@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/10.2196/19690,
author="Hawley-Hague, Helen
and Tacconi, Carlo
and Mellone, Sabato
and Martinez, Ellen
and Chiari, Lorenzo
and Helbostad, Jorunn
and Todd, Chris",
title="One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Jan",
day="12",
volume="8",
number="1",
pages="e19690",
keywords="aged",
keywords="postural balance",
keywords="telerehabilitation",
keywords="patient compliance",
keywords="accidental falls",
keywords="mobile phone",
abstract="Background: Falls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. Objective: This study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. Methods: There were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. Results: In the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. Conclusions: Teleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability. ",
doi="10.2196/19690",
url="http://rehab.jmir.org/2021/1/e19690/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33433398"
}


@Article{info:doi/10.2196/24960,
author="Mukaino, Masahiko
and Tatemoto, Tsuyoshi
and Kumazawa, Nobuhiro
and Tanabe, Shigeo
and Katoh, Masaki
and Saitoh, Eiichi
and Otaka, Yohei",
title="An Affordable, User-friendly Telerehabilitation System Assembled Using Existing Technologies for Individuals Isolated With COVID-19: Development and Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Dec",
day="10",
volume="7",
number="2",
pages="e24960",
keywords="telerehabilitation",
keywords="COVID-19",
keywords="telemedicine",
keywords="isolation",
keywords="user-friendly",
keywords="feasibility",
keywords="rehabilitation",
keywords="eHealth",
abstract="Background: Isolation due to a COVID-19 infection can limit activities and cause physical and mental decline, especially in older adults and people with disabilities. However, due to limited contact, adequate rehabilitation is difficult to provide for quarantined patients. Telerehabilitation technology could be a solution; however, issues specific to COVID-19 should be taken into consideration, such as strict quarantine and respiratory symptoms, as well as accessibility to deal with rapid increases in need due to the pandemic. Objective: This study aims to develop and to investigate the feasibility of a telerehabilitation system for patients who are quarantined due to COVID-19 by combining existing commercial devices and computer applications. Methods: A multidisciplinary team has identified the requirements for a telerehabilitation system for COVID-19 and developed the system to satisfy those requirements. In the subsequent feasibility study, patients diagnosed with COVID-19 (N=10; mean age 60 years, SD 18 years) were included. A single session of telerehabilitation consisted of stretching exercises, a 15-minute exercise program, and a video exercise program conducted under real-time guidance by a physical therapist through a video call. The system included a tablet computer, a pulse oximeter, videoconferencing software, and remote control software. The feasibility of the system was evaluated using the Telemedicine Satisfaction Questionnaire (TSQ; 14 items) and an additional questionnaire on the telerehabilitation system (5 items). Each item was rated from ``1 = strongly disagree'' to ``5 = strongly agree.'' Results: The telerehabilitation system was developed by combining existing devices and applications, including a pulse oximeter and remote control mechanism, to achieve user-friendliness, affordability, and safety, which were determined as the system requirements. In the feasibility study, 9 out of 10 patients were able to use the telerehabilitation system without any on-site help. On the TSQ, the mean score for each item was 4.7 (SD 0.7), and in the additional items regarding telerehabilitation, the mean score for each item was 4.3 (SD 1.0). Conclusions: These findings support the feasibility of this simple telerehabilitation system in quarantined patients with COVID-19, encouraging further investigation on the merit of the system's use in clinical practice. ",
doi="10.2196/24960",
url="http://rehab.jmir.org/2020/2/e24960/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33279877"
}


@Article{info:doi/10.2196/17957,
author="Subedi, Narayan
and Rawstorn, C. Jonathan
and Gao, Lan
and Koorts, Harriet
and Maddison, Ralph",
title="Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="27",
volume="8",
number="11",
pages="e17957",
keywords="heart diseases",
keywords="cardiac rehabilitation",
keywords="telerehabilitation",
keywords="implementation science",
keywords="smartphone",
keywords="systematic review",
abstract="Background: Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. Objective: This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. Methods: MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. Results: No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80\%), appropriateness (9/10, 90\%), adoption (6/10, 60\%), feasibility (6/10, 60\%), fidelity (7/10, 70\%), and implementation cost (4/10, 40\%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. Conclusions: Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=124254 ",
doi="10.2196/17957",
url="http://mhealth.jmir.org/2020/11/e17957/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33245286"
}


@Article{info:doi/10.2196/24311,
author="Malliaras, Peter
and Cridland, Kate
and Hopmans, Ruben
and Ashton, Simon
and Littlewood, Chris
and Page, Richard
and Harris, Ian
and Skouteris, Helen
and Haines, Terry",
title="Internet and Telerehabilitation-Delivered Management of Rotator Cuff--Related Shoulder Pain (INTEL Trial): Randomized Controlled Pilot and Feasibility Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="18",
volume="8",
number="11",
pages="e24311",
keywords="rotator cuff",
keywords="tendinopathy",
keywords="shoulder",
keywords="telemedicine",
keywords="telerehabilitation",
keywords="randomized controlled trial",
keywords="pilot",
keywords="feasibility",
keywords="pain",
keywords="internet-delivered intervention",
abstract="Background: Rotator cuff--related shoulder pain (RCRSP) is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes. Objective: The primary aim of this pilot randomized controlled trial was to assess the feasibility of a 12-week internet-delivered intervention for RCRSP comparing advice only, recommended care, and recommended care with group-based telerehabilitation. Methods: Reporting was in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist for pilot and feasibility trials. People with a primary complaint of RCRSP for 3 months or longer were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated (via a Zelen design) to receive (1) advice only, (2) recommended care (internet-delivered evidence-based exercise and education), or (3) recommended care and telerehabilitation (including a weekly group teleconference session). Progression criteria for a full-scale trial included (1) recruitment of 20\% or greater of eligible participants, (2) acceptable adherence (two or more of the three prescribed weekly sessions) among 70\% or greater of participants, (3) 80\% or greater retention of participants, (4) absence of intervention-related serious adverse events, and (5) 80\% or greater response rates to questionnaires. Secondary clinical and patient knowledge outcomes were collected (via email or text) at baseline, six weeks, and 12 weeks (for clinical and patient knowledge), and within-group change was reported descriptively. Results: We enrolled 36 of 38 (95\%) eligible participants and all participants were recruited within a 3-week period. Of the 36 participants, 12 participants were allocated to each of the three trial arms. The mean age of participants was between 51 and 56 years, and 83\% (10/12) to 92\% (11/12) were female. Retention at the 12-week endpoint was 94\% (34/36) and response to email questionnaires at other time points was 83\% or greater. We found acceptable adherence (defined as greater than 70\% of participants performing exercise 2 or 3 times/week) in the recommended care group with telerehabilitation but not in the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms), with the exception of one instance of elective surgery (unrelated to the person's shoulder condition). Conclusions: Our prespecified success criteria were met or exceeded, but there was a gender imbalance toward women. It is feasible to progress to a fully powered trial, but strategies to address the gender imbalance need to be implemented. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000248965); https://tinyurl.com/yy6eztf5 ",
doi="10.2196/24311",
url="http://mhealth.jmir.org/2020/11/e24311/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33206059"
}


@Article{info:doi/10.2196/19604,
author="Dunne, Stephen
and Close, Helen
and Richards, Nicola
and Ellison, Amanda
and Lane, R. Alison",
title="Maximizing Telerehabilitation for Patients With Visual Loss After Stroke: Interview and Focus Group Study With Stroke Survivors, Carers, and Occupational Therapists",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="23",
volume="22",
number="10",
pages="e19604",
keywords="telerehabilitation",
keywords="vision",
keywords="barriers",
keywords="facilitators",
keywords="technology",
abstract="Background: Visual field defects are a common consequence of stroke, and compensatory eye movement strategies have been identified as the most promising rehabilitation option. There has been a move toward compensatory telerehabilitation options, such as the Durham Reading and Exploration (DREX) training app, which significantly improves visual exploration, reading, and self-reported quality of life. Objective: This study details an iterative process of liaising with stroke survivors, carers, and health care professionals to identify barriers and facilitators to using rehabilitation tools, as well as elements of good practice in telerehabilitation, with a focus on how the DREX package can be maximized. Methods: Survey data from 75 stroke survivors informed 12 semistructured engagement activities (7 focus groups and 5 interviews) with 32 stroke survivors, 10 carers, and 24 occupational therapists. Results: Thematic analysis identified key themes within the data. Themes identified problems associated with poststroke health care from both patients' and occupational therapists' perspectives that need to be addressed to improve uptake of this rehabilitation tool and telerehabilitation options generally. This included identifying additional materials or assistance that were required to boost the impact of training packages. The acute rehabilitation setting was an identified barrier, and perceptions of technology were considered a barrier by some but a facilitator by others. In addition, 4 key features of telerehabilitation were identified: additional materials, the importance of goal setting, repetition, and feedback. Conclusions: The data were used to try to overcome some barriers to the DREX training and are further discussed as considerations for telerehabilitation in general moving forward. ",
doi="10.2196/19604",
url="http://www.jmir.org/2020/10/e19604/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33095179"
}


