification", keywords="algorithms", keywords="sitting position", keywords="spine", keywords="technology", keywords="machine learning", keywords="back pain", keywords="movement", keywords="extremities", abstract="Background: A majority of employees in the industrial world spend most of their working time in a seated position. Monitoring sitting postures can provide insights into the underlying causes of occupational discomforts such as low back pain. Objective: This study focuses on the technologies and algorithms used to classify sitting postures on a chair with respect to spine and limb movements, using sensors and wearables such as inertial measurement units, pressure or piezoresistive sensors, accelerometers or gyroscopes, combined with machine learning approaches. Methods: A total of three electronic literature databases were surveyed to identify studies classifying sitting postures in adults. Quality appraisal was performed to extract critical details and assess biases in the shortlisted papers. Results: A total of 14 papers were shortlisted from 952 papers obtained after a systematic search. The majority of the studies used pressure sensors to measure sitting postures, whereas neural networks were the most frequently used approaches for classification tasks in this context. Only 2 studies were performed in a free-living environment. Most studies presented ethical and methodological shortcomings. Moreover, the findings indicate that the strategic placement of sensors can lead to better performance and lower costs. Conclusions: The included studies differed in various aspects of design and analysis. The majority of studies were rated as medium quality according to our assessment. Our study suggests that future work for posture classification can benefit from using inertial measurement unit sensors, since they make it possible to differentiate among spine movements and similar postures, considering transitional movements between postures, and using three-dimensional cameras to annotate the data for ground truth. Finally, comparing such studies is challenging, as there are no standard definitions of sitting postures that could be used for classification. In addition, this study identifies five basic sitting postures along with different combinations of limb and spine movements to help guide future research efforts. ", doi="10.2196/21105", url="http://biomedeng.jmir.org/2021/1/e21105/" } @Article{info:doi/10.2196/18942, author="Zhuo, Xiaoqian Linda and Macedo, Gazzi Luciana", title="Feasibility and Convergent Validity of an Activity Tracker for Low Back Pain Within a Clinical Study: Cross-sectional Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="26", volume="8", number="1", pages="e18942", keywords="activity monitor", keywords="activity tracker", keywords="low back pain", abstract="Background: Low back pain (LBP) is a highly prevalent condition affecting individuals of all ages. To manage the symptoms and prevent recurrences and flare-ups, physical activity in conjunction with self-management education is recommended. Tools such as diaries and questionnaires have been the gold standard for tracking physical activity in clinical studies. However, there are issues with consistency, accuracy, and recall with the use of these outcome measures. Given the growth of technology in today's society, consumer-grade activity monitors have become a common and convenient method of recording physical activity data. Objective: The aim of this study is to test the feasibility and convergent validity of a Garmin Vivofit 3 activity tracker in evaluating physical activity levels in a clinical trial of patients with LBP. Methods: We recruited 17 individuals with nonspecific LBP referred from health care professionals or self-referred through advertisements in the community. The participants entered into a 12-week physical activity and self-management program. Physical activity was assessed using a self-reported questionnaire and the Garmin activity tracker. Activity tracker data (eg, steps taken, distance walked, and intensity minutes) were extracted weekly from the Garmin Connect online platform. Outcomes of pain and activity limitation were assessed weekly using a mobile app. A linear regression was conducted to evaluate if demographic factors (ie, age, gender, pain level) affected the adherence rates to the activity monitor. We also used Pearson correlations to evaluate the convergent validity of the Garmin activity tracker with the physical activity questionnaire. Results: The mean daily adherence rate for activity monitors was 70\% (SD 31\%) over the 26 weeks of study. The mean response rate for the weekly physical activity measures using REDCap for the first 12 weeks of the study was 91\% (SD 17\%). None of the hypothesized variables or questionnaires were predictors of response rate. Conclusions: The majority of participants were compliant with wearing the tracker, and demographic factors were not found to be predictors of adherence to wearing the device. However, there were poor correlations between the modified International Physical Activity Questionnaire Short Form (IPAQ-SF) and the activity monitor, demonstrating problems with convergent validity. ", doi="10.2196/18942", url="https://rehab.jmir.org/2021/1/e18942", url="http://www.ncbi.nlm.nih.gov/pubmed/33769301" } @Article{info:doi/10.2196/25313, author="Muggeridge, Joseph David and Hickson, Kirsty and Davies, Victoria Aimie and Giggins, M. Oonagh and Megson, L. Ian and Gorely, Trish and Crabtree, R. Daniel", title="Measurement of Heart Rate Using the Polar OH1 and Fitbit Charge 3 Wearable Devices in Healthy Adults During Light, Moderate, Vigorous, and Sprint-Based Exercise: Validation Study", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="25", volume="9", number="3", pages="e25313", keywords="heart rate", keywords="photoplethysmography", keywords="wearable electronic devices", keywords="validation study", keywords="exercise", keywords="mobile phone", abstract="Background: Accurate, continuous heart rate measurements are important for health assessment, physical activity, and sporting performance, and the integration of heart rate measurements into wearable devices has extended its accessibility. Although the use of photoplethysmography technology is not new, the available data relating to the validity of measurement are limited, and the range of activities being performed is often restricted to one exercise domain and/or limited intensities. Objective: The primary objective of this study was to assess the validity of the Polar OH1 and Fitbit Charge 3 devices for measuring heart rate during rest, light, moderate, vigorous, and sprint-type exercise. Methods: A total of 20 healthy adults (9 female; height: mean 1.73 [SD 0.1] m; body mass: mean 71.6 [SD 11.0] kg; and age: mean 40 [SD 10] years) volunteered and provided written informed consent to participate in the study consisting of 2 trials. Trial 1 was split into 3 components: 15-minute sedentary activities, 10-minute cycling on a bicycle ergometer, and incremental exercise test to exhaustion on a motorized treadmill (18-42 minutes). Trial 2 was split into 2 components: 4 {\texttimes} 15-second maximal sprints on a cycle ergometer and 4 {\texttimes} 30- to 50-m sprints on a nonmotorized resistance treadmill. Data from the 3 devices were time-aligned, and the validity of Polar OH1 and Fitbit Charge 3 was assessed against Polar H10 (criterion device). Validity was evaluated using the Bland and Altman analysis, Pearson moment correlation coefficient, and mean absolute percentage error. Results: Overall, there was a very good correlation between the Polar OH1 and Polar H10 devices (r=0.95), with a mean bias of ?1 beats{\textperiodcentered}min-1 and limits of agreement of ?20 to 19 beats{\textperiodcentered}min-1. The Fitbit Charge 3 device underestimated heart rate by 7 beats{\textperiodcentered}min-1 compared with Polar H10, with a limit of agreement of ?46 to 33 beats{\textperiodcentered}min-1 and poor correlation (r=0.8). The mean absolute percentage error for both devices was deemed acceptable (<5\%). Polar OH1 performed well across each phase of trial 1; however, validity was worse for trial 2 activities. Fitbit Charge 3 performed well only during rest and nonsprint-based treadmill activities. Conclusions: Compared with our criterion device, Polar OH1 was accurate at assessing heart rate, but the accuracy of Fitbit Charge 3 was generally poor. Polar OH1 performed worse during trial 2 compared with the activities in trial 1, and the validity of the Fitbit Charge 3 device was particularly poor during our cycling exercises. ", doi="10.2196/25313", url="https://mhealth.jmir.org/2021/3/e25313", url="http://www.ncbi.nlm.nih.gov/pubmed/33764310" } @Article{info:doi/10.2196/21312, author="Bhattacharjya, Sutanuka and Cavuoto, Anne Lora and Reilly, Brandon and Xu, Wenyao and Subryan, Heamchand and Langan, Jeanne", title="Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study", journal="JMIR Hum Factors", year="2021", month="Mar", day="22", volume="8", number="1", pages="e21312", keywords="stroke", keywords="rehabilitation", keywords="smart technology", keywords="3-dimensional printing", keywords="usability", abstract="Background: Smart technology use in rehabilitation is growing and can be used remotely to assist clients in self-monitoring their performance. With written home exercise programs being the commonly prescribed form of rehabilitation after discharge, mobile health technology coupled with task-oriented programs can enhance self-management of upper extremity training. In the current study, a rehabilitation system, namely mRehab, was designed that included a smartphone app and 3D-printed household items such as mug, bowl, key, and doorknob embedded with a smartphone. The app interface allowed the user to select rehabilitation activities and receive feedback on the number of activity repetitions completed, time to complete each activity, and quality of movement. Objective: This study aimed to assess the usability, perceived usefulness, and acceptance of the mRehab system by individuals with stroke and identify the challenges experienced by them when using the system remotely in a home-based setting. Methods: A mixed-methods approach was used with 11 individuals with chronic stroke. Following training, individuals with stroke used the mRehab system for 6 weeks at home. Each participant completed surveys and engaged in a semistructured interview. Participants' qualitative reports regarding the usability of mRehab were integrated with their survey reports and quantitative performance data. Results: Of the 11 participants, 10 rated the mRehab system between the 67.5th and 97.5th percentile on the System Usability Scale, indicating their satisfaction with the usability of the system. Participants also provided high ratings of perceived usefulness (mean 5.8, SD 0.9) and perceived ease of use (mean 5.3, SD 1.5) on a 7-point scale based on the Technology Acceptance Model. Common themes reported by participants showed a positive response to mRehab with some suggestions for improvements. Participants reported an interest in activities they perceived to be adequately challenging. Some participants indicated a need for customizing the feedback to be more interpretable. Overall, most participants indicated that they would like to continue using the mRehab system at home. Conclusions: Assessing usability in the lived environment over a prolonged duration of time is essential to identify the match between the system and users' needs and preferences. While mRehab was well accepted, further customization is desired for a better fit with the end users. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ", doi="10.2196/21312", url="https://humanfactors.jmir.org/2021/1/e21312", url="http://www.ncbi.nlm.nih.gov/pubmed/33749608" } @Article{info:doi/10.2196/18739, author="Cornelis, Nils and Buys, Roselien and Dewit, Tijl and Benoit, Dries and Claes, Jomme and Fourneau, Inge and Cornelissen, V{\'e}ronique", title="Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="22", volume="8", number="1", pages="e18739", keywords="eHealth", keywords="telerehabilitation", keywords="intermittent claudication", keywords="pilot", abstract="Background: Current guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice. Objective: The aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises. Methods: A total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests. Results: All patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients' questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered. Conclusions: Patients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking. Trial Registration: ClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546 ", doi="10.2196/18739", url="https://rehab.jmir.org/2021/1/e18739", url="http://www.ncbi.nlm.nih.gov/pubmed/33749616" } @Article{info:doi/10.2196/22548, author="Raiszadeh, Kamshad and Tapicer, Jonathan and Taitano, Lissa and Wu, Jonathan and Shahidi, Bahar", title="In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model", journal="J Med Internet Res", year="2021", month="Mar", day="18", volume="23", number="3", pages="e22548", keywords="low back pain", keywords="telehealth", keywords="online therapy", keywords="physical therapy", keywords="integrated practice unit", keywords="rehabilitation", abstract="Background: The recent onset of the COVID-19 pandemic has highlighted the need to reduce barriers to access physical therapy and associated care through the use of web-based programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared the effectiveness of clinic-based versus web-based or telehealth services. Objective: This study aims to compare the clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit (C-IPU) model with online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP. Methods: A total of 1090 participants were prospectively recruited to participate in a clinical trial registry (NCT04081896) through the SpineZone rehabilitation IPU program. All participants provided informed consent. Participants were allocated to the C-IPU (N=988) or O-IPU (N=102) groups based on their personal preferences. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist-directed home core strengthening exercises through a web-based platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient-Specific Functional Scale), and frequency of opioid use were compared between the C-IPU and O-IPU groups using multivariate linear regression modeling adjusted for age, gender, treatment number, program duration, and baseline pain and disability. Results: Approximately 93.03\% (1014/1090) of the participants completed their recommended programs, with no group differences in dropout rates (P=.78). The C-IPU group showed greater pain relief (P<.001) and reductions in disability (P=.002) than the O-IPU group, whereas the O-IPU group reported greater improvements in goal achievement (P<.001). Both programs resulted in reduced opioid use frequency, with 19.0\% (188/988) and 21.5\% (22/102) of participants reporting cessation of opioid use for C-IPU and O-IPU programs, respectively, leaving only 5.59\% (61/1090) of participants reporting opioid use at the end of their treatment. Conclusions: Both in-clinic and web-based multidisciplinary programs are beneficial in reducing pain, disability, and opioid use and in improving goal achievement. The differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs. Trial Registration: ClinicalTrials.gov NCT04081896; https://clinicaltrials.gov/ct2/show/NCT04081896 ", doi="10.2196/22548", url="https://www.jmir.org/2021/3/e22548", url="http://www.ncbi.nlm.nih.gov/pubmed/33734088" } @Article{info:doi/10.2196/22659, author="Van de Winckel, Ann and Nawshin, Tanjila and Byron, Casey", title="Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Mar", day="18", volume="5", number="3", pages="e22659", keywords="chronic disease", keywords="spinal cord injury", keywords="stroke", keywords="telehealth", keywords="telemedicine", keywords="traumatic brain injury", abstract="Background: Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective: To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods: We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results: Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51\%) and control (22/45, 49\%) groups, with 74\% (17/23) and 86\% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68\% (15/22) sent videos. They sent 68\% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87\% in the experimental group (P=.99), whereas it decreased from 89\% at 8 weeks to 74\% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions: The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration: ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280 ", doi="10.2196/22659", url="https://formative.jmir.org/2021/3/e22659", url="http://www.ncbi.nlm.nih.gov/pubmed/33640865" } @Article{info:doi/10.2196/21374, author="Burns, David and Boyer, Philip and Razmjou, Helen and Richards, Robin and Whyne, Cari", title="Adherence Patterns and Dose Response of Physiotherapy for Rotator Cuff Pathology: Longitudinal Cohort Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="11", volume="8", number="1", pages="e21374", keywords="rehabilitation", keywords="treatment adherence and compliance", keywords="wearable electronic devices", keywords="machine learning", keywords="rotator cuff", abstract="Background: Physiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; however, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown. Objective: The purpose of this study was to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose response between physiotherapy activity and recovery, and explore patient factors predictive of physiotherapy participation. Methods: We report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smartwatch that recorded inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from smartwatch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand and numeric pain rating scale assessed every 4 weeks until 12 weeks follow-up. The relationships between participation, outcomes, and clinical patient variables were assessed in univariable analyses. Results: Mean physiotherapy exercise participation in clinic and at home were 11 minutes per week and 33 minutes per week, respectively, with patients participating in physiotherapy on 41\% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P=.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery demonstrated by pain scores at 8 weeks (P=.02) and 12 weeks (P=.05) and disability scores at 8 weeks (P=.04) and 12 weeks (P=.04). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation. Conclusions: There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders. International Registered Report Identifier (IRRID): RR2-10.2196/17841 ", doi="10.2196/21374", url="https://rehab.jmir.org/2021/1/e21374", url="http://www.ncbi.nlm.nih.gov/pubmed/33704076" } @Article{info:doi/10.2196/21911, author="Gilson, D. Nicholas and Papinczak, E. Zoe and Mielke, Iven Gregore and Haslam, Catherine and Fooken, Jonas and McKenna, Jim and Brown, J. Wendy", title="Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Feb", day="24", volume="10", number="2", pages="e21911", keywords="military service veterans", keywords="self-managed physical activity", keywords="behavioral support program", keywords="psychological well-being", keywords="social connectedness", keywords="health service utilization", keywords="health service costs", keywords="physical activity", keywords="well-being", keywords="health professional", keywords="veterans", keywords="behavioral", keywords="support program", abstract="Background: A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans. Objective: This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans' Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA. Methods: The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans' Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences. Results: Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so. Conclusions: Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/21911 ", doi="10.2196/21911", url="https://www.researchprotocols.org/2021/2/e21911", url="http://www.ncbi.nlm.nih.gov/pubmed/33625365" } @Article{info:doi/10.2196/23612, author="Kowatsch, Tobias and Lohse, Kim-Morgaine and Erb, Val{\'e}rie and Schittenhelm, Leo and Galliker, Helen and Lehner, Rea and Huang, M. Elaine", title="Hybrid Ubiquitous Coaching With a Novel Combination of Mobile and Holographic Conversational Agents Targeting Adherence to Home Exercises: Four Design and Evaluation Studies", journal="J Med Internet Res", year="2021", month="Feb", day="22", volume="23", number="2", pages="e23612", keywords="ubiquitous coaching", keywords="augmented reality", keywords="health care", keywords="treatment adherence", keywords="design science research", keywords="physiotherapy", keywords="chronic back pain", keywords="pain", keywords="chronic pain", keywords="exercise", keywords="adherence", keywords="treatment", keywords="conversational agent", keywords="smartphone", keywords="mobile phone", abstract="Background: Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. Objective: To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. Methods: We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients' perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. Results: Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality--based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92\% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. Conclusions: The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders. ", doi="10.2196/23612", url="https://www.jmir.org/2021/2/e23612", url="http://www.ncbi.nlm.nih.gov/pubmed/33461957" } @Article{info:doi/10.2196/24080, author="Kim, Mihui and Kim, Changhwan and Kim, Eunkyo and Choi, Mona", title="Effectiveness of Mobile Health--Based Exercise Interventions for Patients with Peripheral Artery Disease: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="15", volume="9", number="2", pages="e24080", keywords="peripheral artery disease", keywords="mobile health", keywords="exercise", keywords="adherence", keywords="meta-analysis", abstract="Background: Peripheral artery disease (PAD) affects over 236 million people worldwide, and exercise interventions are commonly used to alleviate symptoms of this condition. However, no previous systematic review has evaluated the effects of mobile health (mHealth)--based exercise interventions for patients with PAD. Objective: This study aimed to assess the effect of mHealth-based exercise interventions on walking performance, functional status, and quality of life in patients with PAD. Methods: A systematic review and meta-analysis were conducted. We searched in seven databases to identify randomized controlled trials of patients with PAD published in English up to December 4, 2020. Studies were included if patients participated in mHealth-based exercise interventions and were assessed for walking performance. We analyzed pooled effect size on walking performance, functional status, and quality of life based on the standardized mean differences between groups. Results: A total of seven studies were selected for the systematic review, and six studies were included in the meta-analysis. The duration of interventions in the included studies was 12 to 48 weeks. In the pooled analysis, when compared with the control groups, the mHealth-based exercise intervention groups were associated with significant improvements in pain-free walking (95\% CI 0.13-0.88), maximal walking (95\% CI 0.03-0.87), 6-minute walk test (6MWT) distance (95\% CI 0.59-1.24), and walking distance (95\% CI 0.02-0.49). However, benefits of the interventions on walking speed, stair-climbing ability, and quality of life were not observed. Conclusions: mHealth-based exercise interventions for patients with PAD were beneficial for improving pain-free walking, maximal walking, and 6MWT distance. We found that exercise interventions using mHealth are an important strategy for improving the exercise effectiveness and adherence rate of patients with PAD. Future studies should consider the use of various and suitable functions of mHealth that can increase the adherence rates and improve the effectiveness of exercise. ", doi="10.2196/24080", url="http://mhealth.jmir.org/2021/2/e24080/", url="http://www.ncbi.nlm.nih.gov/pubmed/33587042" } @Article{info:doi/10.2196/21107, author="Elgert, Lena and Steiner, Bianca and Saalfeld, Birgit and Marschollek, Michael and Wolf, Klaus-Hendrik", title="Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Feb", day="4", volume="8", number="1", pages="e21107", keywords="shoulder", keywords="upper extremity", keywords="musculoskeletal diseases", keywords="exercises", keywords="physical therapy", keywords="telerehabilitation", keywords="technology-assisted therapy", keywords="assistive technologies", keywords="mobile phone", abstract="Background: Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. Objective: This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. Methods: The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. Results: Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient's range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients' evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. Conclusions: There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects. ", doi="10.2196/21107", url="http://rehab.jmir.org/2021/1/e21107/", url="http://www.ncbi.nlm.nih.gov/pubmed/33538701" } @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/10.2196/21094, author="Daly, M. Robin and Gianoudis, Jenny and Hall, Travis and Mundell, L. Niamh and Maddison, Ralph", title="Feasibility, Usability, and Enjoyment of a Home-Based Exercise Program Delivered via an Exercise App for Musculoskeletal Health in Community-Dwelling Older Adults: Short-term Prospective Pilot Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="13", volume="9", number="1", pages="e21094", keywords="home exercise", keywords="multicomponent exercise", keywords="mobile health", keywords="musculoskeletal", keywords="adherence", keywords="usability", keywords="older adults", keywords="physical activity enjoyment", abstract="Background: Many older adults choose and prefer to exercise at home, but to attain the greatest benefits, the correct type and dose of exercise should be prescribed and adherence maintained. Advances in digital health technologies now provide the opportunity for exercise professionals to deliver and monitor personalized, evidence-based exercise programs to anyone at any time. Objective: The aim of this study was to evaluate the feasibility, usability, and enjoyment of a web-based exercise prescription app as a platform for exercise professionals to remotely deliver and monitor an individually tailored, home-based multicomponent exercise program (delivered through tablet computers) to older adults living independently in the community. Methods: This was an 8-week, prospective single-arm pilot study in 20 adults aged ?65 years living independently in the community: 10 owned a tablet computer (tablet owners) and 10 did not own tablets (tablet nonowners). All participants were prescribed a home-based, muscle strengthening, weight-bearing impact and challenging balance/mobility program (3 days/week) using a commercial exercise prescription app on a tablet computer. Study endpoints were feasibility (retention, adherence, adverse events), usability (System Usability Scale), physical activity enjoyment (Physical Activity Enjoyment Scale), changes in lower extremity function (Short Physical Performance Battery [SPPB]), and level of physical activity (questionnaire). Process measures related to the participants' experiences and perceptions of the exercise program and web-based app were also included. Results: A total of 19 participants (mean age, 70 years) completed the study (19/20, 95\%), and mean adherence to the exercise program was 84\% (95\% CI 70\%-97\%). There were 2 minor adverse events in 2 participants from 401 completed sessions. Mean weekly walking time increased by 78 minutes (95\% CI 0-156, P=.049) and moderate-to-vigorous physical activity time by 41 minutes (95\% CI --8 to 90, P=.09). For SPPB scores, there was a 0.3 point (95\% CI --0.1 to 0.7, P=.17) modest sized (effect size, d=0.42) improvement after 8 weeks. Mean (SD) system usability was high (86 [10] with 100 best imaginable). There was no change in the overall physical activity enjoyment scores after 8 weeks, but participants reported that they enjoyed using the web-based exercise app and the exercise program (median score 4 on a 5-point Likert scale). For all measures, there were no differences between previous tablet owners and nonowners. Conclusions: This pilot feasibility study indicates that it is safe and feasible for community-dwelling older adults to participate in a home-based, multicomponent exercise program targeting musculoskeletal health and function that was delivered and monitored remotely by exercise professionals using a tablet-based exercise prescription app. ", doi="10.2196/21094", url="http://mhealth.jmir.org/2021/1/e21094/", url="http://www.ncbi.nlm.nih.gov/pubmed/33439147" } @Article{info:doi/10.2196/24689, author="Quilico, Enrico and Swaine, Bonnie and Alarie, Christophe and Colantonio, Angela", title="Community-Based Physical Activity Interventions for Individuals with Moderate to Severe Traumatic Brain Injury: Scoping Review Protocol", journal="JMIR Res Protoc", year="2021", month="Jan", day="13", volume="10", number="1", pages="e24689", keywords="traumatic brain injury", keywords="community", keywords="physical activity", keywords="exercise", keywords="sex", keywords="gender", abstract="Background: Long-term physical, cognitive, and psychosocial problems resulting from moderate to severe traumatic brain injury (TBI) can prevent individuals from returning to preinjury lifestyles because of significant challenges with employment, leisure, and relationships. While physical activity (PA) is proposed as a cost-effective method to alleviate problems after moderate to severe TBI, there is no review to date that synthesizes the evidence for PA in the community-based context. Further, although sex- and gender-based considerations in research are considered requisite to good science, there is no review on PA and TBI that has included this explicit focus. Objective: The purpose of this review is to map and synthesize the current evidence identified through a systematic search of community-based PA interventions for individuals of all ages with moderate to severe TBI and provide an overview of that evidence by asking the following research questions: (1) what are the characteristics of community-based PA programs for individuals with moderate to severe TBI, (2) what are the reported health-related outcomes and measurement tools used to evaluate them, and (3) what considerations have been given to sex and/or gender? Methods: Searches will be conducted of six academic databases for peer-reviewed articles. Two reviewers will independently screen the articles for inclusion and extract data for the analysis. The extracted data will be coded according to the Consensus on Exercise Reporting Template checklist and the Template for Intervention Description and Replication checklist to provide sufficient detail for replication. Results: The abstract screening was completed by two reviewers and the extracted data were analyzed. A qualitative synthesis and description of community-based PA interventions for individuals with moderate to severe TBI will be provided. Conclusions: This scoping review will generate new knowledge from published and publicly available literature. Dissemination of the results will include activities related to knowledge transfer for community-based PA after moderate to severe TBI for future research and practice. Evidence-based recommendations, future directions, potential limitations, use of online/digital components, and the possible need for a systematic review will be discussed as well. International Registered Report Identifier (IRRID): DERR1-10.2196/24689 ", doi="10.2196/24689", url="http://www.researchprotocols.org/2021/1/e24689/", url="http://www.ncbi.nlm.nih.gov/pubmed/33439145" } @Article{info:doi/10.2196/18860, author="Nelligan, K. Rachel and Hinman, S. Rana and Teo, Ling Pek and Bennell, L. Kim", title="Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2020", month="Nov", day="26", volume="7", number="2", pages="e18860", keywords="text messaging", keywords="mobile phone", keywords="knee osteoarthritis", keywords="exercise", keywords="qualitative", keywords="pain", abstract="Background: Knee osteoarthritis (OA) is a highly prevalent and debilitating condition. Exercise is a recommended treatment because of its effectiveness at improving pain and function. However, exercise is underutilized in OA management. Difficulty accessing health care has been identified as a key barrier to exercise uptake. Innovative and scalable methods of delivering exercise treatments to people with knee OA are needed. We developed a self-directed eHealth intervention to enable and encourage exercise participation. The effectiveness of this intervention on pain and function in people with knee OA is being evaluated in a randomized clinical trial. Objective: This study aimed to explore the attitudes and experiences of people with knee OA who accessed the self-directed eHealth intervention and the features perceived as useful to facilitate self-directed exercise. Methods: This was a qualitative study embedded within a randomized controlled trial. Individual, semistructured phone interviews were conducted with 16 people with knee OA who had accessed a 24-week eHealth intervention (website and behavior change SMS program) designed to support exercise participation. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed using an inductive approach. Results: Five themes arose: (1) technology easy to use and follow (website ease of use, SMS ease of use), (2) facilitators to exercise participation (credible OA and exercise information, website features, prescribed exercises simple to do unsupervised, freedom to adapt the exercise to suit needs, influence of other health care experiences), (3) sense of support and accountability (SMS good reminder and prompt, accountable, SMS tone and automation could trigger negative emotions [eg, guilt or shame], inability to contact someone when needed), (4) positive outcomes (knee symptom improvements, confidence to self-manage, encouraged active living), (5) suggestions for real-world application (provided by a health professional preferred, should be provided at subsidized or low out-of-pocket cost). Conclusions: People with knee OA had mostly positive experiences with and attitudes towards the use of an eHealth intervention that supported exercise participation independent of a health professional. A human connection associated with the eHealth intervention appeared important. ", doi="10.2196/18860", url="http://rehab.jmir.org/2020/2/e18860/", url="http://www.ncbi.nlm.nih.gov/pubmed/33242021" } @Article{info:doi/10.2196/18649, author="Georgiou, Theodoros and Holland, Simon and van der Linden, Janet", title="Rhythmic Haptic Cueing for Gait Rehabilitation of People With Hemiparesis: Quantitative Gait Study", journal="JMIR Biomed Eng", year="2020", month="Nov", day="24", volume="5", number="1", pages="e18649", keywords="hemiparetic gait", keywords="stroke", keywords="technology assisted rehabilitation", keywords="quantitative study", keywords="gait analysis", keywords="gait asymmetry", keywords="gait", keywords="neurology", keywords="hemiparesis", keywords="rehabilitation", keywords="brain injury", abstract="Background: Rhythm, brain, and body are closely linked. Humans can synchronize their movement to auditory rhythms in ways that can improve the regularity of movement while reducing perceived effort. However, the ability to perform rhythmic movement may be disrupted by various neurological conditions. Many such conditions impair mechanisms that control movement, such as gait, but typically without rhythmic perception being affected. This paper focuses on hemiparetic stroke, a neurological condition that affects one side of the body. Hemiparetic stroke can cause severe asymmetries in gait, leading to numerous physical problems ranging from muscle degeneration to bone fractures. Movement synchronization via entrainment to auditory metronomes is known to improve asymmetry and related gait problems; this paper presents the first systematic study of entrainment for gait rehabilitation via the haptic modality. Objective: This paper explores the gait rehabilitation of people with hemiparesis following a stroke or brain injury, by a process of haptic entrainment to rhythmic cues. Various objective measures, such as stride length and stride time, are considered. Methods: This study is a quantitative gait study combining temporal and spatial data on haptically cued participants with hemiparetic stroke and brain injury. We designed wearable devices to deliver the haptic rhythm, called Haptic Bracelets, which were placed on the leg near the knee. Spatial data were recorded using a Qualisys optical motion capturing system, consisting of 8 optoelectronic cameras, and 20 markers placed on anatomical lower limb landmarks and 4 additional tracking clusters placed on the right and left shank and thigh. Gait characteristics were measured before, during, and after cueing. Results: All 11 successfully screened participants were able to synchronize their steps to a haptically presented rhythm. Specifically, 6 participants demonstrated immediate improvements regarding their temporal gait characteristics, and 3 of the 6 improved their gait in terms of spatial characteristics. Conclusions: Considering the great variability between survivors of stroke and brain injury and the limited number of available participants in our study, there is no claim of statistical evidence that supports a formal experimental result of improved gait. However, viewing this empirical gait investigation as a set of 11 case studies, more modest empirical claims can be made. All participants were able to synchronize their steps to a haptically presented rhythm. For a substantial proportion of participants, an immediate (though not necessarily lasting) improvement of temporal gait characteristics was found during cueing. Some improvements over baseline occurred immediately after, rather than during, haptic cueing. Design issues and trade-offs are identified, and interactions between perception, sensory deficit, attention, memory, cognitive load, and haptic entrainment are noted. ", doi="10.2196/18649", url="http://biomedeng.jmir.org/2020/1/e18649/" } @Article{info:doi/10.2196/19111, author="Post, A. Andrew and Rio, K. Ebonie and Sluka, A. Kathleen and Moseley, Lorimer G. and Bayman, O. Emine and Hall, M. Mederic and de Cesar Netto, Cesar and Wilken, M. Jason and Danielson, F. Jessica and Chimenti, Ruth", title="Effect of Pain Education and Exercise on Pain and Function in Chronic Achilles Tendinopathy: Protocol for a Double-Blind, Placebo-Controlled Randomized Trial", journal="JMIR Res Protoc", year="2020", month="Nov", day="3", volume="9", number="11", pages="e19111", keywords="Achilles tendon", keywords="tendinopathy", keywords="rehabilitation", keywords="pain", keywords="tendon", keywords="patient education", abstract="Background: Achilles tendinopathy (AT) rehabilitation traditionally includes progressive tendon loading exercises. Recent evidence suggests a biopsychosocial approach that incorporates patient education on psychosocial factors and mechanisms of pain can reduce pain and disability in individuals with chronic pain. This is yet to be examined in individuals with AT. Objective: This study aims to compare the effects on movement-evoked pain and self-reported function of pain education as part of a biopsychosocial approach with pathoanatomical education for people with AT when combined with a progressive tendon loading exercise program. Methods: A single-site, randomized, double-blind, placebo-controlled clinical trial will be conducted in a university-based hospital in a laboratory setting and/or by telehealth. A total of 66 participants with chronic (>3 months) midportion or insertional AT will be randomized for the Tendinopathy Education of the Achilles (TEAch) study. All