@Article{info:doi/10.2196/66037, author="Long, Jing and You, Jikai and Yang, Yanan", title="Effect of Digital Exercise Therapy on the Pain and Physical Function of Patients With Osteoarthritis: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2025", month="Apr", day="25", volume="27", pages="e66037", keywords="exercise program", keywords="telerehabilitation", keywords="rehabilitation", keywords="digital care", keywords="physical activity", keywords="health app", keywords="physical therapy", keywords="systematic review", keywords="meta-analysis", abstract="Background: Osteoarthritis (OA) is a chronic degenerative bone and joint disease that significantly impacts patients' quality of life and mental health, while also imposing a substantial economic burden on society. However, access to rehabilitation for patients with OA is challenging upon hospital discharge. Digital exercise therapy represents a promising telemedicine strategy for enhancing the management of OA, but its effect on OA is not yet clear. Objective: This study aimed to systematically evaluate the therapeutic effects of digital exercise therapy on pain and physical function in patients with OA. Methods: Databases including PubMed, Embase, Cochrane Library, Web of Science, and SPORTDiscus were searched for randomized controlled trials on using digital exercise therapy for OA until October 25, 2023. The primary outcomes included the measures of pain scores or physical function scores immediately after the intervention and at full follow-up. The risk of bias was evaluated using the Physiotherapy Evidence Database scale. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software (Cochrane Collaboration). Results: A total of 9 studies with 1604 patients were included in the final meta-analysis. Compared with the conventional treatment group, digital exercise therapy significantly reduced numerical rating scale pain scores (mean difference [MD]=--1.07, 95\% CI --1.35 to --0.78; P<.001) and Western Ontario and McMaster Universities Osteoarthritis Index physical function scores (MD=--2.39, 95\% CI --3.68 to --1.10; P<.001) in patients with OA immediately after the intervention. However, follow-up results revealed no statistically significant difference in numerical rating scale pain scores (MD=--0.20, 95\% CI --0.59 to 0.20; P=.34), while Western Ontario and McMaster Universities Osteoarthritis Index physical function scores showed a significant improvement in the digital exercise therapy group compared with the control group (MD=--1.89, 95\% CI --3.52 to --0.26; P=.02). These findings suggest that digital exercise therapy provides immediate benefits for both pain and physical function in patients with OA, with sustained improvements in physical function observed during follow-up, though pain relief may not persist long term. Conclusions: Digital exercise therapy can alleviate the pain and improve the physical function in patients with OA and can be used as an auxiliary means in the rehabilitation treatment of OA. It provides great convenience for patients with OA who need long-term treatment, allowing them to exercise at home for rehabilitation training. Trial Registration: PROSPERO CRD42023484819; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023484819 ", doi="10.2196/66037", url="https://www.jmir.org/2025/1/e66037" } @Article{info:doi/10.2196/62986, author="?erban, Bianca Irina and Fruytier, Lonneke and Houben, Steven and Colombo, Sara and van de Sande, Danny and Kemps, Hareld and Brombacher, Aarnout", title="Design Requirements for Cardiac Telerehabilitation Technologies Supporting Athlete Values: Qualitative Interview Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="17", volume="12", pages="e62986", keywords="athletes with established coronary artery disease", keywords="cardiac telerehabilitation", keywords="value-sensitive design", keywords="sports monitoring", keywords="card sorting", keywords="qualitative research", keywords="artificial intelligence", keywords="AI", abstract="Background: Cardiac telerehabilitation (CTR) interventions can provide accessible and affordable remote rehabilitation services. However, as cardiac rehabilitation (CR) primarily targets inactive patients, little is known about the experiences with CR of highly active patients (ie, recreational athletes or, simply, athletes) with established coronary artery disease. Consequently, existing CTR interventions do not address the specific needs of the athletic subpopulation. Understanding the needs and values of athletes is crucial for designing meaningful CTR interventions that enhance user acceptance and engagement, thereby facilitating effective rehabilitation for this patient subgroup. Objective: This study aimed to inform the design of technologies that facilitate CTR for athletes. We intended to identify athletes' values related to CR, including health and sports tracking, as well as high-level requirements for technologies that can facilitate the CTR of athletes according to the identified values. Methods: We used value-sensitive design with a human-centric design approach to elicit design requirements for CTR that can serve athletes with established coronary artery disease. To identify athletes' values, we conducted 25 value-oriented semistructured interviews with 15 athletic patients and 10 health care professionals involved in CR programs. In a second phase, we conducted 6 card-sorting focus group sessions with 13 patients and 7 health care professionals to identify desired CTR features. Finally, we derived high-level CTR technology requirements connected to the athletes' needs and values. Results: We defined 12 athlete values divided into 3 categories: body centric, care centric, and data and technology centric. We clustered findings from the card-sorting activity into CTR technology requirements, such as remotely monitored sport-specific training and training data representations next to clinical limitations, and paired them with corresponding values. Conclusions: Athletes have distinct values and health goals in CR compared to general populations targeted by CTR interventions. Designing patient-centric CTR interventions that address these needs is crucial to support optimal recovery, safe return to sports, and adherence to CTR technologies in the home environment. ", doi="10.2196/62986", url="https://rehab.jmir.org/2025/1/e62986", url="http://www.ncbi.nlm.nih.gov/pubmed/40245391" } @Article{info:doi/10.2196/59688, author="Chew, Shuxian Eleanor and Scully, Eugenia Aileen and Koh, Shi-Man Samanth and Woon, Ee-Lin and Low, Miao-Shi Juanita Krysten and Kwan, Yu-Heng and Tan, Wei-Ming John and Pua, Yong-Hao and Tan, Ia-Choo Celia and Haseler, Jonathan Luke", title="Understanding Patient and Physiotherapist Requirements for a Personalized Automated Smartphone Telemonitored App for Posttotal Knee Arthroplasty Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="14", volume="12", pages="e59688", keywords="knee replacement", keywords="knee arthroplasty", keywords="mobile", keywords="application", keywords="interview", keywords="telemonitored", keywords="smartphone rehabilitation", keywords="mobile phone", abstract="Background: Total knee arthroplasty (TKA) is a cost-effective surgical intervention for painful knee osteoarthritis in older adults, but postsurgery rehabilitation access is limited. Telerehabilitation offers a solution, but existing models require significant therapist involvement and a costly setup. A personalized smartphone-based automated program could be a cost-effective alternative. Objective: This study aimed to understand the requirements of both patients and physiotherapists in developing an automated telemonitored rehabilitation smartphone app for individuals undergoing TKA. To ensure uptake and long-term sustainability, this study adopted a person-based approach. Methods: A multistakeholder qualitative study of user needs was conducted. Physiotherapists and patients who underwent TKA were recruited via purposive sampling. Individual in-depth, hour-long interviews were conducted via Zoom by an experienced, trained female interviewer with a Master of Arts in Sociology. Data were audio-recorded and transcribed by the same interviewer. Two reviewers (ESC and SSK) independently analyzed the data using thematic analysis, with data triangulation achieved through cross-checking of data sources by 3 reviewers (ESC, SSK, and AES). Interviews were conducted to data saturation. Results: Six patients and 4 physiotherapists participated. For the patient interface, patients emphasized ease of use and specified features like a search function and multilingual options. For the physiotherapist interface, physiotherapists stated ease of accessing patient data and outcome measures for effective monitoring as important. Both patients and physiotherapists highlighted the need for timely, condition-specific information, supplemented by visual aids to support exercises, pain management, and recovery goals. They also stressed the significance of progress tracking, feedback, and the ability to access health care professionals for reassurance. Motivational features, including reminders, prompts, and exercise logs, were recommended to improve adherence. Both groups similarly identified the need for initial training to ensure confident use of the app. Conclusion: This study provided insights into the requirements of potential end users of a smartphone app for automated telemonitored rehabilitation following TKA. This is useful for steering the development of a user-centric smartphone app. ", doi="10.2196/59688", url="https://rehab.jmir.org/2025/1/e59688" } @Article{info:doi/10.2196/72466, author="Plavoukou, Theodora and Iosifidis, Michail and Papagiannis, Georgios and Stasinopoulos, Dimitrios and Georgoudis, Georgios", title="The Effectiveness of Telerehabilitation in Managing Pain, Strength, and Balance in Adult Patients With Knee Osteoarthritis: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="8", volume="12", pages="e72466", keywords="telerehabilitation", keywords="knee osteoarthritis", keywords="pain management", keywords="remote physiotherapy", keywords="digital health", keywords="remote therapy", keywords="physiotherapy", keywords="strength", keywords="balance", keywords="functional mobility", keywords="rehabilitation technology", abstract="Background: Knee osteoarthritis (KOA) is a chronic, degenerative joint disease characterized by pain, stiffness, and functional impairment, significantly affecting mobility and quality of life. Traditional rehabilitation, mainly through in-person physiotherapy, is widely recommended for KOA management. However, access to these services is often limited due to geographic, financial, and mobility constraints. Telerehabilitation has emerged as an alternative, providing remote rehabilitation through digital platforms. Despite its increasing adoption, its effectiveness in improving key functional parameters such as pain, strength, and balance remains uncertain. While previous studies have focused primarily on pain relief and overall functional improvement, a broader assessment of its impact on mobility and fall prevention is needed. Objective: This systematic review examines the effectiveness of telerehabilitation in improving pain, strength, and balance in adults with KOA compared with traditional rehabilitation or no intervention. In addition, it evaluates the impact of different telerehabilitation models, such as therapist-guided versus self-managed programs, and explores the feasibility of integrating telerehabilitation as an alternative in KOA management. Methods: A systematic search of 4 databases (PubMed, PEDro, Cochrane, and Scopus) was conducted to identify randomized controlled trials (RCTs) published from May 2004 to May 2024. Inclusion criteria consisted of adults with KOA, evaluation of telerehabilitation either as a stand-alone intervention or in comparison to traditional rehabilitation or no intervention, and measurement of at least one primary outcome (pain, strength, or balance). A total of 2 independent reviewers assessed the risk of bias using validated tools. Due to variations in intervention programs and assessment methods, a narrative synthesis was performed instead of a meta-analysis. The review followed established guidelines, and data extraction was conducted using appropriate software. Results: A total of 6 RCTs (N=581 participants) met the inclusion criteria. The results indicate that telerehabilitation effectively reduces pain and improves strength and balance, although the extent of benefits varies. Some studies reported similar pain reductions between telerehabilitation and traditional rehabilitation, while others highlighted greater functional improvements in telerehabilitation groups. Therapist-guided telerehabilitation was associated with higher adherence rates and better functional outcomes compared with self-managed programs. The risk of bias assessment showed that most studies were of moderate to good quality, though common issues included selection bias, performance bias, and participant attrition. Conclusions: Telerehabilitation is a promising alternative for KOA management, especially for individuals facing barriers to in-person therapy. It is effective in reducing pain and improving strength and balance, though its success depends on patient engagement, intervention delivery, and rehabilitation protocols. Therapist-guided programs yield better outcomes than self-managed approaches. Further research is needed to standardize intervention protocols, integrate emerging technologies, and evaluate cost-effectiveness to guide clinical practice and health care policies. Trial Registration: PROSPERO CRD42024564141; https://tinyurl.com/25ykvy7d ", doi="10.2196/72466", url="https://rehab.jmir.org/2025/1/e72466", url="http://www.ncbi.nlm.nih.gov/pubmed/40198917" } @Article{info:doi/10.2196/73174, author="Zhang, Lu and Ge, Ying and Zhao, Wowa and Shu, Xuan and Kang, Lin and Wang, Qiumei and Liu, Ying", title="Authors' Reply: Balancing Challenges and Opportunities When Evaluating Remote Rehabilitation for Sarcopenia in Older Adults", journal="J Med Internet Res", year="2025", month="Apr", day="1", volume="27", pages="e73174", keywords="telerehabilitation", keywords="elderly", keywords="sarcopenia", keywords="resistance exercise", keywords="rehabilitation", keywords="gerontology", keywords="aging", keywords="randomized controlled trial", keywords="rehabilitation training", keywords="body composition", keywords="strength", keywords="balance", keywords="cardiorespiratory endurance", keywords="self-care", keywords="physical therapy", doi="10.2196/73174", url="https://www.jmir.org/2025/1/e73174" } @Article{info:doi/10.2196/71845, author="Zhang, Hao and Liu, Xiangjie", title="Balancing Challenges and Opportunities When Evaluating Remote Rehabilitation for Sarcopenia in Older Adults", journal="J Med Internet Res", year="2025", month="Apr", day="1", volume="27", pages="e71845", keywords="telerehabilitation", keywords="elderly", keywords="sarcopenia", keywords="resistance exercise", keywords="rehabilitation", keywords="gerontology", keywords="aging", keywords="randomized controlled trial", keywords="rehabilitation training", keywords="body composition", keywords="strength", keywords="balance", keywords="cardiorespiratory endurance", keywords="self-care", keywords="physical therapy", doi="10.2196/71845", url="https://www.jmir.org/2025/1/e71845" } @Article{info:doi/10.2196/64729, author="Sheehy, Lisa and Taillon-Hobson, Anne and Sveistrup, Heidi and Bilodeau, Martin and Yang, Christine and Welch, Vivian and Finestone, Hillel", title="Home-Based Nonimmersive Virtual Reality Training After Discharge From Inpatient or Outpatient Stroke Rehabilitation: Parallel Feasibility Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2025", month="Mar", day="28", volume="12", pages="e64729", keywords="virtual reality", keywords="telerehabilitation", keywords="stroke", keywords="home", keywords="exercises", keywords="physical activity", keywords="physiotherapy", keywords="exergames", keywords="rehabilitation intensity", keywords="randomized controlled feasibility trial", keywords="motor", keywords="movement", keywords="patient care", keywords="patient engagement", keywords="health intervention", keywords="stroke rehabilitation", keywords="interactive games", keywords="game therapy", keywords="interactive therapy", keywords="rehabilitation", abstract="Background: Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy. Objective: The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait. Methods: Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor. Results: NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups. Conclusions: Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required. Trial Registration: ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3438-9 ", doi="10.2196/64729", url="https://rehab.jmir.org/2025/1/e64729" } @Article{info:doi/10.2196/72565, author="Kannan, Lakshmi and Bhatt, Tanvi", title="Authors' Reply: Addressing the Digital Divide Among the Older Population Presents a Substantial Challenge", journal="J Med Internet Res", year="2025", month="Mar", day="28", volume="27", pages="e72565", keywords="exergame training", keywords="Matter of Balance", keywords="MOB", keywords="pre-frail", keywords="tele-exergame", keywords="tele-rehabilitation", keywords="gaming-based", keywords="tele-exercise", keywords="physical function", keywords="frailty", keywords="older adults", keywords="aging", keywords="physical activity", keywords="dementia", keywords="CogXergaming", keywords="telehealth", keywords="dynamic balance", doi="10.2196/72565", url="https://www.jmir.org/2025/1/e72565" } @Article{info:doi/10.2196/69482, author="Xie, Su-hang", title="Addressing the Digital Divide Among the Older Population Presents a Substantial Challenge", journal="J Med Internet Res", year="2025", month="Mar", day="28", volume="27", pages="e69482", keywords="exergame training", keywords="Matter of Balance", keywords="MOB", keywords="pre-frail", keywords="tele-exergame", keywords="tele-rehabilitation", keywords="gaming-based", keywords="tele-exercise", keywords="physical function", keywords="frailty", keywords="older adults", keywords="aging", keywords="physical activity", keywords="dementia", keywords="CogXergaming", keywords="telehealth", keywords="dynamic balance", doi="10.2196/69482", url="https://www.jmir.org/2025/1/e69482" } @Article{info:doi/10.2196/64178, author="Corti, Claudia and Papini, Marta and Strazzer, Sandra and Borgatti, Renato and Romaniello, Romina and Poggi, Geraldina and Storm, Alexander Fabio and Urgesi, Cosimo and Jansari, Ashok and Wade, L. Shari and Bardoni, Alessandra", title="Examining the Implementation of the Italian Version of the Teen Online Problem-Solving Program Coupled With Remote Psychological Support: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Feb", day="21", volume="14", pages="e64178", keywords="telerehabilitation", keywords="acquired brain injury", keywords="executive functioning", keywords="pediatric", keywords="problem-solving", keywords="computer", abstract="Background: Pediatric acquired brain injury (ABI) is frequently associated with cognitive and socioemotional alterations. Therefore, targeted rehabilitation to improve everyday functioning, particularly executive functioning (EF), is needed to limit the possible deterioration of cognitive abilities and behavior over time and the associated social and psychological costs. Objective: In this paper, we present the protocol for a phase-2 randomized controlled trial (RCT) aimed at examining the feasibility and efficacy of a web-based intervention (ie, the Italian version of the Teen Online Problem-Solving [I-TOPS] intervention) to improve problem-solving abilities versus an active-control, web-based intervention (ie, wellness intervention) providing health and wellness content. Methods: A double-blinded, phase-2 RCT will be conducted to guarantee controls on data quality and findings. In total, 42 adolescents will be recruited from a rehabilitation institute and individually randomly assigned in a 1:1 ratio to receive the I-TOPS intervention or the web-based wellness intervention. Both interventions will include 10 core sessions and will be delivered remotely using a web-based platform. Participants allocated to both interventions and their caregivers will independently complete the learning modules in an everyday setting using their computer. The I-TOPS intervention's core sessions will target the EF domain (eg, planning, emotion regulation, and social skills), while all the contents of the wellness intervention will be aimed at providing psychoeducation on ABI sequelae and supporting health and wellness. Participants assigned to the I-TOPS intervention will also receive bimonthly direct training in problem-solving coupled with remote support from a psychologist. Feasibility data and efficacy outcomes on both adolescents' and parents' functioning will be assessed. Cognitive abilities in the EF domain and behavioral and psychological functioning (ie, internalizing and externalizing symptoms) of the adolescents will be evaluated via performance-based measures, administered remotely using the Google Meet platform, and paper-and-pencil questionnaires; parents' well-being will be assessed through paper-and-pencil questionnaires. Efficacy will be evaluated immediately after training and at 6-month follow-up. Results: This study started on February 26, 2021, and ended on February 28, 2023. A total of 42 adolescents were enrolled and randomly assigned to the 2 study groups, 34 (81\%) completed the intervention and posttreatment evaluation (I-TOPS: n=19 and wellness intervention: n=15) and 31 performed follow-up evaluation (I-TOPS: n=18 and wellness intervention: n=13). Data analysis on feasibility and efficacy will be performed after protocol publication, and the results will be published in the form of a paper in a relevant journal in 2025. Conclusions: This double-blinded, phase-2 RCT could extend knowledge on the best rehabilitation practices to adopt with the survivors of pediatric ABI by providing evidence-based data currently lacking for the Italian context. If this study yields positive results, a larger, multicenter, phase-3 RCT could be planned and delivered to examine program cost-effectiveness in a larger sample. Trial Registration: ClinicalTrials.gov NCT05169788; https://clinicaltrials.gov/study/NCT05169788 International Registered Report Identifier (IRRID): DERR1-10.2196/64178 ", doi="10.2196/64178", url="https://www.researchprotocols.org/2025/1/e64178" } @Article{info:doi/10.2196/64259, author="Dinesen, Birthe and Albertsen, Eie Andi and Joensen, Ragnvaldsd{\'o}ttir Elisabet Dortea and Spindler, Helle and Jensen, M{\o}ller Katja and Kidholm, Kristian and Frost, Lars and Dittman, Lars and Gunasegaram, Mathushan and Johnsen, Paaske S{\o}ren and Jochumsen, Rovsing Mads and Svenstrup, Dorthe", title="Future Patient---Telerehabilitation of Patients With Atrial Fibrillation: Protocol for a Multicenter, Mixed Methods, Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Feb", day="18", volume="14", pages="e64259", keywords="atrial fibrillation", keywords="telerehabilitation", keywords="quality of life", keywords="research design", keywords="patient education", keywords="co-creation", keywords="randomized controlled trial", keywords="chronic", keywords="cardiovascular disease", keywords="adult", keywords="aging", keywords="prevalence", keywords="comorbidity", keywords="Future Patient", keywords="patient engagement", keywords="primary outcome", keywords="cost-effectiveness", keywords="monitoring", keywords="health care professional", keywords="digital health", keywords="remote therapy", keywords="telehealth", abstract="Background: Atrial fibrillation (AF) is a chronic cardiovascular condition with a lifetime risk of 1 in 3 and a prevalence of 3\% among adults. AF's prevalence is predicted to more than double during the next 20 years due to better detection, increasing comorbidities, and an aging population. Due to increased AF prevalence, telerehabilitation has been developed to enhance patient engagement, health care accessibility, and compliance through digital technologies. A telerehabilitation program called ``Future Patient---telerehabilitation of patients with AF (FP-AF)'' has been developed to enhance rehabilitation for AF. The FP-AF program comprises two modules: (1) an education and monitoring module using telerehabilitation technologies (4 months) and (2) a follow-up module, where patients can measure steps and access a data and knowledge-sharing portal, HeartPortal, using their digital devices. Those patients in the FP-AF program measure their heart rhythm, pulse, blood pressure, weight, steps, and sleep. Patients also complete web-based questionnaires regarding their well-being and coping with AF. All recorded data are transmitted to the HeartPortal, accessible to patients, relatives, and health care professionals. Objective: This paper aims to describe the research design, outcome measures, and data collection techniques in a clinical trial of the FP-AF program for patients with AF. Methods: This is a multicenter, mixed methods, randomized controlled trial. Patients are recruited from AF clinics serving the North Jutland region of Denmark. The telerehabilitation group will participate in the FP-AF program, while the control group will follow the conventional care regime based on physical visits to the AF clinic. The primary outcome measure is AF-specific health-related quality of life, to be assessed using the Atrial Fibrillation Effect on Quality-of-Life Questionnaire. Secondary outcomes are knowledge of AF; measurement of vital parameters; level of anxiety and depression; degree of motivation; burden of AF; use of the HeartPortal; qualitative exploration of patients', relatives', and health care professionals' experiences of participating in the FP-AF program; cost-effectiveness evaluation of the program; and analysis of multiparametric monitoring data. Outcomes are assessed through data from digital technologies, interviews, and questionnaires. Results: Patient enrollment began in January 2023 and will be completed by December 2024, with a total of 208 patients enrolled. Qualitative interviews conducted in spring 2024 will be analyzed and published in peer-reviewed journals in 2025. Data from questionnaires and digital technologies will be analyzed upon study completion and presented at international conferences and published in peer-reviewed journals by the fall of 2025. Conclusions: Results from the FP-AF study will determine whether the FP-AF program can increase quality of life for patients with AF and increase their knowledge of symptoms and living with AF in everyday life compared to conventional AF care. The cost-effectiveness evaluation will determine whether telerehabilitation can be a viable alternative for rehabilitation of patients with AF. Trial Registration: ClinicalTrials.gov NCT06101485; https://clinicaltrials.gov/study/NCT06101485 International Registered Report Identifier (IRRID): DERR1-10.2196/64259 ", doi="10.2196/64259", url="https://www.researchprotocols.org/2025/1/e64259" } @Article{info:doi/10.2196/58713, author="Klatt, N. Brooke and Hovareshti, Pedram and Holt, S. Lisa and Dunlap, M. Pamela and Zalkin, Chad and Tolani, Devendra and Whitney, L. Susan", title="A Tablet-Based Technology for Objective Exercise Monitoring in Vestibular Rehabilitation: Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Feb", day="4", volume="12", pages="e58713", keywords="technology", keywords="rehabilitation", keywords="vestibular", keywords="physical therapy", keywords="vestibulo-ocular reflex", keywords="ocular", keywords="physiotherapy", keywords="vision", keywords="feasibility", keywords="exercises", keywords="mHealth", keywords="mobile health", keywords="app", keywords="tablet", keywords="digital health", keywords="telerehabilitation", keywords="e-health", keywords="web-based", keywords="clinical use", keywords="physiotherapist", keywords="home exercise", keywords="usability study", keywords="mobile app", abstract="Background: A low-cost home exercise system called VestAid has been developed to assist participants during vestibulo-ocular reflex gaze stabilization exercises outside of clinic visits. The system includes a tablet-based app for the participant and a web-based portal for the physical therapist that provides data to make judgments about exercise accuracy and performance. Objective: The purpose of this study was to assess the feasibility and acceptability of VestAid in a pilot study of 10 participants (mean age 45 [SD 19] years; 6 women) with various vestibular diagnoses. Methods: All participants completed twelve 30-second horizontal vestibulo-ocular reflex exercises in a seated position (6 ``easy'' and 6 ``hard'' exercises). The exercises differed by variations in the background color, pattern, and movement. One of the exercises was repeated to assess the test-retest reliability of the measure of gaze stability accuracy and head motion compliance during the exercise. Participants rated the difficulty of the exercises (0?10 where 0=easy, 10=difficult) and completed usability surveys. Results: Participants completed the VestAid session without adverse events. The responses from the usability survey demonstrate the acceptability of VestAid. The mean rating of the ``easy'' exercises was 2.7/10 (SD 1.9). The mean rating for the ``difficult'' exercises across participants was 4.8/10 (SD 2.1). Conclusions: The consistency of the mean ratings of the participants with the exercise classifications (``easy'' and ``difficult'') suggests that VestAid has clinical utility. ", doi="10.2196/58713", url="https://rehab.jmir.org/2025/1/e58713" } @Article{info:doi/10.2196/58026, author="Tacchino, Andrea and Ponzio, Michela and Confalonieri, Paolo and Leocani, Letizia and Inglese, Matilde and Centonze, Diego and Cocco, Eleonora and Gallo, Paolo and Paolicelli, Damiano and Rovaris, Marco and Sabattini, Loredana and Tedeschi, Gioacchino and Prosperini, Luca and Patti, Francesco and Sessa, Edoardo and Pedrazzoli, Elisabetta and Battaglia, Alberto Mario and Brichetto, Giampaolo", title="Effect of an Internet-Based Pilates Telerehabilitation Intervention in People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Feb", day="3", volume="14", pages="e58026", keywords="exergame", keywords="MS-FIT", keywords="Pilates", keywords="Kinect", keywords="multiple sclerosis", keywords="exercise", keywords="physical activity", keywords="leisure time physical activity", keywords="Timed Up and Go", abstract="Background: Physical activity (PA) has been recommended in multiple sclerosis (MS) to maintain good physical fitness and mental health, reduce the severity of symptoms and risk of relapse, and improve quality of life. Pilates has been suggested as an ideal PA to manage physical, cognitive, and psychological symptoms of MS and a useful method to maintain and improve balance and gait. Objective: This paper presents the protocol for a study that aims to evaluate the efficacy on the physical domain (specifically balance and gait) of a home-based, self-managed PA intervention delivered through the MS-FIT exergame (HELAGLOBE Societ{\`a} a responsabilit{\`a} limitata). In addition, measures of cognitive performance, quality of life, and well-being will be considered. Methods: This is a 2-arm, multicenter, randomized controlled trial with 3 assessment points (baseline, 12 weeks postintervention, and 6 weeks follow-up). People with MS with mild disability, low risk of falling, preserved cognitive functions, and low anxiety and depression are potential eligible participants. The experimental group (MS-FIT) will self-administer the MS-FIT exergame at home in addition to their leisure-time physical activities. MS-FIT is an internet- and Pilates-based tool that uses the Microsoft Kinect Sensor V2. Participants in the control group will only have access to their leisure-time physical activities. Participants in the MS-FIT group will train at home with MS-FIT for 12 weeks and will be required to perform the exercises for a total of 30 minutes/day for at least 3 days/week. The primary outcome is the Timed Up and Go, a test designed to assess walking. We will also administer additional tests for motor function (visual analog scale 0-10, Timed 25-Foot Walk, Ambulation Index, 2-minute walk test, Twelve Item Multiple Sclerosis Walking Scale, Nine-Hole Peg Test), cognition (Brief International Cognitive Assessment for Multiple Sclerosis), fatigue (Modified Fatigue Impact Scale), quality of life (Multiple Sclerosis Quality of Life-54), well-being (Psychological Well-Being Scales), and PA (International Physical Activity Questionnaire and Minnesota Leisure Time Physical Activity Questionnaire). Acceptance and satisfaction with the intervention received (Client Satisfaction Questionnaire and an adapted version of the Tele-healthcare Satisfaction Questionnaire -- Wearable Technology) and subjective impressions of changes in performance (Patients' Global Impression of Change) will also be assessed. Results: Recruitment for the trial started on March 16, 2022, and the first participant was randomized the same day. Data analysis and results are expected to be published in 2025. Conclusions: Pilates has proven beneficial in several neurological diseases such as MS. With this study, we will provide evidence for the use in clinical practice of a digital tool for self-administered Pilates exercises at home as a complement to rehabilitation and for the continuity of care in MS. Trial Registration: ClinicalTrials.gov NCT04011579; https://tinyurl.com/2p9n4d2t International Registered Report Identifier (IRRID): DERR1-10.2196/58026 ", doi="10.2196/58026", url="https://www.researchprotocols.org/2025/1/e58026" } @Article{info:doi/10.2196/46047, author="Lonner, H. Jess and Naidu-Helm, Ashwini and Van Andel, David and Anderson, B. Mike and Ditto, Richard and Redfern, E. Roberta and Foran, Jared", title="Smartphone-Based Care Platform Versus Traditional Care in Primary Knee Arthroplasty in the United States: Cost Analysis", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="3", volume="13", pages="e46047", keywords="telerehabilitation", keywords="telehealth", keywords="telemedicine", keywords="rehabilitation", keywords="physiotherapy", keywords="mobile health", keywords="knee arthroplasty", abstract="Trial registration: ClinicalTrials.gov NCT03737149; https://clinicaltrials.gov/study/NCT03737149 ", doi="10.2196/46047", url="https://mhealth.jmir.org/2025/1/e46047" } @Article{info:doi/10.2196/54790, author="Oh, Sejun and Lee, SangHeon", title="Rehabilomics Strategies Enabled by Cloud-Based Rehabilitation: Scoping Review", journal="J Med Internet Res", year="2025", month="Jan", day="28", volume="27", pages="e54790", keywords="cloud-based", keywords="health", keywords="rehabilitation", keywords="rehabilomics", keywords="strategies", abstract="Background: Rehabilomics, or the integration of rehabilitation with genomics, proteomics, metabolomics, and other ``-omics'' fields, aims to promote personalized approaches to rehabilitation care. Cloud-based rehabilitation offers streamlined patient data management and sharing and could potentially play a significant role in advancing rehabilomics research. This study explored the current status and potential benefits of implementing rehabilomics strategies through cloud-based rehabilitation. Objective: This scoping review aimed to investigate the implementation of rehabilomics strategies through cloud-based rehabilitation and summarize the current state of knowledge within the research domain. This analysis aims to understand the impact of cloud platforms on the field of rehabilomics and provide insights into future research directions. Methods: In this scoping review, we systematically searched major academic databases, including CINAHL, Embase, Google Scholar, PubMed, MEDLINE, ScienceDirect, Scopus, and Web of Science to identify relevant studies and apply predefined inclusion criteria to select appropriate studies. Subsequently, we analyzed 28 selected papers to identify trends and insights regarding cloud-based rehabilitation and rehabilomics within this study's landscape. Results: This study reports the various applications and outcomes of implementing rehabilomics strategies through cloud-based rehabilitation. In particular, a comprehensive analysis was conducted on 28 studies, including 16 (57\%) focused on personalized rehabilitation and 12 (43\%) on data security and privacy. The distribution of articles among the 28 studies based on specific keywords included 3 (11\%) on the cloud, 4 (14\%) on platforms, 4 (14\%) on hospitals and rehabilitation centers, 5 (18\%) on telehealth, 5 (18\%) on home and community, and 7 (25\%) on disease and disability. Cloud platforms offer new possibilities for data sharing and collaboration in rehabilomics research, underpinning a patient-centered approach and enhancing the development of personalized therapeutic strategies. Conclusions: This scoping review highlights the potential significance of cloud-based rehabilomics strategies in the field of rehabilitation. The use of cloud platforms is expected to strengthen patient-centered data management and collaboration, contributing to the advancement of innovative strategies and therapeutic developments in rehabilomics. ", doi="10.2196/54790", url="https://www.jmir.org/2025/1/e54790" } @Article{info:doi/10.2196/67846, author="Zhang, Lu and Ge, Ying and Zhao, Wowa and Shu, Xuan and Kang, Lin and Wang, Qiumei and Liu, Ying", title="A 4-Week Mobile App--Based Telerehabilitation Program vs Conventional In-Person Rehabilitation in Older Adults With Sarcopenia: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Jan", day="24", volume="27", pages="e67846", keywords="telerehabilitation", keywords="elderly", keywords="sarcopenia", keywords="resistance exercise", keywords="rehabilitation", keywords="gerontology", keywords="aging", keywords="randomized controlled trial", keywords="rehabilitation training", keywords="body composition", keywords="strength", keywords="balance", keywords="cardiorespiratory endurance", keywords="self-care", keywords="physical therapy", abstract="Background: Sarcopenia is closely associated with a poor quality of life and mortality, and its prevention and treatment represent a critical area of research. Resistance training is an effective treatment for older adults with sarcopenia. However, they often face challenges when receiving traditional rehabilitation treatments at hospitals. Objective: We aimed to compare the effects of a digital rehabilitation program with those of traditional therapist-supervised rehabilitation training on older adults with sarcopenia. Methods: In total, 58 older adults with sarcopenia were recruited offline and randomized (1:1) into 2 groups: the telerehabilitation group (TRG, n=29, 50\%) and the in-person rehabilitation group (IRG, n=29, 50\%). Both groups underwent 4-week resistance training targeting 6 major muscle groups. The TRG received exercise guidance via a mobile app, while the IRG received in-person training from a therapist. Offline assessments of body composition, grip strength, and balance using the 30-Second Arm Curl Test (30SACT), 30-Second Sitting-to-Rising Test (30SSRT), quadriceps femoris extension peak torque (EPT) and extension total power (ETP), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), 6-Minute Walk Test (6MWT), and Instrumental Activities of Daily Living (IADL) scale, were conducted before and after the intervention. Results: Of the 58 patients, 51 (88\%; TRG: n=24, 47\%; IRG: n=27, 53\%) completed the trial. After 4 weeks of intervention, the mean grip strength increased from 18.10 (SD 5.56) to 19.92 (SD 5.90) kg in the TRG (P=.02) and from 18.59 (SD 5.95) to 19.59 (SD 6.11) kg in the IRG (P=.01). The 30SACT and 30SSRT scores increased from 12.48 (SD 2.68) to 14.94 (SD 3.68) times (P=.01) and from 15.16 (SD 7.23) to 16.58 (SD 8.42) times (P=.045), respectively, in the TRG and from 12.25 (SD 4.19) to 14.68 (SD 4.36) times (P=.003) and from 14.31 (SD 4.04) to 16.25 (SD 4.91) times (P=.01), respectively, in the IRG. The quadriceps femoris EPT increased from 26.19 (SD 10.26) to 35.00 (SD 13.74) Nm (P=.004) in the TRG and from 26.95 (SD 11.81) to 32.74 (SD 12.33) Nm (P=.003) in the IRG. The BBS scores significantly improved in both groups (P<.001), with the mean TRG score increasing by 