@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/10.2196/20406,
author="Szczepura, Ala
and Holliday, Nikki
and Neville, Catriona
and Johnson, Karen
and Khan, Khan Amir Jahan
and Oxford, W. Samuel
and Nduka, Charles",
title="Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="5",
volume="22",
number="10",
pages="e20406",
keywords="Bell palsy",
keywords="facial nerve paralysis",
keywords="patient experience",
keywords="treatment pathway",
keywords="facial exercise therapy",
keywords="neuromuscular retraining",
keywords="treatment adherence",
keywords="digital technology",
keywords="outcome measures",
keywords="telerehabilitation",
keywords="biosensors",
keywords="COVID-19",
abstract="Background: Facial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients' and clinicians' views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways. Objective: This study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology. Methods: Separate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis. Results: A total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9\% (8/93) of adults reported traveling ?115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology. Conclusions: The study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated. ",
doi="10.2196/20406",
url="https://www.jmir.org/2020/10/e20406",
url="http://www.ncbi.nlm.nih.gov/pubmed/32763890"
}


@Article{info:doi/10.2196/18835,
author="Waqas, Ahmed
and Teoh, Huat Soo
and Lap{\~a}o, Velez Lu{\'i}s
and Messina, Ary Luiz
and Correia, C{\'e}sar Jorge",
title="Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="2",
volume="22",
number="10",
pages="e18835",
keywords="telemedicine",
keywords="scientometric analysis",
keywords="evidence synthesis",
keywords="health information technology",
keywords="research",
keywords="theme",
abstract="Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. ",
doi="10.2196/18835",
url="https://www.jmir.org/2020/10/e18835",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006571"
}


@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/10.2196/15460,
author="Hawley-Hague, Helen
and Tacconi, Carlo
and Mellone, Sabato
and Martinez, Ellen
and Ford, Claire
and Chiari, Lorenzo
and Helbostad, Jorunn
and Todd, Chris",
title="Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="28",
volume="8",
number="9",
pages="e15460",
keywords="aged",
keywords="postural balance",
keywords="telerehabilitation",
keywords="patient compliance",
keywords="accidental falls",
abstract="Background: Falls have implications for older adults' health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps' usability and acceptability with both health professionals and patients. Methods: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of ``Motivate Me'' and ``My Activity Programme.'' Key changes from the workshops included being able to add more details about the patients' exercise program and a wider selection of goals within ``Motivate Me.'' The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable. ",
doi="10.2196/15460",
url="http://mhealth.jmir.org/2020/9/e15460/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985992"
}


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


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


@Article{info:doi/10.2196/16989,
author="Geerds, J. Merle A.
and Nijmeijer, S. Wieke
and Hegeman, H. J.
and Vollenbroek-Hutten, R. Miriam M.",
title="Mobile App for Monitoring 3-Month Postoperative Functional Outcome After Hip Fracture: Usability Study",
journal="JMIR Hum Factors",
year="2020",
month="Sep",
day="14",
volume="7",
number="3",
pages="e16989",
keywords="hip fracture",
keywords="remote monitoring",
keywords="elderly",
keywords="telemedicine",
keywords="orthogeriatric",
keywords="mHealth",
keywords="app",
abstract="Background: As a result of an aging population, there has been an increasing incidence of hip fractures worldwide. In the Netherlands, in order to improve the quality of care for elderly patients with hip fractures, the multidisciplinary Centre for Geriatric Traumatology was established in 2008 at the Department of Trauma Surgery at Ziekenhuisgroep Twente hospital (located in Almelo and Hengelo in the Netherlands). Objective: Though the Dutch Hip Fracture audit is used to monitor the quality of care for patients with fractures of the hip, only 30.7\% of patients complete registration in the 3-month follow-up period. Mobile apps offer an opportunity for improvement in this area. The aim of this study was to investigate the usability and acceptance of a mobile app for gathering indicators of quality of care in a 3-month follow-up period after postoperative treatment of hip fracture. Methods: From July 2017 to December 2017, patients who underwent surgical treatment for hip fracture were recruited. Patients and caregivers, who were collectively considered the participant cohort, were asked to download the app and answer a questionnaire. Participants were divided into two groups---those who downloaded the app and those who did not download the app. A telephone interview that was based upon the Unified Theory of Acceptance and Use of Technology was conducted with a subset of participants from each group (1:1 ratio). This study was designated as not being subject to the Dutch Medical Research Involving Human Subjects Act according to the appropriate medical research ethics committees. Results: Of the patients and caregivers who participated, 26.4\% (29/110) downloaded the app, whereas 73.6\% (81/110) did not. Telephone interviews with the subset of participants (n=24 per group) revealed that 54.0\% (13/24) of the group of participants who did not download the app had forgotten the study. Among the group who downloaded the app, 95.8\% (23/24) had the intention of completing the questionnaire, but only 4.2\% (1/24) did so. The reasons for not completing the questionnaire included technical problems, cognitive disorders, or patient dependency on caregivers. Most participants in the group who downloaded the app self-reported a high level of expertise in using a smartphone (22/24, 91.7\%), and sufficient facilitating conditions for using a smartphone were self-reported in both groups (downloaded the app: 23/24, 95.8\%; did not download the app: 21/24, 87.5\%), suggesting that these factors were not barriers to completion. Conclusions: Despite self-reported intention to use the app, smartphone expertise, and sufficient facilitating conditions for smartphone use, implementation of the mobile app was infeasible for daily practice. This was due to a combination of technical problems, factors related to the implementation process, and the population of interest having cognitive disorders or a dependency on caregivers for mobile technology. ",
doi="10.2196/16989",
url="https://humanfactors.jmir.org/2020/3/e16989",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924949"
}


@Article{info:doi/10.2196/20834,
author="Blair, K. Cindy
and Harding, Elizabeth
and Herman, Carla
and Boyce, Tawny
and Demark-Wahnefried, Wendy
and Davis, Sally
and Kinney, Y. Anita
and Pankratz, S. Vernon",
title="Remote Assessment of Functional Mobility and Strength in Older Cancer Survivors: Protocol for a Validity and Reliability Study",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="1",
volume="9",
number="9",
pages="e20834",
keywords="physical function",
keywords="physical performance",
keywords="older adults",
keywords="remote assessment",
keywords="videoconferencing",
keywords="cancer survivors",
keywords="cancer",
keywords="elderly",
keywords="physical activity",
keywords="telehealth",
abstract="Background: Older cancer survivors, faced with both age- and treatment-related morbidity, are at increased and premature risk for physical function limitations. Physical performance is an important predictor of disability, quality of life, and premature mortality, and thus is considered an important target of interventions designed to prevent, delay, or attenuate the physical functional decline. Currently, low-cost, valid, and reliable methods to remotely assess physical performance tests that are self-administered by older adults in the home-setting do not exist, thus limiting the reach, scalability, and dissemination of interventions. Objective: This paper will describe the rationale and design for a study to evaluate the accuracy, reliability, safety, and acceptability of videoconferencing and self-administered tests of functional mobility and strength by older cancer survivors in their own homes. Methods: To enable remote assessment, participants receive a toolkit and instructions for setting up their test course and communicating with the investigator. Two standard gerontologic performance tests are being evaluated: the Timed Up and Go test and the 30-second chair stand test. Phase 1 of the study evaluates proof-of-concept that older cancer survivors (age ?60 years) can follow the testing protocol and use a tablet PC to communicate with the study investigator. Phase 2 evaluates the criterion validity of videoconference compared to direct observation of the two physical performance tests. Phase 3 evaluates reliability by enrolling 5-10 participants who agree to repeat the remote assessment (without direct observation). Phase 4 enrolls 5-10 new study participants to complete the remote assessment test protocol. Feedback from participants in each phase is used to refine the test protocol and instructions. Results: Enrollment began in December 2019. Ten participants completed the Phase 1 proof-of-concept. The study was paused in mid-March 2020 due to the COVID-19 pandemic. The study is expected to be completed by the end of 2020. Conclusions: This validity and reliability study will provide important information on the acceptability and safety of using videoconferencing to remotely assess two tests of functional mobility and strength, self-administered by older adults in their homes. Videoconferencing has the potential to expand the reach, scalability, and dissemination of interventions to older cancer survivors, and potentially other older adults, especially in rural areas. Trial Registration: ClinicalTrials.gov NCT04339959; https://clinicaltrials.gov/ct2/show/NCT04339959 International Registered Report Identifier (IRRID): DERR1-10.2196/20834 ",
doi="10.2196/20834",
url="https://www.researchprotocols.org/2020/9/e20834",
url="http://www.ncbi.nlm.nih.gov/pubmed/32769075"
}