participants will complete progressive Achilles tendon loading exercises over 12 weeks and will be encouraged to continue with self-selected exercises as tolerated. All participants will complete 6-7 one-to-one sessions with a physical therapist to progress exercises in a standardized manner over 8 weeks. During the last 4 weeks of the intervention, participants will be encouraged to maintain their home exercise program. Participants will be randomized to 1 of 2 types of education (pain education or pathoanatomic), in addition to exercise. Pain education will focus on the biological and psychological mechanisms of pain within a biopsychosocial framing of AT. Pathoanatomic education will focus on biological processes within a more traditional biomedical framework of AT. Evaluation sessions will be completed at baseline and 8-week follow-up, and self-reported outcome measures will be completed at the 12-week follow-up. Both groups will complete progressive Achilles loading exercises in 4 phases throughout the 12 weeks and will be encouraged to continue with self-selected exercises as tolerated. Primary outcomes are movement-evoked pain during heel raises and self-reported function (patient-reported outcome measure information system---Physical Function). Secondary outcomes assess central nervous system nociceptive processing, psychological factors, motor function, and feasibility. Results: Institutional review board approval was obtained on April 15, 2019, and study funding began in July 2019. As of March 2020, we randomized 23 out of 66 participants. In September 2020, we screened 267 individuals, consented 68 participants, and randomized 51 participants. We anticipate completing the primary data analysis by March 2022. Conclusions: The TEAch study will evaluate the utility of pain education for those with AT and the effects of improved patient knowledge on pain, physical function, and clinical outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/19111 ", doi="10.2196/19111", url="https://www.researchprotocols.org/2020/11/e19111", url="http://www.ncbi.nlm.nih.gov/pubmed/33141102" } @Article{info:doi/10.2196/18291, author="Boedecker, Cosima Simone and Philippi, Akanby Keito Finn and Neuberger, Elmo and Schmidt, Sebastian and Pfirrmann, Daniel and Haller, Nils and Schwarting, Andreas and Simon, Perikles and Weinmann-Menke, Julia", title="Twelve-Week Internet-Based Individualized Exercise Program in Adults With Systemic Lupus Erythematosus: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2020", month="Nov", day="3", volume="9", number="11", pages="e18291", keywords="systemic lupus erythematosus", keywords="physical activity", keywords="internet-based exercise program, disease activity", keywords="fatigue", abstract="Background: Systemic lupus erythematosus is a systemic autoimmune disease, which is associated with high cardiovascular risk, a predisposition to metabolic disorders, muscle wasting, and fatigue. Exercise therapy has become an important part of the long-term treatment of comorbidities in systemic lupus erythematosus. Exercise can lead to various benefits in patients with systemic lupus erythematosus such as increased aerobic capacity and exercise tolerance, resulting in an increased quality of life, decreased depression, and decreased fatigue. At the moment, no evidence-based treatment guidelines that recommend exercise for patients with systemic lupus erythematosus exist. Also, the efficacy of different training programs requires further investigation. Objective: This study focuses on the feasibility, efficacy, and safety of an internet-based exercise program in patients with systemic lupus erythematosus. Furthermore, we investigate the feasibility and efficiency of anaerobic training compared to aerobic training. Methods: Overall, patients with systemic lupus erythematosus from the Division of Nephrology, Rheumatology, and Immunology outpatient clinic of the University Medical Center Mainz who are clinically stable status are included and randomized in an aerobic exercise group (n=10), anaerobic exercise group (n=10), or treatment as usual group (n=10). After completing initial clinical testing and physical fitness tests, patients undergo supervised 12-week online exercise programs, receiving weekly individualized training plans adapted to their physical performance. The primary outcome is change in physical fitness (VO2 peak) after 12 weeks compared to baseline. Secondary outcomes are disease activity measured via laboratory results (complement, autoantibodies) and questionnaires, as well as changes in muscle mass (anaerobic exercise group), results of the Chair-Stand test, and measurements of circulating cell-free DNA and extracellular vesicles. Results: The study was registered in May 2019. Enrollment began in May 2019. Of 40 patients who were initially screened, 30 patients fulfilled the inclusion criteria and were included in the study; 1 participant withdrew prior to the start of the exercise program. Among the 25 patients who completed the study, no serious adverse events have been reported; 3 participants withdrew during the program (due to frequent colds, n=1; Crohn relapse, n=1; physical strain, n=1), and 1 participant has not yet completed the program. Data analysis is ongoing, and results are expected to be submitted for publication in January 2021. Conclusions: We expect the online exercise intervention to be a feasible and efficient tool to provide regular individualized exercise for patients with systemic lupus erythematosus. Trial Registration: ClinicalTrials.gov NCT03942718; http://clinicaltrials.gov/ct2/show/NCT03942718. International Registered Report Identifier (IRRID): DERR1-10.2196/18291 ", doi="10.2196/18291", url="https://www.researchprotocols.org/2020/11/e18291", url="http://www.ncbi.nlm.nih.gov/pubmed/33141101" } @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/10.2196/18985, author="Landers, R. Merrill and Ellis, D. Terry", title="A Mobile App Specifically Designed to Facilitate Exercise in Parkinson Disease: Single-Cohort Pilot Study on Feasibility, Safety, and Signal of Efficacy", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="5", volume="8", number="10", pages="e18985", keywords="Parkinson disease", keywords="smartphone", keywords="mobile phone", keywords="telehealth", keywords="telerehabilitation", keywords="digital health", keywords="physical therapy", abstract="Background: Many people with Parkinson disease do not have access to exercise programs that are specifically tailored to their needs and capabilities. This mobile app allows people with Parkinson disease to access Parkinson disease--specific exercises that are individually tailored using in-app demographic questions and performance tests which are fed into an algorithm which in turn produces a video-guided exercise program. Objective: To test the feasibility, safety, and signal of efficacy of a mobile app that facilitates exercise for people with Parkinson disease. Methods: A prospective, single-cohort design of people with Parkinson disease who had downloaded the 9zest app for exercise was used for this 12-week pilot study. Participants, who were recruited online, were encouraged to exercise with the full automated app for ?150 minutes each week. The primary endpoints were feasibility (app usage and usability questions) and safety (adverse events and falls). The primary endpoints for signal of efficacy were a comparison of the in-app baseline and 8-week outcomes on the 30-second Sit-To-Stand (STS) test, Timed Up and Go (TUG) test, and the Parkinson's Disease Questionnaire 8 (PDQ8). Results: For feasibility, of the 28 participants that completed the study, 12 participants averaged >150 minutes of app usage per week (3 averaged 120-150, 4 averaged 90-120, and 9 averaged less than 90 minutes). A majority of participants (>74\%) felt the exercise was of value (16/19; 9 nonrespondents), provided adequate instruction (14/19; 9 nonrespondents), and was appropriate for level of function (16/19; 9 nonrespondents). For safety, there were no serious adverse events that occurred during the app-guided exercise. There were 4 reports of strain/sprain injuries while using the app among 3 participants, none of which necessitated medical attention. For signal of efficacy, there was improvement for each of the primary endpoints: STS (P=.01), TUG (P<.001), and PDQ8 (P=.01). Conclusions: Independent, video-guided exercise using a mobile app designed for exercise in Parkinson disease was safe and feasible though there was variability in app usage. Despite this, the results provide evidence for a signal of efficacy as there were improvements in 3 of the 3 outcomes. Trial Registration: ClinicalTrials.gov NCT03459586; https://clinicaltrials.gov/ct2/show/NCT03459586 ", doi="10.2196/18985", url="https://mhealth.jmir.org/2020/10/e18985", url="http://www.ncbi.nlm.nih.gov/pubmed/33016887" } @Article{info:doi/10.2196/21749, author="Bennell, Kim and Nelligan, K. Rachel and Schwartz, Sarah and Kasza, Jessica and Kimp, Alexander and Crofts, JC Samuel and Hinman, S. Rana", title="Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial", journal="J Med Internet Res", year="2020", month="Sep", day="28", volume="22", number="9", pages="e21749", keywords="knee osteoarthritis", keywords="exercise", keywords="patient compliance", keywords="mobile phone", keywords="randomized controlled trial", abstract="Background: Exercise is a core recommended treatment for knee osteoarthritis (OA), yet adherence declines, particularly following cessation of clinician supervision. Objective: This study aims to evaluate whether a 24-week SMS intervention improves adherence to unsupervised home exercise in people with knee OA and obesity compared with no SMS. Methods: A two-group superiority randomized controlled trial was performed in a community setting. Participants were people aged 50 years with knee OA and BMI ?30 kg/m2 who had undertaken a 12-week physiotherapist-supervised exercise program as part of a preceding clinical trial. Both groups were asked to continue their home exercise program unsupervised three times per week for 24 weeks and were randomly allocated to a behavior change theory--informed, automated, semi-interactive SMS intervention addressing exercise barriers and facilitators or to control (no SMS). Primary outcomes were self-reported home exercise adherence at 24 weeks measured by the Exercise Adherence Rating Scale (EARS) Section B (0-24, higher number indicating greater adherence) and the number of days exercised in the past week (0-3). Secondary outcomes included self-rated adherence (numeric rating scale), knee pain, physical function, quality of life, global change, physical activity, self-efficacy, pain catastrophizing, and kinesiophobia. Results: A total of 110 participants (56 SMS group and 54 no SMS) were enrolled and 99 (90.0\%) completed both primary outcomes (48/56, 86\% SMS group and 51/54, 94\% no SMS). At 24 weeks, the SMS group reported higher EARS scores (mean 16.5, SD 6.5 vs mean 13.3, SD 7.0; mean difference 3.1, 95\% CI 0.8-5.5; P=.01) and more days exercised in the past week (mean 1.8, SD 1.2 vs mean 1.3, SD 1.2; mean difference 0.6, 95\% CI 0.2-1.0; P=.01) than the control group. There was no evidence of between-group differences in secondary outcomes. Conclusions: An SMS program increased self-reported adherence to unsupervised home exercise in people with knee OA and obesity, although this did not translate into improved clinical outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry 12617001243303; https://tinyurl.com/y2ud7on5 International Registered Report Identifier (IRRID): RR2-10.1186/s12891-019-2801-z ", doi="10.2196/21749", url="http://www.jmir.org/2020/9/e21749/", url="http://www.ncbi.nlm.nih.gov/pubmed/32985994" } @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/10.2196/19251, author="Bass, Alec and Aubertin-Leheudre, Myl{\`e}ne and Vincent, Claude and Karelis, D. Antony and Morin, N. Suzanne and McKerral, Michelle and Duclos, Cyril and Gagnon, H. Dany", title="Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study", journal="JMIR Res Protoc", year="2020", month="Sep", day="24", volume="9", number="9", pages="e19251", keywords="assistive technology", keywords="locomotion", keywords="spinal cord injury", keywords="rehabilitation", keywords="robotics", keywords="osteoporosis", abstract="Background: In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity---typically linked to this mode of mobility---contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. Objective: This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton--assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. Methods: A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton--assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. Results: This study is currently underway with active recruitment in Montr{\'e}al, Qu{\'e}bec, Canada. Results are expected in the spring of 2021. Conclusions: The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton--assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. Trial Registration: ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID): DERR1-10.2196/19251 ", doi="10.2196/19251", url="http://www.researchprotocols.org/2020/9/e19251/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663160" } @Article{info:doi/10.2196/18209, author="Dove, Erica and Wang, Rosalie and Zabjek, Karl and Astell, Arlene", title="Impacts of Motion-Based Technology on Balance, Movement Confidence, and Cognitive Function Among People With Dementia or Mild Cognitive Impairment: Protocol for a Quasi-Experimental Pre- and Posttest Study", journal="JMIR Res Protoc", year="2020", month="Sep", day="18", volume="9", number="9", pages="e18209", keywords="motion-based technology", keywords="dementia", keywords="mild cognitive impairment", keywords="cognitive dysfunction", keywords="postural balance", keywords="movement confidence", keywords="cognition", keywords="exercise movement techniques", abstract="Background: While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined. Objective: The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. Methods: In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings. Results: This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021. Conclusions: This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered. International Registered Report Identifier (IRRID): DERR1-10.2196/18209 ", doi="10.2196/18209", url="http://www.researchprotocols.org/2020/9/e18209/", url="http://www.ncbi.nlm.nih.gov/pubmed/32945780" } @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/10.2196/18888, author="van der Veen, M. Susanne and Stamenkovic, Alexander and Applegate, E. Megan and Leitkam, T. Samuel and France, R. Christopher and Thomas, S. James", title="Effects of Avatar Perspective on Joint Excursions Used to Play Virtual Dodgeball: Within-Subject Comparative Study", journal="JMIR Serious Games", year="2020", month="Aug", day="19", volume="8", number="3", pages="e18888", keywords="virtual reality", keywords="avatar perspective", keywords="reaching", keywords="joint excursion", keywords="exergaming", keywords="exercise rehabilitation", keywords="head mounted display", abstract="Background: Visual representation of oneself is likely to affect movement patterns. Prior work in virtual dodgeball showed greater excursion of the ankles, knees, hips, spine, and shoulder occurs when presented in the first-person perspective compared to the third-person perspective. However, the mode of presentation differed between the two conditions such that a head-mounted display was used to present the avatar in the first-person perspective, but a 3D television (3DTV) display was used to present the avatar in the third-person. Thus, it is unknown whether changes in joint excursions are driven by the visual display (head-mounted display versus 3DTV) or avatar perspective during virtual gameplay. Objective: This study aimed to determine the influence of avatar perspective on joint excursion in healthy individuals playing virtual dodgeball using a head-mounted display. Methods: Participants (n=29, 15 male, 14 female) performed full-body movements to intercept launched virtual targets presented in a game of virtual dodgeball using a head-mounted display. Two avatar perspectives were compared during each session of gameplay. A first-person perspective was created by placing the center of the displayed content at the bridge of the participant's nose, while a third-person perspective was created by placing the camera view at the participant's eye level but set 1 m behind the participant avatar. During gameplay, virtual dodgeballs were launched at a consistent velocity of 30 m/s to one of nine locations determined by a combination of three different intended impact heights and three different directions (left, center, or right) based on subject anthropometrics. Joint kinematics and angular excursions of the ankles, knees, hips, lumbar spine, elbows, and shoulders were assessed. Results: The change in joint excursions from initial posture to the interception of the virtual dodgeball were averaged across trials. Separate repeated-measures ANOVAs revealed greater excursions of the ankle (P=.010), knee (P=.001), hip (P=.0014), spine (P=.001), and shoulder (P=.001) joints while playing virtual dodgeball in the first versus third-person perspective. Aligning with the expectations, there was a significant effect of impact height on joint excursions. Conclusions: As clinicians develop treatment strategies in virtual reality to shape motion in orthopedic populations, it is important to be aware that changes in avatar perspective can significantly influence motor behavior. These data are important for the development of virtual reality assessment and treatment tools that are becoming increasingly practical for home and clinic-based rehabilitation. ", doi="10.2196/18888", url="http://games.jmir.org/2020/3/e18888/", url="http://www.ncbi.nlm.nih.gov/pubmed/32812885" } @Article{info:doi/10.2196/17289, author="Haghighi Osgouei, Reza and Soulsby, David and Bello, Fernando", title="Rehabilitation Exergames: Use of Motion Sensing and Machine Learning to Quantify Exercise Performance in Healthy Volunteers", journal="JMIR Rehabil Assist Technol", year="2020", month="Aug", day="18", volume="7", number="2", pages="e17289", keywords="rehabilitation exergames", keywords="performance assessment", keywords="similarity score", keywords="motion sensing", keywords="machine learning", keywords="dynamic time warping", keywords="hidden Markov model", abstract="Background: Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well patients are performing the prescribed tasks. The absence of proper feedback might result in patients performing the exercises incorrectly, which could worsen their condition. We present an approach to generate performance scores to enable tracking the progress by both the patient at home and the physiotherapist in the clinic. Objective: This study aims to propose the use of 2 machine learning algorithms, dynamic time warping (DTW) and hidden Markov model (HMM), to quantitatively assess the patient's performance with respect to a reference. Methods: Movement data were recorded using a motion sensor (Kinect V2), capable of detecting 25 joints in the human skeleton model, and were compared with those of a reference. A total of 16 participants were recruited to perform 4 different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand exercises. Their performance was compared with that of a physiotherapist as a reference. Results: Both algorithms showed a similar trend in assessing participant performance. However, their sensitivity levels were different. Although DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details. Conclusions: The chosen algorithms demonstrated their capacity to objectively assess the performance of physical therapy. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whereas DTW could be used later to focus on the details. The scores enable the patient to monitor their daily performance. They can also be reported back to the physiotherapist to track and assess patient progress, provide feedback, and adjust the exercise program if needed. ", doi="10.2196/17289", url="http://rehab.jmir.org/2020/2/e17289/", url="http://www.ncbi.nlm.nih.gov/pubmed/32808932" } @Article{info:doi/10.2196/17799, author="Hennessy, White Rebecca and Rumble, Deanna and Christian, Mike and Brown, A. David and Trost, Zina", title="A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design", journal="JMIR Serious Games", year="2020", month="Aug", day="10", volume="8", number="3", pages="e17799", keywords="virtual reality", keywords="chronic low back pain", keywords="walking", keywords="rehabilitation", keywords="virtual reality exposure therapy", abstract="Background: Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP. Objective: This study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities. Methods: We recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up. Results: The 12 participants who completed the study period assigned higher avoidance (P=.002), expected pain (P=.002), and expected concern (P=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; P=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (P=.20) nor pain-related fear (P=.58) changed significantly across sessions. Conclusions: The GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely. ", doi="10.2196/17799", url="http://games.jmir.org/2020/3/e17799/", url="http://www.ncbi.nlm.nih.gov/pubmed/32773381" } @Article{info:doi/10.2196/16862, author="Petersen, Lee Curtis and Halter, Ryan and Kotz, David and Loeb, Lorie and Cook, Summer and Pidgeon, Dawna and Christensen, C. Brock and Batsis, A. John", title="Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="7", volume="8", number="8", pages="e16862", keywords="aged adults", keywords="sarcopenia", keywords="remote sensing technology", keywords="telemedicine", keywords="mobile phone", abstract="Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40\% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process. Objective: This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in NLP and sentiment analysis Methods: Through a user-centered design process, we conducted semistructured interviews during the development of a geriatric-friendly Bluetooth-connected resistance exercise band app. We interviewed patients and clinicians at weeks 0, 5, and 10 of the app development. Each semistructured interview consisted of heuristic evaluations, cognitive walkthroughs, and observations. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. Sentiment was defined as the sum of positive and negative words (each word with a +1 or ?1 value). To assess utility, we used quantitative assessment questionnaires---System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). Finally, we used multivariate linear models---adjusting for age, sex, subject group (clinician vs patient), and development---to explore the association between sentiment analysis and SUS and USE outcomes. Results: The mean age of the 22 participants was 68 (SD 14) years, and 17 (77\%) were female. The overall mean SUS and USE scores were 66.4 (SD 13.6) and 41.3 (SD 15.2), respectively. Both patients and clinicians provided valuable insights into the needs of older adults when designing and building an app. The mean positive-negative sentiment per sentence was 0.19 (SD 0.21) and 0.47 (SD 0.21) for patient and clinician interviews, respectively. We found a positive association with positive sentiment in an interview and SUS score ({\ss}=1.38; 95\% CI 0.37 to 2.39; P=.01). There was no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Conclusions: Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults. ", doi="10.2196/16862", url="https://mhealth.jmir.org/2020/8/e16862", url="http://www.ncbi.nlm.nih.gov/pubmed/32540843" } @Article{info:doi/10.2196/15335, author="Rossen, Sine and Kayser, Lars and Vibe-Petersen, Jette and Christensen, Frank Jesper and Ried-Larsen, Mathias", title="Cancer Survivors' Receptiveness to Digital Technology--Supported Physical Rehabilitation and the Implications for Design: Qualitative Study", journal="J Med Internet Res", year="2020", month="Aug", day="5", volume="22", number="8", pages="e15335", keywords="cancer", keywords="rehabilitation", keywords="physical activity", keywords="digital technology", abstract="Background: Physical activity is associated with a positive prognosis in cancer survivors and may decrease the risk of adverse effects of treatment. Accordingly, physical activity programs are recommended as a part of cancer rehabilitation services. Digital technology may support cancer survivors in increasing their level of physical activity and increase the reach or efficiency of cancer rehabilitation services, yet it also comes with a range of challenges. Objective: The aim of this qualitative study was to explore cancer survivors' receptiveness to using digital technology as a mode of support to increase their physical activity in a municipality-based cancer rehabilitation setting. Methods: Semistructured interviews were conducted with 11 cancer survivors (3 males, 8 females, age range 32-82 years) who were referred for cancer rehabilitation and had participated in a questionnaire survey using the Readiness and Enablement Index for Health Technology (READHY) questionnaire. Data analysis was based on the content analysis method. Results: Two themes were identified as important for the interviewees' receptiveness to using digital technology services in connection with their physical activity during rehabilitation: their attitude toward physical activity and their attitude toward digital technology--assisted physical activity. Our results indicated that it is important to address the cancer survivors' motivation for using technology for physical activity and their individual preferences in terms of the following: (1) incidental or structured (eg, cardiovascular and strength exercises or disease-specific rehabilitative exercises) physical activity; (2) social or individual context; and (3) instruction (know-how) or information (know-why). Conclusions: The identified preferences provide new insight that complements the cancer survivors' readiness level and can likely help designers, service providers, and caregivers provide solutions that increase patient receptiveness toward technology-assisted physical activity. Combining digital technology informed by cancer survivors' needs, preferences, and readiness with the capacity building of the workforce can aid in tailoring digital solutions to suit not only individuals who are receptive to using such technologies but also those reluctant to do so. ", doi="10.2196/15335", url="https://www.jmir.org/2020/8/e15335", url="http://www.ncbi.nlm.nih.gov/pubmed/32755892" } @Article{info:doi/10.2196/16596, author="Kwan, YC Rick and Lee, Deborah and Lee, H. Paul and Tse, Mimi and Cheung, SK Daphne and Thiamwong, Ladda and Choi, Kup-Sze", title="Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="31", volume="8", number="7", pages="e16596", keywords="cognitive frailty", keywords="brisk walking", keywords="smartphone", keywords="moderate-to-vigorous physical activity", keywords="older people", abstract="Background: Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. Objective: We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. Methods: An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ?60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. Results: We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85\%). The recruitment rate was 33\% (33/99), the participant retention rate was 91\% (30/33), and the attendance rate of all the face-to-face sessions was 100\% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1\%). ActiGraph (58/66 days, 88\%) and smartphone (54/56 days, 97\%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. Conclusions: Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects. Trial Registration: HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756 ", doi="10.2196/16596", url="https://mhealth.jmir.org/2020/7/e16596", url="http://www.ncbi.nlm.nih.gov/pubmed/32735218" } @Article{info:doi/10.2196/17036, author="Signal, June Nada Elizabeth and McLaren, Ruth and Rashid, Usman and Vandal, Alain and King, Marcus and Almesfer, Faisal and Henderson, Jeanette and Taylor, Denise", title="Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="29", volume="8", number="7", pages="e17036", keywords="stroke", keywords="rehabilitation", keywords="physical activity", keywords="movement", keywords="disability", keywords="technology", keywords="upper limb", keywords="wearable", keywords="haptic", keywords="nudge", abstract="Background: As many as 80\% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. Objective: This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. Methods: A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a ``Planned Nudge'' to the odds of affected limb movement during the observation period following ``No Nudge.'' Results: The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95\% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95\% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95\% CI 0.99-1.29, P=.07). Conclusions: Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. Trial Registration: Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687\&isReview=true ", doi="10.2196/17036", url="https://mhealth.jmir.org/2020/7/e17036", url="http://www.ncbi.nlm.nih.gov/pubmed/32723718" } @Article{info:doi/10.2196/17032, author="Chen, Yu-Pin and Lin, Chung-Ying and Tsai, Ming-Jr and Chuang, Tai-Yuan and Lee, Kuang-Sheng Oscar", title="Wearable Motion Sensor Device to Facilitate Rehabilitation in Patients With Shoulder Adhesive Capsulitis: Pilot Study to Assess Feasibility", journal="J Med Internet Res", year="2020", month="Jul", day="23", volume="22", number="7", pages="e17032", keywords="motion sensor", keywords="adhesive capsulitis", keywords="rehabilitation", keywords="home-based exercise", keywords="telerehabilitation", keywords="telehealth, telemonitoring", abstract="Background: Adhesive capsulitis (AC) of the shoulder is a common disorder that painfully reduces the shoulder range of motion (ROM) among middle-aged individuals. Although physical therapy with home-based exercises is widely advised to restore ROM in the treatment of AC, clinical results vary owing to inconsistent patient compliance. Objective: In this study, we aimed to verify the feasibility of a treatment model that involves applying a wearable motion sensor device to assist patients conduct home-based exercises to improve training compliance and the accuracy of exercises, with the ultimate goal of improving the functional recovery of patients with AC. Methods: The motion sensor device was comprised of inertial measurement unit--based sensors and mobile apps for patients and physicians, offering shoulder mobility tracing, home-based exercise support, and progress monitoring. The interrater reliability of shoulder mobility measurement using the motion sensor device on 10 healthy participants and 15 patients with AC was obtained using an intraclass correlation coefficient analysis and compared with the assessments performed by two highly experienced physicians. A pilot prospective control trial was then carried out to allocate the 15 patients with AC to two groups: home-based exercise group and motion sensor--assisted rehabilitation group. Changes in active and passive shoulder ROM, pain and functional scores, and exercise completion rates were compared between the groups during a treatment period of 3 months. Results: Shoulder ROM, as measured using the motion sensor device, exhibited good to excellent reliability based on the comparison with the measurements of two physicians (intraclass correlation coefficient range, 0.771 to 0.979). Compared with patients with AC in the home-based exercise group, those in the motion sensor--assisted rehabilitation group exhibited better shoulder mobility and functional recovery and a higher exercise completion rate during and after 3 months of rehabilitation. Conclusions: Motion sensor device--assisted home-based rehabilitation for the treatment of AC is a useful treatment model for telerehabilitation that enhances the compliance of patients through training, thus improving functional recovery. This helps overcome important obstacles in physiotherapy at home by providing comprehensible and easily accessible exercise instructions, enhancing compliance, ensuring the correctness of exercise, and monitoring the progress of patients. ", doi="10.2196/17032", url="http://www.jmir.org/2020/7/e17032/", url="http://www.ncbi.nlm.nih.gov/pubmed/32457026" } @Article{info:doi/10.2196/16380, 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/10.2196/19582, author="Langan, Jeanne and Bhattacharjya, Sutanuka and Subryan, Heamchand and Xu, Wenyao and Chen, Baicheng and Li, Zhengxiong and Cavuoto, Lora", title="In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e19582", keywords="stroke", keywords="rehabilitation", keywords="smart technology", keywords="3D printing", keywords="usability", abstract="Background: Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback. Objective: To examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments. Methods: mRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user's perception of mRehab. Results: A total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant's perception of mRehab was positive. Conclusions: Despite heterogeneity in participants' use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ", doi="10.2196/19582", url="http://mhealth.jmir.org/2020/7/e19582/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706702" } @Article{info:doi/10.2196/18584, author="De Oliveira Silva, Danilo and Pazzinatto, F. Marcella and Crossley, M. Kay and Azevedo, M. Fabio and Barton, J. Christian", title="Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study", journal="J Med Internet Res", year="2020", month="Jul", day="22", volume="22", number="7", pages="e18584", keywords="pain", keywords="internet", keywords="knee", keywords="rehabilitation", keywords="eHealth", abstract="Background: Patellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation. Objective: This study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care. Methods: Phase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks. Results: A total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100\% (35/35) and 88\% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20\% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93\% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40\% (14/35) of the participants following phase 1 and 71\% (25/35) of the participants following phase 2. Conclusions: Self-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20\% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP. ", doi="10.2196/18584", url="http://www.jmir.org/2020/7/e18584/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706674" } @Article{info:doi/10.2196/18232, author="Mohsen, Hanaa and Samy, Omnya", title="Effect of Platform Swing Walkway on Locomotor Behavior in Children With Diplegic Cerebral Palsy: Randomized Controlled Trial", journal="JMIR Biomed Eng", year="2020", month="Jul", day="21", volume="5", number="1", pages="e18232", keywords="cerebral palsy", keywords="platform swing walkway", keywords="spastic diplegia", abstract="Background: Limited attention has been given to the effectiveness of the platform swing walkway, which is a common way to improve gait pattern through activation of sensory stimuli (visual, auditory, vestibular, and somatosensory). Objective: The objective of this study was to determine the effect of a platform swing walkway on gait parameters in children with diplegic cerebral palsy (CP). Methods: A total of 30 children of both sexes (aged 6-8 years) with diplegic CP were enrolled in this study. They were randomly assigned into two groups of equal number: the control group (n=15) and the study group (n=15). The control group received the conventional physical therapy plan, whereas the study group received the same conventional physical therapy program in addition to gait training on a platform swing walkway. Temporal parameters during the gait cycle were collected using gait tracker video analysis, and the Growth Motor Function Measure Scale (GMFM-88) was used to assess standing and walking (Dimensions D and E) before and after the treatment program. Results: A statistically significant improvement in both groups was noted when comparing the mean values of all measured variables before and after treatment (P?.05). There were significant differences between the control and study groups with respect to all measured variables, which favored the study group when comparing the posttreatment outcomes (P?.05). Conclusions: Results suggest that gait training on platform swing walkways can be included as an alternative therapeutic modality to enhance gait parameters and gross motor function in children with diplegic CP. Trial Registration: ClinicalTrials.gov NTC04246658; https://clinicaltrials.gov/ct2/show/NTC04246658 ", doi="10.2196/18232", url="http://biomedeng.jmir.org/2020/1/e18232/" } @Article{info:doi/10.2196/16991, author="Naeemabadi, MReza and Fazlali, Hesam and Najafi, Samira and Dinesen, Birthe and Hansen, John", title="Telerehabilitation for Patients With Knee Osteoarthritis: A Focused Review of Technologies and Teleservices", journal="JMIR Biomed Eng", year="2020", month="Jul", day="21", volume="5", number="1", pages="e16991", keywords="telemedicine", keywords="telerehabilitation", keywords="communication technologies", keywords="knee osteoarthritis", keywords="total knee replacement", abstract="Background: Telerehabilitation programs are designed with the aim of improving the quality of services as well as overcoming existing limitations in terms of resource management and accessibility of services. This review will collect recent studies investigating telerehabilitation programs for patients with knee osteoarthritis while focusing on the technologies and services provided in the programs. Objective: The main objective of this review is to identify and discuss the modes of service delivery and technologies in telerehabilitation programs for patients with knee osteoarthritis. The gaps, strengths, and weaknesses of programs will be discussed individually. Methods: Studies published in English since 2000 were retrieved from the EMBASE, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Physiotherapy Evidence Database (PEDro), and PsycINFO databases. The search words ``telerehabilitation,'' ``telehealth,'' ``telemedicine,'' ``teletherapy,'' and ``ehealth'' were combined with ``knee'' and ``rehabilitation'' to generate a data set of studies for screening and review. The final group of studies reviewed here includes those that implemented teletreatment for patients for at least 2 weeks of rehabilitation. Results: In total, 1198 studies were screened, and the full text of 154 studies was reviewed. Of these, 38 studies were included, and data were extracted accordingly. Four modes of telerehabilitation service delivery were identified: phone-based, video-based, sensor-based, and expert system--based telerehabilitation. The intervention services provided in the studies included information, training, communication, monitoring, and tracking. Video-based telerehabilitation programs were frequently used. Among the identified services, information and educational material were introduced in only one-quarter of the studies. Conclusions: Video-based telerehabilitation programs can be considered the best alternative solution to conventional treatment. This study shows that, in recent years, sensor-based solutions have also become more popular due to rapid developments in sensor technology. Nevertheless, communication and human-generated feedback remain as important as monitoring and intervention services. ", doi="10.2196/16991", url="http://biomedeng.jmir.org/2020/1/e16991/" } @Article{info:doi/10.2196/17216, author="Chae, Hoon Sang and Kim, Yushin and Lee, Kyoung-Soub and Park, Hyung-Soon", title="Development and Clinical Evaluation of a Web-Based Upper Limb Home Rehabilitation System Using a Smartwatch and Machine Learning Model for Chronic Stroke Survivors: Prospective Comparative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="9", volume="8", number="7", pages="e17216", keywords="home-based