3.19 (SD 2.86) points and the mean IRG score by 3.06 (SD 2.44) points. Neither group exhibited significant within-group changes on the TUGT or the 6MWT. Both groups reported significant improvements in the IADL (TRG: P=.04; IRG: P=.02). Between-group comparisons revealed no significant differences in changes in all indicators. Conclusions: A 4-week remote resistance training program is effective in improving strength, balance, and the IADL in older adults with sarcopenia, with effects comparable to rehabilitation supervised by a physical therapist. Telerehabilitation may be a convenient and effective alternative for older adults with sarcopenia who have limited access to rehabilitation resources. Trial Registration: ChiCTR 2300071648; https://www.chictr.org.cn/showprojEN.html?proj=196313 ", doi="10.2196/67846", url="https://www.jmir.org/2025/1/e67846" } @Article{info:doi/10.2196/47951, author="Mastorci, Francesca and Lazzeri, Lodovica Maria Francesca and Ait-Ali, Lamia and Marcheschi, Paolo and Quadrelli, Paola and Mariani, Massimiliano and Margaryan, Rafik and Penn{\`e}, Wanda and Savino, Marco and Prencipe, Giuseppe and Sirbu, Alina and Ferragina, Paolo and Priami, Corrado and Tommasi, Alessandro and Zavattari, Cesare and Festa, Pierluigi and Dalmiani, Stefano and Pingitore, Alessandro", title="Home-Based Intervention Tool for Cardiac Telerehabilitation: Protocol for a Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Jan", day="22", volume="14", pages="e47951", keywords="cardiac rehabilitation", keywords="exercise", keywords="patient education", keywords="patient-centered approach", keywords="eHealth", keywords="artificial intelligence", abstract="Background: Among cardiovascular diseases, adult patients with congenital heart disease represent a population that has been continuously increasing, which is mainly due to improvement of the pathophysiological framing, including the development of surgical and reanimation techniques. However, approximately 20\% of these patients will require surgery in adulthood and 40\% of these cases will necessitate reintervention for residual defects or sequelae of childhood surgery. In this field, cardiac rehabilitation (CR) in the postsurgical phase has an important impact on the patient by improving psychophysical and clinical recovery in reducing fatigue and dyspnea to ultimately increase survival. In this context, compliance with the rehabilitation program is a key element for the therapeutic benefits of the program. The increase of mobile health care devices and software has greatly extended self-care capabilities across the spectrum of health care activities. Moreover, the possibility of telemonitoring the progress of this self-care provides elements of empowerment and awareness of one's state of health. As a branch of telehealth, CR can be optimized and facilitated using remote telemedicine devices. Objective: The principal goal of the Innovation in Postoperative Rehabilitation Training and Monitoring (IPOTERI) study is to design, realize, and test a composite and integrated system for postsurgical rehabilitation therapies at home specialized for cardiac surgery. The secondary aims are to implement the system in a ``real-life'' context of postcardiac surgical rehabilitation, and to create a data set and a data collection methodology to prototype data analytics algorithms and artificial intelligence techniques for customizing the rehabilitation pathway. Methods: The IPOTERI method consists of a telemonitoring platform that guarantees continuity of postoperative care, an intelligent home station based on an Android app for the patient with a user-friendly interface to record vital signals (electrocardiogram, blood pressure, oxygen saturation, and body weight) and access the planning of rehabilitation activities, and a decision support system that communicates with hospital medical records to transmit alerts and specific support information for the formulation and updating of the treatment and care plan. Results: The pilot test started in June 2023 (protocol number 20406/2021) including 50 patients who will be monitored for 12-14 weeks using the developed platform, as described in the Procedures subsection of the Methods section. Conclusions: The IPOTERI approach, based on the processing of data recorded during the monitoring of telemedicine devices used at home during the postsurgical rehabilitation of a cardiac patient, together with clinical data from the perioperative and postoperative periods could have positive effects on adherence to the rehabilitation program and clinical improvement as well as result in overall improvement of quality of life. International Registered Report Identifier (IRRID): DERR1-10.2196/47951 ", doi="10.2196/47951", url="https://www.researchprotocols.org/2025/1/e47951", url="http://www.ncbi.nlm.nih.gov/pubmed/39841521" } @Article{info:doi/10.2196/54049, author="Kondylakis, Haridimos and Giglioli, Chicchi Irene Alice and Katehakis, Dimitrios and Aldemir, Hatice and Zikas, Paul and Papagiannakis, George and Hors-Fraile, Santiago and Gonz{\'a}lez-Sanz, L. Pedro and Apostolakis, Konstantinos and Stephanidis, Constantine and N{\'u}{\~n}ez-Benjumea, J. Francisco and Ba{\~n}os-Rivera, M. Rosa and Fernandez-Luque, Luis and Kouroubali, Angelina", title="Stress Reduction in Perioperative Care: Feasibility Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Jan", day="7", volume="27", pages="e54049", keywords="CARINAE", keywords="digital health", keywords="patient empowerment", keywords="stress and anxiety management", keywords="mHealth", keywords="virtual reality", keywords="feasibility", keywords="perioperative", keywords="randomized controlled trial", keywords="surgery", keywords="risk", keywords="wearable devices", keywords="patient education", keywords="mobile app", keywords="psychological", keywords="self-efficacy", keywords="self-management", keywords="well-being", keywords="patient monitoring", abstract="Background: Patients undergoing surgery often experience stress and anxiety, which can increase complications and hinder recovery. Effective management of these psychological factors is key to improving outcomes. Preoperative anxiety is inversely correlated with the amount of information patients receive, but accessible, personalized support remains limited, especially in preoperative settings. Face-to-face education is often impractical due to resource constraints. Digital health (DH) interventions offer a promising alternative, enhancing patient engagement and empowerment. However, most current tools focus on providing information, overlooking the importance of personalization and psychological support. Objective: This study aimed to assess the viability of a DH intervention known as the Adhera CARINAE DH Program. This program is specifically designed to offer evidence-based and personalized stress- and anxiety-management techniques. It achieves this by using a comprehensive digital ecosystem that incorporates wearable devices, mobile apps, and virtual reality technologies. The intervention program also makes use of advanced data-driven techniques to deliver tailored patient education and lifestyle support. Methods: A total of 74 patients scheduled for surgery across 4 hospitals in 3 European countries were enrolled in this study from September 2021 to March 2022. Surgeries included cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacements, prostate or bladder cancer surgeries, hip and knee replacements, maxillofacial surgery, and scoliosis procedures. After assessment for eligibility, participants were randomized into 2 groups: the intervention group (n=23) received the Adhera CARINAE DH intervention in addition to standard care, while the control group (n=27) received standard care alone. Psychological metrics such as self-efficacy, self-management, and mental well-being were assessed before and after the intervention, alongside physiological markers of stress. Results: The intervention group demonstrated significant improvements across several psychological outcomes. For example, Visual Analogue Scale Stress at the?hospital improved at admission by 5\% and at hospital discharge by?11.1\% and Visual Analogue Scale Pain at admission improved by 31.2\%. In addition, Hospital Anxiety and Depression Scale Anxiety after surgery improved by 15.6\%, and Positive and Negative Affect Scale-Negative at hospital admission improved by 17.5\%. Overall, patients in the intervention study spent 17.12\% less days in the hospital. Besides these individual scores, the intervention group shows more positive relationships among the psychological dimensions of self-efficacy, self-management, and mental well-being, suggesting that the?CARINAE solution could have a positive effect and impact on the reduction of stress and negative emotions. Conclusions: Our results provide an important first step toward a deeper understanding of optimizing DH solutions to support patients undergoing surgery and for potential applications in remote patient monitoring and communication. Trial Registration: ClinicalTrials.gov NCT05184725; https://clinicaltrials.gov/study/NCT05184725 International Registered Report Identifier (IRRID): RR2-10.2196/38536 ", doi="10.2196/54049", url="https://www.jmir.org/2025/1/e54049" } @Article{info:doi/10.2196/65734, author="Smiley, Aref and Finkelstein, Joseph", title="Home Automated Telemanagement System for Individualized Exercise Programs: Design and Usability Evaluation", journal="JMIR Biomed Eng", year="2024", month="Dec", day="27", volume="9", pages="e65734", keywords="telemedicine", keywords="home-based exercise", keywords="telerehabilitation", keywords="remote cycling", keywords="usability", keywords="physical rehabilitation", keywords="exercise therapy", abstract="Background: Exercise is essential for physical rehabilitation, helping to improve functional performance and manage chronic conditions. Telerehabilitation offers an innovative way to deliver personalized exercise programs remotely, enhancing patient adherence and clinical outcomes. The Home Automated Telemanagement (HAT) System, integrated with the interactive bike (iBikE) system, was designed to support home-based rehabilitation by providing patients with individualized exercise programs that can be monitored remotely by a clinical rehabilitation team. Objective: This study aims to evaluate the design, usability, and efficacy of the iBikE system within the HAT platform. We assessed the system's ability to enhance patient adherence to prescribed exercise regimens while minimizing patient and clinician burden in carrying out the rehabilitation program. Methods: We conducted a quasi-experimental study with 5 participants using a pre- and posttest design. Usability testing included 2 primary tasks that participants performed with the iBikE system. Task completion times, adherence to exercise protocols, and user satisfaction were measured. A System Usability Scale (SUS) was also used to evaluate participants' overall experience. After an initial introduction, users performed the tasks independently following a 1-week break to assess retention of the system's operation skills and its functionality. Results: Task completion times improved substantially from the pretest to the posttest: execution time for task 1 reduced from a mean of 8.6 (SD 4.7) seconds to a mean of 1.8 (SD 0.8) seconds, and the time for task 2 decreased from a mean of 315 (SD 6.9) seconds to a mean of 303.4 (SD 1.1) seconds. Adherence to the prescribed cycling speed also improved, with deviations from the prescribed speed reduced from a mean of 6.26 (SD 1.00) rpm (revolutions per minute) to a mean of 4.02 (SD 0.82) rpm (t=3.305, n=5, P=.03). SUS scores increased from a mean of 92 (SD 8.6) to a mean of 97 (SD 3.3), indicating high user satisfaction and confidence in system usability. All participants successfully completed both tasks without any additional assistance during the posttest phase, demonstrating the system's ease of use and effectiveness in supporting independent exercise. Conclusions: The iBikE system, integrated into the HAT platform, effectively supports home-based telerehabilitation by enabling patients to follow personalized exercise prescriptions with minimal need for further training or supervision. The significant improvements in task performance and exercise adherence suggest that the system is well-suited for use in home-based rehabilitation programs, promoting sustained patient engagement and adherence to exercise regimens. Further studies with larger sample sizes are recommended to validate these findings and explore the long-term benefits of the system in broader patient populations. ", doi="10.2196/65734", url="https://biomedeng.jmir.org/2024/1/e65734", url="http://www.ncbi.nlm.nih.gov/pubmed/39658220" } @Article{info:doi/10.2196/57661, author="Barnes, Keely and Sveistrup, Heidi and Bayley, Mark and Egan, Mary and Bilodeau, Martin and Rathbone, Michel and Taljaard, Monica and Karimijashni, Motahareh and Marshall, Shawn", title="Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study", journal="JMIR Neurotech", year="2024", month="Nov", day="27", volume="3", pages="e57661", keywords="brain injury", keywords="virtual", keywords="assessment", keywords="remote", keywords="evaluation", keywords="concussion", keywords="adult", keywords="clinician review", keywords="in-person", keywords="comparison", keywords="sensitivity", keywords="reliability", keywords="acceptability survey", keywords="feasibility study", keywords="psychometric properties", keywords="vestibular/ocular motor screening", keywords="VOMS", keywords="workplace", keywords="clinician", keywords="hospital", keywords="rehabilitation center", keywords="brain", keywords="neurology", keywords="neuroscience", keywords="neurotechnology", keywords="technology", keywords="digital intervention", keywords="digital health", keywords="psychometrics", keywords="physical assessment", keywords="clinical assessment", keywords="workplace safety", keywords="mobile phone", abstract="Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61\% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: $\kappa$=0.38?0.49) to excellent (VOMS change in symptoms: $\kappa$=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision. International Registered Report Identifier (IRRID): RR2-10.2196/57663 ", doi="10.2196/57661", url="https://neuro.jmir.org/2024/1/e57661" } @Article{info:doi/10.2196/65680, author="Lancioni, E. Giulio and Alberti, Gloria and Filippini, Chiara and Singh, N. Nirbhay and O'Reilly, F. Mark and Sigafoos, Jeff and Orlando, Isabella and Desideri, Lorenzo", title="A Technology System to Help People With Intellectual Disability and Blindness Find Room Destinations During Indoor Traveling: Case Series Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Nov", day="27", volume="11", pages="e65680", keywords="barcode reader", keywords="barcode", keywords="blindness", keywords="intellectual disability", keywords="indoor traveling", keywords="indoor travel", keywords="digital health", keywords="travel", keywords="navigation", keywords="wayfinding", keywords="patient care", keywords="patient support", keywords="mobile health", keywords="patient assessment", keywords="health intervention", keywords="user engagement", keywords="technology use", keywords="telerehabilitation", keywords="rehabilitation", keywords="disability", keywords="support tools", keywords="mobility", keywords="orientation", keywords="mobile phone", abstract="Background: People with severe or profound intellectual disability and visual impairment tend to have serious problems in orientation and mobility and need assistance for their indoor traveling. The use of technology solutions may be critically important to help them curb those problems and achieve a level of independence. Objective: This study aimed to assess a new technology system to help people with severe to profound intellectual disability and blindness find room destinations during indoor traveling. Methods: A total of 7 adults were included in the study. The technology system entailed a barcode reader, a series of barcodes marking the room entrances, a smartphone, and a special app that controlled the presentation of different messages (instructions) for the participants. The messages varied depending on whether the participants were (1) in an area between room entrances, (2) in correspondence with a room entrance to bypass, or (3) in correspondence with a room entrance representing the destination to enter. The intervention with the technology system was implemented according to a nonconcurrent multiple baseline design across participants. Sessions included 7 traveling trials, in each of which the participants were to reach and enter a specific room (1 of the 7 or 9 available) to deliver an object they had carried (transported) during their traveling. Results: The participants' mean frequency of traveling trials completed correctly was between zero and 2 per session during the baseline (without the system). Their mean frequency increased to between about 6 and nearly 7 per session during the intervention (with the system). Conclusions: The findings suggest that the new technology system might be a useful support tool for people with severe to profound intellectual disability and blindness. ", doi="10.2196/65680", url="https://rehab.jmir.org/2024/1/e65680", url="http://www.ncbi.nlm.nih.gov/pubmed/39602792" } @Article{info:doi/10.2196/56810, author="Kannan, Lakshmi and Sahu, Upasana and Subramaniam, Savitha and Mehta, Neha and Kaur, Tanjeev and Hughes, Susan and Bhatt, Tanvi", title="Gaming-Based Tele-Exercise Program to Improve Physical Function in Frail Older Adults: Feasibility Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Nov", day="27", volume="26", pages="e56810", keywords="exergame training", keywords="Matter of Balance", keywords="MOB", keywords="pre-frail", keywords="tele-exergame", keywords="tele-rehabilitation", keywords="gaming-based", keywords="tele-exercise", keywords="physical function", keywords="frailty", keywords="older adults", keywords="aging", keywords="physical activity", keywords="dementia", keywords="CogXergaming", keywords="telehealth", keywords="dynamic balance", abstract="Background: Frailty leads to reduced physical activity can cause increased fall risk. This contributes to accelerated aging processes, leading to adverse health outcomes and reduced quality of life. We have developed and piloted the design, usability, safety, and feasibility of a gaming-based cognitive-motor (CogXergaming) tele-exercise protocol in prefrail older adults. Objective: This pilot randomized control trial tested preliminary feasibility and effectiveness of the CogXergaming telehealth protocol for improving physical function. Methods: Community-dwelling, prefrail older adults were randomly assigned to CogXergaming (n=13) or a control group (n=14). The CogXergaming group received supervised tele-exercises in a gaming format for 6 weeks (3 sessions per week) comprising 18 sessions lasting 90 minutes each. Control group participants participated in a Matter of Balance (MOB), an 8-week, once-a-week structured 90-minute tele-session that has been shown to reduce the fear of falling and increase physical activity. Feasibility of training was obtained by computing the median duration of training sessions for the CogXergaming group. Effectiveness was assessed using dynamic balance control (Four Square Step Test), subjective self-efficacy (Activities-Specific Balance Confidence scale), gait function (Tinetti Performance Oriented Mobility Assessment), muscle strength (30-second chair stand test), and endurance (2-minute step in-place test). Results: Of the 45 participants enrolled in the study, 4 participants from CogXergaming group and 5 from MOB group lost contact after signing the consent form and did not receive their respective intervention. Eighteen participants were randomized to each group. In the CogXergaming group, 15 (83\%) completed the intervention, with 3 (16\%) dropping out in the first week. In the MOB group, 16 (88\%) completed the program, with 2 (11\%) withdrawing during the first week. In addition, there was a significant time group interaction for Four Square Step Test (F1,21=5.55, P=.03), Tinetti Performance Oriented Mobility Assessment (F1,25=4.16, P=.05), and 30-second chair stand test (F1,21=5.06, P=.03), with a significant improvement in these measures for the CogXergaming group post training, compared with no change observed in the MOB group. Conclusions: These pilot findings indicate that CogXergaming is feasible and applicable in prefrail older adults. Such game-based protocols can be beneficial in improving physical function among community-dwelling, prefrail older adults, however, the efficacy of such training requires further investigation. Trial Registration: ClinicalTrials.gov NCT04534686; https://clinicaltrials.gov/study/NCT04534686 ", doi="10.2196/56810", url="https://www.jmir.org/2024/1/e56810" } @Article{info:doi/10.2196/60049, author="Chien, Shih-Ying", title="Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study", journal="JMIR Hum Factors", year="2024", month="Nov", day="15", volume="11", pages="e60049", keywords="digital health", keywords="chronic obstructive pulmonary disease", keywords="COPD", keywords="usability", keywords="telerehabilitation", keywords="mobile health app", abstract="Background: Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure. Objective: This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home. Methods: This study used a mixed methods approach involving two key stakeholders---patients with chronic obstructive pulmonary disease and HCPs---across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Results: The research indicated a notable difference in app usability perceptions: 66\% (8/12) of HCPs found tasks ``very easy,'' compared to only 22\% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non--native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation. Conclusions: Most HCPs (11/12, 91\%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62\% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care. ", doi="10.2196/60049", url="https://humanfactors.jmir.org/2024/1/e60049" } @Article{info:doi/10.2196/56158, author="Barnes, Keely and Sveistrup, Heidi and Karimijashni, Motahareh and Bayley, Mark and Egan, Mary and Bilodeau, Martin and Rathbone, Michel and Taljaard, Monica and Marshall, Shawn", title="Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study", journal="J Med Internet Res", year="2024", month="Nov", day="13", volume="26", pages="e56158", keywords="remote care", keywords="mild traumatic brain injury", keywords="telehealth", keywords="assessment", keywords="workplace injury", keywords="concussion", keywords="telemedicine", keywords="brain injury", abstract="Background: Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. Objective: This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Methods: Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants' experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. Results: A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8\%) and 9/201 (4\%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10\%) of the time for patient participants); communication (mentioned 34/162 (21\%) and 9/201 (4\%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7\%) of the time for patient and 15/201 (7\%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27\%) and 21/151 (14\%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7\%) of the time for patient participants); and having access to resources (mentioned 25/151 (17\%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Conclusions: Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. International Registered Report Identifier (IRRID): RR2-10.2196/40446 ", doi="10.2196/56158", url="https://www.jmir.org/2024/1/e56158" } @Article{info:doi/10.2196/56795, author="Lu, Taiping and Deng, Ting and Long, Yangyang and Li, Jin and Hu, Anmei and Hu, Yufan and Ouyang, Li and Wang, Huiping and Ma, Junliang and Chen, Shaolin and Hu, Jiale", title="Effectiveness and Feasibility of Digital Pulmonary Rehabilitation in Patients Undergoing Lung Cancer Surgery: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Nov", day="11", volume="26", pages="e56795", keywords="app-based", keywords="digital rehabilitation", keywords="internet-based intervention", keywords="lung cancer", keywords="perioperative pulmonary rehabilitation", keywords="systematic review", keywords="telerehabilitation", abstract="Background: Pulmonary rehabilitation (PR) has been shown to effectively support postsurgical recovery in patients with lung cancer (LC) at various stages. While digital PR programs offer a potential solution to traditional challenges, such as time and space constraints, their efficacy and feasibility for patients undergoing LC surgery remain unclear. Objective: This systematic review aims to assess the feasibility and effectiveness of digital PR programs for individuals undergoing LC surgery. Methods: A systematic review was conducted, retrieving data from 6 English and 4 Chinese databases from their inception to January 1, 2024. References in related studies were also manually reviewed. The primary outcomes assessed were physical capacity, lung function, and the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were compliance, hospital stay, chest tube duration, anxiety, depression, and quality of life. Where applicable, recruitment and withdrawal rates were also evaluated. Meta-analysis and descriptive analysis were used to assess the outcomes. Results: A total of 5 randomized controlled trials and 6 quasi-experimental studies (n=1063) were included, with 4 studies being included in the meta-analyses. Our meta-analyses revealed that digital PR reduced the decline in 6-minute walk distance (6-MWD) by an average of 15 m compared with routine PR programs from admission to discharge, demonstrating a clinically significant improvement in physical capacity (mean difference --15.00, 95\% CI --25.65 to --4.34, P=.006). Additionally, digital PR was associated with a reduction (26/58, 45\%) in the likelihood of PPCs (risk ratio 0.45, 95\% CI 0.30-0.66, P<.001) and a reduction of 1.53 days in chest tube duration (mean difference --1.53, 95\% CI --2.95 to --0.12, P=.03), without a statistically significant effect on postoperative hospital stay (mean difference --1.42, 95\% CI --3.45 to 0.62, P=.17). Descriptive analyses suggested that digital PR has the potential to improve knowledge, lung function, quality of life, and self-efficacy, while reducing depression and anxiety. Notably, digital PR was found to be a safe, feasible, and acceptable supplementary intervention. Despite challenges with low recruitment, digital PR enhanced exercise compliance, increased patient satisfaction, and lowered dropout rates. Conclusions: This systematic review is the first comprehensive analysis to suggest that digital PR is a safe, feasible, acceptable, and effective intervention for promoting recovery in patients with LC after surgery. Digital PR has the potential to be a valuable supplement, expanding access to traditional PR programs. Future research should prioritize the development of interactive and inclusive digital solutions tailored to diverse age groups and educational backgrounds. Rigorous studies, including large-scale, high-quality randomized controlled trials with detailed protocols and robust methodologies, are needed to assess the short-, medium-, and long-term efficacy of digital PR, ensuring reproducibility in future research. Trial Registration: PROSPERO CRD42023430271; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=430271 ", doi="10.2196/56795", url="https://www.jmir.org/2024/1/e56795" } @Article{info:doi/10.2196/51865, author="Lange-Drenth, Lukas and Schulz, Holger and Suck, Isabell and Bleich, Christiane", title="Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e51865", keywords="telerehabilitation", keywords="rehabilitation", keywords="eHealth development", keywords="value specification", keywords="stakeholder participation", keywords="occupational injuries", keywords="vocational rehabilitation", keywords="aftercare", keywords="mobile phone", abstract="Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients' lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. ", doi="10.2196/51865", url="https://formative.jmir.org/2024/1/e51865" } @Article{info:doi/10.2196/65354, author="Areias, C. Anabela and Janela, Dora and Molinos, Maria and Bento, Virg{\'i}lio and Moreira, Carolina and Yanamadala, Vijay and Cohen, P. Steven and Correia, Dias Fernando and Costa, Fab{\'i}ola", title="Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study", journal="J Med Internet Res", year="2024", month="Oct", day="29", volume="26", pages="e65354", keywords="musculoskeletal pain", keywords="physical therapy", keywords="telerehabilitation", keywords="eHealth", keywords="racial/ethnic concordance", keywords="patient--provider concordance", keywords="digital rehabilitation", keywords="musculoskeletal conditions", abstract="Background: Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. Objective: This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. Methods: This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). Results: Of 71,201 patients, 63.9\% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2\% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95\% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95\% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95\% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted $\beta$ coefficient 5.32, 95\% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95\% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95\% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95\% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95\% CI 1.05-1.47, P=.01). Conclusions: Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. Trial Registration: ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946 ", doi="10.2196/65354", url="https://www.jmir.org/2024/1/e65354", url="http://www.ncbi.nlm.nih.gov/pubmed/39470695" } @Article{info:doi/10.2196/56432, author="van Westerhuis, Charlotte and Sanders, F. Astrid and Aarden, J. Jesse and Major, E. Mel and de Leeuwerk, E. Marijke and Florisson, Nadine and Wijbenga, H. Miriam and van der Schaaf, Marike and van der Leeden, Marike and van Egmond, A. Maarten", title="Capabilities for Using Telemonitoring in Physiotherapy Treatment: Exploratory Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Oct", day="24", volume="11", pages="e56432", keywords="telemedicine", keywords="telemonitoring", keywords="technology", keywords="physical therapy modalities", keywords="education", keywords="physiotherapist", keywords="physiotherapy", keywords="telehealth", abstract="Background: Telemonitoring (TM), as part of telehealth, allows physiotherapists to monitor and coach their patients using remotely collected data. The use of TM requires a different approach compared with face-to-face treatment. Although a telehealth capability framework exists for health care professionals, it remains unclear what specific capabilities are required to use TM during physiotherapy treatments. Objective: This study aims to identify the capabilities required to use TM in physiotherapy treatment. Methods: An exploratory qualitative study was conducted following a constructivist semistructured grounded theory approach. Three heterogeneous focus groups were conducted with 15 lecturers of the School of Physiotherapy (Bachelor of Science Physiotherapy program) from the Amsterdam University of Applied Sciences. Focus group discussions were audiotaped and transcribed verbatim. Capabilities for using TM in physiotherapy treatment were identified during an iterative process of data collection and analysis, based on an existing framework with 4 different domains. Team discussions supported further conceptualization of the findings. Results: Sixteen capabilities for the use of TM in physiotherapy treatment were found addressing 3 different domains. Four capabilities were identified in the ``digital health technologies, systems, and policies'' domain, 7 capabilities in the ``clinical practice and application'' domain, and 5 capabilities in the ``data analysis and knowledge creation'' domain. No capabilities were identified in the ``system and technology implementation'' domain. Conclusions: The use of TM in physiotherapy treatment requires specific skills from physiotherapists. To best use TM in physiotherapy treatment, it is important to integrate these capabilities into the education of current and future physiotherapists. ", doi="10.2196/56432", url="https://rehab.jmir.org/2024/1/e56432" } @Article{info:doi/10.2196/60496, author="Rauzi, R. Michelle and Akay, B. Rachael and Balakrishnan, Swapna and Piper, Christi and Gobert, Denise and Flach, Alicia", title="Current State of Connected Sensor Technologies Used During Rehabilitation Care: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Oct", day="24", volume="13", pages="e60496", keywords="connected sensor technology", keywords="digital health", keywords="rehabilitation", keywords="rehabilitation care", keywords="remote monitoring", keywords="telehealth", keywords="mHealth", keywords="mobile health", keywords="wearables", keywords="wearable technology", abstract="Background: Connected sensor technologies can capture raw data and analyze them using advanced statistical methods such as machine learning or artificial intelligence to generate interpretable behavioral or physiological outcomes. Previous research conducted on connected sensor technologies has focused on design, development, and validation. Published review studies have either summarized general technological solutions to address specific behaviors such as physical activity or focused on remote monitoring solutions in specific patient populations. Objective: This study aimed to map research that focused on using connected sensor technologies to augment rehabilitation services by informing care decisions. Methods: The Population, Concept, and Context framework will be used to define inclusion criteria. Relevant articles published between 2008 to the present will be included if (1) the study enrolled adults (population), (2) the intervention used at least one connected sensor technology and involved data transfer to a clinician so that the data could be used to inform the intervention (concept), and (3) the intervention was within the scope of rehabilitation (context). An initial search strategy will be built in Embase; peer reviewed; and then translated to Ovid MEDLINE ALL, Web of Science Core Collection, and CINAHL. Duplicates will be removed prior to screening articles for inclusion. Two independent reviewers will screen articles in 2 stages: title/abstract and full text. Discrepancies will be resolved through group discussion. Data from eligible articles relevant to population, concept, and context will be extracted. Descriptive statistics will be used to report findings, and relevant outcomes will include the type and frequency of connected sensor used and method of data sharing. Additional details will be narratively summarized and displayed in tables and figures. Key partners will review results to enhance interpretation and trustworthiness. Results: We conducted initial searches to refine the search strategy in February 2024. The results of this scoping review are expected in October 2024. Conclusions: Results from the scoping review will identify critical areas of inquiry to advance the field of technology-augmented rehabilitation. Results will also support the development of a longitudinal model to support long-term health outcomes. Trial Registration: Open Science Framework jys53; https://osf.io/jys53 International Registered Report Identifier (IRRID): DERR1-10.2196/60496 ", doi="10.2196/60496", url="https://www.researchprotocols.org/2024/1/e60496", url="http://www.ncbi.nlm.nih.gov/pubmed/39446418" } @Article{info:doi/10.2196/60270, author="Zeidan, S. Rola and Ohama, K. Margaret and Evripidou, Natalia and Anton, D. Stephen and Hamed, L. Laith and Lin, Yi and Leeuwenburgh, Christiaan and Guirguis, W. Faheem and Efron, A. Philip and Flynn, Sheryl and Smith, Barbara and Bacher, Rhonda and Bakarasan, Naveen and Sarmiento Delgado, Juan and Mankowski, T. Robert", title="Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="17", volume="13", pages="e60270", keywords="sepsis", keywords="physical function", keywords="exercise", keywords="rehabilitation", keywords="remotely delivered", keywords="aging", abstract="Background: While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. Objective: This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. Methods: The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. Results: This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. Conclusions: This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. Trial Registration: ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511 International Registered Report Identifier (IRRID): DERR1-10.2196/60270 ", doi="10.2196/60270", url="https://www.researchprotocols.org/2024/1/e60270", url="http://www.ncbi.nlm.nih.gov/pubmed/39418096" } @Article{info:doi/10.2196/59098, author="Bilbrey, Tim and Martin, Jenny and Zhou, Wen and Bai, Changhao and Vaswani, Nitin and Shah, Rishab and Chokshi, Sara and Chen, Xi and Bhusri, Satjit and Niemi, Samantha and Meng, Hongdao and Lei, Zhen", title="A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Oct", day="1", volume="12", pages="e59098", keywords="cardiac rehabilitation", keywords="telehealth", keywords="mHealth", keywords="digital health", keywords="exercise", keywords="quality of life", keywords="myocardial infarction", keywords="app", keywords="application", keywords="physical fitness", keywords="self-management", keywords="disease management", abstract="Background: Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD. Objective: We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD. Methods: This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ?40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables. Results: In total, 162 met the inclusion criteria and 75 (46.3\%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49\%; White: n=46, 61\%). Heart failure was the most common diagnosis (37/75, 49\%). In total, 62/75 (83\%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79\%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81\%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95\% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95\% CI 1.1-4.3) and 2.2 (SD 9.09) points (95\% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. Conclusions: The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States. Trial Registration: ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500 ", doi="10.2196/59098", url="https://mhealth.jmir.org/2024/1/e59098", url="http://www.ncbi.nlm.nih.gov/pubmed/39150858" } @Article{info:doi/10.2196/52964, author="Vincent, Rapha{\"e}l and Charron, Maxime and Lafrance, Simon and Cormier, Audrey-Anne and Kairy, Dahlia and Desmeules, Fran{\c{c}}ois", title="Investigating the Use of Telemedicine by Health Care Providers to Diagnose and Manage Patients With Musculoskeletal Disorders: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Sep", day="23", volume="26", pages="e52964", keywords="telemedicine", keywords="musculoskeletal diseases", keywords="physical examination", keywords="diagnosis", keywords="treatment", keywords="health care", keywords="telecare", keywords="meta-analysis", keywords="systematic review", keywords="telehealth", keywords="orthopedic", keywords="test", keywords="musculoskeletal disorder", keywords="MSKD", keywords="older adult", keywords="older adults", keywords="older person", keywords="older people", keywords="aging", keywords="musculoskeletal", keywords="mobile phone", abstract="Background: Access to care is a major challenge for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, initial remote diagnosis of MSKDs involves some challenges, such as the impossibility of touching the patient during the physical examination, which makes it more complex to obtain a valid diagnosis. No meta-analysis has been performed to date to synthesize evidence regarding the initial assessment including a physical evaluation using telemedicine to diagnose patients with MSKDs. Objective: This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various