@Article{info:doi/10.2196/19495,
author="Petersen, Ding Jindong
and Larsen, Ladekj{\ae}r Eva
and la Cour, Karen
and von B{\"u}low, Cecilie
and Skouboe, Malene
and Christensen, Reffstrup Jeanette
and Waldorff, Boch Frans",
title="Motion-Based Technology for People With Dementia Training at Home: Three-Phase Pilot Study Assessing Feasibility and Efficacy",
journal="JMIR Ment Health",
year="2020",
month="Aug",
day="26",
volume="7",
number="8",
pages="e19495",
keywords="dementia",
keywords="motion-based technology",
keywords="virtual reality",
keywords="telerehabilitation",
keywords="physical training",
keywords="physical and mental function",
abstract="Background: Persons with dementia tend to be vulnerable to mobility challenges and hence face a greater risk of fall and subsequent fractures, morbidity, and mortality. Motion-based technologies (MBTs), also called sensor-based technologies or virtual reality, have the potential for assisting physical exercise and training as a part of a disease management and rehabilitation program, but little is known about its' use for people with dementia.  Objective: The purpose of this pilot study was to investigate the feasibility and efficacy of MBT physical training at home for people with dementia. Methods: A 3-phase pilot study: (1) baseline start-up, (2) 15 weeks of group training at a local care center twice a week, and (3) 12 weeks of group training reduced to once a week, supplemented with individual MBT training twice a week at home. A total of 26 people with dementia from a municipality in Southern Denmark were eligible and agreed to participate in this study. Three withdrew from the study, leaving 23 participants for the final analysis. Feasibility was measured by the percentage of participants who trained with MBT at home, and their completion rate of total scheduled MBT sessions. Efficacy was evaluated by physical function, measured by Sit-to-Stand (STS), Timed-Up-and-Go (TUG), 6-minute Walk Test (6MW), and 10-meter Dual-task Walking Test (10MDW); cognitive function was measured by Mini-Mental State Examination (MMSE) and Neuropsychiatric Inventory-Questionnaire (NPI-Q); and European Quality of Life 5 dimensions questionnaire (EQOL5) was used for measuring quality of life. Descriptive statistics were applied accordingly. Wilcoxon signed-rank and rank-sum tests were applied to explore significant differences within and between the groups. Results: As much as 12 of 23 participants (52\%) used the supplemental MBT training at home. Among them, 6 (50\%) completed 75\% or more scheduled sessions, 3 completed 25\% or less, and 3 completed between 25\% and 75\% of scheduled sessions. For physical and cognitive function tests, supplementing with MBT training at home showed a tendency of overall stabilization of scores among the group of participants who actively trained with MBT; especially, the 10MDW test even showed a significant improvement from 9.2 to 7.1 seconds (P=.03). We found no positive effect on EQOL5 tests. Conclusions: More than half of the study population with dementia used MBT training at home, and among them, half had an overall high adherence to the home training activity. Physical function tended to remain stable or even improved among high-adherence MBT individuals. We conclude that MBT training at home may be feasible for some individuals with dementia. Further research is warranted. ",
doi="10.2196/19495",
url="http://mental.jmir.org/2020/8/e19495/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32845243"
}


@Article{info:doi/10.2196/16947,
author="Shen, Jiabin
and Xiang, Henry
and Luna, John
and Grishchenko, Alice
and Patterson, Jeremy
and Strouse, V. Robert
and Roland, Maxwell
and Lundine, P. Jennifer
and Koterba, H. Christine
and Lever, Kimberly
and Groner, I. Jonathan
and Huang, Yungui
and Lin, Deborah En-Ju",
title="Virtual Reality--Based Executive Function Rehabilitation System for Children With Traumatic Brain Injury: Design and Usability Study",
journal="JMIR Serious Games",
year="2020",
month="Aug",
day="25",
volume="8",
number="3",
pages="e16947",
keywords="traumatic brain injury",
keywords="virtual reality",
keywords="neurological rehabilitation",
keywords="executive function",
keywords="cognitive rehabilitation",
abstract="Background: Traumatic brain injury (TBI) poses a significant threat to children's health. Cognitive rehabilitation for pediatric TBI has the potential to improve the quality of life following the injury. Virtual reality (VR) can provide enriched cognitive training in a life-like but safe environment. However, existing VR applications for pediatric TBIs have primarily focused on physical rehabilitation. Objective: This study aims to design and develop an integrative hardware and software VR system to provide rehabilitation of executive functions (EF) for children with TBI, particularly in 3 core EF: inhibitory control, working memory, and cognitive flexibility. Methods: The VR training system was developed by an interdisciplinary team with expertise in best practices of VR design, developmental psychology, and pediatric TBI rehabilitation. Pilot usability testing of this novel system was conducted among 10 healthy children and 4 children with TBIs. Results: Our VR-based interactive cognitive training system was developed to provide assistive training on core EF following pediatric TBI. Pilot usability testing showed adequate user satisfaction ratings for both the hardware and software components of the VR system. Conclusions: This project designed and tested a novel VR-based system for executive function rehabilitation that is specifically adapted to children following TBI. ",
doi="10.2196/16947",
url="http://games.jmir.org/2020/3/e16947/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32447275"
}


@Article{info:doi/10.2196/16004,
author="King, D'Arcy
and Khan, Sundas
and Polo, Jennifer
and Solomon, Jeffrey
and Pekmezaris, Renee
and Hajizadeh, Negin",
title="Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Aug",
day="4",
volume="7",
number="2",
pages="e16004",
keywords="chronic obstructive pulmonary disease",
keywords="usability testing",
keywords="telehealth",
keywords="telerehabilitation",
keywords="vulnerable populations",
abstract="Background: Telehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD).  However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices. Objective: The objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study. Methods: Usability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions. Results: During usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements. Conclusions: Usability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions. ",
doi="10.2196/16004",
url="http://rehab.jmir.org/2020/2/e16004/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32749229"
}


@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/10.2196/18584,
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/10.2196/16991,
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/10.2196/19099,
author="Patel, Ben
and Thind, Arron",
title="Usability of Mobile Health Apps for Postoperative Care: Systematic Review",
journal="JMIR Perioper Med",
year="2020",
month="Jul",
day="20",
volume="3",
number="2",
pages="e19099",
keywords="postoperative monitoring",
keywords="postoperative care",
keywords="mobile health app",
keywords="telemedicine",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps are increasingly used postoperatively to monitor, educate, and rehabilitate. The usability of mHealth apps is critical to their implementation. Objective: This systematic review evaluates the (1) methodology of usability analyses, (2) domains of usability being assessed, and (3) results of usability analyses. Methods: The A Measurement Tool to Assess Systematic Reviews checklist was consulted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was adhered to. Screening was undertaken by 2 independent reviewers. All included studies were assessed for risk of bias. Domains of usability were compared with the gold-standard mHealth App Usability Questionnaire (MAUQ). Results: A total of 33 of 720 identified studies were included for data extraction. Of the 5 included randomized controlled trials (RCTs), usability was never the primary end point. Methodology of usability analyses included interview (10/33), self-created questionnaire (18/33), and validated questionnaire (9/33). Of the 3 domains of usability proposed in the MAUQ, satisfaction was assessed in 28 of the 33 studies, system information arrangement was assessed in 11 of the 33 studies, and usefulness was assessed in 18 of the 33 studies. Usability of mHealth apps was above industry average, with median System Usability Scale scores ranging from 76 to 95 out of 100. Conclusions: Current analyses of mHealth app usability are substandard. RCTs are rare, and validated questionnaires are infrequently consulted. Of the 3 domains of usability, only satisfaction is regularly assessed. There is significant bias throughout the literature, particularly with regards to conflicts of interest. Future studies should adhere to the MAUQ to assess usability and improve the utility of mHealth apps. ",
doi="10.2196/19099",
url="https://periop.jmir.org/2020/2/e19099",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393925"
}