rehabilitation", keywords="artificial intelligence", keywords="machine learning", keywords="wearable device", keywords="smartwatch", keywords="chronic stroke", abstract="Background: Recent advancements in wearable sensor technology have shown the feasibility of remote physical therapy at home. In particular, the current COVID-19 pandemic has revealed the need and opportunity of internet-based wearable technology in future health care systems. Previous research has shown the feasibility of human activity recognition technologies for monitoring rehabilitation activities in home environments; however, few comprehensive studies ranging from development to clinical evaluation exist. Objective: This study aimed to (1) develop a home-based rehabilitation (HBR) system that can recognize and record the type and frequency of rehabilitation exercises conducted by the user using a smartwatch and smartphone app equipped with a machine learning (ML) algorithm and (2) evaluate the efficacy of the home-based rehabilitation system through a prospective comparative study with chronic stroke survivors. Methods: The HBR system involves an off-the-shelf smartwatch, a smartphone, and custom-developed apps. A convolutional neural network was used to train the ML algorithm for detecting home exercises. To determine the most accurate way for detecting the type of home exercise, we compared accuracy results with the data sets of personal or total data and accelerometer, gyroscope, or accelerometer combined with gyroscope data. From March 2018 to February 2019, we conducted a clinical study with two groups of stroke survivors. In total, 17 and 6 participants were enrolled for statistical analysis in the HBR group and control group, respectively. To measure clinical outcomes, we performed the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment of Upper Extremity, grip power test, Beck Depression Inventory, and range of motion (ROM) assessment of the shoulder joint at 0, 6, and 12 months, and at a follow-up assessment 6 weeks after retrieving the HBR system. Results: The ML model created with personal data involving accelerometer combined with gyroscope data (5590/5601, 99.80\%) was the most accurate compared with accelerometer (5496/5601, 98.13\%) or gyroscope data (5381/5601, 96.07\%). In the comparative study, the drop-out rates in the control and HBR groups were 40\% (4/10) and 22\% (5/22) at 12 weeks and 100\% (10/10) and 45\% (10/22) at 18 weeks, respectively. The HBR group (n=17) showed a significant improvement in the mean WMFT score (P=.02) and ROM of flexion (P=.004) and internal rotation (P=.001). The control group (n=6) showed a significant change only in shoulder internal rotation (P=.03). Conclusions: This study found that a home care system using a commercial smartwatch and ML model can facilitate participation in home training and improve the functional score of the WMFT and shoulder ROM of flexion and internal rotation in the treatment of patients with chronic stroke. This strategy can possibly be a cost-effective tool for the home care treatment of stroke survivors in the future. Trial Registration: Clinical Research Information Service KCT0004818; https://tinyurl.com/y92w978t ", doi="10.2196/17216", url="http://mhealth.jmir.org/2020/7/e17216/", url="http://www.ncbi.nlm.nih.gov/pubmed/32480361" } @Article{info:doi/10.2196/19116, author="Li, C. Linda and Feehan, M. Lynne and Xie, Hui and Lu, Na and Shaw, D. Christopher and Gromala, Diane and Zhu, Siyi and Avi{\~n}a-Zubieta, Antonio J. and Hoens, M. Alison and Koehn, Cheryl and Tam, Johnathan and Therrien, Stephanie and Townsend, F. Anne and Noonan, Gregory and Backman, L. Catherine", title="Effects of a 12-Week Multifaceted Wearable-Based Program for People With Knee Osteoarthritis: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="3", volume="8", number="7", pages="e19116", keywords="physical activity", keywords="counseling", keywords="knee osteoarthritis", keywords="physiotherapy", keywords="wearables", abstract="Background: Current guidelines emphasize an active lifestyle in the management of knee osteoarthritis (OA), but up to 90\% of patients with OA are inactive. In a previous study, we demonstrated that an 8-week physiotherapist (PT)-led counseling intervention, with the use of a Fitbit, improved step count and quality of life in patients with knee OA, compared with a control. Objective: This study aimed to examine the effect of a 12-week, multifaceted wearable-based program on physical activity and patient outcomes in patients with knee OA. Methods: This was a randomized controlled trial with a delay-control design. The immediate group (IG) received group education, a Fitbit, access to FitViz (a Fitbit-compatible app), and 4 biweekly phone calls from a PT over 8 weeks. Participants then continued using Fitbit and FitViz independently up to week 12. The delay group (DG) received a monthly electronic newsletter in weeks 1 to 12 and started the same intervention in week 14. Participants were assessed in weeks 13, 26, and 39. The primary outcome was time spent in daily moderate-to-vigorous physical activity (MVPA; in bouts ?10 min) measured with a SenseWear Mini. Secondary outcomes included daily steps, time spent in purposeful activity and sedentary behavior, Knee Injury and OA Outcome Score, Patient Health Questionnaire-9, Partners in Health Scale, Theory of Planned Behavior Questionnaire, and Self-Reported Habit Index. Results: We enrolled 51 participants (IG: n=26 and DG: n=25). Compared with the IG, the DG accumulated significantly more MVPA time at baseline. The adjusted mean difference in MVPA was 13.1 min per day (95\% CI 1.6 to 24.5). A significant effect was also found in the adjusted mean difference in perceived sitting habit at work (0.7; 95\% CI 0.2 to 1.2) and during leisure activities (0.7; 95\% CI 0.2 to 1.2). No significant effect was found in the remaining secondary outcomes. Conclusions: A 12-week multifaceted program with the use of a wearable device, an app, and PT counseling improved physical activity in people with knee OA. Trial Registration: ClinicalTrials.gov NCT02585323; https://clinicaltrials.gov/ct2/show/NCT02585323 ", doi="10.2196/19116", url="https://mhealth.jmir.org/2020/7/e19116", url="http://www.ncbi.nlm.nih.gov/pubmed/32618578" } @Article{info:doi/10.2196/18415, author="Lai, Byron and Chiu, Chia-Ying and Pounds, Emily and Tracy, Tracy and Mehta, Tapan and Young, Hui-Ju and Riser, Emily and Rimmer, James", title="COVID-19 Modifications for Remote Teleassessment and Teletraining of a Complementary Alternative Medicine Intervention for People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2020", month="Jul", day="3", volume="9", number="7", pages="e18415", keywords="multiple sclerosis", keywords="telerehabilitation", keywords="teletraining", keywords="physical activity", keywords="disability", keywords="tele-exercise", keywords="telehealth", keywords="COVID-19", abstract="Background: Access to comprehensive exercise and rehabilitation services for people with multiple sclerosis (MS) remains a major challenge, especially in rural, low-income areas. Hence, the Tele-Exercise and Multiple Sclerosis (TEAMS) study aims to provide patient-centered, coordinated care by implementing a 12-week complementary and alternative medicine (CAM) intervention for adults with MS. However, due to the societal impact of coronavirus disease (COVID-19) in mid-March 2020, the University of Alabama at Birmingham announced a limited business model halting all nonessential research requiring on-site visits, which includes the TEAMS study. Objective: In compliance with the shelter-in-place policy and quarantine guidance, a modified testing and training protocol was developed to allow participants to continue the study. Methods: The modified protocol, which replaces on-site data collection and training procedures, includes a teleassessment package (computer tablet, blood pressure cuff, hand dynamometer, mini disc cone, measuring tape, an 8'' step, and a large-print 8'' {\texttimes} 11'' paper with ruler metrics and wall-safe tape) and a virtual meeting platform for synchronous interactive training between the therapist and the participant. The teleassessment measures include resting blood pressure and heart rate, grip strength, Five Times Sit to Stand, Timed Up \& Go, and the Berg Balance Scale. The teletraining component includes 20 sessions of synchronous training sessions of dual tasking, yoga, and Pilates exercises designed and customized for a range of functional levels. Teletraining lasts 12 weeks and participants are instructed to continue exercising for a posttraining period of 9 months. Results: The protocol modifications were supported with supplemental funding (from the Patient-Centered Outcomes Research Institute) and approved by the University Institutional Review Board for Human Use. At the time nonessential research visits were halted by the university, there were 759 people enrolled and baseline tested, accounting for 92.5\% of our baseline testing completion target (N=820). Specifically, 325 participants completed the 12-week intervention and follow-up testing visits, and 289 participants needed to complete either the intervention or follow-up assessments. A modified analysis plan will include sensitivity analyses to ensure the robustness of the study results in the presence of uncertainty and protocol deviations. Study results are projected to be published in 2021. Conclusions: This modified remote teleassessment/teletraining protocol will impact a large number of participants with MS who would otherwise have been discontinued from the study. Trial Registration: ClinicalTrials.gov NCT03117881; https://clinicaltrials.gov/ct2/show/NCT03117881 International Registered Report Identifier (IRRID): DERR1-10.2196/18415 ", doi="10.2196/18415", url="https://www.researchprotocols.org/2020/7/e18415", url="http://www.ncbi.nlm.nih.gov/pubmed/32540838" } @Article{info:doi/10.2196/16354, author="Radha, Mustafa and den Boer, Niels and Willemsen, C. Martijn and Paardekooper, Thom and IJsselsteijn, A. Wijnand and Sartor, Francesco", title="Assisting Home-Based Resistance Training for Normotensive and Prehypertensive Individuals Using Ambient Lighting and Sonification Feedback: Sensor-Based System Evaluation", journal="JMIR Cardio", year="2020", month="Jun", day="29", volume="4", number="1", pages="e16354", keywords="hypertension", keywords="sonification", keywords="respiratory guidance", keywords="intrinsic motivation", keywords="physical exertion", abstract="Background: Physical exercise is an effective lifestyle intervention to improve blood pressure. Although aerobic sports can be performed anywhere, resistance exercises are traditionally performed at the gym; extending the latter to the home setting may promote an increase in the number of practitioners. Objective: This study aims to evaluate a sensor-based system that guides resistance exercises through ambient lighting and sonification (A/S) feedback in a home setting in 34 study participants who were normotensive and prehypertensive. Methods: Participants took part in a 1.5-hour exercise session in which they experienced the A/S feedback (ie, experimental condition) as well as a control condition (ie, no feedback) and a reference condition (ie, verbal feedback through a human remote coach). The system was evaluated for improving exercise form (range of motion, timing, and breathing patterns) as well as psychophysiological experience (perceived exertion, attentional focus, competence, and motivation). Results: A/S feedback was significantly better than the control for concentric (mean 2.48, SD 0.75 seconds; P<.001) and eccentric (mean 2.92, SD 1.05 seconds; P<.001) contraction times, concentric range of motion consistency (mean 15.64, SD 8.31 cm vs mean 17.94, SD 9.75 cm; P<.001), and perceived exertion (mean 3.37, SD 0.78 vs mean 3.64, SD 0.76; P<.001). However, A/S feedback did not outperform verbal feedback on any of these measures. The breathing technique was best in the control condition (ie, without any feedback). Participants did not show more positive changes in perceived competence with A/S feedback or verbal feedback. Conclusions: The system seemed to improve resistance exercise execution and perception in comparison with the control, but did not outperform a human tele-coach. Further research is warranted to improve the breathing technique. ", doi="10.2196/16354", url="https://cardio.jmir.org/2020/1/e16354", url="http://www.ncbi.nlm.nih.gov/pubmed/32597789" } @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/10.2196/15015, author="Kelechi, J. Teresa and Prentice, A. Margaret and Mueller, Martina and Madisetti, Mohan and Vertegel, Alexey", title="A Lower Leg Physical Activity Intervention for Individuals With Chronic Venous Leg Ulcers: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="15", volume="8", number="5", pages="e15015", keywords="leg ulcer", keywords="physical activity", keywords="exercise", keywords="mHealth", keywords="adherence", keywords="randomized controlled trial", keywords="feasibility", abstract="Background: Individuals with venous leg ulcers (VLUs) suffer disproportionately with multiple chronic conditions, are often physically deconditioned, and demonstrate high levels of physical inactivity. Objective: The primary objective of this randomized controlled trial was to establish the feasibility of a mobile health (mHealth) physical activity exercise app for individuals with VLUs to improve lower leg function. Methods: In a 6-week study, adults with VLUs were recruited from 2 wound centers in South Carolina, United States, and enrolled if they were aged 18 years or older with impaired functional mobility and an ankle-brachial index between 0.8 and 1.3. Participants were randomized 1:1 to receive evidence-based, phased, nonexertive physical conditioning activities for lower leg function (FOOTFIT) or FOOTFIT+ with an added patient-provider communication feature. The mHealth Conditioning Activities for Lower Leg Function app also provided automated educational and motivational messages and user reports. Foot movement on the VLU-affected leg was tracked by a Bluetooth-enabled triaxial accelerometer. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the feasibility of reach, adherence, acceptability, implementation, and maintenance. Results: A total of 24 patients were recruited, enrolled, and randomized in the study. Most patients reported difficulty following the protocol for exercising and using the accelerometer and mobile phone and did not use the provider contact feature. However, all patients were adherent to the 6-week exercise program more than 85\% of the time for duration, whereas 33\% (8/24) of patients adhered more than 85\% for the frequency of performing the exercises. Across the three exercise levels, adherence did not differ between the two groups. Confidence limits around the difference in proportions ranged from ?0.4 to 0.7. Providers in FOOTFIT+ were inconsistent in checking participant progress reports because of lack of time from competing work commitments. The technology became outdated quickly, making maintenance problematic. Participants said they would continue to exercise their foot and legs and liked being able to follow along with the demonstrations of each level of exercise provided through the app. Conclusions: The findings of this study suggest that despite initial interest in using the app, several components of the program as originally designed had limited acceptability and feasibility. Future refinements should include the use of more modern technology including smaller wearable accelerometers, mobile phones or tablets with larger screens, an app designed with larger graphics, automated reporting for providers, and more engaging user features. Trial Registration: ClinicalTrials.gov NTC02632695; https://clinicaltrials.gov/ct2/show/NCT02632695 ", doi="10.2196/15015", url="https://mhealth.jmir.org/2020/5/e15015", url="http://www.ncbi.nlm.nih.gov/pubmed/32412419" } @Article{info:doi/10.2196/18250, author="Bailey, F. Jeannie and Agarwal, Vibhu and Zheng, Patricia and Smuck, Matthew and Fredericson, Michael and Kennedy, J. David and Krauss, Jeffrey", title="Digital Care for Chronic Musculoskeletal Pain: 10,000 Participant Longitudinal Cohort Study", journal="J Med Internet Res", year="2020", month="May", day="11", volume="22", number="5", pages="e18250", keywords="musculoskeletal pain", keywords="low back pain", keywords="patient engagement", keywords="exercise therapy", keywords="telemedicine", keywords="telerehabilitation", keywords="mobile phone", abstract="Background: Chronic musculoskeletal pain has a vast global prevalence and economic burden. Conservative therapies are universally recommended but require patient engagement and self-management to be effective. Objective: This study aimed to evaluate the efficacy of a 12-week digital care program (DCP) in a large population of patients with chronic knee and back pain. Methods: A longitudinal observational study was conducted using a remote DCP available through a mobile app. Subjects participated in a 12-week multimodal DCP incorporating education, sensor-guided exercise therapy (ET), and behavioral health support with 1-on-1 remote health coaching. The primary outcome was pain measured by the visual analog scale (VAS). Secondary measures included engagement levels, program completion, program satisfaction, condition-specific pain measures, depression, anxiety, and work productivity. Results: A total of 10,264 adults with either knee (n=3796) or low back (n=6468) pain for at least three months were included in the study. Participants experienced a 68.45\% average improvement in VAS pain between baseline intake and 12 weeks. In all, 73.04\% (7497/10,264) participants completed the DCP into the final month. In total, 78.60\% (5893/7497) of program completers (7144/10,264, 69.60\% of all participants) achieved minimally important change in pain. Furthermore, the number of ET sessions and coaching interactions were both positively associated with improvement in pain, suggesting that the amount of engagement influenced outcomes. Secondary outcomes included a 57.9\% and 58.3\% decrease in depression and anxiety scores, respectively, and 61.5\% improvement in work productivity. Finally, 3 distinct clusters of pain response trajectories were identified, which could be predicted with a mean 76\% accuracy using baseline measures. Conclusions: These results support the efficacy and scalability of a DCP for chronic low back and knee pain in a large, diverse, real-world population. Participants demonstrated high completion and engagement rates and a significant positive relationship between engagement and pain reduction was identified, a finding that has not been previously demonstrated in a DCP. Furthermore, the large sample size allowed for the identification of distinct pain response subgroups, which may prove beneficial in predicting recovery and tailoring future interventions. This is the first longitudinal digital health study to analyze pain outcomes in a sample of this magnitude, and it supports the prospect for DCPs to serve the overwhelming number of musculoskeletal pain sufferers worldwide. ", doi="10.2196/18250", url="https://www.jmir.org/2020/5/e18250", url="http://www.ncbi.nlm.nih.gov/pubmed/32208358" } @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/10.2196/14139, 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/10.2196/14182, author="Brauner, Philipp and Ziefle, Martina", title="Serious Motion-Based Exercise Games for Older Adults: Evaluation of Usability, Performance, and Pain Mitigation", journal="JMIR Serious Games", year="2020", month="Apr", day="1", volume="8", number="2", pages="e14182", keywords="serious games", keywords="exercise game", keywords="health care", keywords="pain", keywords="ambient assisted living", keywords="technology acceptance", abstract="Background: Many societies are facing demographic changes that challenge the viability of health and welfare systems. Serious games for health care and ambient assisted living (AAL) offer health benefits and support for older adults and may mitigate some of the negative effects of the demographic shift. Objective: This