MSKDs. Methods: An electronic search was conducted up to August 2023 using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Random-effect model meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to synthesize the quality and certainty of the evidence. Results: A total of 23 concordance studies were eligible and included adult participants (N=1493) with various MSKDs. On the basis of high certainty, pooled $\kappa$ and prevalence-adjusted and bias-adjusted $\kappa$ for the diagnostic concordance between remote and in-person assessments of MSKDs were 0.80 (95\% CI 0.72-0.89; 7 studies, 353 patients) and 0.83 (95\% CI 0.76-0.89; 6 studies, 306 patients). On the basis of moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95\% CI 0.80-0.99; 2 studies, 142 patients). Conclusions: The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use, such as imaging tests, are needed. ", doi="10.2196/52964", url="https://www.jmir.org/2024/1/e52964" } @Article{info:doi/10.2196/53455, author="Po, Hui-Wen and Chu, Ying-Chien and Tsai, Hui-Chen and Lin, Chen-Liang and Chen, Chung-Yu and Ma, Huei-Ming Matthew", title="Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study", journal="JMIR Form Res", year="2024", month="Sep", day="13", volume="8", pages="e53455", keywords="telemonitoring", keywords="discharge planning", keywords="case manager", keywords="hospital readmission", keywords="telehealth", keywords="remote healthcare", keywords="high-risk", keywords="post-discharge", keywords="respiratory disease", keywords="respiratory diseases", keywords="cardiovascular disease", keywords="cardiovascular diseases", keywords="case management", keywords="patient education", keywords="readmission", keywords="health status tracking", keywords="care guidance", keywords="medical advice", keywords="male", keywords="men", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="home monitoring", keywords="physiological signal", keywords="physiological signals", keywords="mobile phone", abstract="Background: Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. Objective: This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. Methods: This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. Results: Among 41 eligible patients, 93\% (n=38) were male, and 46\% (n=19) were aged 41-60 years, while 46\% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). Conclusions: By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management. ", doi="10.2196/53455", url="https://formative.jmir.org/2024/1/e53455" } @Article{info:doi/10.2196/52143, author="Glyde, Granger Henry Mark and Morgan, Caitlin and Wilkinson, A. Tom M. and Nabney, T. Ian and Dodd, W. James", title="Remote Patient Monitoring and Machine Learning in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Dual Systematic Literature Review and Narrative Synthesis", journal="J Med Internet Res", year="2024", month="Sep", day="9", volume="26", pages="e52143", keywords="acute exacerbations of COPD", keywords="chronic obstructive pulmonary disease", keywords="exacerbate", keywords="exacerbation", keywords="exacerbations", keywords="remote patient monitoring", keywords="RPM", keywords="predict", keywords="prediction", keywords="predictions", keywords="predictive", keywords="machine learning", keywords="monitoring", keywords="remote", keywords="COPD", keywords="pulmonary", keywords="respiratory", keywords="lung", keywords="lungs", keywords="literature review", keywords="literature reviews", keywords="synthesis", keywords="narrative review", keywords="narrative reviews", keywords="review methods", keywords="review methodology", abstract="Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high mortality, morbidity, and poor quality of life and constitute a substantial burden to patients and health care systems. New approaches to prevent or reduce the severity of AECOPD are urgently needed. Internationally, this has prompted increased interest in the potential of remote patient monitoring (RPM) and digital medicine. RPM refers to the direct transmission of patient-reported outcomes, physiological, and functional data, including heart rate, weight, blood pressure, oxygen saturation, physical activity, and lung function (spirometry), directly to health care professionals through automation, web-based data entry, or phone-based data entry. Machine learning has the potential to enhance RPM in chronic obstructive pulmonary disease by increasing the accuracy and precision of AECOPD prediction systems. Objective: This study aimed to conduct a dual systematic review. The first review focuses on randomized controlled trials where RPM was used as an intervention to treat or improve AECOPD. The second review examines studies that combined machine learning with RPM to predict AECOPD. We review the evidence and concepts behind RPM and machine learning and discuss the strengths, limitations, and clinical use of available systems. We have generated a list of recommendations needed to deliver patient and health care system benefits. Methods: A comprehensive search strategy, encompassing the Scopus and Web of Science databases, was used to identify relevant studies. A total of 2 independent reviewers (HMGG and CM) conducted study selection, data extraction, and quality assessment, with discrepancies resolved through consensus. Data synthesis involved evidence assessment using a Critical Appraisal Skills Programme checklist and a narrative synthesis. Reporting followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: These narrative syntheses suggest that 57\% (16/28) of the randomized controlled trials for RPM interventions fail to achieve the required level of evidence for better outcomes in AECOPD. However, the integration of machine learning into RPM demonstrates promise for increasing the predictive accuracy of AECOPD and, therefore, early intervention. Conclusions: This review suggests a transition toward the integration of machine learning into RPM for predicting AECOPD. We discuss particular RPM indices that have the potential to improve AECOPD prediction and highlight research gaps concerning patient factors and the maintained adoption of RPM. Furthermore, we emphasize the importance of a more comprehensive examination of patient and health care burdens associated with RPM, along with the development of practical solutions. ", doi="10.2196/52143", url="https://www.jmir.org/2024/1/e52143" } @Article{info:doi/10.2196/56580, author="Shi, Weihong and Zhang, Yuhang and Bian, Yanyan and Chen, Lixia and Yuan, Wangshu and Zhang, Houqiang and Feng, Qiyang and Zhang, Huiling and Liu, Diana and Lin, Ye", title="The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Sep", day="6", volume="12", pages="e56580", keywords="nonspecific low back pain", keywords="telerehabilitation", keywords="physical therapy", keywords="low back pain", keywords="back pain", keywords="psychological", keywords="exercise", keywords="randomized controlled trial", keywords="efficacy", keywords="medical infrastructure", keywords="pain intensity", keywords="quality of life", keywords="health survey", keywords="therapeutic", keywords="mobile phone", abstract="Background: Physical therapy has demonstrated efficacy in managing nonspecific low back pain (NLBP) among patients. Nevertheless, the prevalence of NLBP poses a challenge, as the existing medical infrastructure may be insufficient to care for the large patient population, particularly in geographically remote regions. Telerehabilitation emerges as a promising method to address this concern by offering a method to deliver superior medical care to a greater number of patients with NLBP. Objective: The purpose of this study is to demonstrate the physical and psychological effectiveness of a user-centered telerehabilitation program, consisting of a smartphone app and integrated sensors, for patients with NLBP. Methods: This was a single-center, prospective, randomized controlled trial for individuals with NLBP for a duration exceeding 3 months. All participants were assigned randomly to either the telerehabilitation-based exercise group (TBEG) or the outpatient-based exercise group (OBEG). All participants completed a 30-minute regimen of strength and stretching exercises 3 times per week, for a total of 8 weeks, and were required to complete assessment questionnaires at 0, 2, 4, and 8 weeks. The TBEG completed home-based exercises and questionnaires using a telerehabilitation program, while the OBEG completed them in outpatient rehabilitation. The Oswestry Disability Index (ODI) served as the primary outcome measure, assessing physical disability. Secondary outcomes included the Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire, and 36-item Short-Form Health Survey. Results: In total, 54 of 129 eligible patients were enrolled and randomly assigned to the study. The completion of all the interventions and assessments in the TBEG and OBEG was 89\% (24/27) and 81\% (22/27). The findings indicate that no statistical significance was found in the difference of ODI scores between the TBEG and the OBEG at 2 weeks (mean difference ?0.91; odds ratio [OR] 0.78, 95\% CI ?5.96 to 4.14; P=.72), 4 weeks (mean difference ?3.80; OR 1.33, 95\% CI ?9.86 to ?2.25; P=.21), and 8 weeks (mean difference ?3.24; OR 0.92, 95\% CI ?8.65 to 2.17; P=.24). The improvement of the ODI in the TBEG (mean ?16.42, SD 7.30) and OBEG (mean ?13.18, SD 8.48) was higher than 10 after an 8-week intervention. No statistically significant differences were observed between the 2 groups at the 8-week mark regarding the Fear-Avoidance Beliefs Questionnaire (mean difference 8.88; OR 1.04, 95\% CI ?2.29 to 20.06; P=.12) and Numeric Pain Rating Scale (mean difference ?0.39; OR 0.44, 95\% CI ?2.10 to 1.31; P=.64). In the subgroup analysis, there was no statistically significant difference in outcomes between the 2 groups. Conclusions: Telerehabilitation interventions demonstrate comparable therapeutic efficacy for individuals with NLBP when compared to conventional outpatient-based physical therapy, yielding comparable outcomes in pain reduction and improvement in functional limitations. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300068984; https://www.chictr.org.cn/showproj.html?proj=189852 ", doi="10.2196/56580", url="https://mhealth.jmir.org/2024/1/e56580" } @Article{info:doi/10.2196/55852, author="Pohl, Petra and Klerfors, Karoline and Kj{\"o}rk, K. Emma", title="Evaluation of a Digital Previsit Tool for Identifying Stroke-Related Health Problems Before a Follow-Up Visit (Part 1): Survey Study", journal="JMIR Hum Factors", year="2024", month="Sep", day="3", volume="11", pages="e55852", keywords="e-health", keywords="stroke", keywords="Strokeh{\"a}lsa", keywords="follow-up", keywords="previsit", keywords="person-centred care", keywords="health literacy", keywords="digital tool", keywords="shared decision-making", keywords="survey", keywords="mobile phone", abstract="Background: Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool ``Strokehealth'' was developed for patients to fill out in advance. The concept Strokeh{\"a}lsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se. Objective: The study's primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems. Methods: Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed. Results: All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73\% (58/80; 39 men). The majority (48/58, 83\%) reported using the internet daily. Most respondents (56/58, 97\%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text. Conclusions: People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs. Trial Registration: Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135 ", doi="10.2196/55852", url="https://humanfactors.jmir.org/2024/1/e55852" } @Article{info:doi/10.2196/47246, author="Barnes, Keely and Sveistrup, Heidi and Bayley, Mark and Egan, Mary and Bilodeau, Martin and Rathbone, Michel and Taljaard, Monica and Marshall, Shawn", title="Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study", journal="JMIR Form Res", year="2024", month="Sep", day="2", volume="8", pages="e47246", keywords="telehealth", keywords="remote care", keywords="concussion", keywords="mTBI", keywords="mild traumatic brain injury", keywords="assessment", keywords="examination", keywords="telemedicine", keywords="TBI", keywords="traumatic brain injury", keywords="brain injury", keywords="Delphi", keywords="measure", keywords="measures", keywords="measurement", keywords="mobile phone", abstract="Background: There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. Objective: This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. Methods: The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15\% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. Results: In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15\% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Conclusions: Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. International Registered Report Identifier (IRRID): RR2-10.2196/40446 ", doi="10.2196/47246", url="https://formative.jmir.org/2024/1/e47246", url="http://www.ncbi.nlm.nih.gov/pubmed/39222352" } @Article{info:doi/10.2196/51878, author="Wasilewski, B. Marina and Vijayakumar, Abirami and Szigeti, Zara and Mayo, Amanda and Desveaux, Laura and Shaw, James and Hitzig, L. Sander and Simpson, Robert", title="Patient and Provider Experiences With Compassionate Care in Virtual Physiatry: Qualitative Study", journal="J Med Internet Res", year="2024", month="Aug", day="6", volume="26", pages="e51878", keywords="compassionate care", keywords="rehabilitation", keywords="physiatry", keywords="telemedicine", keywords="burnout", keywords="care", keywords="qualitative study", keywords="patient experience", keywords="compassion", keywords="compassionate", keywords="patient centered", keywords="virtual care", keywords="communication", keywords="health care delivery", keywords="patient engagement", keywords="physiatrist", keywords="physiatrists", keywords="Canada", keywords="social media", keywords="physical medicine", keywords="technology", keywords="communication technology", keywords="ICT", keywords="experience", abstract="Background: Telemedicine in the realm of rehabilitation includes the remote delivery of rehabilitation services using communication technologies (eg, telephone, emails, and video). The widespread application of virtual care grants a suitable time to explore the intersection of compassion and telemedicine, especially due to the impact of COVID-19 and how it greatly influenced the delivery of health care universally. Objective: The purpose of this study was to explore how compassionate care is understood and experienced by physiatrists and patients engaged in telemedicine. Methods: We used a qualitative descriptive approach to conduct interviews with patients and physiatrists between June 2021 and March 2022. Patients were recruited across Canada from social media and from a single hospital network in Toronto, Ontario. Physiatrists were recruited across Canada through social media and the Canadian Association for Physical Medicine and Rehabilitation (CAPM\&R) email listserve. Interviews were recorded and transcribed. Data were analyzed thematically. Results: A total of 19 participants were interviewed---8 physiatrists and 11 patients. Two themes capturing physiatrists' and patients' experiences with delivering and receiving compassionate care, especially in the context of virtual care were identified: (1) compassionate care is inherently rooted in health care providers' inner intentions and are, therefore, expressed as caring behaviors and (2) virtual elements impact the delivery and receipt of compassionate care. Conclusions: Compassionate care stemmed from physiatrists' caring attitudes which then manifest as caring behaviors. In turn, these caring attitudes and behaviors enable individualized care and the establishment of a safe space for patients. Moreover, the virtual care modality both positively and negatively influenced how compassion is enacted by physiatrists and received by patients. Notably, there was large ambiguity around the norms and etiquette surrounding virtual care. Nonetheless, the flexibility and person-centeredness of virtual care cause it to be useful in health care settings. ", doi="10.2196/51878", url="https://www.jmir.org/2024/1/e51878", url="http://www.ncbi.nlm.nih.gov/pubmed/39106094" } @Article{info:doi/10.2196/55693, author="Clohessy, Sophie and Kempton, Christian and Ryan, Kate and Grinbergs, Peter and Elliott, T. Mark", title="Exploring Older Adults' Perceptions of Using Digital Health Platforms for Self-Managing Musculoskeletal Health Conditions: Focus Group Study", journal="JMIR Aging", year="2024", month="Aug", day="1", volume="7", pages="e55693", keywords="musculoskeletal", keywords="digital health platform", keywords="physiotherapy self-management", keywords="digital triaging", keywords="phone app", keywords="qualitative", keywords="focus group", keywords="mobile phone", abstract="Background: Digital technologies can assist and optimize health care processes. This is increasingly the case in the musculoskeletal health domain, where digital platforms can be used to support the self-management of musculoskeletal conditions, as well as access to services. However, given a large proportion of the population with musculoskeletal conditions are older adults (aged ?60 years), it is important to consider the acceptability of such platforms within this demographic. Objective: This study aims to explore participants' opinions and perceptions on the use of digital platforms for supporting the self-management of musculoskeletal conditions within older adult (aged ?60 years) populations and to gather their opinions on real examples. Methods: A total of 2 focus groups (focus group 1: 6/15, 40\%; focus group 2: 9/15, 60\%) were conducted, in which participants answered questions about their thoughts on using digital health platforms to prevent or manage musculoskeletal conditions. Participants were further presented with 2 example scenarios, which were then discussed. Interviews were audio recorded, transcribed, and analyzed thematically. Participants were aged ?60 years and with or without current musculoskeletal conditions. Prior experience of using smartphone apps or other digital health platforms for musculoskeletal conditions was not required. Focus groups took place virtually using the Teams (Microsoft Corp) platform. Results: A total of 6 themes were identified across both focus groups: ``experiences of digital health platforms,'' ``preference for human contact,'' ``barriers to accessing clinical services,'' ``individual differences and digital literacy,'' ``trust in technology,'' and ``features and benefits of digital health technologies.'' Each theme is discussed in detail based on the interview responses. The findings revealed that most participants had some existing experience with digital health platforms for preventing or managing musculoskeletal conditions. Overall, there was a lack of trust in and low expectations of quality for digital platforms for musculoskeletal health within this age group. While there was some concern about the use of digital platforms in place of in-person health consultations, several benefits were also identified. Conclusions: Results highlighted the need for better communication on the benefits of using digital platforms to support the self-management of musculoskeletal conditions, without the platforms replacing the role of the health care professionals. The concerns about which apps are of suitable quality and trustworthiness lead us to recommend raising public awareness around the role of organizations that verify and assess the quality of digital health platforms. ", doi="10.2196/55693", url="https://aging.jmir.org/2024/1/e55693" } @Article{info:doi/10.2196/54599, author="Johnson, K. Joshua and Longhurst, K. Jason and Gevertzman, Michael and Jefferson, Corey and Linder, M. Susan and Bethoux, Francois and Stilphen, Mary", title="The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Jul", day="31", volume="8", pages="e54599", keywords="rehabilitation", keywords="physical therapy", keywords="PT", keywords="physiotherapy", keywords="telehealth", keywords="Parkinson disease", keywords="tele-rehabilitation", keywords="telerehabilitation", keywords="TR", keywords="exercise", keywords="physical activity", keywords="exercise therapy", keywords="tele-health", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="digital health", keywords="smartphone", keywords="smartphones", keywords="Parkinson's disease", keywords="Parkinson", keywords="Parkinsons", keywords="Parkinsonism", keywords="PD", abstract="Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5\%) met eligibility criteria, and 20 (29.4\% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non--study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as ``good'' or ``very good'' across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 ", doi="10.2196/54599", url="https://formative.jmir.org/2024/1/e54599" } @Article{info:doi/10.2196/48525, author="Austin, Tara and Smith, Jennifer and Rabin, Borsika and Lindamer, Laurie and Pittman, James and Justice, Staley and Twamley, W. Elizabeth and Lantrip, Crystal", title="The Effects of a Single-Session Virtual Rumination Intervention to Enhance Cognitive Functioning in Veterans With Subjective Cognitive Symptoms: Multimethod Pilot Study", journal="JMIR Form Res", year="2024", month="Apr", day="12", volume="8", pages="e48525", keywords="army", keywords="cognition", keywords="cognitive", keywords="emotion regulation", keywords="memory symptoms", keywords="memory", keywords="military", keywords="rumination", keywords="subjective cognitive decline", keywords="telehealth", keywords="telemedicine", keywords="veteran", keywords="worry", abstract="Background: Subjective cognitive concerns (SCCs) entail perceived difficulties in thinking or memory, often reported without substantial objective evidence of cognitive impairment. These concerns are prevalent among individuals with a history of brain injuries, neurological conditions, or chronic illnesses, contributing to both psychological distress and functional limitations. They are increasingly considered to be a risk factor for future objective decline. A considerable number of individuals reporting SCCs also exhibit mental health symptoms, such as a history of trauma, depression, or anxiety. Interventions that address modifiable emotional and cognitive factors related to SCC could improve functioning and quality of life. Therefore, the use of emotion regulation strategies, especially those directed at minimizing rumination, could serve as a promising focus for interventions aimed at mitigating subjective cognitive concerns in veteran populations. Objective: This pilot study explored the feasibility, acceptability, and preliminary efficacy of a brief, 1-session emotion regulation intervention called ``Worry Less, Remember More.'' The Worry Less, Remember More intervention was designed to reduce rumination and improve subjective cognitive functioning in veterans with subjective cognitive changes (N=15). Methods: We randomized 15 veterans to either the active telehealth condition or waitlist control and completed the intervention. Participants were aged between 31 and 67 (mean 49.5, SD 10.1) years, and the sample was primarily male (12/15, 83\%) and White (10/15, 67\%). The most common diagnoses were posttraumatic stress disorder and depression. Following the intervention, veteran input was sought through semistructured interviews with a subset of 12 participants, examining feasibility, acceptability, and perceived efficacy. Preliminary efficacy was also measured using pre- and postintervention self-report measures. Results: Veterans reported that this intervention was acceptable, with 92\% (11/12) of the sample reporting that they benefited from the intervention and would recommend the intervention to others with similar difficulties. Semistructured interviews revealed difficulties with feasibility, including problems with the remote consenting process, forgetting appointments, and needing additional strategies to remember to consistently use the interventions. The intervention improved self-reported cognitive symptoms on quantitative measures but did not improve self-reported rumination. Conclusions: This pilot study establishes the preliminary feasibility, acceptability, and efficacy of the Worry Less, Remember More intervention for veterans with subjective cognitive symptoms. Future iterations of the intervention may benefit from simplifying the electronic consent process, providing reminders for appointments, and incorporating compensatory cognitive strategies to assist with using the telehealth system, as well as applying the strategies learned in the intervention. While future research is needed with larger samples, including nonveteran populations, the intervention may also be a useful clinical tool to bridge care between neuropsychology clinics and mental health treatment. ", doi="10.2196/48525", url="https://formative.jmir.org/2024/1/e48525", url="http://www.ncbi.nlm.nih.gov/pubmed/38608264" } @Article{info:doi/10.2196/51150, author="Chien, Shih-Ying and Wong, May-Kuen Alice and Tseng, Winston and Hu, Han-Chung and Cho, Hsiu-Ying", title="Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study", journal="JMIR Hum Factors", year="2024", month="Mar", day="7", volume="11", pages="e51150", keywords="chronic lung diseases", keywords="home-based pulmonary rehabilitation", keywords="telehealth", keywords="remote health care", abstract="Background: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Objective: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. Methods: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. Results: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. Conclusions: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design. ", doi="10.2196/51150", url="https://humanfactors.jmir.org/2024/1/e51150", url="http://www.ncbi.nlm.nih.gov/pubmed/38452366" } @Article{info:doi/10.2196/50863, author="Li, Zhaoying and Lei, Yating and Bui, Quoc and DePaul, Olivia and Nicol, E. Ginger and Mohr, C. David and Lee, I. Sunghoon and Fong, M. Mandy W. and Metts, L. Christopher and Tomazin, E. Stephanie and Wong, K. Alex W.", title="A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2024", month="Feb", day="19", volume="11", pages="e50863", keywords="digital intervention", keywords="feasibility", keywords="mobile health", keywords="participation", keywords="rehabilitation", keywords="self-efficacy", keywords="self-management", keywords="stroke", keywords="technology", keywords="telehealth", keywords="telemedicine", keywords="text messaging", abstract="Background: Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. Objective: This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. Methods: A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System's Self-Efficacy for Managing Chronic Conditions. Results: The retention rate was 82\% (9/11), and the engagement (SMS text message response) rate was 78\% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). Conclusions: Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. Trial Registration: ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137\&rank=1 ", doi="10.2196/50863", url="https://rehab.jmir.org/2024/1/e50863", url="http://www.ncbi.nlm.nih.gov/pubmed/38373029" } @Article{info:doi/10.2196/50582, author="Lai, Byron and Wadsworth, Danielle and Spring, Katherine and Jones, S. Chloe and Mintz, Madison and Malone, A. Laurie and Kim, Yumi and Wilroy, Jereme and Lee, Holim", title="Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Feb", day="12", volume="11", pages="e50582", keywords="cerebral palsy", keywords="telehealth", keywords="young adults", keywords="telemonitoring", keywords="exercise", keywords="therapy", keywords="therapeutic exercise", keywords="assessment", keywords="teleassessment", keywords="reliability", keywords="usability", keywords="disability", keywords="youth", keywords="physical fitness", keywords="videoconference", abstract="Background: Youth (age 15-24 years) with and without disability are not adequately represented enough in exercise research due to a lack of time and transportation. These barriers can be overcome by including accessible web-based assessments that eliminate the need for on-site visitations. There is no simple, low-cost, and psychometrically sound compilation of measures for physical fitness and function that can be applied to youth with and without mobility disabilities. Objective: The first purpose was to determine the statistical level of agreement of 4 web-modified clinical assessments with how they are typically conducted in person at a laboratory (convergent validity). The second purpose was to determine the level of agreement between a novice and an expert rater (interrater reliability). The third purpose was to explore the feasibility of implementing the assessments via 2 metrics: safety and duration. Methods: The study enrolled 19 ambulatory youth: 9 (47\%) with cerebral palsy with various mobility disabilities from a children's hospital and 10 (53\%) without disabilities from a university student population. Participants performed a battery of tests via videoconferencing and in person. The test condition (teleassessment and in person) order was randomized. The battery consisted of the hand grip strength test with a dynamometer, the five times sit-to-stand test (FTST), the timed up-and-go (TUG) test, and the 6-minute walk test (6MWT) either around a standard circular track (in person) or around a smaller home-modified track (teleassessment version, home-modified 6-minute walk test [HM6MWT]). Statistical analyses included descriptive data, intraclass correlation coefficients (ICCs), and Bland-Altman plots. Results: The mean time to complete the in-person assessment was 16.9 (SD 4.8) minutes and the teleassessment was 21.1 (SD 5.9) minutes. No falls, injuries, or adverse events occurred. Excellent convergent validity was shown for telemeasured hand grip strength (right ICC=0.96, left ICC=0.98, P<.001) and the TUG test (ICC=0.92, P=.01). The FTST demonstrated good agreement (ICC=0.95, 95\% CI 0.79-0.98; P=.01). The HM6MWT demonstrated poor absolute agreement with the 6MWT. However, further exploratory analysis revealed a strong positive correlation between the tests (r=0.83, P<.001). The interrater reliability was excellent for all tests (all ICCs>0.9, P<.05). Conclusions: This study suggests that videoconference assessments are convenient and useful measures of fitness and function among youth with and without disabilities. This paper presents operationalized teleassessment procedures that can be replicated by health professionals to produce valid and reliable measurements. This study is a first step toward developing teleassessments that can bypass the need for on-site data collection visitations for this age group. Further research is needed to identify psychometrically sound teleassessment procedures, particularly for measures of cardiorespiratory endurance or walking ability. ", doi="10.2196/50582", url="https://rehab.jmir.org/2024/1/e50582", url="http://www.ncbi.nlm.nih.gov/pubmed/38345838" } @Article{info:doi/10.2196/46957, author="Wang, Zeyu and He, Kang and Sui, Xin and Yi, Jiang and Yang, Zhaoyun and Wang, Kai and Gao, Yan and Bian, Linfang and Jiang, Junjie and Zhao, Lijing", title="The Effect of Web-Based Telerehabilitation Programs on Children and Adolescents With Brain Injury: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2023", month="Dec", day="25", volume="25", pages="e46957", keywords="acquired brain injury", keywords="web-based", keywords="telerehabilitation", keywords="motor function", keywords="physical activity level", keywords="lower limb strength", keywords="children", keywords="adolescents", keywords="meta-analysis", abstract="Background: Acquired brain injury (ABI) in children and adolescents can lead to motor and executive impairments that often require long-term treatment. The implementation of web-based telerehabilitation therapy at home is a method to improve the functional status of patients. Therefore, we performed a systematic review of the effects of web-based telerehabilitation programs on functional outcomes in children and adolescents with brain injury and supplemented the findings with a meta-analysis. Objective: This study evaluated the therapeutic effect of web-based telerehabilitation training on children and adolescents with brain injury to determine whether web-based telerehabilitation therapy improved motor function, executive function, physical activity level, lower limb strength, hand and upper limb function, visual processing skills, and occupational functional performance in children and adolescents with brain injury. Methods: PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials on web-based telerehabilitation programs in children and adolescents with brain injury until December 2022, and the risk of bias was evaluated using the Cochrane Collaboration Tool. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software. Results: Overall, 17 studies involving 848 patients were included. Web-based telerehabilitation therapy improved the motor function (standardized mean difference [SMD] 0.29, 95\% CI 0.01-0.57; P=.04), physical activity level (SMD 0.42, 95\% CI 0.11-0.73; P=.007), lower limb strength (SMD 0.52, 95\% CI 0.13-0.90; P=.009), and visual processing skills (SMD 0.26, 95\% CI 0.02-0.50; P=.04) of children and adolescents with brain injury. It also improved executive function in letter-number sequencing (SMD 1.26, 95\% CI 0.26-2.26; P=.01), attention (SMD 0.38, 95\% CI 0.09-0.66; P=.009), and symbol search (SMD 1.18, 95\% CI 0.43-1.93, P=.002). Conclusions: Web-based telerehabilitation therapy improved motor function, physical activity level, lower limb strength, letter-number sequencing, attention, and symbol search, which improved the quality of life in children and adolescents with brain injury. Web-based telerehabilitation programs provide great convenience for children and adolescents with ABI who need long-term treatment and allow them to exercise at home for rehabilitation training. The widespread implementation of remote interventions also provides children and adolescents in remote areas with better access to rehabilitation services. This review provides evidence for the effectiveness of web-based telerehabilitation therapy, but there was heterogeneity in some of the results because of different disease types and intervention programs. Future studies can expand the sample size according to disease type and increase follow-up time according to different exercise prescriptions to further refine the long-term effects of this intervention on various functions of children and adolescents with ABI. Trial Registration: PROSPERO CRD42023421917; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=421917 ", doi="10.2196/46957", url="https://www.jmir.org/2023/1/e46957", url="http://www.ncbi.nlm.nih.gov/pubmed/38145485" } @Article{info:doi/10.2196/49685, author="Mohanraj, Sangeetha and Malone, A. Laurie and Mendonca, J. Christen and Thirumalai, Mohanraj", title="Development and Formative Evaluation of a Virtual Exercise Platform for a Community Fitness Center Serving Individuals With Physical Disabilities: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Dec", day="15", volume="7", pages="e49685", keywords="web-based exercise", keywords="user experience", keywords="community health", keywords="fitness facility", keywords="tele-exercise", keywords="physical disability", keywords="physical activity", keywords="exercise", keywords="fitness", keywords="virtual", keywords="interface", keywords="disability", keywords="disabilities", keywords="accessibility", keywords="telehealth", keywords="telemedicine", keywords="eHealth", keywords="digital health", keywords="mixed methods study", abstract="Background: People with disabilities experience numerous barriers to being physically active, such as transportation issues, a lack of trained exercise professionals who understand disabilities, and facility access. The use of a virtual exercise platform (VEP) may provide an alternative and limit certain barriers. Objective: The aim of this mixed method study was to evaluate user interaction (effectiveness, efficiency, and satisfaction), the strengths and weaknesses of the user interface, and the user experience with a VEP. Methods: Participants were recruited from a community fitness facility that offers programs for people with disabilities. Inclusion criteria were being older than 18 years, fluent in English, and availability of internet access. Features of the VEP included articles, prerecorded videos, live Zoom classes, web-based class registration, weekly progress tracking, incentives, and surveys. A one-on-one Zoom session was scheduled with each participant, during which they completed certain tasks: (1) create an account or login, (2) register for class, (3) join class, (4) add to calendar, and (5) complete surveys. As participants completed tasks, quantitative observations (time on task, task success, rate of task completion, and number of errors by users, which determined task difficulty), qualitative observations were made and interviews were conducted at the end of the session. The ``concurrent think-aloud'' method was encouraged by the moderator to gauge participants' thoughts as they worked through testing. Participants also completed the System Usability Scale (SUS) and Questionnaire for User Interface Satisfaction (QUIS). Results: A total of 5 people with disabilities (3 male, 2 female), aged 36-78 (mean 54) years, with education levels from high school to PhD, were recruited. Devices used for testing included a laptop (n=3), a Chromebook (n=1), and a desktop (n=1). All participants completed tasks \#1 and \#2 without errors but could not complete task \#4. One participant completed task \#5 with difficulty and another completed task \#3 with difficulty. The average time to complete each task was: (1) 82 seconds (55-110), (2) 11 seconds (4-21), (3) 9 seconds (5-27), and (4) 921.5 seconds (840-958). The mean SUS score was 86.5/100, and the mean user QUIS score was 8.08 out of 10. Qualitative observations indicated that the system was simple, user-friendly, and accessible. Conclusions: People with disabilities reported high usability and user satisfaction with the web-based exercise platform, and the system appears to be an efficient and effective physical activity option. ", doi="10.2196/49685", url="https://formative.jmir.org/2023/1/e49685", url="http://www.ncbi.nlm.nih.gov/pubmed/38100173" } @Article{info:doi/10.2196/48845, author="Seinsche, Julia and de Bruin, D. Eling and Saibene, Enrico and Rizzo, Francesco and Carpinella, Ilaria and Ferrarin, Maurizio and Moza, Sotiria and Ritter, Tanja and Giannouli, Eleftheria", title="A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study", journal="JMIR Hum Factors", year="2023", month="Dec", day="7", volume="10", pages="e48845", keywords="older adults", keywords="motor-cognitive intervention", keywords="exergame", keywords="telerehabilitation", keywords="information and communications technologies", keywords="user-centered design", keywords="usability", keywords="technology acceptance", abstract="Background: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). Objective: This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. Methods: At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants' perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire--3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. Results: A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83\%, range 36\%-100\% and HPs: 81\%, range 63.8\%-93.3\% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system's usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman $\rho$=0.35, P=.02 to $\rho$=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman $\rho$=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman $\rho$=?0.35; P=.02) and the UTAUT total score ($\rho$=?0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. Conclusions: The study's findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system's feasibility and effectiveness. ", doi="10.2196/48845", url="https://humanfactors.jmir.org/2023/1/e48845", url="http://www.ncbi.nlm.nih.gov/pubmed/38060283" } @Article{info:doi/10.2196/47542, author="Harrison, Madeleine and