@Article{info:doi/10.2196/18919,
author="Bashir, Ayisha",
title="Stroke and Telerehabilitation: A Brief Communication",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Jul",
day="17",
volume="7",
number="2",
pages="e18919",
keywords="telerehabilitation",
keywords="rehabilitation",
keywords="nursing",
keywords="stroke",
keywords="telehealth",
doi="10.2196/18919",
url="https://rehab.jmir.org/2020/2/e18919",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706739"
}


@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/10.2196/18415,
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/10.2196/18688,
author="Gagnon, Marianne
and Collins, Jessica
and Elfassy, Caroline
and Marino Merlo, Gabriela
and Marsh, Jacquelyn
and Sawatzky, Bonita
and Yap, Rita
and Hamdy, Reggie
and Veilleux, Louis-Nicolas
and Dahan-Oliel, No{\'e}mi",
title="A Telerehabilitation Intervention for Youths With Arthrogryposis Multiplex Congenita: Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2020",
month="Jun",
day="26",
volume="9",
number="6",
pages="e18688",
keywords="telerehabilitation",
keywords="arthrogryposis multiplex congenita",
keywords="physical therapy",
keywords="occupational therapy",
abstract="Background: Arthrogryposis multiplex congenita (AMC) is characterized by joint contractures present in at least two body areas. In addition to these contractures, individuals with AMC can have decreased muscle mass, leading to limitations in activities of daily living. Exercise has the potential to maintain or improve the range of motion and muscle strength. However, this type of intervention necessitates frequent follow ups that are currently difficult to provide for youths with AMC because they often live far from a specialized hospital. To overcome this distance challenge, telecommunication technologies can be used to deliver rehabilitation remotely, which is called telerehabilitation. The study protocol for one such type of rehabilitation will be presented in this paper. Objective: This pilot study aims to (1) evaluate the feasibility of using telerehabilitation to provide a home exercise program for youths with AMC, and (2) assess the effectiveness of a home exercise program. Methods: A total of 10 youths aged 8-21 years with AMC will be recruited. The intervention consists of a 12-week individualized home-based exercise program delivered remotely using telerehabilitation. At baseline, youths will complete the Physical Activity Questionnaire for Adolescents and the Pediatrics Outcomes Data Collection Instrument to assess pain, function, and level of physical activity. During the first telerehabilitation meeting, the rehabilitation therapists will measure range of motion using a virtual goniometer and assess the youth's functional level. The therapists will then use the Goal Attainment Scale to set objectives and develop the individualized intervention. Follow ups will occur every 3 weeks to make sure exercises are performed safely and to progress the exercises when needed. At the end of the 12-week intervention, rehabilitation therapists will re-evaluate the youth using the same outcome measures as the initial evaluation. The youths will be asked to complete the same questionnaires, with the addition of questions about their satisfaction regarding the intervention. Nonparametric and descriptive statistics will be used to evaluate the feasibility and effectiveness. Results: Ethics approval was obtained in October 2018. Recruitment and data collection started in January 2019 and was completed in May 2020. Conclusions: This pilot study will help us learn how a large-scale project may work in practice to improve outcomes in physical activity, pain, and function, and goal attainment among youths with AMC, thus informing a future clinical trial. International Registered Report Identifier (IRRID): DERR1-10.2196/18688 ",
doi="10.2196/18688",
url="http://www.researchprotocols.org/2020/6/e18688/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32589157"
}


@Article{info:doi/10.2196/15375,
author="Fatoye, Francis
and Gebrye, Tadesse
and Fatoye, Clara
and Mbada, E. Chidozie
and Olaoye, I. Mistura
and Odole, C. Adesola
and Dada, Olumide",
title="The Clinical and Cost-Effectiveness of Telerehabilitation for People With Nonspecific Chronic Low Back Pain: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="24",
volume="8",
number="6",
pages="e15375",
keywords="cost-utility analysis",
keywords="quality-adjusted life years",
keywords="telerehabilitation",
keywords="low back pain",
keywords="mobile phone",
abstract="Background: Telerehabilitation can facilitate multidisciplinary management for people with nonspecific chronic low back pain (NCLBP). It provides health care access to individuals who are physically and economically disadvantaged. Objective: This study aimed to evaluate the clinical and cost-effectiveness of telerehabilitation compared with a clinic-based intervention for people with NCLBP in Nigeria. Methods: A cost-utility analysis alongside a randomized controlled trial from a health care perspective was conducted. Patients with NCLBP were assigned to either telerehabilitation-based McKenzie therapy (TBMT) or clinic-based McKenzie therapy (CBMT). Interventions were carried out 3 times weekly for a period of 8 weeks. Patients' level of disability was measured using the Oswestry Disability Index (ODI) at baseline, week 4, and week 8. To estimate the health-related quality of life of the patients, the ODI was mapped to the short-form six dimensions instrument to generate quality-adjusted life years (QALYs). Health care resource use and costs were assessed based on the McKenzie extension protocol in Nigeria in 2019. Descriptive and inferential data analyses were also performed to assess the clinical effectiveness of the interventions. Bootstrapping was conducted to generate the point estimate of the incremental cost-effectiveness ratio (ICER). Results: A total of 47 patients (TBMT, n=21 and CBMT, n=26), with a mean age of 47 (SD 11.6) years for telerehabilitation and 50 (SD 10.7) years for the clinic-based intervention, participated in this study. The mean cost estimates of TBMT and CBMT interventions per person were 22,200 naira (US \$61.7) and 38,200 naira (US \$106), respectively. QALY gained was 0.085 for TBMT and 0.084 for CBMT. The TBMT arm was associated with an additional 0.001 QALY (95\% CI 0.001 to 0.002) per participant compared with the CBMT arm. Thus, the ICER showed that the TBMT arm was less costly and more effective than the CBMT arm. Conclusions: The findings of the study suggested that telerehabilitation for people with NCLBP was cost saving. Given the small number of participants in this study, further examination of effects and costs of the interventions is needed within a larger sample size. In addition, future studies are required to assess the cost-effectiveness of this intervention in the long term from the patient and societal perspective. ",
doi="10.2196/15375",
url="http://mhealth.jmir.org/2020/6/e15375/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32357128"
}


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


@Article{info:doi/10.2196/15843,
author="V{\"o}lter, Christiane
and Schirmer, Christiane
and Hinsen, Dorothee
and Roeber, Marieke
and Dazert, Stefan
and Bilda, Kerstin",
title="Therapist-Guided Telerehabilitation for Adult Cochlear Implant Users: Developmental and Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="May",
day="28",
volume="7",
number="1",
pages="e15843",
keywords="telerehabilitation",
keywords="cochlear implantation",
keywords="computer-based auditory training",
keywords="multimodal platform system",
abstract="Background: Cochlear implants can provide auditory perception to many people with hearing impairment who derive insufficient benefits from hearing aid use. For optimal speech perception with a cochlear implant, postoperative auditory training is necessary to adapt the brain to the new sound transmitted by the implant. Currently, this training is usually conducted via face-to-face sessions in rehabilitation centers. With the aging of society, the prevalence of age-related hearing loss and the number of adults with cochlear implants are expected to increase. Therefore, augmenting face-to-face rehabilitation with alternative forms of auditory training may be highly valuable. Objective: The purpose of this multidisciplinary study was to evaluate the newly developed internet-based teletherapeutic multimodal system Train2hear, which enables adult cochlear implant users to perform well-structured and therapist-guided hearing rehabilitation sessions on their own. Methods: The study was conducted in 3 phases: (1) we searched databases from January 2005 to October 2018 for auditory training programs suitable for adult cochlear implant users; (2) we developed a prototype of Train2hear based on speech and language development theories; (3) 18 cochlear implant users (mean age 61, SD 15.4 years) and 10 speech and language therapists (mean age 34, SD 10.9 years) assessed the usability and the feasibility of the prototype. This was achieved via questionnaires, including the System Usability Scale (SUS) and a short version of the intrinsic motivation inventory (KIM) questionnaires. Results: The key components of the Train2hear training program are an initial analysis according to the International Classification of Functioning, Disability and Health; a range of different hierarchically based exercises; and an automatic and dynamic adaptation of the different tasks according to the cochlear implant user's progress. In addition to motivational mechanisms (such as supportive feedback), the cochlear implant user and therapist receive feedback in the form of comprehensive statistical analysis. In general, cochlear implant users enjoyed their training as assessed by KIM scores (mean 19, SD 2.9, maximum 21). In terms of usability (scale 0-100), the majority of users rated the Train2hear program as excellent (mean 88, SD 10.5). Age (P=.007) and sex (P=.01) had a significant impact on the SUS score with regard to usability of the program. The therapists (SUS score mean 93, SD 9.2) provided slightly more positive feedback than the cochlear implant users (mean 85, SD 10.3). Conclusions: Based on this first evaluation, Train2hear was well accepted by both cochlear implant users and therapists. Computer-based auditory training might be a promising cost-effective option that can provide a highly personalized rehabilitation program suited to individual cochlear implant user characteristics. ",
doi="10.2196/15843",
url="http://rehab.jmir.org/2020/1/e15843/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32255434"
}