study aimed to examine the acceptance of serious games to promote physical health in AAL environments. Since AAL environments are designed specifically to support independent living in older adults, we studied the relationship among age and user diversity, performance in the game, and overall usability and acceptance evaluation. Methods: We developed a motion-based serious exercise game for prototypical AAL environments. In two evaluations, outside (n=71) and within (n=64) the AAL environment, we investigated the influence of age, gender, self-efficacy in interacting with technology, need for achievement on performance, effect of the game, usability evaluation of the game, and overall acceptance. Results: Both games were evaluated as easy to use and fun to play. Both game interventions had a strong pain-mitigating effect in older adults (game 1: ?55\%, P=.002; game 2: ?66\%, P=.01). Conclusions: Serious exercise games outside and inside AAL environments can contribute to individuals' health and well-being and to the stability of health care systems. ", doi="10.2196/14182", url="https://games.jmir.org/2020/2/e14182", url="http://www.ncbi.nlm.nih.gov/pubmed/32234703" } @Article{info:doi/10.2196/14435, author="Kim, Yoon and Seo, Jinserk and An, So-Yeon and Sinn, Hyun Dong and Hwang, Hye Ji", title="Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Mar", day="11", volume="8", number="3", pages="e14435", keywords="mHealth", keywords="hepatocellular carcinoma", keywords="rehabilitation", keywords="exercise", keywords="physical fitness", keywords="physical activity", abstract="Background: Exercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients. Objective: The aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients. Methods: A total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants' physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted. Results: Of the 37 patients, 31 (84\%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration. Conclusions: Following 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy. ", doi="10.2196/14435", url="http://mhealth.jmir.org/2020/3/e14435/", url="http://www.ncbi.nlm.nih.gov/pubmed/32159517" } @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/10.2196/13441, author="Cole, Maria and Froehlich-Grobe, Katherine and Driver, Simon and Shegog, Ross and McLaughlin, Jeffery", title="Website Redesign of a 16-Week Exercise Intervention for People With Spinal Cord Injury by Using Participatory Action Research", journal="JMIR Rehabil Assist Technol", year="2019", month="Dec", day="17", volume="6", number="2", pages="e13441", keywords="internet", keywords="exercise", keywords="intervention", keywords="spinal cord injury", keywords="community-based research", abstract="Background: People with spinal cord injury (SCI) are at higher risk for numerous preventable chronic conditions. Physical activity is a protective factor that can reduce this risk, yet those with SCI encounter barriers to activity and are significantly less likely to be active. Limited evidence supports approaches to promote increased physical activity for those with SCI. Objective: Building upon our previous theory- and evidence-based approach to increase participation in regular physical activity for those with SCI, this study aimed to use a participatory action research approach to translate a theory-based intervention to be delivered via the Web to individuals with SCI. Methods: A total of 10 individuals with SCI were invited to participate in consumer input meetings to provide the research team with iterative feedback on an initial website designed as a platform for delivering a theory-based exercise intervention. Results: A total of 7 individuals with SCI whose average age was 43.6 years (SD 13.4) and lived an average age of 12.5 years (SD 14.9) with SCI met on 2 occasions to provide their feedback of the website platform, both on the initial design and subsequently on the revamped site. Their iterative feedback resulted in redesigning the website content, format, and functionality as well as delivery of the intervention program. Conclusions: The substantially redesigned website offers an easier-to-navigate platform for people with SCI with greater functionality that delivers information using a module format with less text, short video segments, and presents more resources. Preliminary testing of the site is the next step. ", doi="10.2196/13441", url="http://rehab.jmir.org/2019/2/e13441/", url="http://www.ncbi.nlm.nih.gov/pubmed/31845902" } @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 \<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/10.2196/14788, author="Wilroy, D. Jereme and Martin Ginis, A. Kathleen and Rimmer, H. James and Wen, Huacong and Howell, Jennifer and Lai, Byron", title="An E-Learning Program for Increasing Physical Activity Associated Behaviors Among People with Spinal Cord Injury: Usability Study", journal="JMIR Form Res", year="2019", month="Aug", day="21", volume="3", number="3", pages="e14788", keywords="physical activity", keywords="mhealth", keywords="ehealth", keywords="people with disabilities", keywords="spinal cord injuries", abstract="Background: The majority of people with spinal cord injury (SCI) in the United States are not meeting the recommended guidelines for regular physical activity. Behavior change techniques (eg, goal setting and action planning) that are framed within the principles of the social cognitive theory (self-efficacy and self-regulation) have the potential to enhance physical activity behavior. Objective: The aim of the study was to develop and test the usability of an electronic learning (e-learning) program for improving social cognitive factors related to physical activity behavior among people with SCI. Methods: The program was created through an iterative process of development and refinement, using a modification of a similar methodology used to develop evidence-informed guidelines in health promotion for people with disabilities (Guidelines, Recommendations, and Adaptations Including Disability; GRAIDs framework). The study included 4 phases: (1) initial product creation, (2) national survey, (3) expert review, and (4) usability testing. Usability testing included both quantitative and qualitative data collection and analyses. Results: The review of the program by an expert panel (n=5) and the results from a national survey (n=142) led to several refinements. Usability testing demonstrated that the program could be completed in a timely manner (<30 min). Participants reported 5 themes: (1) the program improves social cognitions related to physical activity participation; (2) reflection of physical activity behavior; (3) positive perceptions of the quality of the program; (4) positive perceptions of the program operation and effectiveness; and (5) recommendations for improvement. Each item was incorporated into a revised program version 1.0. Conclusions: This study incorporated an evidence-based framework for developing a brief 30-min e-learning program for increasing the physical activity behavior among people with SCI. The Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling (e-STORIES) program could be completed in a timely manner and was reported by participants as valuable and useful for enhancing intent-to-perform physical activity in individuals with SCI. The program has the potential to be applied in a variety of settings, but feasibility testing is required before implementing in a larger trial. ", doi="10.2196/14788", url="http://formative.jmir.org/2019/3/e14788/", url="http://www.ncbi.nlm.nih.gov/pubmed/31436161" } @Article{info:doi/10.2196/12507, author="Pancer, Max and Manganaro, Melissa and Pace, Isabella and Marion, Patrick and Gagnon, H. Dany and Laram{\'e}e, Marie-Th{\'e}r{\`e}se and Messier, Fr{\'e}d{\'e}ric and Amari, Fatima and Ahmed, Sara", title="A Web-Based Physical Activity Portal for Individuals Living With a Spinal Cord Injury: Qualitative Study", journal="JMIR Form Res", year="2019", month="Jul", day="26", volume="3", number="3", pages="e12507", keywords="spinal cord injuries", keywords="self-management", keywords="internet", keywords="exercise", keywords="motivation", keywords="volition", abstract="Background: The population with a spinal cord injury (SCI) largely remains inactive following discharge from rehabilitation despite evidence on the benefits of physical activity. These individuals need to develop skills to self-manage their condition in order to prevent secondary comorbidities and rehospitalization. A Web-based physical activity portal can address this need. Few Web-based interventions incorporate theoretical frameworks, behavior change techniques, and modes of delivery into their design. Objective: This study aimed to identify the preferred features of a Web-based self-management physical activity portal through stakeholder engagement with individuals with a spinal cord injury and health care professionals (HCPs). Methods: An interpretative phenomenology methodology and participatory design, along with an integrated knowledge translation approach, were used to conduct this study. Convenience sampling was used to recruit individuals with an SCI living in the community, who were either interested or already engaging in physical activity, and HCPs working with individuals with an SCI, from three city-based rehabilitation sites. Individual 1-hour sessions involving navigation of an existing website and a semistructured interview were conducted with all participants. Individuals with an SCI completed a demographics questionnaire prior to the individual sessions, while demographic information of the HCPs was collected during their interviews. Additionally, all participants were asked a question on their intention to use or recommend a portal. An in-depth thematic analysis was used to derive themes from participants' responses. Results: Thirteen individuals with an SCI and nine HCPs participated in the study. Five core themes emerged: (1) knowledge: guidance and barrier management; (2) possibility of achievement: the risks and benefits of physical activity and modelling; (3) self-regulation strategies: action planning, goal setting, tracking, rewards, and reminders; (4) interactivity: peers and professionals; and (5) format: appearance, language, and ease of use. The mean (median) ratings of the likelihood of promoting and using a Web-based portal tailored to individuals' needs were 9.00 (8.78) and 7.75 (7.88) for HCPs and individuals with an SCI, respectively. Conclusions: This study highlights features of an online self-management platform that can provide individuals with an SCI the motivation and volition to engage in physical activity. These findings will inform the design of a Web-based self-management physical activity portal to increase physical activity adherence and behavior change. ", doi="10.2196/12507", url="http://formative.jmir.org/2019/3/e12507/", url="http://www.ncbi.nlm.nih.gov/pubmed/31350835" } @Article{info:doi/10.2196/12587, author="Dufour, Sin{\'e}ad and Fedorkow, Donna and Kun, Jessica and Deng, Xiaoxuan Shirley and Fang, Qiyin", title="Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="11", volume="7", number="7", pages="e12587", keywords="postpartum", keywords="pelvic floor", keywords="mobile health", keywords="feasibility study", keywords="wireless technology", keywords="wearable technology", keywords="computer games", keywords="biofeedback", abstract="Background: The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective: The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods: A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne's interpretive description approach. Results: A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77\%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77\%), a cumbersome initiation process (n=8, 61\%), and discomfort from the device (n=8, 61\%) were reasons impeding intervention acceptability. Most participants (n=17, 74\%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions: Our pilot study demonstrated the potential for mHealth solution--enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome. Trial Registration: ClinicalTrials.gov NCT02865954;?https://clinicaltrials.gov/ct2/show/NCT02865954 ", doi="10.2196/12587", url="http://mhealth.jmir.org/2019/7/e12587/", url="http://www.ncbi.nlm.nih.gov/pubmed/31298221" } @Article{info:doi/10.2196/14090, author="Ramezani, Ramin and Zhang, Wenhao and Xie, Zhuoer and Shen, John and Elashoff, David and Roberts, Pamela and Stanton, Annette and Eslami, Michelle and Wenger, Neil and Sarrafzadeh, Majid and Naeim, Arash", title="A Combination of Indoor Localization and Wearable Sensor--Based Physical Activity Recognition to Assess Older Patients Undergoing Subacute Rehabilitation: Baseline Study Results", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="10", volume="7", number="7", pages="e14090", keywords="rehabilitation", keywords="frailty", keywords="remote sensing technology", keywords="wearable electronic devices", keywords="fitness trackers", keywords="monitoring ambulatory", keywords="smartwatches", keywords="bluetooth low energy beacons", abstract="Background: Health care, in recent years, has made great leaps in integrating wireless technology into traditional models of care. The availability of ubiquitous devices such as wearable sensors has enabled researchers to collect voluminous datasets and harness them in a wide range of health care topics. One of the goals of using on-body wearable sensors has been to study and analyze human activity and functional patterns, thereby predicting harmful outcomes such as falls. It can also be used to track precise individual movements to form personalized behavioral patterns, to standardize the concept of frailty, well-being/independence, etc. Most wearable devices such as activity trackers and smartwatches are equipped with low-cost embedded sensors that can provide users with health statistics. In addition to wearable devices, Bluetooth low-energy sensors known as BLE beacons have gained traction among researchers in ambient intelligence domain. The low cost and durability of newer versions have made BLE beacons feasible gadgets to yield indoor localization data, an adjunct feature in human activity recognition. In the studies by Moatamed et al and the patent application by Ramezani et al, we introduced a generic framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and extracting indoor localization using BLE beacons, in concert. Objective: The study aimed to examine the ability of combination of physical activity and indoor location features, extracted at baseline, on a cohort of 154 rehabilitation-dwelling patients to discriminate between subacute care patients who are re-admitted to the hospital versus the patients who are able to stay in a community setting. Methods: We analyzed physical activity sensor features to assess activity time and intensity. We also analyzed activities with regard to indoor localization. Chi-square and Kruskal-Wallis tests were used to compare demographic variables and sensor feature variables in outcome groups. Random forests were used to build predictive models based on the most significant features. Results: Standing time percentage (P<.001, d=1.51), laying down time percentage (P<.001, d=1.35), resident room energy intensity (P<.001, d=1.25), resident bed energy intensity (P<.001, d=1.23), and energy percentage of active state (P=.001, d=1.24) are the 5 most statistically significant features in distinguishing outcome groups at baseline. The energy intensity of the resident room (P<.001, d=1.25) was achieved by capturing indoor localization information. Random forests revealed that the energy intensity of the resident room, as a standalone attribute, is the most sensitive parameter in the identification of outcome groups (area under the curve=0.84). Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features at baseline, a subset of which can better distinguish between at-risk patients that can gain independence versus the patients that are rehospitalized. ", doi="10.2196/14090", url="http://mhealth.jmir.org/2019/7/e14090/", url="http://www.ncbi.nlm.nih.gov/pubmed/31293244" } @Article{info:doi/10.2196/13651, author="Pald{\'a}n, Katrin and Simanovski, Jan and Ullrich, Greta and Steinmetz, Martin and Rammos, Christos and J{\'a}nosi, Alexander Rolf and Moebus, Susanne and Rassaf, Tienush and Lortz, Julia", title="Feasibility and Clinical Relevance of a Mobile Intervention Using TrackPAD to Support Supervised Exercise Therapy in Patients With Peripheral Arterial Disease: Study Protocol for a Randomized Controlled Pilot Trial", journal="JMIR Res Protoc", year="2019", month="Jun", day="26", volume="8", number="6", pages="e13651", keywords="peripheral arterial disease", keywords="telemedicine", keywords="patient participation", keywords="patient compliance", keywords="primary health care", abstract="Background: Peripheral arterial disease (PAD) is a common and severe disease with a highly increased cardiovascular morbidity and mortality. Through the circulatory disorder and the linked undersupply of oxygen carriers in the lower limbs, the ongoing decrease of the pain-free walking distance occurs with a significant reduction in patients' quality of life. Studies including activity monitoring for patients with PAD are rare and digital support to increase activity via mobile health technologies is mainly targeted at patients with cardiovascular disease in general. The special requirement of patients with PAD is the need to reach a certain pain level to improve the pain-free walking distance. Unfortunately, both poor adherence and availability of institutional resources are major problems in patient-centered care. Objective: The objective of this trackPAD pilot study is to evaluate the feasibility of a mobile phone--based self tracking app to promote physical activity and supervised exercise therapy (SET) in particular. We also aim for a subsequent patient centered adjustment of the app prototype based on the results of the app evaluation and process evaluation. Methods: This study was designed as a closed user group trial, with assessors blinded, and parallel group study with face-to-face components for assessment with a follow-up of 3 months. Patients with symptomatic PAD (Fontaine stage IIa or IIb) and possession of a mobile phone were eligible. Eligible participants were randomly assigned into study and control group, stratified by their distance covered in the 6-min walk test, using the software TENALEA. Participants randomized to the study group received usual care and the mobile intervention (trackPAD) for the follow-up period of 3 months, whereas participants randomized to the control group received only usual care. TrackPAD records the frequency and duration of training sessions and pain level using manual user input. Clinical outcome data were collected at the baseline and after 3 months via validated tools (6-min walk test, ankle-brachial index, and duplex ultrasound at the lower arteries) and self-reported quality of life. Usability and quality of the app was determined using the user version of the Mobile Application Rating Scale. Results: The study enrolled 45 participants with symptomatic PAD (44\% male). Of these participants, 21 (47\%) were randomized to the study group and 24 (53\%) were randomized to the control group. The distance walked in the 6-min walk test was comparable in both groups at baseline (study group: mean 368.1m [SD 77.6] vs control group: mean 394.6m [SD 100.6]). Conclusions: This is the first trial to test a mobile intervention called trackPAD that was designed especially for patients with PAD. Its results will provide important insights in terms of feasibility, effectiveness, and patient preferences of an app-based mobile intervention supporting SET for the conservative treatment of PAD. International Registered Report Identifier (IRRID): DERR1-10.2196/13651 ", doi="10.2196/13651", url="http://www.researchprotocols.org/2019/6/e13651/", url="http://www.ncbi.nlm.nih.gov/pubmed/31244477" } @Article{info:doi/10.2196/14523, author="Dias Correia, Fernando and Nogueira, Andr{\'e} and Magalh{\~a}es, Ivo and Guimar{\~a}es, Joana and Moreira, Maria and Barradas, Isabel and