Palmer, Rebecca and Cooper, Cindy", title="Identifying the Active Ingredients of a Computerized Speech and Language Therapy Intervention for Poststroke Aphasia: Multiple Methods Investigation Alongside a Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="5", volume="10", pages="e47542", keywords="aphasia", keywords="stroke", keywords="computer therapy", keywords="tele-rehabilitation", keywords="speech and language therapy", keywords="word finding", keywords="qualitative", keywords="language", keywords="language therapy", keywords="speech therapy", keywords="aphasia therapy", keywords="speech", keywords="interview", keywords="self managed", keywords="computer aphasia", keywords="persistent aphasia", keywords="rehabilitation", keywords="machines", keywords="technology", keywords="computer", keywords="online", keywords="online health", keywords="ehealth", keywords="digital health", abstract="Background: Aphasia is a communication disorder affecting more than one-third of stroke survivors. Computerized Speech and Language Therapy (CSLT) is a complex intervention requiring computer software, speech and language therapists, volunteers, or therapy assistants, as well as self-managed practice from the person with aphasia. CSLT was found to improve word finding, a common symptom of aphasia, in a multicenter randomized controlled trial (Clinical and Cost Effectiveness of Computer Treatment for Aphasia Post Stroke [Big CACTUS]). Objective: This study provides a detailed description of the CSLT intervention delivered in the Big CACTUS trial and identified the active ingredients of the intervention directly associated with improved word finding for people with aphasia. Methods: We conducted a multiple methods study within the context of a randomized controlled trial. In study 1, qualitative interviews explored key informants' understanding of the CSLT intervention, how the components interacted, and how they could be measured. Qualitative data were transcribed verbatim and analyzed thematically. Qualitative findings informed the process measures collected as part of a process evaluation of the CSLT intervention delivered in the Big CACTUS trial. In study 2, quantitative analyses explored the relationship between intervention process measures (length of computer therapy access; therapists' knowledge of CSLT; degree of rationale for CSLT tailoring; and time spent using the software to practice cued confrontation naming, noncued naming, and using words in functional sentences) and change in word-finding ability over a 6-month intervention period. Results: Qualitative interviews were conducted with 7 CSLT approach experts. Thematic analysis identified four overarching components of the CSLT approach: (1) the StepByStep software (version 5; Steps Consulting Ltd), (2) therapy setup: tailoring and personalizing, (3) regular independent practice, and (4) support and monitoring. Quantitative analyses included process and outcome data from 83 participants randomized to the intervention arm of the Big CACTUS trial. The process measures found to be directly associated with improved word-finding ability were therapists providing a thorough rationale for tailoring the computerized therapy exercises and the amount of time the person with aphasia spent using the computer software to practice using words in functional sentences. Conclusions: The qualitative exploration of the CSLT approach provided a detailed description of the components, theories, and mechanisms underpinning the intervention and facilitated the identification of process measures to be collected in the Big CACTUS trial. Quantitative analysis furthered our understanding of which components of the intervention are associated with clinical improvement. To optimize the benefits of using the CSLT approach for word finding, therapists are advised to pay particular attention to the active ingredients of the intervention: tailoring the therapy exercises based on the individual's specific language difficulties and encouraging people with aphasia to practice the exercises focused on saying words in functional sentences. Trial Registration: ISRCTN Registry ISRCTN68798818; https://www.isrctn.com/ISRCTN68798818 ", doi="10.2196/47542", url="https://rehab.jmir.org/2023/1/e47542", url="http://www.ncbi.nlm.nih.gov/pubmed/38051577" } @Article{info:doi/10.2196/40735, author="Xiang, Wu and Wang, Jun-Yu and Ji, Bing-jin and Li, Li-Jun and Xiang, Han", title="Effectiveness of Different Telerehabilitation Strategies on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2023", month="Dec", day="4", volume="25", pages="e40735", keywords="telerehabilitation", keywords="telemedicine", keywords="knee osteoarthritis", keywords="pain", keywords="physical function", keywords="systematic review", keywords="meta-analysis", abstract="Background: Knee osteoarthritis (OA) is a chronic, degenerative bone and joint disease. It can lead to major pressure to the quality of life and mental health of patients, and also brings a serious economic burden to society. However, it is difficult for patients with knee OA to access rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies for the improvement of knee OA, but the effect of different telerehabilitation strategies on knee OA is not clear. Objective: The aim of this systematic review and meta-analysis was to identify telerehabilitation strategies attributing to the improvement of pain and physical function outcomes in patients with knee OA. Methods: We reviewed and analyzed telerehabilitation strategies from randomized controlled trials (RCTs) comparing telerehabilitation with conventional treatment or usual care. For each strategy, we examined whether RCTs that applied the telerehabilitation strategy resulted in a significant improvement in pain or physical function compared with conventional treatment or usual care. Results: We included 6 RCTs (n=734) incorporating 8 different telerehabilitation strategies. The duration of the interventions ranged from 1 to 48 weeks, and sample sizes ranged from 20 to 350 patients. The results showed that RCTs that provided telerehabilitation were found to be more effective than conventional treatments for improving pain (P=.003; standardized mean difference [SMD] --0.21, 95\% CI --0.35 to --0.07), but not physical function (P=.24; SMD --0.09, 95\% CI --0.25 to 0.06). Furthermore, this systematic review and meta-analysis indicated that there is no significant correlation between different telerehabilitation strategies and the pain and physical function of patients with knee OA. Conclusions: This systematic review and meta-analysis showed that telerehabilitation programs could relieve pain but not improve physical function for patients with knee OA. These results indicated that telerehabilitation is beneficial for the implementation of home rehabilitation exercises for patients with knee OA, thereby reducing the economic burden of health. However, there were limitations in terms of the number of search results and the number of studies that were eligible for this review and meta-analysis. Therefore, the results need to be interpreted with caution, and more high-quality studies with large samples are needed to focus on the long-term outcomes of telerehabilitation for patients with knee OA to address this limitation. ", doi="10.2196/40735", url="https://www.jmir.org/2023/1/e40735", url="http://www.ncbi.nlm.nih.gov/pubmed/37982411" } @Article{info:doi/10.2196/47114, author="Pittara, Melpo and Matsangidou, Maria and Pattichis, S. Constantinos", title="Virtual Reality for Pulmonary Rehabilitation: Comprehensive Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="2", volume="10", pages="e47114", keywords="breathing exercise", keywords="breathing exercise gaming", keywords="pulmonary rehabilitation", keywords="respiratory biofeedback", keywords="virtual reality", abstract="Background: Pulmonary rehabilitation is a vital component of comprehensive care for patients with respiratory conditions, such as lung cancer, chronic obstructive pulmonary disease, and asthma, and those recovering from respiratory diseases like COVID-19. It aims to enhance patients' functional ability and quality of life, and reduce symptoms, such as stress, anxiety, and chronic pain. Virtual reality is a novel technology that offers new opportunities for customized implementation and self-control of pulmonary rehabilitation through patient engagement. Objective: This review focused on all types of virtual reality technologies (nonimmersive, semi-immersive, and fully immersive) that witnessed significant development and were released in the field of pulmonary rehabilitation, including breathing exercises, biofeedback systems, virtual environments for exercise, and educational models. Methods: The review screened 7 electronic libraries from 2010 to 2023. The libraries were ACM Digital Library, Google Scholar, IEEE Xplore, MEDLINE, PubMed, Sage, and ScienceDirect. Thematic analysis was used as an additional methodology to classify our findings based on themes. The themes were virtual reality training, interaction, types of virtual environments, effectiveness, feasibility, design strategies, limitations, and future directions. Results: A total of 2319 articles were identified, and after a detailed screening process, 32 studies were reviewed. Based on the findings of all the studies that were reviewed (29 with a positive label and 3 with a neutral label), virtual reality can be an effective solution for pulmonary rehabilitation in patients with lung cancer, chronic obstructive pulmonary disease, and asthma, and in individuals and children who are dealing with mental health--related disorders, such as anxiety. The outcomes indicated that virtual reality is a reliable and feasible solution for pulmonary rehabilitation. Interventions can provide immersive experiences to patients and offer tailored and engaging rehabilitation that promotes improved functional outcomes of pulmonary rehabilitation, breathing body awareness, and relaxation breathing techniques. Conclusions: The identified studies on virtual reality in pulmonary rehabilitation showed that virtual reality holds great promise for improving the outcomes and experiences of patients. The immersive and interactive nature of virtual reality interventions offers a new dimension to traditional rehabilitation approaches, providing personalized exercises and addressing psychological well-being. However, additional research is needed to establish standardized protocols, identify the most effective strategies, and evaluate long-term benefits. As virtual reality technology continues to advance, it has the potential to revolutionize pulmonary rehabilitation and significantly improve the lives of patients with chronic lung diseases. ", doi="10.2196/47114", url="https://rehab.jmir.org/2023/1/e47114", url="http://www.ncbi.nlm.nih.gov/pubmed/37782529" } @Article{info:doi/10.2196/47460, author="Hnatiak, Jakub and Zikmund Galkova, Lujza and Winnige, Petr and Batalik, Ladislav and Dosbaba, Filip and Ludka, Ondrej and Krejci, Jan", title="Obstructive Sleep Apnea and a Comprehensive Remotely Supervised Rehabilitation Program: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="18", volume="12", pages="e47460", keywords="obstructive sleep apnea", keywords="telerehabilitation", keywords="telemonitoring", keywords="CPAP", keywords="apnea-hypopnea index", keywords="telehealth", keywords="telemedicine", keywords="sleep", keywords="respiratory", keywords="home based", keywords="rehabilitation", keywords="RCT", keywords="randomized controlled trial", abstract="Background: Obstructive sleep apnea (OSA) is characterized by recurrent, intermittent partial or complete obstruction of the upper respiratory tract during sleep, which negatively affects the patient's daily quality of life (QoL). Middle-aged and older men who smoke and have obesity are most at risk. Even though the use of continuous positive airway pressure (CPAP) during sleep remains the gold standard treatment, various rehabilitation methods, such as exercise, respiratory therapy, myofunctional therapy, and nutritional lifestyle interventions, also appear to be effective. Moreover, it is increasingly recommended to use alternative or additional therapy options in combination with CPAP therapy. Objective: This study aims to evaluate if a comprehensive home-based, remotely supervised rehabilitation program (tele-RHB), in combination with standard therapy, can improve OSA severity by decreasing the apnea-hypopnea index (AHI); improve objective parameters of polysomnographic, spirometric, anthropometric, and body composition examinations; improve lipid profile, maximal mouth pressure, and functional capacity tests; and enhance the subjective perception of QoL, as well as daytime sleepiness in male participants with moderate to severe OSA. Our hypothesis is that a combination of the tele-RHB program and CPAP therapy will be more effective by improving OSA severity and the abovementioned parameters. Methods: This randomized controlled trial aims to recruit 50 male participants between the ages of 30 and 60 years with newly diagnosed moderate to severe OSA. Participants will be randomized 1:1, either to a 12-week tele-RHB program along with CPAP therapy or to CPAP therapy alone. After the completion of the intervention, the participants will be invited to complete a 1-year follow-up. The primary outcomes will be the polysomnographic value of AHI, Epworth Sleepiness Scale score, 36-Item Short Form Health Survey (SF-36) score, percentage of body fat, 6-minute walk test distance covered, as well as maximal inspiratory and expiratory mouth pressure values. Secondary outcomes will include polysomnographic values of oxygen desaturation index, supine AHI, total sleep time, average heart rate, mean oxygen saturation, and the percentage of time with oxygen saturation below 90\%; anthropometric measurements of neck, waist, and hip circumference; BMI values; forced vital capacity; forced expiratory volume in 1 second; World Health Organization's tool to measure QoL (WHOQOL-BREF) score; and lipid profile values. Results: Study recruitment began on October 25, 2021, and the estimated study completion date is December 2024. Analyses will be performed to examine whether the combination of the tele-RHB program and CPAP therapy will be more effective in the reduction of OSA severity and improvement of QoL, body composition and circumferences, exercise tolerance, lipid profile, as well as respiratory muscle and lung function, compared to CPAP therapy alone. Conclusions: The study will evaluate the effect of a comprehensive tele-RHB program on selected parameters mentioned above in male participants. The results of this intervention could help the further development of novel additional therapeutic home-based options for OSA. Trial Registration: ClinicalTrials.gov NCT04759456; https://clinicaltrials.gov/ct2/show/NCT04759456 International Registered Report Identifier (IRRID): DERR1-10.2196/47460 ", doi="10.2196/47460", url="https://www.researchprotocols.org/2023/1/e47460", url="http://www.ncbi.nlm.nih.gov/pubmed/37721786" } @Article{info:doi/10.2196/36808, author="Hedbom, Towe and Liljeroos, Maria and Thyl{\'e}n, Ingela and Orwelius, Lotti and Jaarsma, Tiny and Str{\"o}mberg, Anna", title="Expectations of Tele-Yoga in Persons With Long-Term Illness: Qualitative Content Analysis", journal="J Med Internet Res", year="2023", month="Sep", day="13", volume="25", pages="e36808", keywords="yoga", keywords="telerehabilitation", keywords="eHealth", keywords="chronic illness", keywords="heart failure", keywords="implantable cardioverter defibrillator", keywords="postintensive care", abstract="Background: Yoga is a mind-body exercise that has demonstrated its feasibility and safety even for individuals with severe long-term illness. Engaging in yoga has the potential to yield positive effects on both physical and mental well-being. Tele-yoga is a novel approach to rehabilitation in which participants practice group yoga with a live-streamed yoga instructor digitally via a tablet. This is especially beneficial for individuals who may find it difficult to leave their homes to participate in an exercise session. As part of our ongoing evaluation of the tele-yoga intervention in individuals with long-term illness, we have undertaken an exploration of participants' expectations regarding yoga in general and tele-yoga specifically. Understanding these expectations is crucial, as they can significantly impact their satisfaction with treatment and care and influence overall intervention outcomes. Objective: This study aims to explore the expectations of tele-yoga among individuals with long-term illness before starting a tele-yoga intervention. Methods: The study employed an inductive qualitative design and is part of a process evaluation within an ongoing randomized controlled trial. A total of 89 participants were interviewed before the start of the tele-yoga intervention. The interview guide encompassed questions about their general perceptions of yoga and the specific expectations they held for the upcoming tele-yoga sessions. The interviews were transcribed and analyzed using inductive qualitative content analysis. Results: Participants expressed their expectations for tele-yoga, focusing on the anticipated improvements in physical function and overall health. These expectations included hopes for reduced respiratory issues; relief from discomfort, aches, and pains; as well as increased physical flexibility, coordination, and overall well-being. Besides, they expected to achieve improved psychological well-being and performance; to acquire strategies to manage stress, anger, and anxiety; and to have their motivational drive strengthened and influence other activities. Participants described tele-yoga as a new and exciting technical solution that would facilitate the delivery of yoga. A few participants remained a little hesitant toward the use of technology, with some expectations based on previous experiences. When asked about expectations, some had no idea about what to expect. Participants also had varying perspectives on yoga, with some finding it mysterious and difficult to understand. Participants expressed thoughts that they found the idea of tele-yoga taking place in groups exciting and enjoyable. They also had expectations that being part of a group would provide opportunities for mutual inspiration and encouragement among the group members. Conclusions: Expectations before an intervention can provide valuable insights into understanding the factors influencing adherence to tele-yoga and its outcomes. Our findings provide a wide range of expectations for tele-yoga, spanning both physical and mental aspects. Moreover, the technology's potential to facilitate yoga delivery and the supportive nature of digital group interactions were evident from the results. Trial Registration: ClinicalTrials.gov NCT03703609; https://clinicaltrials.gov/ct2/show/NCT03703609 ", doi="10.2196/36808", url="https://www.jmir.org/2023/1/e36808", url="http://www.ncbi.nlm.nih.gov/pubmed/37703082" } @Article{info:doi/10.2196/47324, author="Yang, Wenwen and Du, Yifei and Chen, Mengran and Li, Sufang and Zhang, Fan and Yu, Peiyang and Xu, Xiaoxia", title="Effectiveness of Home-Based Telerehabilitation Interventions for Dysphagia in Patients With Head and Neck Cancer: Systematic Review", journal="J Med Internet Res", year="2023", month="Sep", day="8", volume="25", pages="e47324", keywords="head and neck cancer", keywords="home-based rehabilitation", keywords="remote intervention", keywords="swallowing exercise", keywords="systematic review", abstract="Background: Multimodal treatment--induced dysphagia has serious negative effects on survivors of head and neck cancer. Owing to advances in communication technologies, several studies have applied telecommunication-based interventions that incorporate swallowing exercises, education, monitoring, feedback, self-management, and communication. It is especially urgent to implement home-based remote rehabilitation in the context of the COVID-19 pandemic. However, the optimal strategy and effectiveness of remote interventions are unclear. Objective: This systematic review aimed to examine the evidence regarding the efficacy of telerehabilitation for reducing physiological and functional impairments related to swallowing and for improving adherence and related influencing factors among head and neck cancer survivors. Methods: The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Library databases were systematically searched up to July 2023 to identify relevant articles. In total, 2 investigators independently extracted the data and assessed the methodological quality of the included studies using the quality assessment tool of the Joanna Briggs Institute. Results: A total of 1465 articles were initially identified; ultimately, 13 (0.89\%) were included in the systematic review. The quality assessment indicated that the included studies were of moderate to good quality. The results showed that home-based telerehabilitation improved the safety of swallowing and oral feeding, nutritional status, and swallowing-related quality of life; reduced negative emotions; improved swallowing rehabilitation adherence; was rated by participants as highly satisfactory and supportive; and was cost-effective. In addition, this review investigated factors that influenced the efficacy of telerehabilitation, which included striking a balance among swallowing training strategy, intensity, frequency, duration, and individual motor ability; treating side effects of radiotherapy; providing access to medical, motivational, and educational information; providing feedback on training; providing communication and support from speech pathologists, families, and other survivors; and addressing technical problems. Conclusions: Home-based telerehabilitation has shown great potential in reducing the safety risks of swallowing and oral feeding, improving quality of life and adherence, and meeting information needs for dysphagia among survivors of head and neck cancer. However, this review highlights limitations in the current literature, and the current research is in its infancy. In addition, owing to the diversity of patient sociodemographic, medical, physiological and functional swallowing, and behavioral factors, we recommend the development of tailored telemedicine interventions to achieve the best rehabilitation effects with the fewest and most precise interventions. ", doi="10.2196/47324", url="https://www.jmir.org/2023/1/e47324", url="http://www.ncbi.nlm.nih.gov/pubmed/37682589" } @Article{info:doi/10.2196/47172, author="Baffert, Sandrine and Hadouiri, Nawale and Fabron, C{\'e}cile and Burgy, Floriane and Cassany, Aurelia and Kemoun, Gilles", title="Economic Evaluation of Telerehabilitation: Systematic Literature Review of Cost-Utility Studies", journal="JMIR Rehabil Assist Technol", year="2023", month="Sep", day="5", volume="10", pages="e47172", keywords="telerehabilitation", keywords="cost-effectiveness", keywords="quality-adjusted life year", keywords="economic evaluation", keywords="cost", keywords="rehabilitation", keywords="systematic review", abstract="Background: Telerehabilitation could benefit a large population by increasing adherence to rehabilitation protocols. Objective: Our objective was to review and discuss the use of cost-utility approaches in economic evaluations of telerehabilitation interventions. Methods: A review of the literature on PubMed, Scopus, Centres for Review and Dissemination databases (including the HTA database, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database), Cochrane Library, and ClinicalTrials.gov (last search on February 8, 2021) was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were defined in accordance with the PICOS (population, intervention, comparison, outcomes, and study design) system: the included studies had to evaluate patients in rehabilitation therapy for all diseases and disorders (population) through exercise-based telerehabilitation (intervention) and had to have a control group that received face-to-face rehabilitation (comparison), and these studies had to evaluate effectiveness through gain in quality of life (outcome) and used the design of randomized and controlled clinical studies (study). Results: We included 11 economic evaluations, of which 6 concerned cardiovascular diseases. Several types of interventions were assessed as telerehabilitation, consisting in monitoring of rehabilitation at home (monitored by physicians) or a rehabilitation program with exercise and an educational intervention at home alone. All studies were based on randomized clinical trials and used a validated health-related quality of life instrument to describe patients' health states. Four evaluations used the EQ-5D, 1 used the EQ-5D-5L, 2 used the EQ-5D-3L, 3 used the Short-Form Six-Dimension questionnaire, and 1 used the 36-item Short Form survey. The mean quality-adjusted life years gained using telerehabilitation services varied from --0.09 to 0.89. These results were reported in terms of the probability that the intervention was cost-effective at different thresholds for willingness-to-pay values. Most studies showed results about telerehabilitation as dominant (ie, more effective and less costly) together with superiority or noninferiority in outcomes. Conclusions: There is evidence to support telerehabilitation as a cost-effective intervention for a large population among different disease areas. There is a need for conducting cost-effectiveness studies in countries because the available evidence has limited generalizability in such countries. Trial Registration: PROSPERO CRD42021248785; https://tinyurl.com/4xurdvwf ", doi="10.2196/47172", url="https://rehab.jmir.org/2023/1/e47172", url="http://www.ncbi.nlm.nih.gov/pubmed/37669089" } @Article{info:doi/10.2196/45993, author="Broderick, Michelle and O'Shea, Robert and Burridge, Jane and Demain, Sara and Johnson, Louise and Bentley, Paul", title="Examining Usability, Acceptability, and Adoption of a Self-Directed, Technology-Based Intervention for Upper Limb Rehabilitation After Stroke: Cohort Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="21", volume="10", pages="e45993", keywords="stroke rehabilitation", keywords="interactive gaming", keywords="rehabilitation technology", keywords="technology usability", keywords="technology acceptability", keywords="self-management", keywords="usability", keywords="acceptability", keywords="stroke", keywords="rehabilitation", keywords="adoption", keywords="engagement", keywords="acceptance", keywords="limb", keywords="mobility", keywords="mobile phone", abstract="Background: Upper limb (UL) recovery after stroke is strongly dependent upon rehabilitation dose. Rehabilitation technologies present pragmatic solutions to dose enhancement, complementing therapeutic activity within conventional rehabilitation, connecting clinicians with patients remotely, and empowering patients to drive their own recovery. To date, rehabilitation technologies have been poorly adopted. Understanding the barriers to adoption may shape strategies to enhance technology use and therefore increase rehabilitation dose, thus optimizing recovery potential. Objective: We examined the usability, acceptability, and adoption of a self-directed, exercise-gaming technology within a heterogeneous stroke survivor cohort and investigated how stroke survivor characteristics, technology usability, and attitudes toward technology influenced adoption. Methods: A feasibility study of a novel exercise-gaming technology for self-directed UL rehabilitation in early subacute stroke survivors (N=30) was conducted in an inpatient, acute hospital setting. Demographic and clinical characteristics were recorded; participants' performance in using the system (usability) was assessed using a 4-point performance rating scale (adapted from the Barthel index), and adherence with the system was electronically logged throughout the trial. The technology acceptance model was used to formulate a survey examining the acceptability of the system. Spearman rank correlations were used to examine associations between participant characteristics, user performance (usability), end-point technology acceptance, and intervention adherence (adoption). Results: The technology was usable for 87\% (n=26) of participants, and the overall technology acceptance rating was 68\% (95\% CI 56\%-79\%). Participants trained with the device for a median of 26 (IQR 16-31) minutes daily over an enrollment period of 8 (IQR 5-14) days. Technology adoption positively correlated with user performance (usability) ($\rho$=0.55; 95\% CI 0.23-0.75; P=.007) and acceptability as well as domains of perceived usefulness ($\rho$=0.42; 95\% CI 0.09-0.68; P=.03) and perceived ease of use ($\rho$=0.46; 95\% CI 0.10-0.74; P=.02). Technology acceptance decreased with increased global stroke severity ($\rho$=?0.56; 95\% CI ?0.79 to ?0.22; P=.007). Conclusions: This technology was usable and acceptable for the majority of the cohort, who achieved an intervention dose with technology-facilitated, self-directed UL training that exceeded conventional care norms. Technology usability and acceptability were determinants of adoption and appear to be mediated by stroke severity. The results demonstrate the importance of selecting technologies for stroke survivors on the basis of individual needs and abilities, as well as optimizing the accessibility of technologies for the target user group. Facilitating changes in stroke survivors' beliefs and attitudes toward rehabilitation technologies may enhance adoption. Further work is needed to understand how technology can be optimized to benefit those with more severe stroke. ", doi="10.2196/45993", url="https://rehab.jmir.org/2023/1/e45993", url="http://www.ncbi.nlm.nih.gov/pubmed/37603405" } @Article{info:doi/10.2196/49673, author="Areias, C. Anabela and Janela, Dora and Molinos, Maria and Moulder, G. Robert and Bento, Virg{\'i}lio and Yanamadala, Vijay and Cohen, P. Steven and Correia, Dias Fernando and Costa, Fab{\'i}ola", title="Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="15", volume="10", pages="e49673", keywords="aged", keywords="digital therapy", keywords="eHealth", keywords="musculoskeletal conditions", keywords="older adults", keywords="pain", keywords="physical therapy", keywords="telehealth", keywords="telerehabilitation", abstract="Background: Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). Objective: This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. Methods: We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ?44 years old (young adults), 45-64 years old (middle-aged adults), and ?65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30\%), analgesic usage, mental health, work productivity, and non--work-related activity impairment. Results: Of 16,229 patients, 12,082 started the program: 38.3\% (n=4629) were young adults, 55.7\% (n=6726) were middle-aged adults, and 6\% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95\% CI 1.45-2.06; P<.001 and OR 2.40, 95\% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95\% CI 1.03-1.45; P=.03 and OR 1.38, 95\% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6\%; middle-aged adults: 1848/2834, 65.2\%; and older adults: 241/387, 62.3\%; P=.17). Conclusions: Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population. ", doi="10.2196/49673", url="https://rehab.jmir.org/2023/1/e49673", url="http://www.ncbi.nlm.nih.gov/pubmed/37465960" } @Article{info:doi/10.2196/46619, author="Kerr, Andy and Keogh, Maisie and Slachetka, Milena and Grealy, Madeleine and Rowe, Philip", title="An Intensive Exercise Program Using a Technology-Enriched Rehabilitation Gym for the Recovery of Function in People With Chronic Stroke: Usability Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="21", volume="10", pages="e46619", keywords="rehabilitation technology", keywords="stroke", keywords="feasibility", keywords="intensive exercise", keywords="rehabilitation", keywords="exercise", keywords="motor impairment", keywords="feasibility study", keywords="telehealth", keywords="recovery", keywords="telerehabilitation", abstract="Background: Rehabilitation improves poststroke recovery with greater effect for many when applied intensively within enriched environments. The failure of health care providers to achieve minimum recommendations for rehabilitation motivated the development of a technology-enriched rehabilitation gym (TERG) that enables individuals under supervision to perform high-intensity self-managed exercises safely in an enriched environment. Objective: This study aimed to assess the feasibility of the TERG approach and gather preliminary evidence of its effect for future research. Methods: This feasibility study recruited people well enough to exercise but living with motor impairment following a stroke at least 12 months previously. Following assessment, an 8-week exercise program using a TERG (eg, virtual reality treadmills, power-assisted equipment, balance trainers, and upper limb training systems) was structured in partnership with participants. The feasibility was assessed through recruitment, retention, and adherence rates along with participant interviews. Effect sizes were calculated from the mean change in standard outcome measures. Results: In total, 70 individuals registered interest, the first 50 were invited for assessment, 39 attended, and 31 were eligible and consented. Following a pilot study (n=5), 26 individuals (mean age 60.4, SD 13.3 years; mean 39.0, SD 29.2 months post stroke; n=17 males; n=10 with aphasia) were recruited to a feasibility study, which 25 individuals completed. Participants attended an average of 18.7 (SD 6.2) sessions with an 82\% attendance rate. Reasons for nonattendance related to personal life, illness, weather, care, and transport. In total, 19 adverse events were reported: muscle or joint pain, fatigue, dizziness, and viral illness, all resolved within a week. Participants found the TERG program to be a positive experience with the equipment highly usable albeit with some need for individual tailoring to accommodate body shape and impairment. The inclusion of performance feedback and gamification was well received. Mean improvements in outcome measures were recorded across all domains with low to medium effect sizes. Conclusions: This study assessed the feasibility of a holistic technology-based solution to the gap between stroke rehabilitation recommendations and provision. The results clearly demonstrate a rehabilitation program delivered through a TERG is feasible in terms of recruitment, retention, adherence, and user acceptability and may lead to considerable improvement in function, even in a chronic stroke population. International Registered Report Identifier (IRRID): RR2-doi.org/10.3389/fresc.2021.820929 ", doi="10.2196/46619", url="https://rehab.jmir.org/2023/1/e46619", url="http://www.ncbi.nlm.nih.gov/pubmed/37477954" } @Article{info:doi/10.2196/44498, author="Pol, Margriet and Qadeer, Amarzish and van Hartingsveldt, Margo and Choukou, Mohamed-Amine", title="Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="18", volume="10", pages="e44498", keywords="aging in place", keywords="aging well", keywords="digital technology", keywords="remote monitoring", keywords="activity", keywords="sensor", keywords="mobile phone", abstract="Background: Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identi?ed as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. Objective: The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. Methods: We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. Results: The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. Conclusions: Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals. ", doi="10.2196/44498", url="https://rehab.jmir.org/2023/1/e44498", url="http://www.ncbi.nlm.nih.gov/pubmed/37463040" } @Article{info:doi/10.2196/47264, author="Duran, T. Andrea and Keener-DeNoia, Adrianna and Stavrolakes, Kimberly and Fraser, Adina and Blanco, V. Luis and Fleisch, Emily and Pieszchata, Nicole and Cannone, Diane and Keys McKay, Charles and Whittman, Emma and Edmondson, Donald and Shelton, C. Rachel and Moise, Nathalie", title="Applying User-Centered Design and Implementation Science to the Early-Stage Development of a Telehealth-Enhanced Hybrid Cardiac Rehabilitation Program: Quality Improvement Study", journal="JMIR Form Res", year="2023", month="Jul", day="13", volume="7", pages="e47264", keywords="user-centered design", keywords="implementation science", keywords="cardiac rehabilitation", keywords="telemedicine", keywords="remote patient monitoring", keywords="behavioral intervention development", keywords="hybrid", abstract="Background: Cardiac rehabilitation (CR) is an evidence-based intervention that improves event-free survival in patients with cardiac conditions, yet <27\% of all eligible patients use CR in the United States. CR is traditionally delivered in clinic-based settings where implementation barriers abound. Innovative nontraditional program designs and strategies are needed to support widespread CR uptake. Objective: This study aimed to demonstrate how user-centered design (UCD) and implementation science (IS) principles and methods can be integrated into the early-stage development of nontraditional CR interventions. Methods: As part of a NewYork-Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we combined UCD and IS principles and methods to design a novel home- and clinic-based telehealth-enhanced hybrid CR (THCR) program. We co-designed this program with multilevel stakeholders using an iterative 3-step UCD process to identify user and contextual barriers and facilitators to CR uptake (using semistructured interviews and contextual inquiry [step 1]), design an intervention prototype that targets contextual and user factors and emulates the evidence-based practice (through design workshops and journey mapping [step 2]), and review and refine the prototype (according to real-world usability testing and feedback [step 3]). The UCD process was informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research. Results: At step 1, we conducted semistructured interviews with 9 provider- and system-level stakeholders (female: n=6, 67\%) at 3 geographically diverse academic medical centers, which revealed behavioral (eg, self-efficacy and knowledge) and contextual (eg, social distancing guidelines, physical space, staffing, and reimbursement) barriers to uptake; hybrid delivery was a key facilitator. Step 2 involved conducting 20 design workshops and 3 journey-mapping sessions with multidisciplinary NYPH stakeholders (eg, digital health team, CR clinicians, and creative director) where we identified key design elements (eg, mix of clinic- and home-based CR and synchronous remote patient monitoring), yielding an initial THCR prototype that leveraged NYPH's telehealth infrastructure. At step 3, we conducted usability testing with 2 CR clinicians (both female) administering home-based sessions to 3 CR patients (female: n=1, 33\%), which revealed usability themes (eg, ease of using remote patient monitoring devices or a telehealth platform, technology disruptions, and confidence in using the telehealth platform to safely monitor patients) and design solutions (eg, onboarding sessions, safety surveys, and fully supervised remote sessions) to be included in the final THCR prototype. Conclusions: Combining UCD and IS methods while engaging multidisciplinary stakeholders in an iterative process yielded a theory-informed THCR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process and guidance for incorporating UCD and IS principles and methods into the early-stage development of a nontraditional CR intervention. The feasibility, acceptability, appropriateness, and usability of the final THCR prototype is being evaluated in an ongoing study. ", doi="10.2196/47264", url="https://formative.jmir.org/2023/1/e47264", url="http://www.ncbi.nlm.nih.gov/pubmed/37440285" } @Article{info:doi/10.2196/47009, author="Hasan, Mosaad Mohamed and Rafferty, R. Miriam and Tawfik, Sara and Tawfik, Ahmed and Beestrum, Molly and Smith, D. Justin and Hirschhorn, R. Lisa and Roth, J. Elliot and Woods, M. Donna", title="Implementation of Home-Based Telerehabilitation of Patients With Stroke in the United States: Protocol for a Realist Review", journal="JMIR Res