@Article{info:doi/10.2196/17219,
author="Li, Li
and Huang, Jia
and Wu, Jingsong
and Jiang, Cai
and Chen, Shanjia
and Xie, Guanli
and Ren, Jinxin
and Tao, Jing
and Chan, H. Chetwyn C.
and Chen, Lidian
and Wong, K. Alex W.",
title="A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="13",
volume="8",
number="5",
pages="e17219",
keywords="telemedicine",
keywords="cell phone",
keywords="stroke",
keywords="rehabilitation",
keywords="activities of daily living",
keywords="outcome and process assessment",
keywords="health care",
abstract="Background: Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. Objective: This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone--based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. Methods: A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. Results: Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95\% and 82\% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95\% and 80\% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (X21=1.6, P=.21 for 2-week follow-up; X21=1.9, P=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (X23=6.7, P=.04 for 2-week follow-up; X23=8.0, P=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (X23=13.9; P=.03). Conclusions: The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. Trial Registration: chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831\&htm=4. ",
doi="10.2196/17219",
url="https://mhealth.jmir.org/2020/5/e17219",
url="http://www.ncbi.nlm.nih.gov/pubmed/32401221"
}


@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/10.2196/13197,
author="Pekmezaris, Renee
and Kozikowski, Andrzej
and Pascarelli, Briana
and Wolf-Klein, Gisele
and Boye-Codjoe, Eugenia
and Jacome, Sonia
and Madera, Danielle
and Tsang, Donna
and Guerrero, Brenda
and Medina, Richard
and Polo, Jennifer
and Williams, Myia
and Hajizadeh, Negin",
title="A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="31",
volume="4",
number="1",
pages="e13197",
keywords="COPD",
keywords="pulmonary rehabilitation",
keywords="telehealth",
keywords="CPBR",
keywords="disparities",
keywords="telemonitoring",
abstract="Background: Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. Objective: This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. Methods: We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. Results: We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. Conclusions: These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. Trial Registration: ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485 ",
doi="10.2196/13197",
url="https://formative.jmir.org/2020/1/e13197",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012039"
}


@Article{info:doi/10.2196/15045,
author="Herkert, Cyrille
and Kraal, Johannes Jos
and van Loon, Agnes Eline Maria
and van Hooff, Martijn
and Kemps, Clemens Hareld Marijn",
title="Usefulness of Modern Activity Trackers for Monitoring Exercise Behavior in Chronic Cardiac Patients: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="19",
volume="7",
number="12",
pages="e15045",
keywords="cardiac diseases",
keywords="activity trackers",
keywords="energy metabolism",
keywords="physical activity",
keywords="validation studies",
abstract="Background: Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population. Objective: The aim of this study was to determine the accuracy and responsiveness of 2 wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients. Methods: EE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile [OM]) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF). Results: A total of 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8\%, SD 7.6\%). The CAD group showed no significant difference in total EE between FC2 and OM (47.5 kcal, SD 112 kcal; P=.09), in contrast to a significant difference between MS and OM (88 kcal, SD 108 kcal; P=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38 kcal, SD 57 kcal; P=.01), as well as between MS and OM (106 kcal, SD 167 kcal; P=.02). Agreement of the activity trackers was low in both groups (CAD: intraclass correlation coefficient [ICC] FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, whereas MS was able to detect changes in cycling loads only. Conclusions: Both activity trackers demonstrated low accuracy in estimating EE in cardiac patients and poor performance to detect within-patient changes in the low-to-moderate exercise intensity domain. Although the use of activity trackers in cardiac patients is promising and could enhance daily exercise behavior, these findings highlight the need for population-specific devices and algorithms. ",
doi="10.2196/15045",
url="http://mhealth.jmir.org/2019/12/e15045/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31855191"
}


@Article{info:doi/10.2196/14236,
author="Eichler, Sarah
and Salzwedel, Annett
and Rabe, Sophie
and Mueller, Steffen
and Mayer, Frank
and Wochatz, Monique
and Hadzic, Miralem
and John, Michael
and Wegscheider, Karl
and V{\"o}ller, Heinz",
title="The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2019",
month="Nov",
day="7",
volume="6",
number="2",
pages="e14236",
keywords="telerehabilitation",
keywords="home-based",
keywords="total hip replacement",
keywords="total knee replacement",
keywords="exercise therapy",
keywords="aftercare",
keywords="rehabilitation",
abstract="Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare. Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare. Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3\% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints. Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75\%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6\%; P=.01) versus the control group (46.2\%) is of note. Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare. Trial Registration: German Clinical Trials Register DRKS00010009; https://www.drks.de/drks\_web/navigate.do? navigationId=trial.HTML\&TRIAL\_ID=DRKS00010009 ",
doi="10.2196/14236",
url="http://rehab.jmir.org/2019/2/e14236/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31697239"
}


@Article{info:doi/10.2196/13901,
author="Lima, Paula Ana
and Nascimento, Oliveira Isabella
and Oliveira, A. Anne Caroline
and Martins, S. Thiago Henrique
and Pereira, Gomes Danielle A.
and Britto, Rodrigues Raquel",
title="Home-Based Cardiac Rehabilitation in Brazil's Public Health Care: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Nov",
day="7",
volume="8",
number="11",
pages="e13901",
keywords="cardiac rehabilitation",
keywords="coronary disease",
keywords="exercise",
abstract="Background: Coronary artery disease (CAD) is among the main causes of hospitalization and death worldwide, therefore, the implementation of programs to reduce its impact is necessary. Supervised cardiac rehabilitation has been shown to have positive effects on CAD control. However, there are barriers to patient participation in the traditional, face-to-face cardiac rehabilitation programs, mainly in low-resource environments. Objective: This study aimed to verify patient compliance to a home-based cardiac rehabilitation program, which includes unsupervised health education and physical exercises, guided by telephone. Moreover, we compare this new method to the traditional supervised cardiac rehabilitation offered in most hospital centers. Methods: We present here a two-arm, single-blinded, and randomized controlled design protocol, which compares the traditional cardiac rehabilitation (CenterRehab) with the home-based cardiac rehabilitation (Home-Based) in 72 patients affected by CAD. The primary outcome is the compliance to the cardiac rehabilitation sessions. The secondary outcomes (to evaluate effectiveness) include measurable variables such as functional capacity, CAD risk factors (blood pressure, waist circumference, glycemic, cholesterol levels, depressive symptoms, and the level of physical activity), the patient's quality of life, the disease knowledge, and the morbidity rate. Parameters such as the program cost and the usability will also be evaluated. The programs will last 12 weeks, with a total of 60 rehabilitation and 6 educational sessions. Patients of the CenterRehab program will participate in 24 supervised sessions and 36 home sessions, while the patients of the Home-Based program will participate in 2 supervised sessions and 58 home sessions, guided by telephone. After the 12-week period all participants will be recommended to continue practicing physical exercises at home or at a community center, and they will be invited for re-evaluation after 3 months. The outcomes will be evaluated at baseline, and after 3 and 6 months. Results: Participants are currently being recruited for the trial. Data collection is anticipated to be completed by October 2019. Conclusions: This is the first study in Brazil comparing the traditional cardiac rehabilitation approach with a novel, home-based protocol that uses an accessible and low-cost technology. If positive results are obtained, the study will contribute to establish a new and viable model of cardiac rehabilitation. Trial Registration: ClinicalTrials.gov NCT03605992; https://clinicaltrials.gov/ct2/show/NCT03605992 International Registered Report Identifier (IRRID): DERR1-10.2196/13901 ",
doi="10.2196/13901",
url="https://www.researchprotocols.org/2019/11/e13901",
url="http://www.ncbi.nlm.nih.gov/pubmed/31697246"
}