Molinos, Maria and Teixeira, Laetitia and Pires, Joaquim and Seabra, Rosmaninho and Lains, Jorge and Bento, Virg{\'i}lio", title="Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study", journal="JMIR Rehabil Assist Technol", year="2019", month="Jun", day="21", volume="6", number="1", pages="e14523", keywords="THA", keywords="THR", keywords="digital physiotherapy", keywords="telerehabilitation", keywords="biofeedback", keywords="motion trackers", keywords="AI-powered rehabilitation", abstract="Background: The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care. Objective: The aim of this study was to assess the feasibility of a novel artificial intelligence--powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation. Methods: This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM). Results: A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86\% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of ?4.79 seconds (95\% CI ?7.24 to ?1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion. Conclusions: This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. Trial Registration: ClinicalTrials.gov NCT03045549; https://clinicaltrials.gov/ct2/show/NCT03045549 ", doi="10.2196/14523", url="http://rehab.jmir.org/2019/1/e14523/", url="http://www.ncbi.nlm.nih.gov/pubmed/31228176" } @Article{info:doi/10.2196/12291, author="Shum, C. Leia and Vald{\'e}s, A. Bulmaro and Van der Loos, Machiel H. F.", title="Determining the Accuracy of Oculus Touch Controllers for Motor Rehabilitation Applications Using Quantifiable Upper Limb Kinematics: Validation Study", journal="JMIR Biomed Eng", year="2019", month="Jun", day="06", volume="4", number="1", pages="e12291", keywords="upper extremity", keywords="kinematics", keywords="physical medicine and rehabilitation", keywords="validation studies", keywords="virtual reality", abstract="Background: As commercial motion tracking technology becomes more readily available, it is necessary to evaluate the accuracy of these systems before using them for biomechanical and motor rehabilitation applications. Objective: This study aimed to evaluate the relative position accuracy of the Oculus Touch controllers in a 2.4 x 2.4 m play-space. Methods: Static data samples (n=180) were acquired from the Oculus Touch controllers at step sizes ranging from 5 to 500 mm along 16 different points on the play-space floor with graph paper in the x (width), y (height), and z (depth) directions. The data were compared with reference values using measurements from digital calipers, accurate to 0.01 mm; physical blocks, for which heights were confirmed with digital calipers; and for larger step sizes (300 and 500 mm), a ruler with hatch marks to millimeter units. Results: It was found that the maximum position accuracy error of the system was 3.5 {\textpm} 2.5 mm at the largest step size of 500 mm along the z-axis. When normalized to step size, the largest error found was 12.7 {\textpm} 9.9\% at the smallest step size in the y-axis at 6.23 mm. When the step size was <10 mm in any direction, the relative position accuracy increased considerably to above 2\% (approximately 2 mm at maximum). An average noise value of 0.036 mm was determined. A comparison of these values to cited visual, goniometric, and proprioceptive resolutions concludes that this system is viable for tracking upper-limb movements for biomechanical and rehabilitation applications. The accuracy of the system was also compared with accuracy values from previous studies using other commercially available devices and a multicamera, marker-based professional motion tracking system. Conclusions: The study found that the linear position accuracy of the Oculus Touch controllers was within an agreeable range for measuring human kinematics in rehabilitative upper-limb exercise protocols. Further testing is required to ascertain acceptable repeatability in multiple sessions and rotational accuracy. ", doi="10.2196/12291", url="http://biomedeng.jmir.org/2019/1/e12291/" } @Article{info:doi/10.2196/10970, 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/10.2196/13111, author="Correia, Dias Fernando and Nogueira, Andr{\'e} and Magalh{\~a}es, Ivo and Guimar{\~a}es, Joana and Moreira, Maria and Barradas, Isabel and Molinos, Maria and Teixeira, Laetitia and Tulha, Jos{\'e} and Seabra, Rosmaninho and Lains, Jorge and Bento, Virg{\'i}lio", title="Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2019", month="Feb", day="28", volume="6", number="1", pages="e13111", keywords="knee", keywords="TKA", keywords="home-based telerehabilitation", keywords="digital physiotherapist", keywords="artificial intelligence", keywords="eHealth", abstract="Background: Physical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times. Objective: This study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring. Methods: The digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion. Results: A total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82\% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95\% CI 1.85-7.47), in favor of the digital intervention group. Conclusions: The present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources. Trial Registration: ClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252 ", doi="10.2196/13111", url="http://rehab.jmir.org/2019/1/e13111/", url="http://www.ncbi.nlm.nih.gov/pubmed/30816849" } @Article{info:doi/10.2196/11326, author="Malone, A. Laurie and Thirumalai, Mohanraj and Padalabalanarayanan, Sangeetha and Neal, N. Whitney and Bowman, Sean and Mehta, Tapan", title="Energy Expenditure and Enjoyment During Active Video Gaming Using an Adapted Wii Fit Balance Board in Adults with Physical Disabilities: Observational Study", journal="JMIR Serious Games", year="2019", month="Feb", day="01", volume="7", number="1", pages="e11326", keywords="exergaming", keywords="video games", keywords="exercise", keywords="physical activity", keywords="disability", keywords="energy expenditure", keywords="enjoyment", abstract="Background: Individuals with physical disabilities have fewer opportunities to participate in enjoyable physical activity. One option for increasing physical activity is playing active video games (AVGs); however, many AVGs are inaccessible or offer limited play options. Objective: This study aimed to examine energy expenditure and enjoyment in adults with mobility impairment during AVG play using off-the-shelf (OTS) and adapted versions of the Wii Fit balance board (Nintendo). Methods: During visit 1, participants completed a functional assessment and the familiarization period. During visit 2, metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus game play, with two bouts on each of the boards. During the resting period, participants completed the Physical Activity Enjoyment Scale (PACES). Statistical analyses were computed using SPSS software. Data were analyzed separately for individuals who were able to play while standing on both boards (StdStd); those who could not play while standing on the OTS board, but were able to play while standing on the adapted board (aStd); and those who could only play while sitting on the adapted board (aSit). Results: Data were collected for 58 participants (StdStd, n=17; aStd, n=10; aSit, n=31). The sample included 31 men and 27 women with a mean age of 41.21 (SD 12.70) years. Energy expenditure (metabolic equivalent [MET]) during game play was significantly greater than that during rest for all players. Only 17 participants (StdStd group) were able to play using the OTS board. During game play on the adapted board, the average MET values for the two game sets were 2.261 (SD 0.718) kcal/kg/hour and 2.233 (SD 0.751) kcal/kg/hour for the aSit group, 3.151 (SD 1.034) and 2.990 (SD 1.121) for the aStd group, and 2.732 (SD 0.655) and 2.777 (SD 0.803) for the StdStd group. For game play on the adapted board, self-reported ratings of perceived exertion on a 0-10 scale suggested greater exercise intensity levels, with median scores ranging from moderate (3) to very hard (7). The PACES scores indicated that all players enjoyed using the adapted board, with a median score of 4 on a 5-point scale. Conclusions: The adapted Wii Fit balance board provided an opportunity for individuals with mobility impairments, including wheelchair users, to engage in AVG. All participants were able to utilize the adapted controller and enjoyed the AVG activity. Although the average MET values achieved during AVG represented light-intensity exercise (<3 METs), 16\% of sitting participants and 41\% of standing participants achieved moderate-intensity exercise (3-6 METs) in at least one of the games. Factors not accounted for, which may have influenced the intensity of exercise, include game selection, limited familiarization period, and discomfort wearing the COSMED portable metabolic system for measurement of oxygen consumption. Accessible AVG controllers offer an innovative approach to overcome various barriers to participation in physical activity. The next steps include assessment of an AVG intervention using an adapted board gaming controller on health and fitness outcomes. Trial Registration: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by Webcite at http://www.webcitation.org/75fc0mN39). ", doi="10.2196/11326", url="http://games.jmir.org/2019/1/e11326/", url="http://www.ncbi.nlm.nih.gov/pubmed/30707098" } @Article{info:doi/10.2196/11598, author="Mehra, Sumit and Visser, Bart and Cila, Nazli and van den Helder, Jantine and Engelbert, HH Raoul and Weijs, JM Peter and Kr{\"o}se, JA Ben", title="Supporting Older Adults in Exercising With a Tablet: A Usability Study", journal="JMIR Hum Factors", year="2019", month="Feb", day="01", volume="6", number="1", pages="e11598", 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="mobile phone", abstract="Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79\% (11/14)-100\% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies. ", doi="10.2196/11598", url="http://humanfactors.jmir.org/2019/1/e11598/", url="http://www.ncbi.nlm.nih.gov/pubmed/30707106" } @Article{info:doi/10.2196/11099, author="Coswig, Victor and Silva, E. Anselmo De Athayde Costa and Barbalho, Matheus and Faria, De Fernando Rosch and Nogueira, D. Claudio and Borges, Mariane and Buratti, R. J{\'e}ssica and Vieira, B. Ivaldo and Rom{\'a}n, L{\'o}pez Francisco Javier and Gorla, I. Jos{\'e}", title="Assessing the Validity of the MyJump2 App for Measuring Different Jumps in Professional Cerebral Palsy Football Players: An Experimental Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="30", volume="7", number="1", pages="e11099", keywords="cerebral palsy football", keywords="jump performance", keywords="mobile apps", keywords="mobile phone", keywords="paralympic sports", abstract="Background: Vertical jumps can be used to assess neuromuscular status in sports performance. This is particularly important in Cerebral Palsy Football (CP Football) because players are exposed to high injury risk, but it may be complicated because the gold standard for assessing jump performance is scarce in field evaluation. Thus, field techniques, such as mobile apps, have been proposed as an alternative method for solving this problem. Objective: This study aims to evaluate the reliability of the measures of the MyJump2 app to assess vertical jump performance in professional CP Football. Methods: We assessed 40 male CP Football athletes (age 28.1 [SD 1.4] years, weight 72.5 [SD 6.2] kg, and height 176 [SD 4.2] cm) through the countermovement jump (CMJ) and squat jump (SJ) using a contact mat. At the same time, we assessed the athletes using the MyJump2 app. Results: There were no significant differences between the instruments in SJ height (P=.12) and flight time (P=.15). Additionally, there were no significant differences between the instruments for CMJ in jump height (P=.16) and flight time (P=.13). In addition, it was observed that there were significant and strong intraclass correlations in all SJ variables varying from 0.86 to 0.89 (both P<.001), which was classified as ``almost perfect.'' Similar results were observed in all variables from the CMJ, varying from 0.92 to 0.96 (both P ?.001). Conclusions: We conclude that the MyJump2 app presents high validity and reliability for measuring jump height and flight time of the SJ and CMJ in CP Football athletes. ", doi="10.2196/11099", url="http://mhealth.jmir.org/2019/1/e11099/", url="http://www.ncbi.nlm.nih.gov/pubmed/30698529" } @Article{info:doi/10.2196/mhealth.9774, author="Loeckx, Matthias and Rabinovich, A. Roberto and Demeyer, Heleen and Louvaris, Zafeiris and Tanner, Rebecca and Rubio, Noah and Frei, Anja and De Jong, Corina and Gimeno-Santos, Elena and Rodrigues, M. Fernanda and Buttery, C. Sara and Hopkinson, S. Nicholas and B{\"u}sching, Gilbert and Strassmann, Alexandra and Serra, Ignasi and Vogiatzis, Ioannis and Garcia-Aymerich, Judith and Polkey, I. Michael and Troosters, Thierry", title="Smartphone-Based Physical Activity Telecoaching in Chronic Obstructive Pulmonary Disease: Mixed-Methods Study on Patient Experiences and Lessons for Implementation", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="21", volume="6", number="12", pages="e200", keywords="physical activity", keywords="COPD", keywords="telemedicine", keywords="smartphone", keywords="patient adherence", keywords="patient satisfaction", keywords="outcome and process assessment (health care)", abstract="Background: Telecoaching approaches can enhance physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD). However, their effectiveness is likely to be influenced by intervention-specific characteristics. Objective: This study aimed to assess the acceptability, actual usage, and feasibility of a complex PA telecoaching intervention from both patient and coach perspectives and link these to the effectiveness of the intervention. Methods: We conducted a mixed-methods study based on the completers of the intervention group (N=159) included in an (effective) 12-week PA telecoaching intervention. This semiautomated telecoaching intervention consisted of a step counter and a smartphone app. Data from a project-tailored questionnaire (quantitative data) were combined with data from patient interviews and a coach focus group (qualitative data) to investigate patient and coach acceptability, actual usage, and feasibility of the intervention. The degree of actual usage of the smartphone and step counter was also derived from app data. Both actual usage and perception of feasibility were linked to objectively measured change in PA. Results: The intervention was well accepted and perceived as feasible by all coaches present in the focus group as well by patients, with 89.3\% (142/159) of patients indicating that they enjoyed taking part. Only a minority of patients (8.2\%; 13/159) reported that they found it difficult to use the smartphone. Actual usage of the step counter was excellent, with patients wearing it for a median (25th-75th percentiles) of 6.3 (5.8-6.8) days per week, which did not change over time (P=.98). The smartphone interface was used less frequently and actual usage of all daily tasks decreased significantly over time (P<.001). Patients needing more contact time had a smaller increase in PA, with mean (SD) of +193 (SD 2375) steps per day, +907 (SD 2306) steps per day, and +1489 (SD 2310) steps per day in high, medium, and low contact time groups, respectively; P for-trend=.01. The overall actual usage of the different components of the intervention was not associated with change in step count in the total group (P=.63). Conclusions: The 12-week semiautomated PA telecoaching intervention was well accepted and feasible for patients with COPD and their coaches. The actual usage of the step counter was excellent, whereas actual usage of the smartphone tasks was lower and decreased over time. Patients who required more contact experienced less PA benefits. Trial Registration: ClinicalTrials.gov NCT02158065; http://clinicaltrials.gov/ct2/show/NCT02158065 (Archived by WebCite at http://www.webcitation.org/73bsaudy9) ", doi="10.2196/mhealth.9774", url="http://mhealth.jmir.org/2018/12/e200/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578215" } @Article{info:doi/10.2196/mhealth.8127, author="Lo, Ambrose Wai Leung and Lei, Di and Li, Le and Huang, Feng Dong and Tong, Kin-Fai", title="The Perceived Benefits of an Artificial Intelligence--Embedded Mobile App Implementing Evidence-Based Guidelines for the Self-Management of Chronic Neck and Back Pain: Observational Study", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="26", volume="6", number="11", pages="e198", keywords="low back pain", keywords="neck pain", keywords="mobile app", keywords="exercise therapy", keywords="mHealth", abstract="Background: Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technology has been suggested as an alternative way to increase adherence to exercise therapy, which may improve clinical outcomes. Objective: The aim was to investigate the self-perceived benefits of an artificial intelligence (AI)--embedded mobile app to self-manage chronic neck and back pain. Methods: A total of 161 participants responded to the invitation. The evaluation questionnaire included 14 questions that were intended to explore if using the AI rehabilitation system may (1) increase time spent on therapeutic exercise, (2) affect pain level (assessed by the 0-10 Numerical Pain Rating Scale), and (3) reduce the need for other interventions. Results: An increase in time spent on therapeutic exercise per day was observed. The median Numerical Pain Rating Scale scores were 6 (interquartile range [IQR] 5-8) before and 4 (IQR 3-6) after using the AI-embedded mobile app (95\% CI 1.18-1.81). A 3-point reduction was reported by the participants who used the AI-embedded mobile app for more than 6 months. Reduction in the usage of other interventions while using the AI-embedded mobile app was also reported. Conclusions: This study demonstrated the positive self-perceived beneficiary effect of using the AI-embedded mobile app to provide a personalized therapeutic exercise program. The positive results suggest that it at least warrants further study to investigate the physiological effect of the AI-embedded mobile app and how it compares with routine clinical care. ", doi="10.2196/mhealth.8127", url="http://mhealth.jmir.org/2018/11/e198/", url="http://www.ncbi.nlm.nih.gov/pubmed/30478019" } @Article{info:doi/10.2196/10147, author="Rabbi, Mashfiqui and Aung, SH Min and Gay, Geri and Reid, Cary M. and Choudhury, Tanzeem", title="Feasibility and Acceptability of Mobile Phone--Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults", journal="J Med Internet Res", year="2018", month="Oct", day="26", volume="20", number="10", pages="e10147", keywords="chronic pain", keywords="machine learning", keywords="personalization", keywords="chronic back pain", keywords="reinforcement learning", abstract="Background: Chronic pain is a globally prevalent condition. It is closely linked with psychological well-being, and it is often concomitant with anxiety, negative affect, and in some cases even depressive disorders. In the case of musculoskeletal chronic pain, frequent physical activity is beneficial. However, reluctance to engage in physical activity is common due to negative psychological associations (eg, fear) between movement and pain. It is known that encouragement, self-efficacy, and positive beliefs are effective to bolster physical activity. However, given that the majority of time is spent away from personnel who can give such encouragement, there is a great need for an automated ubiquitous solution. Objective: MyBehaviorCBP is a mobile phone app that uses machine learning on sensor-based and self-reported physical activity data to find routine behaviors and automatically generate physical activity recommendations that are similar to existing behaviors. Since the recommendations are based on routine behavior, they are likely to be perceived as familiar and therefore likely to be actualized even in the presence of negative beliefs. In this paper, we report the preliminary efficacy of MyBehaviorCBP based on a pilot trial on individuals with chronic back pain. Methods: A 5-week pilot study was conducted on people with chronic