@Article{info:doi/10.2196/12981,
author="Zhou, Leming
and Parmanto, Bambang",
title="Reaching People With Disabilities in Underserved Areas Through Digital Interventions: Systematic Review",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="25",
volume="21",
number="10",
pages="e12981",
keywords="systematic review",
keywords="digital intervention",
keywords="electronic intervention",
keywords="e-intervention",
keywords="underserved area",
keywords="disability",
keywords="telemedicine",
keywords="telerehabilitation",
keywords="eHealth",
keywords="digital health",
abstract="Background: People with disabilities need rehabilitation interventions to improve their physical functioning, mental status, and quality of life. Many rehabilitation interventions can be delivered electronically (``digitally'') via telehealth systems. For people with disabilities in underserved areas, electronically delivered rehabilitation interventions may be the only feasible service available for them. Objective: The objective of this study was to evaluate the current status of digital interventions for people with disabilities in remote and underserved areas. Methods: A systematic review was conducted on this topic. Keyword searches in multiple databases (PubMed, CINAHL, and Inspec) were performed to collect articles published in this field. The obtained articles were selected based on our selection criteria. Of the 198 identified articles, 16 duplicates were removed. After a review of the titles and abstracts of the remaining articles, 165 were determined to be irrelevant to this study and were therefore removed. The full texts of the remaining 17 articles were reviewed, and 6 of these articles were removed as being irrelevant to this study. The 11 articles remaining were discussed and summarized by 2 reviewers. Results: These 11 studies cover a few types of disabilities, such as developmental disabilities and mobility impairments as well as several types of disability-causing disorders such as stroke, multiple sclerosis, traumatic brain injury, and facio-scapulo-humeral muscular dystrophy. Most of these studies were small-scale case studies and relatively larger-scale cohort studies; the project evaluation methods were mainly pre-post comparison, questionnaires, and interviews. A few studies also performed objective assessment of functional improvement. The intervention technology was mainly videoconferencing. Moreover, 10 of these studies were for people with disabilities in rural areas and 1 was for people in urban communities. Conclusions: A small number of small-scale studies have been conducted on digital interventions for people with disabilities in underserved areas. Although the results reported in these studies were mostly positive, they are not sufficient to prove the effectiveness of telehealth-based digital intervention in improving the situation among people with disabilities because of the small sample sizes and lack of randomized controlled trials. ",
doi="10.2196/12981",
url="http://www.jmir.org/2019/10/e12981/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31654569"
}


@Article{info:doi/10.2196/12346,
author="Thorpe, Julia
and Forchhammer, Hysse Birgitte
and Maier, M. Anja",
title="Adapting Mobile and Wearable Technology to Provide Support and Monitoring in Rehabilitation for Dementia: Feasibility Case Series",
journal="JMIR Form Res",
year="2019",
month="Oct",
day="17",
volume="3",
number="4",
pages="e12346",
keywords="dementia",
keywords="cognitive rehabilitation",
keywords="mobility",
keywords="activity",
keywords="mHealth",
keywords="uHealth",
keywords="pervasive health care",
keywords="P4 health care",
keywords="health care design",
abstract="Background: Mobile and wearable devices are increasingly being used to support our everyday lives and track our behavior. Since daily support and behavior tracking are two core components of cognitive rehabilitation, such personal devices could be employed in rehabilitation approaches aimed at improving independence and engagement among people with dementia. Objective: The aim of this work was to investigate the feasibility of using smartphones and smartwatches to augment rehabilitation by providing adaptable, personalized support and objective, continuous measures of mobility and activity behavior. Methods: A feasibility study comprising 6 in-depth case studies was carried out among people with early-stage dementia and their caregivers. Participants used a smartphone and smartwatch for 8 weeks for personalized support and followed goals for quality of life. Data were collected from device sensors and logs, mobile self-reports, assessments, weekly phone calls, and interviews. This data were analyzed to evaluate the utility of sensor data generated by devices used by people with dementia in an everyday life context; this was done to compare objective measures with subjective reports of mobility and activity and to examine technology acceptance focusing on usefulness and health efficacy. Results: Adequate sensor data was generated to reveal behavioral patterns, even for minimal device use. Objective mobility and activity measures reflecting fluctuations in participants' self-reported behavior, especially when combined, may be advantageous in revealing gradual trends and could provide detailed insights regarding goal attainment ratings. Personalized support benefited all participants to varying degrees by addressing functional, memory, safety, and psychosocial needs. A total of 4 of 6 (67\%) participants felt motivated to be active by tracking their step count. One participant described a highly positive impact on mobility, anxiety, mood, and caregiver burden, mainly as a result of navigation support and location-tracking tools. Conclusions: Smartphones and wearables could provide beneficial and pervasive support and monitoring for rehabilitation among people with dementia. These results substantiate the need for further investigation on a larger scale, especially considering the inevitable presence of mobile and wearable technology in our everyday lives for years to come. ",
doi="10.2196/12346",
url="http://formative.jmir.org/2019/4/e12346/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31625951"
}


@Article{info:doi/10.2196/14517,
author="Dinesen, Birthe
and Dittmann, Lars
and Gade, Dam Josefine
and J{\o}rgensen, Klitgaard Cecilia
and Hollingdal, Malene
and Leth, Soeren
and Melholt, Camilla
and Spindler, Helle
and Refsgaard, Jens",
title="``Future Patient'' Telerehabilitation for Patients With Heart Failure: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Sep",
day="19",
volume="8",
number="9",
pages="e14517",
keywords="heart failure",
keywords="telerehabilitation",
keywords="research design",
keywords="quality of life",
keywords="patient education",
keywords="user-driven innovation",
abstract="Background: Cardiovascular disease is the leading cause of mortality worldwide, accounting for 13\%-15\% of all deaths. Cardiac rehabilitation has poor compliance and adherence. Telerehabilitation has been introduced to increase patients' participation, access, and adherence with the help of digital technologies. The target group is patients with heart failure. A telerehabilitation program called ``Future Patient'' has been developed and consists of three phases: (1) titration of medicine (0-3 months), (2) implementation of the telerehabilitation protocols (3 months), and (3) follow-up with rehabilitation in everyday life (6 months). Patients in the Future Patient program measure their blood pressure, pulse, weight, number of steps taken, sleep, and respiration and answer questions online regarding their well-being. All data are transmitted and accessed in the HeartPortal by patients and health care professionals. Objective: The aim of this paper is to describe the research design, outcome measures, and data collection techniques in the clinical test of the Future Patient Telerehabilitation Program for patients with heart failure. Methods: A randomized controlled study will be performed. The intervention group will follow the Future Patient Telerehabilitation program, and the control group will follow the traditional cardiac rehabilitation program. The primary outcome is quality of life measured by the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes are development of clinical data; illness perception; motivation; anxiety and depression; health and electronic health literacy; qualitative exploration of patients', spouses', and health care professionals' experiences of participating in the telerehabilitation program; and a health economy evaluation of the program. Outcomes were assessed using questionnaires and through the data generated by digital technologies. Results: Data collection began in December 2016 and will be completed in October 2019. The study results will be published in peer-reviewed journals and presented at international conferences. Results from the Future Patient Telerehabilitation program are expected to be published by the spring of 2020. Conclusions: The expected outcomes are increased quality of life, increased motivation and illness perception, reduced anxiety and depressions, improved electronic health literacy, and health economics benefits. We expect the study to have a clinical impact for future telerehabilitation of patients with heart failure. Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918 International Registered Report Identifier (IRRID): DERR1-10.2196/14517 ",
doi="10.2196/14517",
url="https://www.researchprotocols.org/2019/9/e14517",
url="http://www.ncbi.nlm.nih.gov/pubmed/31538944"
}


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


@Article{info:doi/10.2196/12647,
author="Marshall, Skye
and van der Meij, S. Barbara
and Milte, Rachel
and Collins, E. Clare
and de van der Schueren, AE Marian
and Banbury, Mark
and Warner, M. Molly
and Isenring, Elizabeth",
title="Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study",
journal="JMIR Res Protoc",
year="2019",
month="Apr",
day="30",
volume="8",
number="4",
pages="e12647",
keywords="carers",
keywords="protein-energy malnutrition",
keywords="telehealth",
keywords="intervention",
keywords="pilot study",
keywords="older adults",
keywords="subacute",
keywords="rehabilitation",
keywords="aged",
abstract="Background: Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting. Objective: The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial. Methods: This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility. Results: Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission. Conclusions: This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home. Trial Registration: Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608\&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2). International Registered Report Identifier (IRRID): DERR1-10.2196/12647 ",
doi="10.2196/12647",
url="https://www.researchprotocols.org/2019/4/e12647/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31038466"
}


@Article{info:doi/10.2196/13163,
author="Gerber, Moreno Stephan
and Sch{\"u}tz, Narayan
and Uslu, Sinan Arif
and Schmidt, Nadine
and R{\"o}thlisberger, Carina
and Wyss, Patric
and Perny, Sandra
and Wyss, Corina
and Koenig-Bruhin, Monica
and Urwyler, Prabitha
and Nyffeler, Thomas
and Marchal-Crespo, Laura
and Mosimann, Peter Urs
and M{\"u}ri, Martin Ren{\'e}
and Nef, Tobias",
title="Therapist-Guided Tablet-Based Telerehabilitation for Patients With Aphasia: Proof-of-Concept and Usability Study",
journal="JMIR Rehabil Assist Technol",
year="2019",
month="Apr",
day="26",
volume="6",
number="1",
pages="e13163",
keywords="aphasia",
keywords="high-intensity training",
keywords="telerehabilitation",
keywords="multiplatform system",
abstract="Background: Aphasia is the loss or impairment of language functions and affects everyday social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, therapy must be adapted individually and dynamically to patient needs. An important factor for successful aphasia therapy is dose and intensity of therapy. Tablet computer--based apps are a promising treatment method that allows patients to train independently at home, is well accepted, and is known to be beneficial for patients. In addition, it has been shown to ease the burden of therapists. Objective: The aim of this project was to develop an adaptive multimodal system that enables aphasic patients to train at home using language-related tasks autonomously, allows therapists to remotely assign individualized tasks in an easy and time-efficient manner, and tracks the patient's progress as well as creation of new individual exercises. Methods: The system consists of two main parts: (1) the patient's interface, which allows the patient to exercise, and (2) the therapist's interface, which allows the therapist to assign new exercises to the patient and supervise the patient's progress. The pool of exercises is based on a hierarchical language structure. Using questionnaires, therapists and patients evaluated the system in terms of usability (ie, System Usability Scale) and motivation (ie, adapted Intrinsic Motivation Inventory). Results: A total of 11 speech and language therapists (age: mean 28, SD 7 years) and 15 patients (age: mean 53, SD 10 years) diagnosed with aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale 0-100) as excellent (score >70; Z=--1.90; P=.03) and therapists rated the app as good (score >85; Z=--1.75; P=.04). Furthermore, patients enjoyed (scale 0-6) solving the exercises (score>3; mean 3.5, SD 0.40; Z=--1.66; P=.049). Conclusions: Based on the questionnaire scores, the system is well accepted and simple to use for patients and therapists. Furthermore, the new tablet computer--based app and the hierarchical language exercise structure allow patients with different types of aphasia to train with different doses and intensities independently at home. Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy. ",
doi="10.2196/13163",
url="http://rehab.jmir.org/2019/1/e13163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31025946"
}


@Article{info:doi/10.2196/13281,
author="Dinesen, Birthe
and Nielsen, Gitte
and Andreasen, Jesper Jan
and Spindler, Helle",
title="Integration of Rehabilitation Activities Into Everyday Life Through Telerehabilitation: Qualitative Study of Cardiac Patients and Their Partners",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="15",
volume="21",
number="4",
pages="e13281",
keywords="telerehabilitation",
keywords="heart diseases",
keywords="social media",
keywords="qualitative study",
abstract="Background: Implementation of cardiac rehabilitation has not been optimal, with patient participation rates below 50\%. Factors that contribute to cardiac patients' lack of participation in rehabilitation programs are patient motivation, logistical difficulties in getting to the rehabilitation facilities, lack of psychosocial elements, and individualization of activities in the rehabilitation programs. Telerehabilitation has been proposed as a new way to address the challenge of engaging and motivating cardiac patients and their partners to participate in rehabilitation. Objective: The aim of this study was to explore the experiences of cardiac patients and their partners of participating in the Teledialog Telerehabilitation Program (TTP). The Teledialog program consisted of a digital rehabilitation plan, transmission of health data from patient's home to hospital and health care center, and an interactive Web portal with information and training videos. Methods: This case study used a theoretical approach combining the ``community of practice'' approach and self-determination theory. A triangulation of data collection techniques was used, including documents, participant observation (72 hours), and qualitative interviews with cardiac patients and their partners enrolled in the telerehabilitation group. A total of 14 cardiac patients, 12 patient spouses/partners, and 1 son participated in the study. The participants were interviewed at enrollment in the telerehabilitation program and after 12 weeks of participation in the program. Interview data were analyzed using NVivo 11.0. Results: Patients and their partners found the Web portal ActiveHeart.dk and the electronic rehabilitation (e-rehabilitation) plan to be helpful tools for health education, coordinating rehabilitation goals, creating an overview of the data, and ensuring continuity in the rehabilitation process. The patients felt that the TTP treated them as individuals, gave them a sense of autonomy, and provided enhanced relatedness to health care professionals and partners and a sense of competence as active participants in their own rehabilitation process. Some patients missed being part of a community of practice with other cardiac patients and did not use the Web forum. Patients' partners found that the telerehabilitation program gave them a sense of security and helped them balance their involvement as a partner to the patient and not push the patient too hard. Conclusions: Cardiac patients and their partners found telerehabilitation technologies a useful digital toolbox in the rehabilitation process. Telerehabilitation motivated the patients to integrate rehabilitation activities into their work schedule and everyday life and made them feel like unique individuals. Participating in the Teledialog Telerehabilitation Program might not be a suitable strategy for all cardiac patients. Being a patient's partner in the telerehabilitation program was associated with a heightened sense of security, navigation between active involvement in the rehabilitation process, being an equal partner, and not pushing the patient too hard. ",
doi="10.2196/13281",
url="http://www.jmir.org/2019/4/e13281/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30985284"
}


@Article{info:doi/10.2196/10985,
author="Anttila, Marjo-Riitta
and Kivist{\"o}, Heikki
and Piirainen, Arja
and Kokko, Katja
and Malinen, Anita
and Pekkonen, Mika
and Sj{\"o}gren, Tuulikki",
title="Cardiac Rehabilitees' Technology Experiences Before Remote Rehabilitation: Qualitative Study Using a Grounded Theory Approach",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="07",
volume="21",
number="2",
pages="e10985",
keywords="coronary disease",
keywords="rehabilitees' experience",
keywords="focus group",
keywords="qualitative study",
keywords="grounded theory",
keywords="remote rehabilitation",
keywords="e-health",
keywords="e-rehabilitation",
keywords="telerehabilitation",
keywords="secondary prevention",
abstract="Background: Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees' perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation. Objective: This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees' experiences and attitudes toward technology before 12 months of remote rehabilitation. Methods: Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74\% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser's mode of the grounded theory approach. Results: The result of the study was an ``identifying e-usage'' experience category, which refers to the rehabilitees' notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees' technology experience. These subcategories are ``feeling outsider,'' ``being uninterested,'' ``reflecting benefit,'' and ``enthusiastic using.'' All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation. Conclusions: The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education. Trial Registration: ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD) ",
doi="10.2196/10985",
url="http://www.jmir.org/2019/2/e10985/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30730298"
}