back pain (N=10). After a week long baseline period with no recommendations, participants received generic recommendations from an expert for 2 weeks, which served as the control condition. Then, in the next 2 weeks, MyBehaviorCBP recommendations were issued. An exit survey was conducted to compare acceptance toward the different forms of recommendations and map out future improvement opportunities. Results: In all, 90\% (9/10) of participants felt positive about trying the MyBehaviorCBP recommendations, and no participant found the recommendations unhelpful. Several significant differences were observed in other outcome measures. Participants found MyBehaviorCBP recommendations easier to adopt compared to the control ($\beta$int=0.42, P<.001) on a 5-point Likert scale. The MyBehaviorCBP recommendations were actualized more ($\beta$int=0.46, P<.001) with an increase in approximately 5 minutes of further walking per day ($\beta$int=4.9 minutes, P=.02) compared to the control. For future improvement opportunities, participants wanted push notifications and adaptation for weather, pain level, or weekend/weekday. Conclusions: In the pilot study, MyBehaviorCBP's automated approach was found to have positive effects. Specifically, the recommendations were actualized more, and perceived to be easier to follow. To the best of our knowledge, this is the first time an automated approach has achieved preliminary success to promote physical activity in a chronic pain context. Further studies are needed to examine MyBehaviorCBP's efficacy on a larger cohort and over a longer period of time. ", doi="10.2196/10147", url="http://www.jmir.org/2018/10/e10147/", url="http://www.ncbi.nlm.nih.gov/pubmed/30368433" } @Article{info:doi/10.2196/mhealth.9563, author="Hong, Jeeyoung and Kong, Hyoun-Joong and Yoon, Hyung-Jin", title="Web-Based Telepresence Exercise Program for Community-Dwelling Elderly Women With a High Risk of Falling: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2018", month="May", day="28", volume="6", number="5", pages="e132", keywords="telegeriatrics", keywords="resistance exercise", keywords="supervised exercise", keywords="home exercise", keywords="WebRTC", keywords="telepresence", abstract="Background: While physical exercise is known to help prevent falls in the elderly, bad weather and long distance between the home and place of exercise represent substantial deterrents for the elderly to join or continue attending exercise programs outside their residence. Conventional modalities for home exercise can be helpful but do not offer direct and prompt feedback to the participant, which minimizes the benefit. Objective: We aimed to develop an elderly-friendly telepresence exercise platform and to evaluate the effects of a 12-week telepresence exercise program on fall-related risk factors in community-dwelling elderly women with a high risk of falling. Methods: In total, 34 women aged 68-91 years with Fall Risk Assessment scores >14 and no medical contraindication to physical training-based therapy were recruited in person from a senior citizen center. The telepresence exercise platform included a 15-inch tablet computer, custom-made peer-to-peer video conferencing server system, and broadband Internet connectivity. The Web-based program included supervised resistance exercises performed using elastic resistance bands and balance exercise for 20-40 minutes a day, three times a week, for 12 weeks. During the telepresence exercise session, each participant in the intervention group was supervised remotely by a specialized instructor who provided feedback in real time. The women in the control group maintained their lifestyle without any intervention. Fall-related physical factors (body composition and physical function parameters) and psychological factors (Korean Falls Efficacy Scale score, Fear of Falling Questionnaire score) before and after the 12-week interventional period were examined in person by an exercise specialist blinded to the group allocation scheme. Results: Of the 30 women enrolled, 23 completed the study. Compared to women in the control group (n=13), those in the intervention group (n=10) showed significant improvements on the scores for the chair stand test (95\% confidence interval -10.45 to -5.94, P<.001), Berg Balance Scale (95\% confidence interval -2.31 to -0.28, P=.02), and Fear of Falling Questionnaire (95\% confidence interval 0.69-3.5, P=.01). Conclusions: The telepresence exercise program had positive effects on fall-related risk factors in community-dwelling elderly women with a high risk of falling. Elderly-friendly telepresence technology for home-based exercises can serve as an effective intervention to improve fall-related physical and psychological factors. Trial Registration: Clinical Research Information Service KCT0002710; https://cris.nih.go.kr/cris/en/search/ search\_result\_st01.jsp?seq=11246 (Archived by WebCite at http://www.webcitation.org/6zdSUEsmb) ", doi="10.2196/mhealth.9563", url="http://mhealth.jmir.org/2018/5/e132/" } @Article{info:doi/10.2196/10181, author="Thirumalai, Mohanraj and Rimmer, H. James and Johnson, George and Wilroy, Jereme and Young, Hui-Ju and Mehta, Tapan and Lai, Byron", title="TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2018", month="May", day="24", volume="6", number="5", pages="e10181", keywords="multiple sclerosis", keywords="exercise", keywords="therapy", keywords="mHealth", keywords="user-centered design", abstract="Background: People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective: This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods: Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results: During testing of the app's effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53\% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions: A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis). ", doi="10.2196/10181", url="http://mhealth.jmir.org/2018/5/e10181/", url="http://www.ncbi.nlm.nih.gov/pubmed/29798832" } @Article{info:doi/10.2196/10021, author="Lawford, J. Belinda and Hinman, S. Rana and Kasza, Jessica and Nelligan, Rachel and Keefe, Francis and Rini, Christine and Bennell, L. Kim", title="Moderators of Effects of Internet-Delivered Exercise and Pain Coping Skills Training for People With Knee Osteoarthritis: Exploratory Analysis of the IMPACT Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="May", day="09", volume="20", number="5", pages="e10021", keywords="telerehabilitation", keywords="moderators", keywords="osteoarthritis", keywords="exercise", abstract="Background: Internet-delivered exercise, education, and pain coping skills training is effective for people with knee osteoarthritis, yet it is not clear whether this treatment is better suited to particular subgroups of patients. Objective: The aim was to explore demographic and clinical moderators of the effect of an internet-delivered intervention on changes in pain and physical function in people with knee osteoarthritis. Methods: Exploratory analysis of data from 148 people with knee osteoarthritis who participated in a randomized controlled trial comparing internet-delivered exercise, education, and pain coping skills training to internet-delivered education alone. Primary outcomes were changes in knee pain while walking (11-point Numerical Rating Scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index function subscale) at 3 and 9 months. Separate regression models were fit with moderator variables (age, gender, expectations of outcomes, self-efficacy [pain], education, employment status, pain catastrophizing, body mass index) and study group as covariates, including an interaction between the two. Results: Participants in the intervention group who were currently employed had significantly greater reductions in pain at 3 months than similar participants in the control group (between-group difference: mean 2.38, 95\% CI 1.52-3.23 Numerical Rating Scale units; interaction P=.02). Additionally, within the intervention group, pain at 3 months reduced by mean 0.53 (95\% CI 0.28-0.78) Numerical Rating Scale units per unit increase in baseline self-efficacy for managing pain compared to mean 0.11 Numerical Rating Scale units (95\% CI --0.13 to 0.35; interaction P=.02) for the control group. Conclusions: People who were employed and had higher self-efficacy at baseline were more likely to experience greater improvements in pain at 3 months after an internet-delivered exercise, education, and pain coping skills training program. There was no evidence of a difference in the effect across gender, educational level, expectation of treatment outcome, or across age, body mass index, or tendency to catastrophize pain. Findings support the effectiveness of internet-delivered care for a wide range of people with knee osteoarthritis, but future confirmatory research is needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000243617; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365812\&isReview=true (Archived by WebCite at http://www.webcitation.org/6z466oTPs) ", doi="10.2196/10021", url="http://www.jmir.org/2018/5/e10021/", url="http://www.ncbi.nlm.nih.gov/pubmed/29743149" } @Article{info:doi/10.2196/rehab.8251, author="Uesugi, Yuko and Koyanagi, Junichiro and Takagi, Keishi and Yamaguchi, Ryota and Hayashi, Shinya and Nishii, Takashi", title="Exercise Therapy Interventions in Patients With Hip Osteoarthritis: Comparison of the Effects of DVD and Website-Based Interventions", journal="JMIR Rehabil Assist Technol", year="2018", month="May", day="07", volume="5", number="1", pages="e10", keywords="hip osteoarthritis", keywords="exercise", keywords="DVD", keywords="website", keywords="self-efficacy", abstract="Background: Prevalence of developmental hip dysplasia is high in Japan. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via digital video discs (DVDs) and websites allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders. Objective: This study aimed to compare the effectiveness of exercise therapy administered via DVD and that administered via a website. Methods: We developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of open kinetic chain and closed kinetic chain exercises. Once the program was developed, exercise DVDs were produced. In addition to the six-step exercise program, our website was enabled to count the number of exercises performed by each patient and was accessible via the Internet at any time. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital in the Kansai area in Japan. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed preintervention and after 6 months. Results: At 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3, SD 16.1 years) and 18 website users (2 male, 16 female; mean age 52.4, SD 10.4 years) were reachable. The change in each parameter could not be confirmed a significant improvement. However, most items tended to reflect overall improvement during the 6 months of intervention (P=.05-.94; paired t test). Regarding effect size, we considered a small effect to be greater than 0.2. Little effect was observed for JHEQ pain, SF-8 physical component summary (PCS), and SF-8 mental component summary in the DVD group, as well as OHS, SF-8 (PCS), and GSES in the website group. Conclusions: When comparing the effectiveness of exercise therapy between our DVD and website, we found that although both groups tended to improve in physical function, only the website group showed tendency of enhanced self-efficacy. ", doi="10.2196/rehab.8251", url="http://rehab.jmir.org/2018/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/29735473" } @Article{info:doi/10.2196/resprot.9308, author="Naidu, Avantika and Brown, David and Roth, Elliot", title="A Challenge-Based Approach to Body Weight--Supported Treadmill Training Poststroke: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2018", month="May", day="03", volume="7", number="5", pages="e118", keywords="stroke", keywords="rehabilitation", keywords="falls", keywords="walking", keywords="hemiparesis", keywords="body weight support treadmill training", keywords="balance", keywords="robotics", keywords="mobility", keywords="walking challenges", abstract="Background: Body weight support treadmill training protocols in conjunction with other modalities are commonly used to improve poststroke balance and walking function. However, typical body weight support paradigms tend to use consistently stable balance conditions, often with handrail support and or manual assistance. Objective: In this paper, we describe our study protocol, which involved 2 unique body weight support treadmill training paradigms of similar training intensity that integrated dynamic balance challenges to help improve ambulatory function post stroke. The first paradigm emphasized walking without any handrails or manual assistance, that is, hands-free walking, and served as the control group, whereas the second paradigm incorporated practicing 9 essential challenging mobility skills, akin to environmental barriers encountered during community ambulation along with hands-free walking (ie hands-free + challenge walking). Methods: We recruited individuals with chronic poststroke hemiparesis and randomized them to either group. Participants trained for 6 weeks on a self-driven, robotic treadmill interface that provided body weight support and a safe gait-training environment. We assessed participants at pre-, mid- and post 6 weeks of intervention-training, with a 6-month follow-up. We hypothesized greater walking improvements in the hands-free + challenge walking group following training because of increased practice opportunity of essential mobility skills along with hands-free walking. Results: We assessed 77 individuals with chronic hemiparesis, and enrolled and randomized 30 individuals poststroke for our study (hands-free group=19 and hands-free + challenge walking group=20) from June 2012 to January 2015. Data collection along with 6-month follow-up continued until January 2016. Our primary outcome measure is change in comfortable walking speed from pre to post intervention for each group. We will also assess feasibility, adherence, postintervention efficacy, and changes in various exploratory secondary outcome measures. Additionally, we will also assess participant responses to a study survey, conducted at the end of training week, to gauge each group's training experiences. Conclusions: Our treadmill training paradigms, and study protocol represent advances in standardized approaches to selecting body weight support levels without the necessity for using handrails or manual assistance, while progressively providing dynamic challenges for improving poststroke ambulatory function during rehabilitation. Trial Registration: ClinicalTrials.gov NCT02787759; https://clinicaltrials.gov/ct2/show/NCT02787759 (Archived by Webcite at http://www.webcitation.org/6yJZCrIea) ", doi="10.2196/resprot.9308", url="http://www.researchprotocols.org/2018/5/e118/", url="http://www.ncbi.nlm.nih.gov/pubmed/29724706" } @Article{info:doi/10.2196/jmir.9465, author="Sch{\"a}fer, Meender Axel Georg and Zalpour, Christoff and von Piekartz, Harry and Hall, Maxwell Toby and Paelke, Volker", title="The Efficacy of Electronic Health--Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review", journal="J Med Internet Res", year="2018", month="Apr", day="26", volume="20", number="4", pages="e152", keywords="osteoarthritis, knee", keywords="telemedicine", keywords="exercise", keywords="treatment outcome", keywords="review", keywords="meta-analysis", abstract="Background: Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. Objective: The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. Methods: MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=?0.31, 95\% CI ?0.58 to ?0.04, low quality; QoL SMD=0.24, 95\% CI 0.05-0.43, moderate quality) and long-term effects (pain ?0.30, 95\% CI ?0.07 to ?0.53, moderate quality; physical function 0.41, 95\% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95\% CI 0.06-0.47, high quality). Conclusions: eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence. ", doi="10.2196/jmir.9465", url="http://www.jmir.org/2018/4/e152/", url="http://www.ncbi.nlm.nih.gov/pubmed/29699963" } @Article{info:doi/10.2196/rehab.8567, author="Bright, Philip and Hambly, Karen", title="Patients Using an Online Forum for Reporting Progress When Engaging With a Six-Week Exercise Program for Knee Conditioning: Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2018", month="Apr", day="26", volume="5", number="1", pages="e9", keywords="eHealth? social media? exercise therapy? rehabilitation", abstract="Background: The use of electronic health (eHealth) and Web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual ``sticky notes.'' Objective: The primary aim of this study was to determine feasibility of patients in a 6-week knee exercise program using Padlet as an online forum for self-reporting on outcome progression. Methods: Undergraduate manual therapy students were recruited as part of a 6-week study into knee conditioning. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analyzed for association between engagement, entry frequency, and participant characteristics. Individual data facilitated single-subject, multiple-baseline analysis using statistical process control. Experiential narrative was analyzed thematically. Results: Nineteen participants were recruited (47\%, 9/19 female); ages ranged from 19 to 53 years. Twelve individuals (63\%) opted to engage with the forum (range 4-40 entries), with five (42\%) reporting across all 6 weeks. Gender did not influence reporting (odds ratio [OR] 0.76, 95\% CI 0.06-6.93). No significant difference manifested between body mass index and engagement P=.46); age and entry frequency did not correlate (R2=.054, 95\% CI --0.42 to 0.51, P=.83). Statistically significant conditioning profiles arose in single participants. Themes of pain, mitigation, and response were inducted from the experiences posted. Conclusions: Patients will engage with an online forum for reporting progress when undertaking exercise programs. In contrast to related literature, no significant association was found with reporting and gender, age, or body mass index. Individual posted data allowed multiple-baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualized visual data to patients and the role of forums in monitoring patients' progress in symptomatic knee pain populations need further consideration. ", doi="10.2196/rehab.8567", url="http://rehab.jmir.org/2018/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/29699967" } @Article{info:doi/10.2196/rehab.8003, author="Thirumalai, Mohanraj and Kirkland, B. William and Misko, R. Samuel and Padalabalanarayanan, Sangeetha and Malone, A. Laurie", title="Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation", journal="JMIR Rehabil Assist Technol", year="2018", month="Mar", day="06", volume="5", number="1", pages="e2", keywords="sedentary lifestyle", keywords="video games", keywords="active video gaming", keywords="Wii Fit", keywords="equipment design", keywords="physical activity", keywords="exercise", keywords="wheelchairs", keywords="physical disability", keywords="rehabilitation", keywords="usability", abstract="Background: Active video game (AVG) playing, also known as ``exergaming,'' is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play. Objective: The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments. Methods: In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants' perceived usability. Results: The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users' range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as ``good,'' while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as ``excellent.'' We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable. Conclusions: This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller's potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial. Trial Registration: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf) ", doi="10.2196/rehab.8003", url="http://rehab.jmir.org/2018/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/29510972" } @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/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" }