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


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


@Article{info:doi/10.2196/10758,
author="Dinesen, Birthe
and Spindler, Helle",
title="The Use of Telerehabilitation Technologies for Cardiac Patients to Improve Rehabilitation Activities and Unify Organizations: Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Nov",
day="19",
volume="5",
number="2",
pages="e10758",
keywords="telerehabilitation",
keywords="heart diseases",
keywords="workflow",
keywords="cooperation",
keywords="professional practice",
keywords="community of practice",
abstract="Background: Cardiovascular disease is a leading cause of death globally causing 31\% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals. Objective: This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program. Methods: Theories of networks between organizations, the sociology of professions, and the ``community of practice'' approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0. Results: The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals. Conclusions: The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs. Trial Registration: ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb) ",
doi="10.2196/10758",
url="http://rehab.jmir.org/2018/2/e10758/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30455168"
}


@Article{info:doi/10.2196/10867,
author="Tchero, Huidi
and Tabue Teguo, Maturin
and Lannuzel, Annie
and Rusch, Emmanuel",
title="Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="26",
volume="20",
number="10",
pages="e10867",
keywords="meta-analysis",
keywords="mobile phone",
keywords="rehabilitation",
keywords="stroke",
keywords="telemedicine",
abstract="Background: Telerehabilitation is an emerging technology through which medical rehabilitation care can be provided from a distance. Objective: This systematic review and meta-analysis aims to investigate the efficacy of telerehabilitation in poststroke patients. Methods: Eligible randomized controlled trials (RCTs) were identified by searching MEDLINE, Cochrane Central, and Web of Science databases. Continuous data were extracted for relevant outcomes and analyzed using the RevMan software as the standardized mean difference (SMD) and 95\% CI in a fixed-effect meta-analysis model. Results: We included 15 studies (1339 patients) in our systematic review, while only 12 were included in the pooled analysis. The combined effect estimate showed no significant differences between the telerehabilitation and control groups in terms of the Barthel Index (SMD --0.05, 95\% CI --0.18 to 0.08), Berg Balance Scale (SMD --0.04, 95\% CI --0.34 to 0.26), Fugl-Meyer Upper Extremity (SMD 0.50, 95\% CI --0.09 to 1.09), and Stroke Impact Scale (mobility subscale; SMD 0.18, 95\% CI --0.13 to 0.48]) scores. Moreover, the majority of included studies showed that both groups were comparable in terms of health-related quality of life (of stroke survivors), Caregiver Strain Index, and patients' satisfaction with care. One study showed that the cost of telerehabilitation was lower than usual care by US \$867. Conclusions: Telerehabilitation can be a suitable alternative to usual rehabilitation care in poststroke patients, especially in remote or underserved areas. Larger studies are needed to evaluate the health-related quality of life and cost-effectiveness with the ongoing improvements in telerehabilitation networks. ",
doi="10.2196/10867",
url="http://www.jmir.org/2018/10/e10867/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30368437"
}


@Article{info:doi/10.2196/jmir.9943,
author="Avila, Andrea
and Claes, Jomme
and Goetschalckx, Kaatje
and Buys, Roselien
and Azzawi, May
and Vanhees, Luc
and Cornelissen, V{\'e}ronique",
title="Home-Based Rehabilitation With Telemonitoring Guidance for Patients With Coronary Artery Disease (Short-Term Results of the TRiCH Study): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="22",
volume="20",
number="6",
pages="e225",
keywords="cardiac rehabilitation",
keywords="telemonitoring",
keywords="exercise",
keywords="coronary artery disease",
abstract="Background: Cardiac rehabilitation (CR) is an essential part of contemporary coronary heart disease management. However, patients exiting a center-based CR program have difficulty retaining its benefits. Objective: We aimed to evaluate the added benefit of a home-based CR program with telemonitoring guidance on physical fitness in patients with coronary artery disease (CAD) completing a phase II ambulatory CR program and to compare the effectiveness of this program in a prolonged center-based CR intervention by means of a randomized controlled trial. Methods: Between February 2014 and August 2016, 90 CAD patients (unblinded, mean age 61.2 years, SD 7.6; 80/90, 89.0\% males; mean height 1.73 m, SD 0.7; mean weight 82.9 kg, SD 13; mean body mass index 27.5 kg/m2, SD 3.4) who successfully completed a 3-month ambulatory CR program were randomly allocated to one of three groups: home-based (30), center-based (30), or control group (30) on a 1:1:1 basis. Home-based patients received a home-based exercise intervention with telemonitoring guidance consisting of weekly emails or phone calls; center-based patients continued the standard in-hospital CR, and control group patients received the usual care including the advice to remain physically active. All the patients underwent cardiopulmonary exercise testing for assessment of their peak oxygen uptake (VO2 P) at baseline and after a 12-week intervention period. Secondary outcomes included physical activity behavior, anthropometric characteristics, traditional cardiovascular risk factors, and quality of life. Results: Following 12 weeks of intervention, the increase in VO2 P was larger in the center-based (P=.03) and home-based (P=.04) groups than in the control group. In addition, oxygen uptake at the first (P-interaction=.03) and second (P-interaction=.03) ventilatory thresholds increased significantly more in the home-based group than in the center-based group. No significant changes were observed in the secondary outcomes. Conclusions: Adding a home-based exercise program with telemonitoring guidance following completion of a phase II ambulatory CR program results in further improvement of physical fitness and is equally as effective as prolonging a center-based CR in patients with CAD. Trial Registration: ClinicalTrials.gov NCT02047942; https://clinicaltrials.gov/ct2/show/NCT02047942 (Archived by WebCite at http://www.webcitation.org/70CBkSURj) ",
doi="10.2196/jmir.9943",
url="http://www.jmir.org/2018/6/e225/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29934286"
}


@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.9123,
author="Dimaguila, Luis Gerardo
and Gray, Kathleen
and Merolli, Mark",
title="Person-Generated Health Data in Simulated Rehabilitation Using Kinect for Stroke: Literature Review",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="May",
day="08",
volume="5",
number="1",
pages="e11",
keywords="health care information systems",
keywords="Kinect",
keywords="patient-generated health data",
keywords="person-generated health data",
keywords="review",
keywords="simulated rehabilitation",
keywords="stroke",
keywords="stroke rehabilitation",
keywords="video games",
keywords="virtual rehabilitation",
abstract="Background: Person- or patient-generated health data (PGHD) are health, wellness, and clinical data that people generate, record, and analyze for themselves. There is potential for PGHD to improve the efficiency and effectiveness of simulated rehabilitation technologies for stroke. Simulated rehabilitation is a type of telerehabilitation that uses computer technologies and interfaces to allow the real-time simulation of rehabilitation activities or a rehabilitation environment. A leading technology for simulated rehabilitation is Microsoft's Kinect, a video-based technology that uses infrared to track a user's body movements. Objective: This review attempts to understand to what extent Kinect-based stroke rehabilitation systems (K-SRS) have used PGHD and to what benefit. Methods: The review is conducted in two parts. In part 1, aspects of relevance for PGHD were searched for in existing systematic reviews on K-SRS. The following databases were searched: IEEE Xplore, Association of Computing Machinery Digital Library, PubMed, Biomed Central, Cochrane Library, and Campbell Collaboration. In part 2, original research papers that presented or used K-SRS were reviewed in terms of (1) types of PGHD, (2) patient access to PGHD, (3) PGHD use, and (4) effects of PGHD use. The search was conducted in the same databases as part 1 except Cochrane and Campbell Collaboration. Reference lists on K-SRS of the reviews found in part 1 were also included in the search for part 2. There was no date restriction. The search was closed in June 2017. The quality of the papers was not assessed, as it was not deemed critical to understanding PGHD access and use in studies that used K-SRS. Results: In part 1, 192 papers were identified, and after assessment only 3 papers were included. Part 1 showed that previous reviews focused on technical effectiveness of K-SRS with some attention on clinical effectiveness. None of those reviews reported on home-based implementation or PGHD use. In part 2, 163 papers were identified and after assessment, 41 papers were included. Part 2 showed that there is a gap in understanding how PGHD use may affect patients using K-SRS and a lack of patient participation in the design of such systems. Conclusions: This paper calls specifically for further studies of K-SRS---and for studies of technologies that allow patients to generate their own health data in general---to pay more attention to how patients' own use of their data may influence their care processes and outcomes. Future studies that trial the effectiveness of K-SRS outside the clinic should also explore how patients and carers use PGHD in home rehabilitation programs. ",
doi="10.2196/rehab.9123",
url="http://rehab.jmir.org/2018/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29739739"
}