Protoc", year="2023", month="Jul", day="11", volume="12", pages="e47009", keywords="telerehabilitation", keywords="telemedicine", keywords="stroke", keywords="implementation", keywords="realist review", abstract="Background: Stroke is a common cause of mortality and morbidity. Insufficient and untimely rehabilitation has been associated with inadequate recovery. Telerehabilitation provides an opportunity for timely and accessible services for individuals with stroke, especially in remote areas. Telerehabilitation is defined as a health care team's use of a communication mode (eg, videoconferencing) to remotely provide rehabilitation services. Telerehabilitation is as effective as facility-based rehabilitation; however, it is infrequently used due to implementation barriers. Objective: The aim of the study is to explore the interaction between the implementation strategies, context, and outcomes of telerehabilitation of patients with stroke. Methods: This review will follow four steps: (1) defining the review scope, (2) literature search and quality appraisal, (3) data extraction and evidence synthesis, and (4) narrative development. PubMed via MEDLINE, the PEDro database, and CINAHL will be queried till June 2023 and supplemented with citation tracking and a gray literature search. The relevance and rigor of papers will be appraised using the TAPUPAS (Transparency, Accuracy, Purposivity, Utility, Propriety, Accessibility, and Specificity) and Weight of Evidence frameworks. The reviewers will extract and synthesize data iteratively and develop explanatory links between contexts, mechanisms, and outcomes. The results will be reported according to the Realist Synthesis publication standards set by Wong and colleagues in 2013. Results: The literature search and screening will be completed in July 2023. Data extraction and analysis will be completed in August 2023, and findings will be synthesized and reported in October 2023. Conclusions: This will be the first realist synthesis, uncovering the causal mechanisms to explain how, why, and to what extent implementation strategies impact telerehabilitation adoption and implementation. International Registered Report Identifier (IRRID): PRR1-10.2196/47009 ", doi="10.2196/47009", url="https://www.researchprotocols.org/2023/1/e47009", url="http://www.ncbi.nlm.nih.gov/pubmed/37432721" } @Article{info:doi/10.2196/41186, author="Mirbaha, Shaghayegh and Morgan, Ashley and Tang, Ada and Smith-Turchyn, Jenna and Richardson, Julie", title="Models of Telehealth Service Delivery in Adults With Spinal Cord Injuries: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Jun", day="29", volume="10", pages="e41186", keywords="community-dwelling adults with spinal cord injury", keywords="models of telehealth services", keywords="remotely delivery of health care", keywords="SCI", keywords="scoping review", keywords="spinal cord injury", keywords="telehealth", keywords="telemedicine", keywords="telerehabilitation", keywords="web-based care", abstract="Background: In Canada, approximately 86,000 people live with spinal cord injury (SCI), and there are an estimated 3675 new cases of traumatic or nontraumatic etiology per year. Most people with SCI will experience secondary health complications, such as urinary and bowel issues, pain syndrome, pressure ulcers, and psychological disorders, resulting in severe chronic multimorbidity. Moreover, people with SCI may face barriers in accessing health care services, such as primary care physicians' expert knowledge regarding secondary complications related to SCI. Telehealth, defined as the delivery of information and health-related services through telecommunication technologies, may help address some of the barriers, and indeed, the present global COVID-19 pandemic has emphasized the importance of integration of telehealth in health care systems. As a result of this crisis, health care providers have increased the usage of telehealth services, providing health services to individuals in need of community-based supportive care. However, the evidence on models of telehealth service delivery for adults with SCI has not been previously synthesized. Objective: The purpose of this scoping review was to identify, describe, and compare models of telehealth services for community-dwelling adults with SCI. Methods: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies published between 1990 and December 31, 2022, were identified by searching the Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Web of Science, and CINAHL databases. Papers with specified inclusion criteria were screened by 2 investigators. Included articles focused on identifying, implementing, or evaluating telehealth interventions, including primary health care services and self-management services delivered in the community and home-based settings. One investigator performed a full-text review of each article, and data extraction included (1) study characteristics; (2) participant characteristics; (3) key characteristics of the interventions, programs, and services; and (4) outcome measures and results. Results: A total of 61 articles reported telehealth services used for preventing, managing, or treating the most common secondary complications and consequences of SCI, including chronic pain, low physical activity, pressure ulcers, and psychosocial dysfunction. Where evidence exists, improvements in community participation, physical activity, and reduction in chronic pain, pressure ulcers, etc, following SCI were demonstrated. Conclusions: Telehealth may offer an efficient and effective option for health service delivery for community-dwelling individuals with SCI, ensuring continuity of rehabilitation, follow-up after hospital discharge, and early detection, management, or treatment of potential secondary complications following SCI. We recommend that the stakeholders involved with patients with SCI consider the uptake of hybridized (blend of web-based and in-person) health care delivery models to optimize the care continuum and self-management of SCI-related care. The findings of this scoping review may be used to inform policy makers, health care professionals, and stakeholders engaged in establishing web-based clinics for individuals with SCI. ", doi="10.2196/41186", url="https://rehab.jmir.org/2023/1/e41186", url="http://www.ncbi.nlm.nih.gov/pubmed/37384377" } @Article{info:doi/10.2196/43888, author="Peterson, Gunnel and Peolsson, Anneli", title="Efficacy of Neck-Specific Exercise With Internet Support Versus Neck-Specific Exercise at a Physiotherapy Clinic in Chronic Whiplash-Associated Disorders: Multicenter Randomized Controlled Noninferiority Trial", journal="J Med Internet Res", year="2023", month="Jun", day="20", volume="25", pages="e43888", keywords="internet-based intervention", keywords="telerehabilitation", keywords="whiplash associated disorders", keywords="neck", keywords="whiplash", keywords="physiotherapy", keywords="physiotherapist", keywords="physical therapy", keywords="neck pain", keywords="exercise", keywords="chronic pain", keywords="digital health intervention", keywords="telehealth", keywords="rehabilitation", keywords="pain management", keywords="internet-based", keywords="telemedicine", keywords="digital health", abstract="Background: Neck-specific exercises (NSE) supervised by a physiotherapist twice a week for 12 weeks have shown good results in chronic whiplash-associated disorders (WADs), but the effect of exercise delivered via the internet is unknown. Objective: This study examined whether NSE with internet support (NSEIT) and 4 physiotherapy sessions for 12 weeks were noninferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE). Methods: In this multicenter randomized controlled noninferiority trial with masked assessors, we recruited adults aged 18-63 years with chronic WAD grade II (ie, neck pain and clinical musculoskeletal signs) or III (ie, grade II plus neurological signs). Outcomes were measured at baseline and at 3- and 15-month follow-ups. The primary outcome was change in neck-related disability, measured with the Neck Disability Index (NDI; 0\%-100\%), with higher percentages indicating greater disability. Secondary outcomes were neck and arm pain intensity (Visual Analog Scale [VAS]), physical function (Whiplash Disability Questionnaire [WDQ] and Patient-Specific Functional Scale [PSFS]), health-related quality of life (EQ-5D-3L and EQ VAS), and self-rated recovery (Global Rating Scale [GRS]). The analyses were conducted on an intention-to-treat basis and with the per-protocol approach as sensitivity analyses. Results: Between April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90\%) and 64 (91\%), respectively, were followed up at 3 months, and 56 (80\%) and 58 (83\%), respectively, at 15 months. NSEIT demonstrated noninferiority to NSE in the primary outcome NDI, as the 1-sided 95\% CI of the mean difference in change did not cross the specified noninferiority margin (7 percentage units). There were no significant between-group differences in change in NDI at the 3- or 15-month follow-up, with a mean difference of 1.4 (95\% CI --2.5 to 5.3) and 0.9 (95\% CI --3.6 to 5.3), respectively. In both groups, the NDI significantly decreased over time (NSEIT: mean change --10.1, 95\% CI --13.7 to --6.5, effect size=1.33; NSE: mean change --9.3, 95\% CI --12.8 to --5.7, effect size=1.19 at 15 months; P<.001). NSEIT was noninferior to NSE for most of the secondary outcomes except for neck pain intensity and EQ VAS, but post hoc analyses showed no differences between the groups. Similar results were seen in the per-protocol population. No serious adverse events were reported. Conclusions: NSEIT was noninferior to NSE in chronic WAD and required less physiotherapist time. NSEIT could be used as a treatment for patients with chronic WAD grades II and III. Trial Registration: ClinicalTrials.gov NCT03022812; https://clinicaltrials.gov/ct2/show/NCT03022812 ", doi="10.2196/43888", url="https://www.jmir.org/2023/1/e43888", url="http://www.ncbi.nlm.nih.gov/pubmed/37338972" } @Article{info:doi/10.2196/43008, author="Darcy, Brianne and Rashford, Lauren and Shultz, Tyler Stephen and Tsai, T. Nancey and Huizenga, David and Reed, B. Kyle and Bamberg, M. Stacy J.", title="Gait Device Treatment Using Telehealth for Individuals With Stroke During the COVID-19 Pandemic: Nonrandomized Pilot Feasibility Study", journal="JMIR Form Res", year="2023", month="May", day="19", volume="7", pages="e43008", keywords="gait device", keywords="telerehabilitation", keywords="iStride", keywords="stroke rehabilitation", keywords="walking speed", keywords="gait", keywords="gait treatment", keywords="telehealth", keywords="COVID-19", abstract="Background: During the COVID-19 pandemic, rehabilitation providers and consumers adopted telehealth practices at unprecedented rates. Multiple prepandemic studies demonstrate the feasibility and comparable efficacy between in-clinic and remote treatment for certain impairments caused by stroke, such as upper extremity weakness and impaired motor function. However, less guidance has been available regarding gait assessment and treatment. Despite this limitation, safe and effective gait treatment is fundamental to optimizing health and well-being after stroke and should be considered a treatment priority, including during the COVID-19 pandemic. Objective: This study explores the feasibility of using telehealth to deliver gait treatment using a wearable gait device, the iStride device, to stroke survivors during the 2020 pandemic. The gait device is used to treat hemiparetic gait impairments caused by stroke. The device alters the user's gait mechanics and creates a subtle destabilization of the nonparetic limb; therefore, supervision is required during its usage. Before the pandemic, treatment with the gait device had been provided in person to appropriate candidates using a combination of physical therapists and trained personnel. However, upon the emergence of the COVID-19 pandemic, in-person treatment was halted in adherence to pandemic guidelines. This study investigates the feasibility of 2 remote delivery treatment models with the gait device for stroke survivors. Methods: Participants were recruited during the first half of 2020 after the onset of the pandemic and included 5 individuals with chronic stroke (mean age 72 years; 84 months post stroke). Four participants were previous gait device users who transitioned to the telehealth delivery model to continue their gait treatment remotely. The fifth participant performed all study-related activities, from recruitment through follow-up, remotely. The protocol included virtual training for the at-home care partner, followed by 3 months of remote treatment with the gait device. Participants were instructed to wear gait sensors during all treatment activities. To assess feasibility, we monitored the safety of the remote treatment, compliance with protocol activities, acceptability of the telehealth treatment delivery, and preliminary efficacy of the gait treatment. Functional improvement was measured using the 10-Meter Walk Test, the Timed Up and Go Test, and the 6-Minute Walk Test, and quality of life was assessed using the Stroke-Specific Quality of Life Scale. Results: No serious adverse events occurred, and participants rated high acceptance of the telehealth delivery. Protocol compliance averaged 95\% of treatment sessions, 100\% of assessments, and 85\% of sensor usage during treatment. After 3 months of treatment, the average improvement in each functional outcome exceeded the minimal clinically important difference or minimal detectable change value. Conclusions: Remote treatment delivery with the gait device appeared feasible with care partner support. Gait treatment using telehealth may be useful to offset negative immobility impacts for those requiring or preferring remote care during the pandemic or otherwise. Trial Registration: ClinicalTrials.gov NCT04434313; https://clinicaltrials.gov/ct2/show/NCT04434313 ", doi="10.2196/43008", url="https://formative.jmir.org/2023/1/e43008", url="http://www.ncbi.nlm.nih.gov/pubmed/37204830" } @Article{info:doi/10.2196/45247, author="Ashikaga, Kohei and Doi, Shunichi and Yoneyama, Kihei and Suzuki, Norio and Kuwata, Shingo and Koga, Masashi and Takeichi, Naoya and Watanabe, Satoshi and Izumo, Masaki and Kida, Keisuke and Akashi, J. Yoshihiro", title="Efficacy and Safety of Home-Based Cardiac Telemonitoring Rehabilitation in Patients After Transcatheter Aortic Valve Implantation: Single-Center Usability and Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2023", month="May", day="17", volume="10", pages="e45247", keywords="transcatheter aortic valve implantation", keywords="telerehabilitation", keywords="cardiac rehabilitation", keywords="remote", keywords="telemonitoring", abstract="Background: No consensus exists on the efficacy of home-based cardiac rehabilitation (CR) in patients who have undergone transcatheter aortic valve implantation (TAVI). Additionally, there are no reports on home-based cardiac telemonitoring rehabilitation (HBTR) in patients after TAVI. Objective: We aimed to investigate the efficacy of HBTR in patients who have undergone TAVI. Methods: This single-center preliminary study introduced HBTR to patients after TAVI, and the efficacy outcomes of the rehabilitation method were compared to that of a historical control cohort. The historical control cohort (control group) consisted of 6 consecutive patients who underwent ordinary outpatient CR after TAVI from February 2016 to March 2020. Patients who participated in the HBTR program were only recruited after the TAVI procedure and before discharge between April 2021 and May 2022. In the first 2 weeks after TAVI, patients underwent outpatient CR and were trained using telemonitoring rehabilitation systems. Thereafter, patients underwent HBTR twice a week for 12 weeks. The control group performed standard outpatient CR at least once a week for 12 to 16 weeks. Efficacy was assessed using peak oxygen uptake (VO2) prior to and after CR. Results: Eleven patients were included in the HBTR group. All patients underwent 24 HBTR sessions during the 12-week training period, and no adverse events were observed. The control group participants performed 19 (SD 7) sessions during the training period, and no adverse events were observed. Participants in the HBTR and control groups had a mean age of 80.4 (SD 6.0) years and 79.0 (SD 3.9) years, respectively. In the HBTR group, preintervention and postintervention peak VO2 values were 12.0 (SD 1.7) mL/min/kg and 14.3 (SD 2.7) mL/min/kg (P=.03), respectively. The peak VO2 changes in the HBTR and control groups were 2.4 (SD 1.4) mL/min/kg and 1.3 (SD 5.0) mL/min/kg (P=.64), respectively. Conclusions: Home-based CR using a telemonitoring system is a safe outpatient rehabilitation method. Its efficacy is not inferior to that of standard CR in patients who have undergone TAVI. Trial Registration: Japan Registry of Clinical Trials jRCTs032200122; https://jrct.niph.go.jp/latest-detail/jRCTs032200122 ", doi="10.2196/45247", url="https://rehab.jmir.org/2023/1/e45247", url="http://www.ncbi.nlm.nih.gov/pubmed/37195764" } @Article{info:doi/10.2196/42090, author="Wu, Yong-Qiang and Long, Yi and Peng, Wei-Jie and Gong, Cheng and Liu, Yue-Quan and Peng, Xu-Miao and Zhong, Yan-Biao and Luo, Yun and Wang, Mao-Yuan", title="The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials", journal="J Med Internet Res", year="2023", month="Apr", day="25", volume="25", pages="e42090", keywords="telerehabilitation", keywords="fibromyalgia", keywords="systematic review", keywords="meta-analysis", keywords="rehabilitation", keywords="chronic pain", keywords="pain", keywords="musculoskeletal", keywords="monitoring", keywords="intervention", keywords="consultation", keywords="education", keywords="efficacy", keywords="safety", abstract="Background: Fibromyalgia is a chronic pain syndrome characterized by persistent and widespread musculoskeletal pain. Telerehabilitation is a promising treatment for patients with fibromyalgia through long-term monitoring, intervention, supervision, consultation, and education. Objective: This study aimed to perform a comprehensive systematic review and meta-analysis of the efficacy and safety of telerehabilitation in patients with fibromyalgia. Methods: Randomized controlled trials (RCTs) related to fibromyalgia and telerehabilitation were systematically searched in the PubMed, PEDro, Cochrane Library, ScienceDirect, Ovid MEDLINE, Embase, and Web of Science databases from inception to November 13, 2022. Two independent researchers screened the literatures and evaluated the methodological quality using the Cochrane Risk of Bias Tool. The outcome measures included the Fibromyalgia Impact Questionnaire scale, pain intensity, depression, pain catastrophizing, quality of life (QoL), and adverse events. Pooled effect sizes were calculated by Stata SE 15.1; a fixed effects model was used when I2<50\%, whereas a random effects model was used when I2?50\%. Results: A total of 14 RCTs with 1242 participants were included in this meta-analysis. The pooled results indicated that the telerehabilitation improved the Fibromyalgia Impact Questionnaire score (weighted mean difference --8.32, 95\% CI --11.72 to --4.91; P<.001), pain intensity (standardized mean difference [SMD] --0.62, 95\% CI --0.76 to --0.47; P<.001), depression levels (SMD --0.42, 95\% CI --0.62 to --0.22; P<.001), pain catastrophizing (weighted mean difference --5.81, 95\% CI --9.40 to --2.23; P=.001), and QoL (SMD 0.32, 95\% CI 0.18 to 0.47; P<.001) in patients with fibromyalgia compared to control interventions. Only 1 RCT reported a mild adverse event of telerehabilitation; the other 13 RCTs did not mention this. Conclusions: Telerehabilitation can improve the symptoms and QoL of fibromyalgia. However, the safety of telerehabilitation remains uncertain due to the lack of sufficient evidence for the management of fibromyalgia. More rigorously designed trials are needed in the future to verify the safety and efficacy of telerehabilitation in fibromyalgia. Trial Registration: PROSPERO CRD42022338200; https://tinyurl.com/322keukv ", doi="10.2196/42090", url="https://www.jmir.org/2023/1/e42090", url="http://www.ncbi.nlm.nih.gov/pubmed/37097721" } @Article{info:doi/10.2196/44179, author="Calvo-L{\'o}pez, Margarita and Arranz Tol{\'o}s, Raquel and Marin Exp{\'o}sito, Josefa and Gruosso, Domenico and Andrea, Rut and Roque, Merc{\`e} and Falces, Carles and Yago, Gemma and Saura Araguas, Judith and Pastor, Nuria and Sitges, Marta and Sanz-de la Garza, Maria", title="Cardio4Health Study, a Cardiac Telerehabilitation Pilot Program Aimed at Patients After an Ischemic Event: Cross-sectional Study", journal="JMIR Cardio", year="2023", month="Apr", day="24", volume="7", pages="e44179", keywords="cardiac rehabilitation", keywords="web-based platform", keywords="telemedicine", keywords="remote care", keywords="ischemic heart disease", abstract="Background: Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underused. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and female patients. Objective: This study aimed to develop a holistic home-based CRP for patients with ischemic heart disease and evaluate its safety and impact on functional capacity, adherence to a healthy lifestyle, and quality of life. Methods: The 8-week home-based CRP included patients of both sexes, with no age limit, who had overcome an acute myocardial infarction in the previous 3 months, had a left ventricular ejection fraction of ?40\%, and had access to a tablet or mobile device. The CRP was developed using a dedicated platform designed explicitly for this purpose and included 3 weekly exercise sessions combining tailored aerobic and strength training and 2 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment. Results: We initially included 62 patients, of whom 1 was excluded for presenting with ventricular arrhythmias during the initial stress test, 5 were excluded because of incompatibility, and 6 dropped out because of a technological barrier. Ultimately, 50 patients completed the program: 85\% (42/50) were male, with a mean age of 58.9 (SD 10.3) years, a mean left ventricular ejection fraction of 52.1\% (SD 6.72\%), and 25 (50\%) New York Heart Association functional class I and 25 (50\%) New York Heart Association II-III. The CRP significantly improved functional capacity (+1.6 metabolic equivalent tasks), muscle strength (arm curl test +15.5\% and sit-to-stand test +19.7\%), weekly training volume (+803 metabolic equivalent tasks), adherence to the Mediterranean diet, emotional state (anxiety), and quality of life. No major complications occurred, and adherence was excellent (>80\%) in both the exercise and educational sessions. In the subgroup analysis, CRP showed equivalent beneficial effects irrespective of sex and age. In addition, patient preferences for CRP approaches were equally distributed, with one-third (14/50, 29\%) of the patients preferring a face-to-face CRP, one-third (17/50, 34\%) preferring a telematic CRP, and one-third (18/50, 37\%) preferring a hybrid approach. Regarding CRP duration, 63\% (31/50) of the patients considered it adequate, whereas the remaining 37\% (19/50) preferred a longer program. Conclusions: A holistic telematic CRP dedicated to patients after an ischemic cardiac event, irrespective of sex and age, is safe and, in our population, has achieved positive results in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with diet, and anxiety symptoms. The preference for a center- or home-based CRP approach is diverse among the study population, emphasizing the need for a tailored CRP to improve adherence and completion rates. ", doi="10.2196/44179", url="https://cardio.jmir.org/2023/1/e44179", url="http://www.ncbi.nlm.nih.gov/pubmed/37093637" } @Article{info:doi/10.2196/44591, author="Munce, Sarah and Andreoli, Angie and Bayley, Mark and Guo, Meiqi and Inness, L. Elizabeth and Kua, Ailene and McIntyre, McKyla", title="Clinicians' Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="10", volume="10", pages="e44591", keywords="telerehabilitation", keywords="implementation", keywords="toolkit", keywords="COVID-19", keywords="qualitative", keywords="clinician", abstract="Background: Although the COVID-19 pandemic resulted in a rapid implementation and scale-up of telehealth for patients in need of rehabilitation, an overall slower scaling up to telerehabilitation has been documented. Objective: The purpose of this study was to understand experiences of implementing telerehabilitation during the COVID-19 pandemic as well as using the Toronto Rehab Telerehab Toolkit from the perspective of rehabilitation professionals across Canada and internationally. Methods: The study adopted a qualitative descriptive approach that consisted of telephone- or videoconference-supported interviews and focus groups. Participants included rehabilitation providers as well as health care leaders who had used the Toronto Rehab Telerehab Toolkit. Each participant took part in a semi-structured interview or focus group, lasting approximately 30-40 minutes. Thematic analysis was used to understand the barriers and enablers of providing telerehabilitation and implementing the Toronto Rehab Telerehab Toolkit. Three members of the research team independently analyzed a set of the same transcripts and met after each set to discuss their analysis. Results: A total of 22 participants participated, and 7 interviews and 4 focus groups were included. The data of participants were collected from both Canadian (Alberta, New Brunswick, and Ontario) and international sites (Australia, Greece, and South Korea). A total of 11 sites were represented, 5 of which focused on neurological rehabilitation. Participants included health care providers (ie, physicians, occupational therapists, physical therapists, speech language pathologists, and social workers), managers and system leaders, as well as research and education professionals. Overall, 4 themes were identified including (1) implementation considerations for telerehabilitation, encompassing 2 subthemes of ``infrastructure, equipment, and space'' and ``leadership and organizational support''; (2) innovations developed as a result of telerehabilitation; (3) the toolkit as a catalyst for implementing telerehabilitation; and (4) recommendations for improving the toolkit. Conclusions: Findings from this qualitative study confirm some of the previously identified experiences with implementing telerehabilitation, but from the perspective of Canadian and international rehabilitation providers and leaders. These findings include the importance of adequate infrastructure, equipment, and space; the key role of organizational or leadership support in adopting telerehabilitation; and availing resources to implement it. Importantly, participants in our study described the toolkit as an important resource to broker networking opportunities and highlighted the need to pivot to telerehabilitation, especially early in the pandemic. Findings from this study will be used to improve the next iteration of the toolkit (Toolkit 2.0) to promote safe, accessible, and effective telerehabilitation to those patients in need in the future. ", doi="10.2196/44591", url="https://rehab.jmir.org/2023/1/e44591", url="http://www.ncbi.nlm.nih.gov/pubmed/36897634" } @Article{info:doi/10.2196/40416, author="Guo, Liquan and Wang, Jiping and Wu, Qunqiang and Li, Xinming and Zhang, Bochao and Zhou, Linfu and Xiong, Daxi", title="Clinical Study of a Wearable Remote Rehabilitation Training System for Patients With Stroke: Randomized Controlled Pilot Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Feb", day="23", volume="11", pages="e40416", keywords="remote rehabilitation", keywords="wearable devices", keywords="human-computer interaction", keywords="rehabilitation training", keywords="stroke", abstract="Background: In contrast to the large and increasing number of patients with stroke, clinical rehabilitation resources cannot meet their rehabilitation needs. Especially for those discharged, ways to carry out effective rehabilitation training without the supervision of physicians and receive guidance from physicians remain urgent problems to be solved in clinical rehabilitation and have become a research hot spot at home and abroad. At present, there are many studies on home rehabilitation training based on wearable devices, Kinect, among others, but these have disadvantages (eg, complex systems, high price, and unsatisfactory rehabilitation effects). Objective: This study aims to design a remote intelligent rehabilitation training system based on wearable devices and human-computer interaction training tasks, and to evaluate the effectiveness and safety of the remote rehabilitation training system for nonphysician-supervised motor rehabilitation training of patients with stroke through a clinical trial study. Methods: A total of 120 inpatients with stroke having limb motor dysfunction were enrolled via a randomized, parallel-controlled method in the rehabilitation institutions, and a 3-week clinical trial was conducted in the rehabilitation hall with 60 patients in the experimental group and 60 in the control group. The patients in the experimental group used the remote rehabilitation training system for rehabilitation training and routine clinical physical therapy (PT) training and received routine drug treatment every day. The patients in the control group received routine clinical occupational therapy (OT) training and routine clinical PT training and routine drug treatment every day. At the beginning of the training (baseline) and after 3 weeks, the Fugl-Meyer Motor Function Rating scale was scored by rehabilitation physicians, and the results were compared and analyzed. Results: Statistics were performed using SAS software (version 9.4). The total mean Fugl-Meyer score improved by 11.98 (SD 8.46; 95\% CI 9.69-14.27) in the control group and 17.56 (SD 11.65; 95\% CI 14.37-20.74) in the experimental group, and the difference between the 2 groups was statistically significant (P=.005). Among them, the mean Fugl-Meyer upper extremity score improved by 7.45 (SD 7.24; 95\% CI 5.50-9.41) in the control group and 11.28 (SD 8.59; 95\% CI 8.93-13.62) in the experimental group, and the difference between the 2 groups was statistically significant (P=.01). The mean Fugl-Meyer lower extremity score improved by 4.53 (SD 4.42; 95\% CI 3.33-5.72) in the control group and 6.28 (SD 5.28; 95\% CI 4.84-7.72) in the experimental group, and there was no significant difference between the 2 groups (P=.06). The test results showed that the experimental group was better than the control group, and that the patients' motor ability was improved. Conclusions: The remote rehabilitation training system designed based on wearable devices and human-computer interaction training tasks can replace routine clinical OT training. In the future, through medical device registration certification, the system will be used without the participation of physicians or therapists, such as in rehabilitation training halls, and in remote environments, such as communities and homes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200061310; https://tinyurl.com/34ka2725 ", doi="10.2196/40416", url="https://mhealth.jmir.org/2023/1/e40416", url="http://www.ncbi.nlm.nih.gov/pubmed/36821348" } @Article{info:doi/10.2196/45448, author="Giesbrecht, Edward and Major, E. Mel and Fricke, Moni and Wener, Pamela and van Egmond, Maarten and Aarden, J. Jesse and Brown, L. Cara and Pol, Margriet and van der Schaaf, Marike", title="Telerehabilitation Delivery in Canada and the Netherlands: Results of a Survey Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Feb", day="20", volume="10", pages="e45448", keywords="telerehabilitation", keywords="digital health", keywords="telehealth", keywords="eHealth", keywords="competencies", keywords="capabilities", keywords="mobile phone", abstract="Background: Following the onset of the COVID-19 pandemic, telerehabilitation (TR) has been expanding to address the challenges and risks of in-person delivery. It is likely that a level of TR delivery will continue after the pandemic because of its advantages, such as reducing geographical barriers to service. Many pandemic-related TR initiatives were put in place quickly. Therefore, we have little understanding of current TR delivery, barriers and facilitators, and how therapists anticipate integrating TR into current practice. Knowing this information will allow the incorporation of competencies specifically related to the use and provision of TR into professional profiles and entry-to-practice education, thereby promoting high-quality TR care. Objective: This study aimed to obtain a descriptive overview of current TR practice among rehabilitation therapists in Canada and the Netherlands and identify perceived barriers to and facilitators of practice. Methods: A web-based cross-sectional survey was conducted with occupational, physical, and respiratory therapists and dietitians in Canada (in French and English) and the Netherlands (in Dutch and English) between November 2021 and March 2022. Recruitment was conducted through advertisements on social media platforms and email invitations facilitated by regulatory and professional bodies. The survey included demographic and practice setting information; whether respondents delivered TR, and if so, components of delivery; confidence and satisfaction ratings with delivery; and barriers to and facilitators of use. TR satisfaction and uptake were measured using the Telehealth Usability Questionnaire and modified Technology Acceptance Model. Data were first summarized descriptively, and then, comparisons were conducted between professions. Results: Overall, 723 survey responses were received, mostly from Canada (n=666, 92.1\%) and occupational therapists (n=434, 60\%). Only 28.1\% (203/723) reported receiving specific training in TR, with 1.2\% (9/723) indicating that it was part of their professional education. Approximately 19.5\% (139/712) reported not using TR at all, whereas most participants (366/712, 51.4\%) had been using this approach for 1 to 2 years. Services delivered were primarily teleconsultation and teletreatment with individuals. Respondents offering TR were moderately satisfied with their service delivery and found it to be effective; 90.1\% (498/553) indicated that they were likely to continue offering TR after the pandemic. Technology access, confidence, and setup were rated the highest as facilitators, whereas technology issues and the clinical need for physical contact were the most common barriers. Conclusions: Professional practice and experience with TR were similar in both countries, suggesting the potential for common strategic approaches. The high prevalence of current practice and strong indicators of TR uptake suggest that therapists are likely to continue TR delivery after the pandemic; however, most therapists (461/712, 64.7\%) felt ill prepared for practice, and the need to target TR competencies during professional and postprofessional education is critical. Future studies should explore best practice for preparatory and continuing education. ", doi="10.2196/45448", url="https://rehab.jmir.org/2023/1/e45448", url="http://www.ncbi.nlm.nih.gov/pubmed/36806194" } @Article{info:doi/10.2196/39076, author="Demoen, Sara and Chalimourdas, Antonios and Timmermans, Annick and Van Rompaey, Vincent and Vanderveken, M. Olivier and Jacquemin, Laure and Schlee, Winfried and Marneffe, Wim and Luyten, Janis and Gilles, Annick and Michiels, Sarah", title="Effectiveness of Telerehabilitation Interventions for Self-management of Tinnitus: Systematic Review", journal="J Med Internet Res", year="2023", month="Feb", day="9", volume="25", pages="e39076", keywords="tinnitus", keywords="audiology", keywords="systematic review", keywords="telerehabilitation", keywords="self-management", keywords="intervention", keywords="quality of life", keywords="internet", keywords="self-help", keywords="mobile phone", abstract="Background: Tinnitus is a highly prevalent symptom affecting 10\%-20\% of the adult population. Most patients with tinnitus have chronic tinnitus, which can directly or indirectly disrupt their daily life and negatively affect the health-related quality of life. Therefore, patients with tinnitus are frequently in need of costly and time-consuming treatments. As an answer, telerehabilitation interventions are on a rise to promote self-management in patients with tinnitus and reduce their dependency on in-person care. Objective: This systematic review aimed to provide an overview of the research concerning the effectiveness of telerehabilitation interventions for self-management of tinnitus. Methods: This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were eligible for inclusion if study participants were adult patients with complaints of primary subjective tinnitus and the study intervention comprised any possible telerehabilitation form for the self-management of tinnitus complaints. A search for eligible studies was conducted on PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Library. The Cochrane Risk of Bias 2 tool was used to the assess risk of bias. Results: In total, 29 articles were found eligible, and of these, 5 (17\%) studied multiple telerehabilitation forms. Internet-based cognitive behavioral treatment with guidance by a psychologist or audiologist was examined in 17 studies (n=1767), internet-based cognitive behavioral treatment without guidance was examined in 4 studies (n=940), self-help manuals were examined in 1 study (n=72), technological self-help devices were examined in 2 studies (n=82), smartphone apps were examined in 8 studies (n=284), and other internet-based interventions were examined in 2 studies (n=130). These rehabilitation categories were proven to be effective in decreasing tinnitus severity and relieving tinnitus distress as measured by tinnitus questionnaires such as Tinnitus Functional Index, Tinnitus Handicap Inventory, or Tinnitus Reactions Questionnaire. However, dropout rates were often high (range 4\%-71.4\%). All studies reported between some concerns and high concerns of risk of bias, resulting in low to moderate certainty levels. Conclusions: Overall, there is low to moderate quality evidence that telerehabilitation interventions effectively reduce tinnitus severity and distress. These interventions form a possible tool to improve the self-management capacities of the patient and the accessibility of tinnitus care as a replacement or an addition to in-person care. Nevertheless, barriers such as lack of time, engagement, motivation, and openness of the patient causing high dropout should be considered. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021285450; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=285450 ", doi="10.2196/39076", url="https://www.jmir.org/2023/1/e39076", url="http://www.ncbi.nlm.nih.gov/pubmed/36757768" } @Article{info:doi/10.2196/40094, author="Miozzo, Paula Aline and Camponogara Righi, Natiele and Yumi Shizukuishi, Luiza Maria and Marques Ferreira Aguilar, H{\'e}rica and Florian, Juliessa and da Costa Machado, Scheila and Schardong, Jociane and Della M{\'e}a Plentz, Rodrigo", title="A Telerehabilitation Program for Maintaining Functional Capacity in Patients With Chronic Lung Diseases During a Period of COVID-19 Social Isolation: Quasi-Experimental Retrospective Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Dec", day="22", volume="9", number="4", pages="e40094", keywords="telerehabilitation", keywords="lung diseases", keywords="social isolation", keywords="COVID-19", keywords="pulmonary rehabilitation", keywords="pulmonary", keywords="rehabilitation", keywords="quality of life", keywords="chronic disease", keywords="mental health", keywords="social functioning", keywords="patient outcome", abstract="Background: Pulmonary diseases represent a great cause of disability and mortality in the world, and given the progression of these pathologies, pulmonary rehabilitation programs have proven to be effective for people with chronic respiratory diseases. During the COVID-19 pandemic, telerehabilitation has become an alternative for patients with such diseases. Objective: The aim of this study was to compare the outcomes (ie, functional capacity and quality of life) of telerehabilitation to those of usual care among patients who previously participated in face-to-face pulmonary rehabilitation programs. Methods: We conducted a quasi-experimental retrospective study from April 2020 to August 2021. A total of 32 patients with chronic lung diseases were included and divided into the control and intervention groups. The intervention group performed telerehabilitation synchronously twice per week and was supervised by a physical therapist during breathing, strengthening, and aerobic exercises. Changes in the degree of dyspnea and leg discomfort were assessed based on changes in Borg scale scores. The control group did not perform any activities during the period of social isolation. Functional capacity was assessed with the 6-minute walk test, and quality of life was assessed with the Medical Outcomes Study 36-item Short Form Health Survey. Results: The telerehabilitation group's mean 6-minute walk distance decreased by 39 m, while that of the control group decreased by 120 m. There was a difference of 81 m between the groups' mean 6-minute walk distances (P=.02). In relation to the quality of life, telerehabilitation was shown to improve the following two domains: social functioning and mental health. Conclusions: Telerehabilitation programs for patients with chronic lung diseases can ease the deleterious effects of disease progression, be used to maintain functional capacity, and improve aspects of quality of life. ", doi="10.2196/40094", url="https://rehab.jmir.org/2022/4/e40094", url="http://www.ncbi.nlm.nih.gov/pubmed/36473024" } @Article{info:doi/10.2196/39148, author="Zougar, Mohammad and Todd, Chris and McGarrigle, Lisa and Stanmore, Emma", title="MIRA Rehab Exergames for Older Male Residents in a Care Home Center in Saudi Arabia: Protocol for a Feasibility Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Dec", day="20", volume="11", number="12", pages="e39148", keywords="exergame", keywords="balance", keywords="older adults", keywords="telerehabilitation", keywords="feasibility", keywords="elderly care", keywords="aging", keywords="elderly population", keywords="rehabilitation", keywords="virtual therapy", keywords="digital rehabilitation", keywords="physical activity", abstract="Background: Physical activity leads to improvements in morbidity, mortality, and quality of life, especially when it is progressive, challenging, and regular. There is strong evidence that strength and balance exercises decrease the risk of falling. However, traditional exercises may be tedious and not very motivating for participants. Exergames have been found to increase engagement and enjoyment for older users. Objective: This study will conduct a feasibility randomized controlled trial (RCT) on the use of MIRA Rehab Exergames among older male residents in a care home setting in Saudi Arabia. A sample of 30 eligible participants will be recruited to meet feasibility study requirements. Methods: We will recruit 38 residents in the care home who will be randomly allocated to either an intervention or a control group. The intervention participants will perform gamified exercises using the MIRA telerehabilitation platform (30 minutes 3 times per week for 6 weeks). The control group will receive educational advice based on booklets of the Otago exercise program and be encouraged to exercise (30 minutes 3 times per week for 6 weeks). Participants will be assessed at weeks 0, 6, and 12. Assessments will include feasibility measures (eligibility, recruitment and attrition rates, and practicalities of data collection methods) and participant outcome measures (balance, strength, mobility, adherence, quality of life, fear of falling, depression, acceptability, and usability). Results: Data collection started in November 2021 and ended in March 2022. The study is currently in the data analysis stage, which commenced in May 2022. The findings from this feasibility RCT will be used to design a definitive RCT to test whether the MIRA Rehab Exergame program benefits older people in Saudi Arabia who may not like participating in traditional exercise programs and may be unwilling or unable to leave their homes. Conclusions: This study will contribute to our understanding of how to recruit in this specific population and provide information to inform the design of a future RCT. International Registered Report Identifier (IRRID): DERR1-10.2196/39148 ", doi="10.2196/39148", url="https://www.researchprotocols.org/2022/12/e39148", url="http://www.ncbi.nlm.nih.gov/pubmed/36538360" } @Article{info:doi/10.2196/40374, author="Kamalakannan, Sureshkumar and Karunakaran, Vijay and Kaliappan, Balaji Ashwin and Nagarajan, Ramakumar", title="Systematic Development of the ReWin Application: A Digital Therapeutic Rehabilitation Innovation for People With Stroke-related Disabilities in India", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="24", volume="9", number="4", pages="e40374", keywords="stroke", keywords="telerehabilitation", keywords="neurological rehabilitation", keywords="disability", keywords="India", keywords="rehabilitation", keywords="recovery", keywords="stroke care", keywords="patient care", keywords="digital technology", keywords="feasibility", keywords="acceptability", keywords="digital therapy", doi="10.2196/40374", url="https://rehab.jmir.org/2022/4/e40374", url="http://www.ncbi.nlm.nih.gov/pubmed/36422867" } @Article{info:doi/10.2196/42157, author="Palmer, C. Louise and Neal, N. Whitney and Motl, W. Robert and Backus, Deborah", title="The Impact of COVID-19 Lockdown Restrictions on Exercise Behavior Among People With Multiple Sclerosis Enrolled in an Exercise Trial: Qualitative Interview Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="22", volume="9", number="4", pages="e42157", keywords="multiple sclerosis", keywords="exercise", keywords="physical activity", keywords="COVID-19", keywords="COVID-19 lockdown restrictions", keywords="telerehabilitation", keywords="interview study", abstract="Background: During spring and summer 2020, US states implemented COVID-19 pandemic restrictions, resulting in the closure of rehabilitation facilities and, with them, some of the clinical trials that were taking place. One such trial was the Supervised Versus Telerehabilitation Exercise Program for Multiple Sclerosis (``STEP for MS'') comparative effectiveness multiple sclerosis (MS) exercise trial. Although 1 study arm was implemented via telerehabilitation, the comparative arm took place in rehabilitation facilities nationwide and was subsequently closed during this time frame. The experience of the STEP for MS participants provides insights into the impact of lockdown restrictions on exercise behavior by mode of exercise delivery (telerehabilitation vs conventional facility based). Objective: This study sought to understand the impact of COVID-19 lockdown restrictions on exercise behavior among people with MS enrolled in an exercise trial at the time of the restrictions. Methods: Semistructured phone and video interviews were conducted with a convenience sample of 8 participants representing both arms of the exercise trial. We applied reflexive thematic analysis to identify, analyze, and interpret common themes in the data. Results: We identified 7 main themes and 2 different narratives describing the exercise experiences during lockdown restrictions. Although the telerehabilitation participants continued exercising without interruption, facility-based participants experienced a range of barriers that impeded their ability to exercise. In particular, the loss of perceived social support gained from exercising in a facility with exercise coaches and other people with MS eroded both the accountability and motivation to exercise. Aerobic exercises via walking were the most impacted, with participants pointing to the need for at-home treadmills. Conclusions: The unprecedented disruption of COVID-19 lockdown restrictions in spring and summer 2020 impacted the ability of facility-based STEP for MS exercise trial participants to exercise in adherence to the intervention protocol. By contrast, the participants in the telerehabilitation-delivered exercise arm continued exercising without interruption and reported positive impacts of the intervention during this time. Telerehabilitation exercise programs may hold promise for overcoming barriers to exercise for people with MS during COVID-19 lockdown restrictions, and potentially other lockdown scenarios, if the participation in telerehabilitation has already been established. ", doi="10.2196/42157", url="https://rehab.jmir.org/2022/4/e42157", url="http://www.ncbi.nlm.nih.gov/pubmed/36269870" } @Article{info:doi/10.2196/38994, author="Ga{\ss}ner, Heiko and Friedrich, Jana and Masuch, Alisa and Jukic, Jelena and Stallforth, Sabine and Regensburger, Martin and Marxreiter, Franz and Winkler, J{\"u}rgen and Klucken, Jochen", title="The Effects of an Individualized Smartphone-Based Exercise Program on Self-defined Motor Tasks in Parkinson Disease: Pilot Interventional Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Nov", day="15", volume="9", number="4", pages="e38994", keywords="Parkinson disease", keywords="exercise", keywords="telemedicine", keywords="wearable sensors", keywords="patient-defined outcome measure", keywords="mobile phone", abstract="Background: Bradykinesia and rigidity are prototypical motor impairments of Parkinson disease (PD) highly influencing everyday life. Exercise training is an effective treatment alternative for motor symptoms, complementing dopaminergic medication. High frequency training is necessary to yield clinically relevant improvements. Exercise programs need to be tailored to individual symptoms and integrated in patients' everyday life. Due to the COVID-19 pandemic, exercise groups in outpatient setting were largely reduced. Developing remotely supervised solutions is therefore of significant importance. Objective: This pilot study aimed to evaluate the feasibility of a digital, home-based, high-frequency exercise program for patients with PD. Methods: In this pilot interventional study, patients diagnosed with PD received 4 weeks of personalized exercise at home using a smartphone app, remotely supervised by specialized therapists. Exercises were chosen based on the patient-defined motor impairment and depending on the patients' individual capacity (therapists defined 3-5 short training sequences for each participant). In a first education session, the tailored exercise program was explained and demonstrated to each participant and they were thoroughly introduced to the smartphone app. Intervention effects were evaluated using the Unified Parkinson Disease Rating Scale, part III; standardized sensor-based gait analysis; Timed Up and Go Test; 2-minute walk test; quality of life assessed by the Parkinson Disease Questionnaire; and patient-defined motor tasks of daily living. Usability of the smartphone app was assessed by the System Usability Scale. All participants gave written informed consent before initiation of the study. Results: In total, 15 individuals with PD completed the intervention phase without any withdrawals or dropouts. The System Usability Scale reached an average score of 72.2 (SD 6.5) indicating good usability of the smartphone app. Patient-defined motor tasks of daily living significantly improved by 40\% on average in 87\% (13/15) of the patients. There was no significant impact on the quality of life as assessed by the Parkinson Disease Questionnaire (but the subsections regarding mobility and social support improved by 14\% from 25 to 21 and 19\% from 15 to 13, respectively). Motor symptoms rated by Unified Parkinson Disease Rating Scale, part III, did not improve significantly but a descriptive improvement of 14\% from 18 to 16 could be observed. Clinically relevant changes in Timed Up and Go test, 2-minute walk test, and sensor-based gait parameters or functional gait tests were not observed. Conclusions: This pilot interventional study presented that a tailored, digital, home-based, and high-frequency exercise program over 4 weeks was feasible and improved patient-defined motor activities of daily life based on a self-developed patient-defined impairment score indicating that digital exercise concepts may have the potential to beneficially impact motor symptoms of daily living. Future studies should investigate sustainability effects in controlled study designs conducted over a longer period. ", doi="10.2196/38994", url="https://rehab.jmir.org/2022/4/e38994", url="http://www.ncbi.nlm.nih.gov/pubmed/36378510" } @Article{info:doi/10.2196/31305, author="Allegue, Rakia Dorra and Sweet, Norman Shane and Higgins, Johanne and Archambault, S. Philippe and Michaud, Francois and Miller, C. William and Tousignant, Michel and Kairy, Dahlia", title="Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Sep", day="15", volume="9", number="3", pages="e31305", keywords="stroke", keywords="rehabilitation", keywords="virtual reality", keywords="video games", keywords="telerehabilitation", keywords="upper extremity", keywords="motivation", abstract="Background: In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician. Objective: We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians. Methods: This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors' use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory. Results: Three stroke survivors (n=2, 67\%, women and n=1, 33\%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors' safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts. Conclusions: This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions. International Registered Report Identifier (IRRID): RR2-10.2196/14629 ", doi="10.2196/31305", url="https://rehab.jmir.org/2022/3/e31305", url="http://www.ncbi.nlm.nih.gov/pubmed/36107484" } @Article{info:doi/10.2196/36028, author="Jirasakulsuk, Nathaphon and Saengpromma, Pattaridaporn and Khruakhorn, Santhanee", title="Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis", journal="JMIR Rehabil Assist Technol", year="2022", month="Sep", day="1", volume="9", number="3", pages="e36028", keywords="telerehabilitation", keywords="internet-based intervention", keywords="older adults", keywords="physical performance", keywords="physical therapy", abstract="Background: Real-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers. Objective: We aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness. Methods: A literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane's risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95\% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR's effectiveness based on different treatments, controls, and outcome measures. Results: The search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95\% CI 0.36-0.9; I2=58.5\%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95\% CI 0.1-0.46; I2=0\%) and muscle strength (SMD 0.76, 95\% CI 0.32-1.2; I2=59.60\%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95\% CI 0.56-1.29; I2=45.8\%), whereas the use of personal computers (SMD 0.25, 95\% CI --0.16 to 0.66; I2=0\%) had no effect on improving balance and was comparable to conventional treatment. Conclusions: We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care. Trial Registration: PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=287289 ", doi="10.2196/36028", url="https://rehab.jmir.org/2022/3/e36028", url="http://www.ncbi.nlm.nih.gov/pubmed/36048520" } @Article{info:doi/10.2196/35743, author="Fioratti, Iuri and Miyamoto, Cristiane Gisela and Fandim, Vitorino Junior and Ribeiro, Pontes Camila Pereira and Batista, Domingues Geovana and Freitas, Evangelista Gabriella and Palomo, Santos Andressa and Reis, dos Felipe Jos{\'e} Jandr{\'e} and Costa, Pena Leonardo Oliveira and Maher, G. Christopher and Saragiotto, Tirotti Bruno", title="Feasibility, Usability, and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: Pilot Trial of the ReabilitaDOR Program", journal="JMIR Form Res", year="2022", month="Aug", day="30", volume="6", number="8", pages="e35743", keywords="telerehabilitation", keywords="musculoskeletal pain", keywords="implementation science", keywords="feasibility study", keywords="chronic pain", keywords="pain", keywords="pilot study", keywords="eHealth", keywords="exercise", keywords="telehealth", keywords="self-management", abstract="Background: Internet-based self-management programs and telerehabilitation initiatives have increased and have been extensively used for delivering health care in many areas. These programs overcome common barriers that patients face with traditional face-to-face health care, such as travel expenditures, lack of time, and high demand on the public health system. During the COVID-19 pandemic, this mode of web-based health care delivery had become more popular. However, there is still a lack of studies testing this mode of delivery in low- and middle-income countries. To gain a better understanding of the context, feasibility, and factors involved in the implementation of a web-based program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable, and adequate for its purposes and for optimizing resource allocation. Objective: This study aims to evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education (ReabilitaDOR) in people with chronic musculoskeletal pain and to compare this program with a program using only a web-based self-management booklet. Methods: The study design was a parallel pilot study of a prospectively registered, assessor-blinded, 2-arm randomized controlled trial with economic evaluation. This study was performed using waiting lists of physiotherapy and rehabilitation centers and advertisements on social media networks. The participants were 65 patients with chronic musculoskeletal pain aged between 18 and 60 years. The effects of an 8-week telerehabilitation program based on exercises and pain education (intervention group) were compared with those of a program based only on a web-based self-management booklet (control group). The main outcome measures were implementation outcomes of patients' perceptions of acceptability, appropriateness, feasibility, and usability of the program and the societal costs and feasibility of the main trial at 8-week posttreatment follow-up. Adverse events were also analyzed. Results: In total, 56 participants were analyzed at the 8-week follow-up. The intervention group showed responses with a mean of 4.5 (SD 0.6) points for acceptability, 4.5 (SD 0.5) points for appropriateness, and 4.5 (SD 0.6) points for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. There is satisfactory evidence for the feasibility of the main trial. For costs related to the interventions, health care, patients, and loss of productivity at 8 weeks, we found a total expenditure of US \$278.30 per patient in the intervention group and US \$141.52 per patient in the control group. No adverse events were reported during the intervention period. Conclusions: We found that the ReabilitaDOR program is feasible, appropriate, and acceptable from the users' implementation perspective. This system was considered usable by all the participants, and the main trial seemed feasible. Cost data were viable to be collected, and the program is likely to be safe. Trial Registration: ClinicalTrials.gov NCT04274439; https://clinicaltrials.gov/ct2/show/NCT04274439 ", doi="10.2196/35743", url="https://formative.jmir.org/2022/8/e35743", url="http://www.ncbi.nlm.nih.gov/pubmed/35776863" } @Article{info:doi/10.2196/38553, author="Dennett, M. Amy and Harding, E. Katherine and Peiris, L. Casey and Shields, Nora and Barton, Christian and Lynch, Lauren and Parente, Phillip and Lim, David and Taylor, F. Nicholas", title="Efficacy of Group Exercise--Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jul", day="18", volume="11", number="7", pages="e38553", keywords="telehealth", keywords="exercise", keywords="telerehabilitation", keywords="physical activity", keywords="supportive care", keywords="cancer", abstract="Background: Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise--based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective: We aimed to evaluate the efficacy of a group exercise--based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods: A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results: The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions: This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr International Registered Report Identifier (IRRID): PRR1-10.2196/38553 ", doi="10.2196/38553", url="https://www.researchprotocols.org/2022/7/e38553", url="http://www.ncbi.nlm.nih.gov/pubmed/35849441" } @Article{info:doi/10.2196/38214, author="Wang, Grace and Yang, Manshu and Hong, Mindy and Krauss, Jeffrey and Bailey, F. Jeannie", title="Clinical Outcomes After a Digital Musculoskeletal Program for Acute and Subacute Pain: Observational, Longitudinal Study With Comparison Group", journal="JMIR Rehabil Assist Technol", year="2022", month="Jun", day="27", volume="9", number="2", pages="e38214", keywords="telemedicine", keywords="acute", keywords="subacute", keywords="musculoskeletal", keywords="pain", keywords="function", keywords="clinical", keywords="quality of life", keywords="intervention", keywords="longitudinal study", keywords="physical therapy", keywords="physiotherapy", keywords="physical therapist", keywords="physiotherapist", keywords="exercise", keywords="physical activity", keywords="telehealth", keywords="eHealth", keywords="digital health", keywords="patient education", keywords="education material", keywords="education resource", keywords="health resource", keywords="mHealth", keywords="mobile health", keywords="health app", keywords="observational study", keywords="video consult", keywords="eConsult", keywords="virtual care", abstract="Background: Telerehabilitation for musculoskeletal (MSK) conditions may produce similar or better outcomes than usual care, but most telerehabilitation studies address only chronic or postsurgical pain. Objective: We aimed to examine pain and function at 3, 6, and 12 weeks for individuals with acute and subacute MSK pain who took part in a digital MSK program versus a nonparticipant comparison group. Methods: We conducted an observational, longitudinal study with a nonparticipant comparison group. The intervention group had video visits with physical therapists who recommended exercise therapies and educational articles delivered via an app. Nonparticipants were those who were registered but unable to participate because their benefit coverage had not yet begun. We collected pain and function outcomes through surveys delivered at 3-, 6-, and 12-week follow-ups. We conducted descriptive analyses, unadjusted regression, and mixed effects regression adjusting for baseline characteristics, time as fixed effects, and a time*group interaction term. Results: The analysis included data from 675 nonparticipants and 262 intervention group participants. Compared to baseline, the intervention group showed significantly more pain improvement at 3, 6, and 12 weeks versus nonparticipants after adjusting for baseline factors. Specifically, the intervention group's pain scores decreased by 55.8\% at 3 weeks versus baseline, 69.1\% at 6 weeks, and 73\% at 12 weeks. The intervention group's adjusted pain scores decreased from 43.7 (95\% CI 41.1-46.2) at baseline to 19.3 (95\% CI 16.8-21.8) at 3 weeks to 13.5 (95\% CI 10.8-16.2) at 6 weeks to 11.8 (95\% CI 9-14.6) at 12 weeks. In contrast, nonparticipants' pain scores decreased by 30.8\% at 3 weeks versus baseline, 45.8\% at 6 weeks, and 46.7\% at 12 weeks. Nonparticipants' adjusted pain scores decreased from 43.8 (95\% CI 42-45.5) at baseline to 30.3 (95\% CI 27.1-33.5) at 3 weeks to 23.7 (95\% CI 20-27.5) at 6 weeks to 23.3 (95\% CI 19.6-27) at 12 weeks. After adjustments, the percentage of participants reporting that pain was better or much better at follow-up was significantly higher by 40.6\% at 3 weeks, 31.4\% at 6 weeks, and 31.2\% at 12 weeks for intervention group participants versus nonparticipants. After adjustments, the percentage of participants with meaningful functional improvement at follow-up was significantly higher by 15.2\% at 3 weeks and 24.6\% at 12 weeks for intervention group participants versus nonparticipants. Conclusions: A digital MSK program may help to improve pain and function in the short term among those with acute and subacute MSK pain. ", doi="10.2196/38214", url="https://rehab.jmir.org/2022/2/e38214", url="http://www.ncbi.nlm.nih.gov/pubmed/35759317" } @Article{info:doi/10.2196/38084, author="H{\"o}rder, Helena and Nero, H{\aa}kan and Misini Ignjatovic, Majda and Kiadaliri, Ali and Lohmander, Stefan L. and Dahlberg, E. Leif and Abbott, Allan", title="Digitally Delivered Exercise and Education Treatment Program for Low Back Pain: Longitudinal Observational Cohort Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Jun", day="21", volume="9", number="2", pages="e38084", keywords="low back pain", keywords="telehealth", keywords="physiotherapy", keywords="digital care", keywords="exercise", keywords="rehabilitation", keywords="back pain", keywords="pain management", keywords="telemedicine", keywords="digital therapy", keywords="chronic pain", keywords="health outcome", abstract="Background: Exercise and education is recommended as first-line treatment by evidence-based, international guidelines for low back pain (LBP). Despite consensus regarding the treatment, there is a gap between guidelines and what is offered to patients. Digital LBP treatments are an emerging way of delivering first-line treatment. Objective: The aim of this study is to evaluate outcomes after participation in a 3-month digitally delivered treatment program for individuals with subacute or chronic LBP. Methods: We analyzed data from 2593 consecutively recruited participants in a digitally delivered treatment program, available via the national health care system in Sweden. The program consists of video-instructed and progressive adaptable exercises, education through text lessons, and a chat and video function connecting participants with a personal physiotherapist. The primary outcome was mean change and proportion reaching a minimal clinically important change (MCIC) for LBP (2 points or 30\% decrease) assessed with the numerical rating scale (average pain during the past week, discrete boxes, 0-10, best to worst). Secondary outcomes were mean change and proportion reaching MCIC (10 points or 30\%) in disability, assessed with the Oswestry Disability Index (ODI; 0-100, best to worst) and a question on patient acceptable symptom state (PASS). Results: The mean participant age was 63 years, 73.85\% (1915/2593) were female, 54.72\% (1419/2593) had higher education, 50.56\% (1311/2593) were retired, and the mean BMI was 26.5 kg/m2. Participants completed on average 84\% of the prescribed exercises and lessons, with an adherence of ?80\% in 69.26\% (1796/2593) and ?90\% in 50.13\% (1300/2593) of the participants.Mean reduction in pain from baseline to 3 months was 1.7 (95\% CI --1.8 to --1.6), corresponding to a 35\% relative change. MCIC was reached by 58.50\% (1517/2593) of participants. ODI decreased 4 points (95\% CI --4.5 to --3.7), and 36.48\% (946/2593) reached an MCIC. A change from no to yes in PASS was seen in 30.35\% (787/2593) of participants.Multivariable analysis showed positive associations between reaching an MCIC in pain and high baseline pain (odds ratio [OR] 1.9, 95\% CI 1.6-2.1), adherence (OR 1.5, 95\% CI 1.3-1.8), and motivation (OR 1.2, 95\% CI 1.0-1.5), while we found negative associations for wish for surgery (OR 0.6, 95\% CI 0.5-0.9) and pain in other joints (OR 0.9, 95\% CI 0.7-0.9). We found no associations between sociodemographic characteristics and pain reduction. Conclusions: Participants in this digitally delivered treatment for LBP had reduced pain at 3-month follow-up, and 58.50\% (1517/2593) reported an MCIC in pain. Our findings suggest that digital treatment programs can reduce pain at clinically important levels for people with high adherence to treatment but that those with such severe LBP problems that they wish to undergo surgery may benefit from additional support. Trial Registration: ClinicalTrials.gov NCT05226156; https://clinicaltrials.gov/ct2/show/NCT05226156 ", doi="10.2196/38084", url="https://rehab.jmir.org/2022/2/e38084", url="http://www.ncbi.nlm.nih.gov/pubmed/35727622" } @Article{info:doi/10.2196/35365, author="Thorup, Brun Charlotte and Villadsen, Anne and Andreasen, Jesper Jan and Aar{\o}e, Jens and Andreasen, Jane and Brocki, Cristina Barbara", title="Perspectives on Participation in a Feasibility Study on Exercise-Based Cardiac Telerehabilitation After Transcatheter Aortic Valve Implantation: Qualitative Interview Study Among Patients and Health Professionals", journal="JMIR Form Res", year="2022", month="Jun", day="20", volume="6", number="6", pages="e35365", keywords="transcatheter aortic valve implantation", keywords="aortic valve", keywords="implant", keywords="TAVI", keywords="telerehabilitation", keywords="rehabilitation", keywords="aortic stenosis", keywords="patients' perspective", keywords="older people", keywords="elder", keywords="aged", keywords="geriatric", keywords="gerontology", keywords="patient experience", keywords="user experience", keywords="health professional experience", keywords="physician experience", keywords="telehealth", keywords="older adult", keywords="telemedicine", keywords="cardiac", keywords="cardiology", keywords="heart", keywords="perspective", keywords="home-based", keywords="exercise", keywords="activity tracker", keywords="physical activity", keywords="mHealth", keywords="mobile health", keywords="fitness", abstract="Background: Aortic valve stenosis affects approximately half of people aged ?85 years, and the recommended surgical treatment for older patients is transcatheter aortic valve implantation (TAVI). Despite strong evidence for its advantages, low attendance rate in cardiac rehabilitation is observed among patients after TAVI. Cardiac telerehabilitation (CTR) has proven comparable with center-based rehabilitation; however, no study has investigated CTR targeting patients after TAVI. On the basis of participatory design, an exercise-based CTR program (TeleTAVI) was developed, which included a web-based session with a cardiac nurse, a tablet containing an informative website, an activity tracker, and supervised home-based exercise sessions that follow the national recommendations for cardiac rehabilitation. Objective: This study aims to explore patients' and health professionals' experiences with using health technologies and participating in the exercise-based CTR program, TeleTAVI. Methods: This study is a part of a feasibility study and will only report patients' and health professionals' experiences of being a part of TeleTAVI. A total of 11 qualitative interviews were conducted using a semistructured interview guide (n=7, 64\% patients and n=4, 36\% health professionals). Patient interviews were conducted after 8 weeks of participation in TeleTAVI, and interviews with health professionals were conducted after the end of the program. The analysis was conducted as inductive content analysis to create a condensed meaning presented as themes. Results: Reticence toward using the website was evident with reduced curiosity to explore it, and reduced benefit from using the activity tracker was observed, as the patients' technical competencies were challenged. This was also found when using the tablet for web-based training sessions, leading to patients feeling worried before the training, as they anticipated technical problems. Disadvantages of the TeleTAVI program were technical problems and inability to use hands-on guidance with the patients. However, both physiotherapists and patients reported a feeling of improvement in patients' physical fitness. The home training created a feeling of safety, supported adherence, and made individualization possible, which the patients valued. A good relationship and continuity in the contact with health professionals seemed very important for the patients and affected their positive attitude toward the program. Conclusions: The home-based nature of the TeleTAVI program seems to provide the opportunity to support individualization, autonomy, independence, and adherence to physical training in addition to improvement in physical capability in older patients. Despite technological challenges, basing the relationship between the health professionals and patients on continuity may be beneficial for patients. Prehabilitation may also be considered, as it may create familiarity toward technology and adherence to the training. ", doi="10.2196/35365", url="https://formative.jmir.org/2022/6/e35365", url="http://www.ncbi.nlm.nih.gov/pubmed/35723925" } @Article{info:doi/10.2196/29936, author="Lambert, Genevieve and Drummond, Kenneth and Tahasildar, Bhagya and Carli, Francesco", title="Virtual Prehabilitation in Patients With Cancer Undergoing Surgery During the COVID-19 Pandemic: Protocol for a Prospective Feasibility Study", journal="JMIR Res Protoc", year="2022", month="May", day="6", volume="11", number="5", pages="e29936", keywords="prehabilitation", keywords="telehealth", keywords="functional capacity", keywords="cancer care", keywords="exercise", keywords="malnutrition", keywords="psychosocial support", abstract="Background: Since the beginning of the COVID-19 pandemic, preoperative care, also termed prehabilitation, has become increasingly relevant due to the decreasing functional and psychosocial health of patients with cancer, which is a result of the pandemic restrictions. Concurrently, access to telehealth has improved; telehealth comprises all remote care delivery facilitated by information technologies (ie, virtually). Objective: The aim of this protocol is to describe the rationale and methodology for a major trial investigating the feasibility and safety of multimodal virtual prehabilitation services (ie, teleprehabilitation). Methods: This single-arm feasibility trial aims to recruit 100 patients with cancer to receive teleprehabilitation throughout their preoperative period. The inclusion criteria are as follows: (1) 18 years of age or older, (2) scheduled for elective cancer surgery and referred by a surgeon, (3) medically cleared by the referring physician to engage in physical activity, and (4) have a good comprehension of the English or French language. Feasibility will be assessed by documenting recruitment, adherence, and retention rates, in addition to patients' motives for not participating in the trial, low participation, or discontinuation. The secondary outcome of safety will be assessed by reporting program-related adverse events. Results: The Montreal General Hospital Foundation funded the project in August 2020. The protocol was then approved by the Research Ethics Board of the McGill University Health Centre in January 2021 (ID No. 2021-6730). The first patient was recruited in March 2021, and recruitment is expected to end in September 2022. As of March 2022, 36 patients have been recruited, including 24 who have completed their participation. No adverse events have been reported. Data collection is expected to conclude in November 2022. Data analysis will be performed, and the results will be published by the beginning of 2023. Conclusions: This trial will provide guidance on the use of telehealth in the administration of prehabilitation services. The trial will provide a large amount of information that will respond to gaps in the literature, as there are minimal reports on the use of telehealth rehabilitation and prehabilitation services among elderly populations and in acute contexts, such as the preoperative period. Trial Registration: ClinicalTrials.gov NCT0479956; https://clinicaltrials.gov/ct2/show/NCT04799561 International Registered Report Identifier (IRRID): DERR1-10.2196/29936 ", doi="10.2196/29936", url="https://www.researchprotocols.org/2022/5/e29936", url="http://www.ncbi.nlm.nih.gov/pubmed/35522464" } @Article{info:doi/10.2196/34819, author="Brocki, Cristina Barbara and Andreasen, Jesper Jan and Aaroe, Jens and Andreasen, Jane and Thorup, Brun Charlotte", title="Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Apr", day="26", volume="9", number="2", pages="e34819", keywords="telerehabilitation", keywords="transcatheter aortic valve implantation", keywords="cardiac surgery", keywords="cardiac rehabilitation", keywords="exercise training", keywords="older adults", keywords="tablet", abstract="Background: The use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. Objective: In this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. Methods: This was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers' observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. Results: Of the initially included 13 patients, 5 (40\%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants' limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. Conclusions: Exercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60\% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients' information technology skills. ", doi="10.2196/34819", url="https://rehab.jmir.org/2022/2/e34819", url="http://www.ncbi.nlm.nih.gov/pubmed/35471263" } @Article{info:doi/10.2196/35700, author="Rozenberg, Dmitry and Santa Mina, Daniel and Nourouzpour, Sahar and Camacho Perez, Encarna and Stewart, Lyn Brooke and Wickerson, Lisa and Tsien, Cynthia and Selzner, Nazia and Shore, Josh and Aversa, Meghan and Woo, Minna and Holdsworth, Sandra and Prevost, Karina and Park, Jeff and Azhie, Amirhossein and Huszti, Ella and McLeod, Elizabeth and Dales, Sarah and Bhat, Mamatha", title="Feasibility of a Home-Based Exercise Program for Managing Posttransplant Metabolic Syndrome in Lung and Liver Transplant Recipients: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Mar", day="23", volume="11", number="3", pages="e35700", keywords="lung transplant", keywords="liver transplant", keywords="posttransplant metabolic syndrome", keywords="exercise training", keywords="randomized controlled trial", keywords="pilot study", abstract="Background: Posttransplant metabolic syndrome (PTMS) is a common contributor to morbidity and mortality among solid organ transplant recipients in the late posttransplant period (?1 year). Patients diagnosed with PTMS are at a higher risk of cardiovascular disease and frequently experience decreased physical function and health-related quality of life (HRQL). Studies in the early posttransplant period (<1 year) have shown the benefits of facility-based exercise training on physical function and HRQL, but have not evaluated the effects on metabolic risk factors. It remains unclear whether home-based exercise programs are feasible and can be delivered at a sufficient exercise dose to have effects on PTMS. This protocol outlines the methodology of a randomized controlled trial of a partly supervised home-based exercise program in lung transplant (LTx) and orthotopic liver transplant (OLT) recipients. Objective: This study aims to evaluate the feasibility (ie, recruitment rate, program adherence, attrition, safety, and participant satisfaction) of a 12-week individualized, home-based aerobic and resistance training program in LTx and OLT recipients initiated 12 to 18 months after transplantation, and to assess estimates of intervention efficacy on metabolic risk factors, exercise self-efficacy, and HRQL. Methods: In total, 20 LTx and 20 OLT recipients with ?2 cardiometabolic risk factors at 12 to 18 months after transplantation will be randomized to an intervention (home-based exercise training) or control group. The intervention group will receive an individualized exercise prescription comprising aerobic and resistance training, 3 to 5 times a week for 12 weeks. Participants will meet on a weekly basis (via videoconference) with a qualified exercise professional who will supervise exercise progression, provide support, and support exercise self-efficacy. Participants in both study groups will receive a counseling session on healthy eating with a dietitian at the beginning of the intervention. For the primary aim, feasibility will be assessed through recruitment rate, program adherence, satisfaction, attrition, and safety parameters. Secondary outcomes will be measured at baseline and 12 weeks, including assessments of metabolic risk factors (ie, insulin resistance, abdominal obesity, blood pressure, and cholesterol), HRQL, and exercise self-efficacy. Descriptive statistics will be used to summarize program feasibility and effect estimates (means and 95\% CIs) for sample size calculations in future trials. Results: Enrollment started in July 2021. It is estimated that the study period will be 18 months, with data collection to be completed by December 2022. Conclusions: A partly supervised home-based, individually tailored exercise program that promotes aerobic and resistance training and exercise self-efficacy may be an important intervention for improving the metabolic profile of LTx and OLT recipients with cardiometabolic risk factors. Thus, characterizing the feasibility and effect estimates of home-based exercise constitutes the first step in developing future clinical trials designed to reduce the high morbidity associated with PTMS. Trial Registration: ClinicalTrials.gov NCT04965142; https://clinicaltrials.gov/ct2/show/NCT04965142 International Registered Report Identifier (IRRID): DERR1-10.2196/35700 ", doi="10.2196/35700", url="https://www.researchprotocols.org/2022/3/e35700", url="http://www.ncbi.nlm.nih.gov/pubmed/35319467" } @Article{info:doi/10.2196/33157, author="Gopal, Arpita and Hsu, Wan-Yu and Allen, D. Diane and Bove, Riley", title="Remote Assessments of Hand Function in Neurological Disorders: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2022", month="Mar", day="9", volume="9", number="1", pages="e33157", keywords="neurological disease", keywords="hand function", keywords="remote assessment", keywords="assessment", keywords="telemedicine", keywords="rehabilitation", keywords="telerehabilitation", keywords="review", keywords="neurological", keywords="hand", keywords="function", keywords="diagnosis", keywords="intervention", keywords="dysfunction", keywords="feasibility", keywords="mobile phone", abstract="Background: Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be regularly assessed to monitor loss of fine motor skills in people with central nervous system disorders; however, there are challenges to in-clinic assessments. Remotely assessing hand function could facilitate monitoring and supporting of early diagnosis and intervention when warranted. Objective: Remote assessments can facilitate the tracking of limitations, aiding in early diagnosis and intervention. This study aims to systematically review existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction. Methods: PubMed and MEDLINE, CINAHL, Web of Science, and Embase were searched for studies that reported remote assessment of hand function (ie, outside of traditional in-person clinical settings) in adults with chronic central nervous system disorders. We excluded studies that included participants with orthopedic upper limb dysfunction or used tools for intervention and treatment. We extracted data on the evaluated hand function domains, validity and reliability, feasibility, and stage of development. Results: In total, 74 studies met the inclusion criteria for Parkinson disease (n=57, 77\% studies), stroke (n=9, 12\%), multiple sclerosis (n=6, 8\%), spinal cord injury (n=1, 1\%), and amyotrophic lateral sclerosis (n=1, 1\%). Three assessment modalities were identified: external device (eg, wrist-worn accelerometer), smartphone or tablet, and telerehabilitation. The feasibility and overall participant acceptability were high. The most common hand function domains assessed included finger tapping speed (fine motor control and rigidity), hand tremor (pharmacological and rehabilitation efficacy), and finger dexterity (manipulation of small objects required for daily tasks) and handwriting (coordination). Although validity and reliability data were heterogeneous across studies, statistically significant correlations with traditional in-clinic metrics were most commonly reported for telerehabilitation and smartphone or tablet apps. The most readily implementable assessments were smartphone or tablet-based. Conclusions: The findings show that remote assessment of hand function is feasible in neurological disorders. Although varied, the assessments allow clinicians to objectively record performance in multiple hand function domains, improving the reliability of traditional in-clinic assessments. Remote assessments, particularly via telerehabilitation and smartphone- or tablet-based apps that align with in-clinic metrics, facilitate clinic to home transitions, have few barriers to implementation, and prompt remote identification and treatment of hand function impairments. ", doi="10.2196/33157", url="https://rehab.jmir.org/2022/1/e33157", url="http://www.ncbi.nlm.nih.gov/pubmed/35262502" } @Article{info:doi/10.2196/31675, author="Koppenaal, Tjarco and Pisters, F. Martijn and Kloek, JJ Corelien and Arensman, M. Remco and Ostelo, WJG Raymond and Veenhof, Cindy", title="The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Feb", day="25", volume="24", number="2", pages="e31675", keywords="eHealth", keywords="nonspecific low back pain", keywords="physiotherapy", keywords="blended care", keywords="mobile phone", abstract="Background: Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients' self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients' physical functioning. Objective: This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods: The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ?18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients' risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results: Both the stratified blended physiotherapy group (104/208, 50\%) and the face-to-face physiotherapy group (104/208, 50\%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference ?1.96, 95\% CI ?4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3\%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference ?16.39, 95\% CI ?27.98 to ?4.79) and several secondary outcomes. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy. Trial Registration: ISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203 International Registered Report Identifier (IRRID): RR2-10.1186/s12891-020-3174-z ", doi="10.2196/31675", url="https://www.jmir.org/2022/2/e31675", url="http://www.ncbi.nlm.nih.gov/pubmed/35212635" } @Article{info:doi/10.2196/27597, author="Barak Ventura, Roni and Stewart Hughes, Kora and Nov, Oded and Raghavan, Preeti and Ruiz Mar{\'i}n, Manuel and Porfiri, Maurizio", title="Data-Driven Classification of Human Movements in Virtual Reality--Based Serious Games: Preclinical Rehabilitation Study in Citizen Science", journal="JMIR Serious Games", year="2022", month="Feb", day="10", volume="10", number="1", pages="e27597", keywords="motion analysis", keywords="principal component analysis", keywords="telerehabilitation", keywords="virtual reality", abstract="Background: Sustained engagement is essential for the success of telerehabilitation programs. However, patients' lack of motivation and adherence could undermine these goals. To overcome this challenge, physical exercises have often been gamified. Building on the advantages of serious games, we propose a citizen science--based approach in which patients perform scientific tasks by using interactive interfaces and help advance scientific causes of their choice. This approach capitalizes on human intellect and benevolence while promoting learning. To further enhance engagement, we propose performing citizen science activities in immersive media, such as virtual reality (VR). Objective: This study aims to present a novel methodology to facilitate the remote identification and classification of human movements for the automatic assessment of motor performance in telerehabilitation. The data-driven approach is presented in the context of a citizen science software dedicated to bimanual training in VR. Specifically, users interact with the interface and make contributions to an environmental citizen science project while moving both arms in concert. Methods: In all, 9 healthy individuals interacted with the citizen science software by using a commercial VR gaming device. The software included a calibration phase to evaluate the users' range of motion along the 3 anatomical planes of motion and to adapt the sensitivity of the software's response to their movements. During calibration, the time series of the users' movements were recorded by the sensors embedded in the device. We performed principal component analysis to identify salient features of movements and then applied a bagged trees ensemble classifier to classify the movements. Results: The classification achieved high performance, reaching 99.9\% accuracy. Among the movements, elbow flexion was the most accurately classified movement (99.2\%), and horizontal shoulder abduction to the right side of the body was the most misclassified movement (98.8\%). Conclusions: Coordinated bimanual movements in VR can be classified with high accuracy. Our findings lay the foundation for the development of motion analysis algorithms in VR-mediated telerehabilitation. ", doi="10.2196/27597", url="https://games.jmir.org/2022/1/e27597", url="http://www.ncbi.nlm.nih.gov/pubmed/35142629" } @Article{info:doi/10.2196/24946, author="Blanc, Margaux and Roy, Anne-Laure and Fraudet, Bastien and Piette, Patrice and Le Toullec, Elodie and Nicolas, Benoit and Gallien, Philippe and Leblong, Emilie", title="Evaluation of a Digitally Guided Self-Rehabilitation Device Coupled With Telerehabilitation Monitoring in Patients With Parkinson Disease (TELEP@RK): Open, Prospective Observational Study", journal="JMIR Serious Games", year="2022", month="Feb", day="7", volume="10", number="1", pages="e24946", keywords="Parkinson's disease", keywords="telerehabilitation", keywords="serious games", keywords="UTAUT", keywords="physiotherapist", keywords="acceptability", keywords="acceptance", abstract="Background: Parkinson disease is a neurodegenerative disease causing a progressive loss of autonomy. This requires long-term rehabilitation care. Currently, new technologies are being developed for use in daily life, and there is a progressive implementation of telerehabilitation. Objective: The aim of this study (the TELEP@RK study) is to evaluate the uses of a digital self-rehabilitation device in patients with Parkinson disease and their independent physiotherapists on the scale of a health territory. Methods: A total of 10 independent physiotherapists and 31 patients with Parkinson disease were followed for 1 year to evaluate the use of a telerehabilitation tool (digital tablet and inertial sensor) via questionnaires of the Unified Theory of Acceptance and Use of Technology (UTAUT). The questionnaires were submitted to participants at 0, 2, and 12 months from the start of follow-up. The averages of the scores of the different determinants and constructs of the UTAUT questionnaires were compared at the different follow-up times. Results: Among professionals, the averages of the various determinants were generally high at the beginning of the study with an average (out of 5) performance expectancy of 4.19, effort expectancy of 3.88, social influence of 3.95, facilitating conditions of 4, and intention to use of 3.97. These averages decreased over time. Conclusions: Acceptability, acceptance, and appropriation of the tool were very high among the physiotherapists as well as the patients, despite the tool's lack of evolution during the study. In the current health care context, these results allow us to envision a new organization of the care pathway for patients with chronic diseases, with the increased use of new technologies associated with telecare. ", doi="10.2196/24946", url="https://games.jmir.org/2022/1/e24946", url="http://www.ncbi.nlm.nih.gov/pubmed/35129449" } @Article{info:doi/10.2196/27759, author="Morimoto, Yuh and Takahashi, Tetsuya and Sawa, Ryuichi and Saitoh, Masakazu and Morisawa, Tomoyuki and Kagiyama, Nobuyuki and Kasai, Takatoshi and Dinesen, Birthe and Hollingdal, Malene and Refsgaard, Jens and Daida, Hiroyuki", title="Web Portals for Patients With Chronic Diseases: Scoping Review of the Functional Features and Theoretical Frameworks of Telerehabilitation Platforms", journal="J Med Internet Res", year="2022", month="Jan", day="27", volume="24", number="1", pages="e27759", keywords="telerehabilitation", keywords="web portal", keywords="chronic disease", keywords="monitoring/data tracking function", keywords="patient-centered care", abstract="Background: The COVID-19 pandemic has required an increased need for rehabilitation activities applicable to patients with chronic diseases. Telerehabilitation has several advantages, including reducing clinic visits by patients vulnerable to infectious diseases. Digital platforms are often used to assist rehabilitation services for patients in remote settings. Although web portals for medical use have existed for years, the technology in telerehabilitation remains a novel method. Objective: This scoping review investigated the functional features and theoretical approaches of web portals developed for telerehabilitation in patients with chronic diseases. Methods: PubMed and Web of Science were reviewed to identify articles associated with telerehabilitation. Of the 477 nonduplicate articles reviewed, 35 involving 14 portals were retrieved for the scoping review. The functional features, targeted diseases, and theoretical approaches of these portals were studied. Results: The 14 portals targeted patients with chronic obstructive pulmonary disease, cardiovascular, osteoarthritis, multiple sclerosis, cystic fibrosis diseases, and stroke and breast cancer survivors. Monitoring/data tracking and communication functions were the most common, followed by exercise instructions and diary/self-report features. Several theoretical approaches, behavior change techniques, and motivational techniques were found to be utilized. Conclusions: The web portals could unify and display multiple types of data and effectively provide various types of information. Asynchronous correspondence was more favorable than synchronous, real-time interactions. Data acquisition often required assistance from other digital tools. Various functions with patient-centered principles, behavior change strategies, and motivational techniques were observed for better support shifting to a healthier lifestyle. These findings suggested that web portals for telerehabilitation not only provided entrance into rehabilitation programs but also reinforced participant-centered treatment, adherence to rehabilitation, and lifestyle changes over time. ", doi="10.2196/27759", url="https://www.jmir.org/2022/1/e27759", url="http://www.ncbi.nlm.nih.gov/pubmed/35084355" } @Article{info:doi/10.2196/34657, author="Ramachandran, Joann Hadassah and Jiang, Ying and Teo, Claire Jun Yi and Yeo, Joo Tee and Wang, Wenru", title="Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review", journal="J Med Internet Res", year="2022", month="Jan", day="7", volume="24", number="1", pages="e34657", keywords="technology acceptance", keywords="coronary heart disease", keywords="home-based", keywords="telerehabilitation", keywords="web-based", keywords="mobile application", keywords="acceptance", keywords="heart", keywords="rehabilitation", keywords="app", keywords="review", keywords="evaluation", keywords="cardiac", keywords="cardiology", keywords="perspective", keywords="usability", keywords="acceptability", abstract="Background: An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective: We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients' perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods: We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results: The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions: Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians. ", doi="10.2196/34657", url="https://www.jmir.org/2022/1/e34657", url="http://www.ncbi.nlm.nih.gov/pubmed/34994711" } @Article{info:doi/10.2196/30516, author="Buckingham, A. Sarah and Anil, Krithika and Demain, Sara and Gunn, Hilary and Jones, B. Ray and Kent, Bridie and Logan, Angela and Marsden, Jonathan and Playford, Diane E. and Freeman, Jennifer", title="Telerehabilitation for People With Physical Disabilities and Movement Impairment: A Survey of United Kingdom Practitioners", journal="JMIRx Med", year="2022", month="Jan", day="3", volume="3", number="1", pages="e30516", keywords="telerehabilitation", keywords="physical disabilities", keywords="movement impairment", keywords="remote assessments", keywords="telehealth", keywords="rehabilitation", keywords="training", keywords="health care practitioners", keywords="physiotherapy", keywords="occupational therapy", abstract="Background: Telerehabilitation is a feasible and potentially effective alternative to face-to-face rehabilitation. However, specific guidance, training, and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment are limited. Objective: The aims of this survey of United Kingdom--based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practices in telerehabilitation for physical disabilities and movement impairment. The aim will be to use the findings to inform a practical tool kit and training package for telerehabilitation use. Methods: UK rehabilitation practitioners were invited to complete an online questionnaire from November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups, and via social media. Closed questionnaire items were analyzed using descriptive statistics. Qualitative inductive analysis using NVivo was used for open responses. Results: There were 247 respondents, of which 177 (72\%) were physiotherapists and occupational therapists. Most (n=207, 84\%) had used video-based consultations (typically supported by telephone and email), and the use of this method had increased in frequency since the COVID-19 pandemic. Practitioners perceived telerehabilitation positively overall and recognized benefits for patients including a reduced infection risk, convenience and flexibility, and reduced travel and fatigue. Common obstacles were technology related (eg, internet connection), practical (eg, difficulty positioning the camera), patient related (eg, health status), practitioner related (eg, lack of technical skills), and organizational (eg, lack of access to technology). Support from family members or carers was a major facilitator for successful remote consultations. Of the 207 respondents who had used video-based consultations, 103 (50\%) had assessed physical impairments using this method, 107 (52\%) had assessed physical function, and 121 (59\%) had used patient-reported outcome measures. Although practitioners generally felt confident in delivering video-based consultations, they felt less proficient in undertaking remote physical assessments, expressing concerns about validity, reliability, and safety. Only 46 of the 247 (19\%) respondents had received any training in telerehabilitation or video consultations, and some felt they were ``feeling their way in the dark.'' Practitioners desired training and guidance on physical assessment tools suitable for remote use, when to use video-based consultations or alternative methods, governance issues, digital platforms, and signposting to digital skills training for themselves and their patients. Conclusions: In response to the COVID-19 pandemic, practitioners rapidly adopted telerehabilitation for people with physical disabilities and movement impairment. However, there are technical, practical, and organizational obstacles to overcome, and a clear need for improved guidance and training in remote physical assessments. The findings of this survey will inform the development of a tool kit of resources and a training package for the current and future workforce in telerehabilitation. ", doi="10.2196/30516", url="https://med.jmirx.org/2022/1/e30516", url="http://www.ncbi.nlm.nih.gov/pubmed/37725532" } @Article{info:doi/10.2196/33130, author="Dennett, Amy and Harding, E. Katherine and Reimert, Jacoba and Morris, Rebecca and Parente, Phillip and Taylor, F. Nicholas", title="Telerehabilitation's Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation", journal="JMIR Cancer", year="2021", month="Dec", day="21", volume="7", number="4", pages="e33130", keywords="telehealth", keywords="exercise", keywords="telerehabilitation", keywords="physical activity", keywords="supportive care", keywords="COVID-19", keywords="feasibility", keywords="cancer", keywords="cancer survivor", keywords="evaluation", keywords="rehabilitation", keywords="impact", keywords="development", keywords="implementation", abstract="Background: Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. Objective: Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. Methods: A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. Results: The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82\%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80\% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29\%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus \$1104 (US \$790). Conclusions: Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation. ", doi="10.2196/33130", url="https://cancer.jmir.org/2021/4/e33130", url="http://www.ncbi.nlm.nih.gov/pubmed/34854817" } @Article{info:doi/10.2196/27186, author="O'Neil, Jennifer and Barnes, Keely and Morgan Donnelly, Erin and Sheehy, Lisa and Sveistrup, Heidi", title="Identification and Description of Balance, Mobility, and Gait Assessments Conducted via Telerehabilitation for Individuals With Neurological Conditions: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2021", month="Dec", day="9", volume="10", number="12", pages="e27186", keywords="telerehabilitation", keywords="remote assessment", keywords="outcome measures", keywords="neurology", keywords="rehabilitation", abstract="Background: The COVID-19 global pandemic pushed many rehabilitation practitioners to pivot their in-person practice to adopt telerehabilitation as their main method of delivery. In addition to documenting information on interventions used with clients, it is best practice for therapists to use reliable and validated outcome measures to inform their interventions. Objective: Through this scoping review, we aim to identify (1) which outcomes are being used remotely to assess balance, mobility, and gait in patients with neurological conditions, and (2) what psychometric data (validity, reliability, etc.) for remotely administered outcomes are available. Methods: Three main concepts will be included in our search: (1) neurological conditions; (2) administration by telerehabilitation; and (3) outcome measures for balance, mobility, and gait. Studies reporting remote assessment of neurological conditions published since 1990 will be included. The database search will be completed in MEDLINE (Ovid), CINAHL, PubMed, PsycINFO, EMBASE, and Cochrane. Gray literature including dissertations, conference papers, and protocol papers will also be sourced. Two reviewers will independently screen each title and abstract using pre-established inclusion and exclusion criteria. Manuscripts that appear to meet the criteria will be subject to further review, and full-text extraction using a pre-piloted extraction sheet if all criteria are met. The data will be categorized by assessment types describing impairments (such as balance, strength, and mobility) or activity limitations or participation restriction (such as functional mobility, ambulatory functions, and activities of daily living). Results: This scoping review will document outcome measures currently used in the remote assessment of neurological conditions. To date, 235 titles and abstracts were screened. We are in the process of finalizing the full text screening for the inclusion of articles. We expect the full screening to be completed in November 2021 and data analysis in January 2022. Our results are expected to be published in early 2022. Conclusions: The optimal use of telerehabilitation as a mode to deliver rehabilitation intervention should be coupled with the completion of validated outcome measures. Therefore, it is crucial to further our knowledge on remote outcome measures and therapeutic assessments. International Registered Report Identifier (IRRID): PRR1-10.2196/27186 ", doi="10.2196/27186", url="https://www.researchprotocols.org/2021/12/e27186", url="http://www.ncbi.nlm.nih.gov/pubmed/34889765" } @Article{info:doi/10.2196/28242, author="Bughin, Fran{\c{c}}ois and Bui, Gaspard and Ayoub, Bronia and Blervaque, Leo and Saey, Didier and Avignon, Antoine and Brun, Fr{\'e}d{\'e}ric Jean and Molinari, Nicolas and Pomies, Pascal and Mercier, Jacques and Gouzi, Fares and Hayot, Maurice", title="Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="6", volume="9", number="12", pages="e28242", keywords="telerehabilitation", keywords="mHealth", keywords="rehabilitation", keywords="obesity", keywords="mobile phone", abstract="Background: Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective: The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods: This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m{\texttwosuperior}) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients' adhesion, and satisfaction. Results: A total of 49 patients completed the study. No significant group {\texttimes} time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: ?0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: ?1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95\%) and satisfaction in the TRG were good. Conclusions: In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients' adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration: ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666 ", doi="10.2196/28242", url="https://mhealth.jmir.org/2021/12/e28242", url="http://www.ncbi.nlm.nih.gov/pubmed/34874887" } @Article{info:doi/10.2196/30378, author="Jorge, Serafim Ana Elisa and Bennell, Louise Kim and Kimp, Jared Alexander and Campbell, Kate Penny and Hinman, Shane Rana", title="An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data", journal="JMIR Med Educ", year="2021", month="Dec", day="1", volume="7", number="4", pages="e30378", keywords="osteoarthritis", keywords="knee", keywords="physiotherapy", keywords="exercise", keywords="e-learning", keywords="telehealth", keywords="pain", keywords="education", keywords="implementation", keywords="evaluation", keywords="professional development", keywords="rehabilitation", abstract="Background: The COVID-19 pandemic necessitated clinicians to transition to telehealth, often with little preparation or training. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules were developed to upskill physiotherapists in management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the e-learning modules are perceived by physiotherapists as effective when they are part of a comprehensive training program for a clinical trial. However, the effectiveness of the modules on their own in a real-world setting is unknown. Objective: This study aims to evaluate the reach, effectiveness, adoption, and implementation of PEAK e-learning modules. Methods: This longitudinal study was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators, and health care students who registered for access to the modules between April 1 and November 30, 2020. Reach was evaluated by outcomes (countries, referral sources, and attrition) extracted from registration data and embedded within precourse surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with videoconferencing; likelihood of using education, strengthening exercise, and physical activity in a treatment plan for knee OA; usefulness of modules) measured using a 10-point numeric rating scale (NRS; score range from 1=not confident or likely or useful at all to 10=extremely confident or likely or useful) in pre- and postcourse (on completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to the use of learning and usefulness of program elements (measured via a 4-point Likert scale, from not at all useful to extremely useful) in a survey administered 4 months after module completion. Results: Broad reach was achieved, with 6720 people from 97 countries registering for access. Among registrants, there were high levels of attrition, with 36.65\% (2463/6720) commencing the program and precourse survey and 19.61\% (1318/6720) completing all modules and the postcourse survey. The program was effective. Learners who completed the modules demonstrated increased confidence with videoconferencing (mean change 3.1, 95\% CI 3.0-3.3 NRS units) and increased likelihood of using education, strengthening and physical activity in a knee OA treatment plan, compared to precourse. Adoption and implementation of learning (n=149 respondents) occurred at 4 months. More than half of the respondents used their learning to structure in-person consultations with patients (80/142, 56.3\%) and patient information booklets in their clinical practice (75/142, 52.8\%). Conclusions: Findings provide evidence of the reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting among physiotherapists. The e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via videoconferencing. Attrition across the e-learning program highlights the challenges of keeping learners engaged in self-directed web-based learning. ", doi="10.2196/30378", url="https://mededu.jmir.org/2021/4/e30378", url="http://www.ncbi.nlm.nih.gov/pubmed/34587585" } @Article{info:doi/10.2196/33589, author="Cabral, F. Danylo and Hinchman, A. Carrie and Nunez, Christina and Rice, Jordyn and Loewenstein, A. David and Cahalin, P. Lawrence and Rundek, Tatjana and Pascual-Leone, Alvaro and Gomes-Osman, Joyce", title="Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study", journal="JMIR Res Protoc", year="2021", month="Nov", day="23", volume="10", number="11", pages="e33589", keywords="exercise", keywords="neuroplasticity", keywords="cognition", keywords="brain health", keywords="cardiorespiratory fitness", keywords="cardiovascular function", keywords="trophic factors", keywords="telehealth", keywords="aging adult", abstract="Background: Extensive evidence supports a link between aerobic exercise and cognitive improvements in aging adults. A major limitation with existing research is the high variability in cognitive response to exercise. Our incomplete understanding of the mechanisms that influence this variability and the low adherence to exercise are critical knowledge gaps and major barriers for the systematic implementation of exercise for promoting cognitive health in aging. Objective: We aimed to provide an in-person and remotely delivered intervention study protocol with the main goal of informing the knowledge gap on the mechanistic action of exercise on the brain by characterizing important mechanisms of neuroplasticity, cardiorespiratory fitness response, and genetics proposed to underlie cognitive response to exercise. Methods: This is an open-label, 2-month, interventional study protocol in neurologically healthy sedentary adults. This study was delivered fully in-person and in remote options. Participants underwent a total of 30 sessions, including the screening session, 3 pretest (baseline) assessments, 24 moderate-to-vigorous aerobic exercise sessions, and 3 posttest assessments. We recruited participants aged 55 years and above, sedentary, and cognitively healthy. Primary outcomes were neuroplasticity, cognitive function, and cardiorespiratory fitness. Secondary outcomes included genetic factors, endothelium function, functional mobility and postural control, exercise questionnaires, depression, and sleep. We also explored study feasibility, exercise adherence, technology adaptability, and compliance of both in-person and remote protocols. Results: The recruitment phase and data collection of this study have concluded. Results are expected to be published by the end of 2021 or in early 2022. Conclusions: The data generated in these studies will introduce tangible parameters to guide the development of personalized exercise prescription models for maximal cognitive benefit in aging adults. Successful completion of the specific aims will enable researchers to acquire the appropriate expertise to design and conduct studies by testing personalized exercise interventions in person and remotely delivered, likely to be more effective at promoting cognitive health in aging adults. Trial Registration: ClinicalTrials.gov NCT03804528; http://clinicaltrials.gov/ct2/show/NCT03804528 International Registered Report Identifier (IRRID): RR1-10.2196/33589 ", doi="10.2196/33589", url="https://www.researchprotocols.org/2021/11/e33589", url="http://www.ncbi.nlm.nih.gov/pubmed/34817393" } @Article{info:doi/10.2196/29799, author="Wilroy, Jereme and Lai, Byron and Currie, Madison and Young, Hui-Ju and Thirumalai, Mohanraj and Mehta, Tapan and Giannone, John and Rimmer, James", title="Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study", journal="JMIR Form Res", year="2021", month="Nov", day="18", volume="5", number="11", pages="e29799", keywords="telehealth", keywords="disability", keywords="COVID-19", keywords="exercise", keywords="assessments", keywords="feasibility", keywords="mHealth", keywords="teleassessment", keywords="mobility impairment", keywords="home exercise", keywords="participation", keywords="physical disabilities", abstract="Background: The Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) initiative is a large randomized controlled study that aims to overcome logistical barriers to exercise via telehealth for people with physical disabilities. However, at the start of the COVID-19 pandemic, enrollment was halted due to limited operations at the testing site, which included no onsite visits that involved participant data collection. In response to the limited operations, a modified data collection protocol was developed for virtual enrollment of study participants. Objective: This paper presents feasibility data on using teleassessments to enroll people with mobility impairment into a home-based exercise trial. Methods: The modified protocol replaced onsite enrollment and data collection visits with teleassessments using a computer tablet and testing equipment that was shipped to the participants' home address prior to the synchronous teleassessments conducted by an exercise physiologist through Zoom. The participants were mailed a teleassessment toolkit that included a digital blood pressure cuff, spirometer, hand dynamometer, mini disc cone, and measuring tape (to complete standardized testing). The teleassessment measures included resting blood pressure and heart rate, forced vital capacity, grip strength, Five Times Sit to Stand, and Timed Up and Go. Feasibility metrics included technological effectiveness, efficiency, and safety. The technological effectiveness of the telehealth assessment was determined by the percentage of sessions completed without technical issues with ?90\% criteria set a priori. Efficiency was measured by a session duration of ?2 hours. Safety was measured by the number of adverse events related to the teleassessments reported. Results: Data from 36 participants were included in this feasibility study, and 34 (94\%) participants completed all teleassessments without technical issues. For efficiency, the teleassessment sessions were completed in a mean time of 65 minutes and a maximum session length of 110 minutes. There were no adverse events reported to indicate concerns with the safety of teleassessments. Conclusions: The modified teleassessment protocol, in response to COVID-19 restrictions, may be a feasible process for enrolling adults with mobility impairment into a home exercise trial who otherwise would have not been able to participate. Trial Registration: ClinicalTrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 ", doi="10.2196/29799", url="https://formative.jmir.org/2021/11/e29799", url="http://www.ncbi.nlm.nih.gov/pubmed/34792477" } @Article{info:doi/10.2196/28634, author="Herkert, Cyrille and Graat-Verboom, Lidwien and Gilsing-Fernhout, Judith and Schols, Manon and Kemps, Clemens Hareld Marijn", title="Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study", journal="JMIR Form Res", year="2021", month="Nov", day="9", volume="5", number="11", pages="e28634", keywords="home-based exercise", keywords="cardiac diseases", keywords="pulmonary diseases", keywords="comorbidities", keywords="elderly", abstract="Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50\% (5/10) were men. Of the 10 participants, 9 (90\%) completed the 8-week program. Median adherence to the exercise prescription was 75\% (IQR 37\%-88\%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86\%, IQR 51\%-100\%, and final 2 weeks: 57\%, IQR 8\%-75\%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44\%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 ", doi="10.2196/28634", url="https://formative.jmir.org/2021/11/e28634", url="http://www.ncbi.nlm.nih.gov/pubmed/34751655" } @Article{info:doi/10.2196/29714, author="Skov Schacksen, Cathrine and Henneberg, Celina Nanna and Muthulingam, Anajan Janusiya and Morimoto, Yuh and Sawa, Ryuichi and Saitoh, Masakazu and Morisawa, Tomoyuki and Kagiyama, Nobuyuki and Takahashi, Tetsuya and Kasai, Takatoshi and Daida, Hiroyuki and Refsgaard, Jens and Hollingdal, Malene and Dinesen, Birthe", title="Effects of Telerehabilitation Interventions on Heart Failure Management (2015-2020): Scoping Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="1", volume="8", number="4", pages="e29714", keywords="heart failure", keywords="telerehabilitation", keywords="quality of life", keywords="physical capacity", keywords="depression", keywords="anxiety", keywords="telehealth", keywords="rehabilitation", keywords="cardiac rehabilitation", keywords="cardiovascular disease", keywords="CVD", keywords="mental health", keywords="adherence", abstract="Background: Heart failure is one of the world's most frequently diagnosed cardiovascular diseases. An important element of heart failure management is cardiac rehabilitation, the goal of which is to improve patients' recovery, functional capacity, psychosocial well-being, and health-related quality of life. Patients in cardiac rehabilitation may lack sufficient motivation or may feel that the rehabilitation process does not meet their individual needs. One solution to these challenges is the use of telerehabilitation. Although telerehabilitation has been available for several years, it has only recently begun to be utilized in heart failure studies. Especially within the past 5 years, we now have several studies focusing on the effectiveness of telerehabilitation for heart failure management, all with varying results. Based on a review of these studies, this paper offers an assessment of the effectiveness of telerehabilitation as applied to heart failure management. Objective: The aim of this scoping review was to assess the effects of telerehabilitation in the management of heart failure by systematically reviewing the available scientific literature within the period from January 1, 2015, to December 31, 2020. Methods: The literature search was carried out using PubMed and EMBASE. After duplicates were removed, 77 articles were screened and 12 articles were subsequently reviewed. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews) guidelines. As measures of the effectiveness of telerehabilitation, the following outcomes were used: patients' quality of life, physical capacity, depression or anxiety, and adherence to the intervention. Results: A total of 12 articles were included in this review. In reviewing the effects of telerehabilitation for patients with heart failure, it was found that 4 out of 6 randomized controlled trials (RCTs), a single prospective study, and 4 out of 5 reviews reported increased quality of life for patients. For physical capacity, 4 RCTs and 3 systematic reviews revealed increased physical capacity. Depression or depressive symptoms were reported as being reduced in 1 of the 6 RCTs and in 2 of the 5 reviews. Anxiety or anxiety-related symptoms were reported as reduced in only 1 review. High adherence to the telerehabilitation program was reported in 4 RCTs and 4 reviews. It should be mentioned that some of the reviewed articles described the same studies although they employed different outcome measures. Conclusions: It was found that there is a tendency toward improvement in patients' quality of life and physical capacity when telerehabilitation was used in heart failure management. The outcome measures of depression, anxiety, and adherence to the intervention were found to be positive. Additional research is needed to determine more precise and robust effects of telerehabilitation. ", doi="10.2196/29714", url="https://rehab.jmir.org/2021/4/e29714", url="http://www.ncbi.nlm.nih.gov/pubmed/34723827" } @Article{info:doi/10.2196/30768, author="Nelligan, K. Rachel and Hinman, S. Rana and McManus, Fiona and Lamb, E. Karen and Bennell, L. Kim", title="Moderators of the Effect of a Self-directed Digitally Delivered Exercise Program for People With Knee Osteoarthritis: Exploratory Analysis of a Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Oct", day="29", volume="23", number="10", pages="e30768", keywords="digital", keywords="text messaging", keywords="exercise", keywords="moderators", keywords="osteoarthritis", keywords="RCT", keywords="clinical trial", keywords="subgroups", keywords="pain", keywords="function", keywords="knee osteoarthritis", keywords="rehabilitation", keywords="digital health", abstract="Background: A 24-week self-directed digitally delivered intervention was found to improve pain and function in people with knee osteoarthritis (OA). However, it is possible that this intervention may be better suited to certain subgroups of people with knee OA compared to others. Objective: The aim of this study was to explore whether certain individual baseline characteristics moderate the effects of a self-directed digitally delivered intervention on changes in pain and function over 24 weeks in people with knee OA. Methods: An exploratory analysis was conducted on data from a randomized controlled trial involving 206 people with a clinical diagnosis of knee OA. This trial compared a self-directed digitally delivered intervention comprising of web-based education, exercise, and physical activity program supported by automated exercise behavior change mobile phone text messages to web-based education alone (control). The primary outcomes were changes in overall knee pain (assessed on an 11-point numerical rating scale) and physical function (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale [WOMAC]) at 24 weeks. Five baseline patient characteristics were selected as the potential moderators: (1) number of comorbidities, (2) number of other painful joints, (3) pain self-efficacy, (4) exercise self-efficacy, and (5) self-perceived importance of exercise. Separate linear regression models for each primary outcome and each potential moderator were fit, including treatment group, moderator, and interaction between treatment group and moderator, adjusting for the outcome at baseline. Results: There was evidence that pain self-efficacy moderated the effect of the intervention on physical function compared to the control at 24 weeks (interaction P=.02). Posthoc assessment of the mean change in WOMAC function by treatment arm showed that each 1-unit increase in baseline pain self-efficacy was associated with a 1.52 (95\% CI 0.27 to 2.78) unit improvement in the control group. In contrast, a reduction of 0.62 (95\% CI --1.93 to 0.68) units was observed in the intervention group with each unit increase in pain self-efficacy. There was only weak evidence that pain self-efficacy moderated the effect of the intervention on pain and that number of comorbidities, number of other painful joints, exercise self-efficacy, or exercise importance moderated the effect of the intervention on pain or function. Conclusions: With the exception of pain self-efficacy, which moderated changes in function but not pain, we found limited evidence that our selected baseline patient characteristics moderated intervention outcomes. This indicates that people with a range of baseline characteristics respond similarly to the unsupervised digitally delivered exercise intervention. As these findings are exploratory in nature, they require confirmation in future studies. ", doi="10.2196/30768", url="https://www.jmir.org/2021/10/e30768", url="http://www.ncbi.nlm.nih.gov/pubmed/34714252" } @Article{info:doi/10.2196/32134, author="Gaboury, Isabelle and Tousignant, Michel and Corriveau, H{\'e}l{\`e}ne and Menear, Matthew and Le Dorze, Guylaine and Rochefort, Christian and Vachon, Brigitte and Rochette, Annie and Gosselin, Sylvie and Michaud, Fran{\c{c}}ois and Bollen, Jessica and Dean, Sarah", title="Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="28", volume="10", number="10", pages="e32134", keywords="adherence", keywords="interprofessional shared decision making", keywords="rehabilitation", keywords="stroke", keywords="telerehabilitation", abstract="Background: Strong evidence supports beginning stroke rehabilitation as soon as the patient's medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients' adherence to a rehabilitation plan and on their level of reintegration into normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration into normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured with clinicians. Methods: In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will be comprised of 220 patients who will take part in stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation group) versus face-to-face standard of care (control group: n=110 patients). Results: Our Research Ethics Board approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. Conclusions: This study will contribute to the minimization of both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practice guidelines regarding telecare services and the provision of telerehabilitation, including recommendations for effective interdisciplinary collaboration regarding stroke rehabilitation. Trial Registration: ClinicalTrials.gov NCT04440215; https://clinicaltrials.gov/ct2/show/NCT04440215 International Registered Report Identifier (IRRID): DERR1-10.2196/32134 ", doi="10.2196/32134", url="https://www.researchprotocols.org/2021/10/e32134", url="http://www.ncbi.nlm.nih.gov/pubmed/34709196" } @Article{info:doi/10.2196/31855, author="Giggins, M. Oonagh and Doyle, Julie and Smith, Suzanne and Moran, Orla and Gavin, Shane and Sojan, Nisanth and Boyle, Gordon", title="Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="7", volume="10", number="10", pages="e31855", keywords="cardiac rehabilitation", keywords="exercise", keywords="cardiovascular disease", keywords="virtual rehabilitation", keywords="digital health", keywords="self-management", keywords="pilot study", keywords="platform", keywords="feasibility", abstract="Background: Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. Objective: The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering -- Cardiac Rehabilitation (ECME-CR) platform. Methods: A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. Results: Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. Conclusions: This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. International Registered Report Identifier (IRRID): PRR1-10.2196/31855 ", doi="10.2196/31855", url="https://www.researchprotocols.org/2021/10/e31855", url="http://www.ncbi.nlm.nih.gov/pubmed/34617908" } @Article{info:doi/10.2196/30725, author="Itoh, Hidetaka and Amiya, Eisuke and Narita, Koichi and Shimbo, Mai and Taya, Masanobu and Komuro, Issei and Hasegawa, Takashi and Makita, Shigeru and Kimura, Yutaka", title="Efficacy and Safety of Remote Cardiac Rehabilitation in the Recovery Phase of Cardiovascular Diseases: Protocol for a Multicenter, Nonrandomized, Single-Arm, Interventional Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="4", volume="10", number="10", pages="e30725", keywords="cardiac rehabilitation", keywords="remote system", keywords="e-learning", keywords="exercise capacity", keywords="rehabilitation", keywords="cardiovascular disease", keywords="monitoring system", keywords="disease prevention", keywords="cardiology", abstract="Background: Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. Objective: This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. Methods: Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. Results: The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. Conclusions: The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. Trial Registration: University Hospital Medical Information Network---Clinical Trials Registry UMIN--CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000048983 International Registered Report Identifier (IRRID): DERR1-10.2196/30725 ", doi="10.2196/30725", url="https://www.researchprotocols.org/2021/10/e30725", url="http://www.ncbi.nlm.nih.gov/pubmed/34407925" } @Article{info:doi/10.2196/31247, author="Correia, D. Fernando and Molinos, Maria and Neves, Carlos and Janela, Dora and Carvalho, Diana and Luis, Sara and Francisco, E. Gerard and Lains, Jorge and Bento, Virgilio", title="Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Sep", day="30", volume="8", number="3", pages="e31247", keywords="acute ankle sprains", keywords="physical rehabilitation", keywords="home-based digital rehabilitation", keywords="digital therapy", keywords="rehabilitation", keywords="sprain", keywords="digital health", keywords="therapy", keywords="prospective", keywords="longitudinal", keywords="cohort", keywords="ankle", keywords="soft tissue", keywords="physical therapy", keywords="pain", keywords="outcome", keywords="fatigue", abstract="Background: Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective: We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods: We performed a prospective longitudinal cohort study of individuals eligible for workers' compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure--activities of daily living (FAAM--ADL) and FAAM--Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results: In total, 93 (89.4\%) patients completed the program and 79 (76.0\%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of --2.72 points (95\% CI --3.31 to --2.13) on the NPRS (49.8\% reduction), 21.7 points (95\% CI 17.13-26.27) on the FAAM--ADL (41.1\% increase), and 37.8 points (95\% CI 30.45-45.15) on the FAAM-Sports (151.8\% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9\% attained full recovery and were discharged with no residual disability. Conclusions: Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration: ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022 ", doi="10.2196/31247", url="https://rehab.jmir.org/2021/3/e31247", url="http://www.ncbi.nlm.nih.gov/pubmed/34499038" } @Article{info:doi/10.2196/26153, author="Allegue, Rakia Dorra and Kairy, Dahlia and Higgins, Johanne and Archambault, S. Philippe and Michaud, Francois and Miller, C. William and Sweet, N. Shane and Tousignant, Michel", title="A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study", journal="JMIR Serious Games", year="2021", month="Aug", day="31", volume="9", number="3", pages="e26153", keywords="stroke", keywords="rehabilitation", keywords="virtual reality", keywords="video games", keywords="telerehabilitation", keywords="upper extremity", keywords="motivation", abstract="Background: In Canada, only 11\% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program. Objective: This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment. Methods: A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment--upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week. Results: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels. Conclusions: VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. International Registered Report Identifier (IRRID): RR2-10.2196/14629 ", doi="10.2196/26153", url="https://games.jmir.org/2021/3/e26153", url="http://www.ncbi.nlm.nih.gov/pubmed/34132649" } @Article{info:doi/10.2196/30610, author="Keller, Maria Franziska and Dahmen, Alina and Derksen, Christina and K{\"o}tting, Lukas and Lippke, Sonia", title="Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects", journal="JMIR Ment Health", year="2021", month="Aug", day="26", volume="8", number="8", pages="e30610", keywords="mental health", keywords="COVID-19", keywords="medical rehabilitation", keywords="psychosomatic rehabilitation", keywords="internet-delivered digital trainings", abstract="Background: The COVID-19 pandemic has largely affected people's mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. Objective: Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19--related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients' rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. Methods: A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points---before (N=1719) and after (n=738) rehabilitation---between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19--related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. Results: Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, $\eta$2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, $\eta$2p=0.04), had lower financial worries (F1,837=38.96, P<.001, $\eta$2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, $\eta$2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, $\eta$2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, $\eta$2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression ($\beta$=--.14, P<.001), anxiety ($\beta$=--.12, P<.001), loneliness ($\beta$=--.18, P<.001), and stress postrehabilitation ($\beta$=--.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, $\eta$2p=0.01) and anxiety (F1,725=6.22, P=.01, $\eta$2p=0.01) from pre- to postrehabilitation. Conclusions: This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. Trial Registration: ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 ", doi="10.2196/30610", url="https://mental.jmir.org/2021/8/e30610", url="http://www.ncbi.nlm.nih.gov/pubmed/34270444" } @Article{info:doi/10.2196/19946, author="Ku, Shing Benny Pang and Tse, Shan Ada Wai and Pang, Hang Benny Chu and Cheung, Tseung Ngai and Pang, Wa Joanna Yuk and Chan, Yin Joyce Ka and Hui, Loi Hing and Chu, Dave and Choi, Wa Kevin Hoi", title="Tele-Rehabilitation to Combat Rehabilitation Service Disruption During COVID-19 in Hong Kong: Observational Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Aug", day="19", volume="8", number="3", pages="e19946", keywords="health information technology", keywords="mobile app", keywords="allied health", keywords="tele-rehabilitation", keywords="telehealth", keywords="rehabilitation", keywords="app", keywords="COVID-19", abstract="Background: A tele-rehabilitation platform was developed to improve access to ambulatory rehabilitation services in Hong Kong. The development was completed in October 2019 and rolled out for use to occupational therapists, physiotherapists, and speech therapists. During the COVID-19 pandemic, rehabilitation services were severely interrupted. Tele-rehabilitation was used extensively to meet the demand for rehabilitation service delivery. Objective: The aims of this study were to (1) describe the design and development process of a tele-rehabilitation service, and (2) study how the tele-rehabilitation platform was used to overcome the disruption of rehabilitation service during the COVID-19 pandemic. Methods: Tele-rehabilitation was developed utilizing 4 core determinants of Unified Theory of Acceptance and Use of Technology as guiding principles. A generic prescription platform, called the activity-based prescription system, and a mobile app, called the Rehabilitation App, were built. Five outcomes were used to examine the utilization of tele-rehabilitation both before and during the pandemic: throughput, patient demographic, patient conditions, workforce, and satisfaction from patients and staff. Results: There was a tremendous increase in the use of tele-rehabilitation during pandemic. The total number of patients (up until July 2020) was 9101, and the main age range was between 51 to 70 years old. Tele-rehabilitation was used for a much wider scope of patient conditions than originally planned. More than 1112 therapists, which constituted 50.6\% of the total workforce (1112/2196), prescribed tele-rehabilitation to their patients. Moreover, there was a high satisfaction rate from patients, with a mean rating of 4.2 out of 5, and a high adherence rate to prescribed rehabilitation activities (107840/131995, 81.7\%). Conclusions: The findings of our study suggested that tele-rehabilitation in the form of a generic prescription platform and mobile app can be an effective means to provide rehabilitation to patient. During the COVID-19 pandemic, tele-rehabilitation has been used extensively and effectively to mitigate service disruption. Our findings also provide support that there is a high level of satisfaction with tele-rehabilitation; however, a longer duration study is required to demonstrate the sustained use of tele-rehabilitation, especially after the pandemic. ", doi="10.2196/19946", url="https://rehab.jmir.org/2021/3/e19946", url="http://www.ncbi.nlm.nih.gov/pubmed/34254945" } @Article{info:doi/10.2196/30239, author="Motz, Victoria and Faust, Alison and Dahmus, Jessica and Stern, Benjamin and Soriano, Christopher and Stine, G. Jonathan", title="Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study", journal="JMIR Form Res", year="2021", month="Aug", day="17", volume="5", number="8", pages="e30239", keywords="physical activity", keywords="fatty liver", keywords="telemedicine", keywords="liver", keywords="nonalcoholic fatty liver disease", keywords="liver disease", keywords="fatty liver disease", keywords="aerobic training", keywords="telehealth", keywords="fitness", keywords="feasibility", keywords="steatohepatitis", abstract="Background: Most patients with nonalcoholic fatty liver disease (NAFLD) are physically inactive despite the well-known benefits of physical activity. Telehealth offers promise as a novel way to deliver an exercise training program and increase physical activity. However, the feasibility, safety, and efficacy of telehealth-based exercise programs is unknown in patients with NAFLD. Objective: The aim of this study was to determine the feasibility of a directly supervised exercise training program delivered exclusively with telehealth to patients with nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD. Methods: In response to COVID-19 research restrictions, we adapted an existing clinical trial and delivered 20 weeks of moderate-intensity aerobic training 5 days a week under real-time direct supervision using an audio--visual telehealth platform. Aerobic training was completed by walking outdoors or using a home treadmill. Fitness activity trackers with heart rate monitors ensured exercise was completed at the prescribed intensity with real-time feedback from an exercise physiologist. Results: Three female patients with biopsy-proven NASH were enrolled with a mean age of 52 (SD 14) years. The mean body mass index was 31.9 (SD 5.1) kg/m2. All patients had metabolic syndrome. All patients completed over 80\% of exercise sessions (mean 84\% [SD 3\%]) and no adverse events occurred. Body weight (mean --5.1\% [SD 3.7\%]), body fat (mean --4.4\% [SD 2.3\%]), and waist circumference (mean --1.3 in. [SD 1.6 in.]) all improved with exercise. The mean relative reduction in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was 35.1\% (SD 8.8\%). Mean reductions in hemoglobin A1c and Homeostatic Model Assessment for Insulin Resistance were also observed (--0.5\% [SD 0.2\%] and --4.0 [SD 1.2], respectively). The mean peak oxygen consumption (VO2peak) improved by 9.9 (SD 6.6) mL/kg/min. Conclusions: This proof-of-concept study found that supervised exercise training delivered via telehealth is feasible and safe in patients with NASH. Telehealth-based exercise training also appears to be highly efficacious in patients with NASH, but this will need to be confirmed by future large-scale trials. Trial Registration: ClinicalTrials.gov NCT03518294; https://clinicaltrials.gov/ct2/show/NCT03518294 ", doi="10.2196/30239", url="https://formative.jmir.org/2021/8/e30239", url="http://www.ncbi.nlm.nih.gov/pubmed/34402795" } @Article{info:doi/10.2196/28267, author="Brehon, Katelyn and Carriere, Jay and Churchill, Katie and Loyola-Sanchez, Adalberto and O'Connell, Petra and Papathanassoglou, Elisavet and MacIsaac, Rob and Tavakoli, Mahdi and Ho, Chester and Pohar Manhas, Kiran", title="Evaluating Community-Facing Virtual Modalities to Support Complex Neurological Populations During the COVID-19 Pandemic: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Jul", day="23", volume="10", number="7", pages="e28267", keywords="telehealth", keywords="evaluation", keywords="rehabilitation", keywords="musculoskeletal", keywords="neurological", keywords="COVID-19", keywords="spinal cord injury", keywords="advice line", keywords="webinar", keywords="artificial intelligence", keywords="machine learning", keywords="community engagement", abstract="Background: The COVID-19 pandemic and concomitant governmental responses have created the need for innovative and collaborative approaches to deliver services, especially for populations that have been inequitably affected. In Alberta, Canada, two novel approaches were created in Spring 2020 to remotely support patients with complex neurological conditions and rehabilitation needs. The first approach is a telehealth service that provides wayfinding and self-management advice to Albertans with physical concerns related to existing neurological or musculoskeletal conditions or post-COVID-19 recovery needs. The second approach is a webinar series aimed at supporting self-management and social connectedness of individuals living with spinal cord injury. Objective: The study aims to evaluate the short- and long-term impacts and sustainability of two virtual modalities (telehealth initiative called Rehabilitation Advice Line [RAL] and webinar series called Alberta Spinal Cord Injury Community Interactive Learning Seminars [AB-SCILS]) aimed at advancing self-management, connectedness, and rehabilitation needs during the COVID-19 pandemic and beyond. Methods: We will use a mixed-methods evaluation approach. Evaluation of the approaches will include one-on-one semistructured interviews and surveys. The evaluation of the telehealth initiative will include secondary data analyses and analysis of call data using artificial intelligence. The evaluation of the webinar series will include analysis of poll questions collected during the webinars and YouTube analytics data. Results: The proposed study describes unique pandemic virtual modalities and our approaches to evaluating them to ensure effectiveness and sustainability. Implementing and evaluating these virtual modalities synchronously allows for the building of knowledge on the complementarity of these methods. At the time of submission, we have completed qualitative and quantitative data collection for the telehealth evaluation. For the webinar series, so far, we have distributed the evaluation survey following three webinars and have conducted five attendee interviews. Conclusions: Understanding the impact and sustainability of the proposed telehealth modalities is important. The results of the evaluation will provide data that can be actioned and serve to improve other telehealth modalities in the future, since health systems need this information to make decisions on resource allocation, especially in an uncertain pandemic climate. Evaluating the RAL and AB-SCILS to ensure their effectiveness demonstrates that Alberta Health Services and the health system care about ensuring the best practice even after a shift to primarily virtual care. International Registered Report Identifier (IRRID): DERR1-10.2196/28267 ", doi="10.2196/28267", url="https://www.researchprotocols.org/2021/7/e28267", url="http://www.ncbi.nlm.nih.gov/pubmed/34101610" } @Article{info:doi/10.2196/27321, author="Dinesen, Birthe and Dam Gade, Josefine and Skov Schacksen, Cathrine and Spindler, Helle and Eie Albertsen, Andi and Dittmann, Lars and Jochumsen, Mads and Svenstrup M{\o}ller, Dorthe", title="The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses", journal="JMIR Cardio", year="2021", month="Jul", day="19", volume="5", number="2", pages="e27321", keywords="atrial fibrillation", keywords="cardiac rehabilitation", keywords="telerehabilitation", keywords="patient education", abstract="Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules. Objective: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF. Methods: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients' perspectives. Secondary outcomes were the development of patients' knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0. Results: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups. Conclusions: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient--TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437. ", doi="10.2196/27321", url="https://cardio.jmir.org/2021/2/e27321", url="http://www.ncbi.nlm.nih.gov/pubmed/34279239" } @Article{info:doi/10.2196/18130, author="Ding, Y. Eric and Erskine, Nathaniel and Stut, Wim and McManus, D. David and Peterson, Amy and Wang, Ziyue and Escobar Valle, Jorge and Albuquerque, Daniella and Alonso, Alvaro and Botkin, F. Naomi and Pack, R. Quinn", title="MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study", journal="JMIR Hum Factors", year="2021", month="Jul", day="8", volume="8", number="3", pages="e18130", keywords="cardiac rehabilitation", keywords="telerehabilitation", keywords="health watch", keywords="mHealth", keywords="exercise", abstract="Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch--informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33\%) were women, and 6 (33\%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86\% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch--based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. ", doi="10.2196/18130", url="https://humanfactors.jmir.org/2021/3/e18130", url="http://www.ncbi.nlm.nih.gov/pubmed/34255660" } @Article{info:doi/10.2196/27064, author="Gagnon, Marianne and Marino Merlo, Gabriela and Yap, Rita and Collins, Jessica and Elfassy, Caroline and Sawatzky, Bonita and Marsh, Jacquelyn and Hamdy, Reggie and Veilleux, Louis-Nicolas and Dahan-Oliel, No{\'e}mi", title="Using Telerehabilitation to Deliver a Home Exercise Program to Youth With Arthrogryposis: Single Cohort Pilot Study", journal="J Med Internet Res", year="2021", month="Jul", day="6", volume="23", number="7", pages="e27064", keywords="telerehabilitation", keywords="teleassessment", keywords="arthrogryposis multiplex congenita", keywords="physical therapy", keywords="occupational therapy", abstract="Background: Arthrogryposis multiplex congenita (AMC) is characterized by joint contractures and muscle weakness, which limit daily activities. Youths with AMC require frequent physical therapeutic follow-ups to limit the recurrence of contractures and maintain range of motion (ROM) and muscle strength; however, access to specialized care may be limited because of geographical distance. Telerehabilitation can offer a potential solution for delivering frequent follow-ups for youth with AMC, but research on the use of telerehabilitation in children with musculoskeletal disorders is scarce. Objective: The study aims to evaluate the feasibility of delivering a home exercise program (HEP) by using telerehabilitation for youth with AMC. We also aim to explore the effectiveness of the HEP as a secondary aim. Methods: Youths aged between 8 and 21 years with AMC were recruited at the Shriners Hospitals for Children--Canada. The participants completed baseline and post-HEP questionnaires (the Physical Activity Questionnaire for Adolescents, Pediatrics Outcomes Data Collection Instrument, and Adolescent and Pediatric Pain Tool), and clinicians assessed their active ROM using a virtual goniometer. Clinicians used the Goal Attainment Scale with the participants to identify individualized goals to develop a 12-week HEP and assess the achievement of these goals. Follow-ups were conducted every 3 weeks to adjust the HEP. Data on withdrawal rates and compliance to the HEP and follow-ups were collected to assess the feasibility of this approach. The interrater reliability of using a virtual goniometer was assessed using the intraclass correlation coefficient and associated 95\% CI. Nonparametric tests were used to evaluate feasibility and explore the effectiveness of the HEP. Results: Of the 11 youths who were recruited, 7 (median age: 16.9 years) completed the HEP. Of the 47 appointments scheduled, 5 had to be rescheduled in ?24 hours. The participants performed their HEP 2.04 times per week (95\% CI 1.25-4.08) and reported good satisfaction with the approach. A general intraclass correlation coefficient of 0.985 (95\% CI 0.980-0.989) was found for the web-based ROM measurement. Individualized goals were related to pain management; endurance in writing, standing, or walking; sports; and daily activities. In total, 12 of the 15 goals set with the participants were achieved. Statistically significant improvements were observed in the pain and comfort domain of the Pediatrics Outcomes Data Collection Instrument (preintervention: median 71; 95\% CI 34-100; postintervention: median 85; 95\% CI 49-100; P=.08) and Physical Activity Questionnaire for Adolescents (preintervention: median 1.62; 95\% CI 1.00-2.82; postintervention: median 2.32; 95\% CI 1.00-3.45; P=.046). Conclusions: The remote delivery of an HEP for youth with AMC is feasible. Promising results were found for the effectiveness of the HEP in helping youths with AMC to achieve their goals. The next step will be to assess the effectiveness of this exercise intervention in a randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.2196/18688 ", doi="10.2196/27064", url="https://www.jmir.org/2021/7/e27064", url="http://www.ncbi.nlm.nih.gov/pubmed/34255680" } @Article{info:doi/10.2196/29322, author="Miller, C. William and Mohammadi, Somayyeh and Watson, Wendy and Crocker, Morag and Westby, Marie", title="The Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER) as an eHealth Approach to Presurgical Hip Replacement Education: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jul", day="6", volume="10", number="7", pages="e29322", keywords="total hip replacement", keywords="osteoarthritis", keywords="eHealth", keywords="prehabiliatation", keywords="preoperative education", keywords="randomized controlled trial", keywords="evaluation", keywords="feasibility", keywords="rehabilitation", keywords="recovery", keywords="hip", keywords="bone", keywords="surgery", keywords="education", abstract="Background: Osteoarthritis (OA), leading to hip replacement (THR), is a primary contributor to global mobility impairment. In 2018, more than 59,000 THR surgeries were performed in Canada. Health promotion education, such as prehabilitation, is vital to optimizing surgical outcomes. Objective: This study aims to evaluate the feasibility of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER), an eHealth approach to prehabilitation education. Methods: A single-blind (assessor-blind), 2-arm, feasibility randomized controlled trial will be conducted. We will recruit 40 (HIPPER group, n=20; control group, n=20) older adults with hip OA and on a waitlist for a THR. The HIPPER intervention consists of 12 online, interactive modules. The control group will receive the current standard practice consisting of 2 online educational sessions lasting 2 hours each (webinars). Feasibility outcomes (eg, recruitment and retention rates) will be evaluated. Results: Recruitment started in March 2021. As of April 20, 2021, 18 participants were recruited. All 18 completed T1 measures. Only 1 participant has been scheduled to have a surgery and therefore has been scheduled to complete T2 measures. The remainder of the participants are waiting to be notified of their surgery date. This project was funded by a Canadian Institutes of Health Research Project Grant. Our institute's research ethics board approved this study in November 2016. Conclusions: Results will lead to refinement of the HIPPER protocol in order to evaluate a standardized and geographically accessible prehabilitation program. Trial Registration: ClinicalTrials.gov NCT02969512; https://clinicaltrials.gov/ct2/show/NCT02969512 International Registered Report Identifier (IRRID): DERR1-10.2196/29322 ", doi="10.2196/29322", url="https://www.researchprotocols.org/2021/7/e29322", url="http://www.ncbi.nlm.nih.gov/pubmed/34255722" } @Article{info:doi/10.2196/26544, author="Skov Schacksen, Cathrine and Dyrvig, Anne-Kirstine and Henneberg, Celina Nanna and Dam Gade, Josefine and Spindler, Helle and Refsgaard, Jens and Hollingdal, Malene and Dittman, Lars and Dremstrup, Kim and Dinesen, Birthe", title="Patient-Reported Outcomes From Patients With Heart Failure Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial", journal="JMIR Cardio", year="2021", month="Jul", day="2", volume="5", number="2", pages="e26544", keywords="adherence", keywords="cardiology", keywords="cardiomyopathy", keywords="compliance", keywords="heart failure", keywords="heart", keywords="Kansas City Cardiomyopathy Questionnaire", keywords="monitoring", keywords="patient-reported outcome", keywords="patients", keywords="quality of life", keywords="rehabilitation", keywords="self-reporting", keywords="telehealth", keywords="telemonitoring", abstract="Background: More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients' recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year. Objective: The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year. Methods: In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0\%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients' sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group. Results: The changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P<.05). Conclusions: There was a significant increase in clinical and social well-being and quality of life during the 1-year period of participating in a telerehabilitation program. These results suggest that patient-reported outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide patients in mastering their own symptoms. Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918 ", doi="10.2196/26544", url="https://cardio.jmir.org/2021/2/e26544", url="http://www.ncbi.nlm.nih.gov/pubmed/34255642" } @Article{info:doi/10.2196/20299, author="Hakala, Sanna and Kivist{\"o}, Heikki and Paajanen, Teemu and Kankainen, Annaliisa and Anttila, Marjo-Riitta and Heinonen, Ari and Sj{\"o}gren, Tuulikki", title="Effectiveness of Distance Technology in Promoting Physical Activity in Cardiovascular Disease Rehabilitation: Cluster Randomized Controlled Trial, A Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Jun", day="18", volume="8", number="2", pages="e20299", keywords="cardiac rehabilitation", keywords="rehabilitation", keywords="cardiovascular diseases", keywords="technology", keywords="exercise", keywords="randomized controlled trial", keywords="clinical trial", abstract="Background: Physical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied. Objective: The aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology--based treatment in 12 months of cardiac rehabilitation. Methods: The cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire. Results: During the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95\% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95\% CI --90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95\% CI --585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD --87.9 minutes per week, 95\% CI --379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95\% CI --75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95\% CI --2099.6 to 3833.9; P=.55). Conclusions: The use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods. Trial Registration: ISRCTN Registry ISRCTN61225589; https://doi.org/10.1186/ISRCTN61225589 ", doi="10.2196/20299", url="https://rehab.jmir.org/2021/2/e20299", url="http://www.ncbi.nlm.nih.gov/pubmed/34142970" } @Article{info:doi/10.2196/28708, author="Wickerson, Lisa and Helm, Denise and Gottesman, Chaya and Rozenberg, Dmitry and Singer, G. Lianne and Keshavjee, Shaf and Sidhu, Aman", title="Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation", journal="JMIR Mhealth Uhealth", year="2021", month="Jun", day="17", volume="9", number="6", pages="e28708", keywords="telerehabilitation", keywords="lung", keywords="transplant", keywords="rehabilitation", keywords="COVID-19", keywords="usage", keywords="satisfaction", keywords="app", keywords="outcome", keywords="telemedicine", abstract="Background: The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. Objective: The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. Methods: This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. Results: In total, 78 LTx candidates and 33 recipients were included (57 [51\%] males, mean age 58 [SD 12] years, 58 [52\%] with interstitial lung disease, 34 [31\%] with chronic obstructive pulmonary disease). A total of 50 (64\%) LTx candidates and 17 (51\%) LTx recipients entered ?10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83\%) candidates agreed the app helped prepare them for surgery and 18/21 (85\%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ?4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57\% of LTx candidates scored as active, which improved to 87\% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76\% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62\% (SD 18\%) predicted (n=8). Conclusions: We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic. ", doi="10.2196/28708", url="https://mhealth.jmir.org/2021/6/e28708", url="http://www.ncbi.nlm.nih.gov/pubmed/34048354" } @Article{info:doi/10.2196/28140, author="Melian, Christina and Frampton, Christopher and Wyatt, Charles Michael and Kieser, David", title="Teleconsultation in the Management of Elective Orthopedic and Spinal Conditions During the COVID-19 Pandemic: Prospective Cohort Study of Patient Experiences", journal="JMIR Form Res", year="2021", month="Jun", day="15", volume="5", number="6", pages="e28140", keywords="telemedicine", keywords="patient satisfaction", keywords="orthopedic surgery", keywords="telehealth", keywords="COVID-19", keywords="pandemic", abstract="Background: The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. Objective: The aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures. Methods: This was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results: We report that 91\% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3\% (446/807) of all patients preferred teleconsultation compared to 31.2\% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95\% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95\% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95\% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95\% CI 4.73-5.42 (P<.001). Conclusions: Patients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic. ", doi="10.2196/28140", url="https://formative.jmir.org/2021/6/e28140", url="http://www.ncbi.nlm.nih.gov/pubmed/34048355" } @Article{info:doi/10.2196/26942, author="Salisbury, Peter Joseph", title="Using Medical Device Standards for Design and Risk Management of Immersive Virtual Reality for At-Home Therapy and Remote Patient Monitoring", journal="JMIR Biomed Eng", year="2021", month="Jun", day="3", volume="6", number="2", pages="e26942", keywords="virtual reality", keywords="telerehabilitation", keywords="remote patient monitoring", keywords="medical device design", keywords="safety", keywords="medical device regulation", keywords="risk assessment", keywords="failure modes and effects analysis", doi="10.2196/26942", url="https://biomedeng.jmir.org/2021/2/e26942" } @Article{info:doi/10.2196/24908, author="Huygens, J. Martine W. and Voogdt-Pruis, R. Helene and Wouters, Myrah and Meurs, M. Maaike and van Lettow, Britt and Kleijweg, Conchita and Friele, D. Roland", title="The Uptake and Use of Telemonitoring in Chronic Care Between 2014 and 2019: Nationwide Survey Among Patients and Health Care Professionals in the Netherlands", journal="J Med Internet Res", year="2021", month="May", day="3", volume="23", number="5", pages="e24908", keywords="eHealth", keywords="telemonitoring", keywords="self-management", keywords="telemedicine", keywords="telehealth", abstract="Background: Telemonitoring could offer solutions to the mounting challenges for health care and could improve patient self-management. Studies have addressed the benefits and challenges of telemonitoring for certain patient groups. Objective: This paper will examine the nationwide uptake of telemonitoring in chronic care in the Netherlands from 2014 to 2019 by means of an annual representative survey among patients and health care professionals. Methods: Between 2014 and 2019, approximately 2900 patients with chronic diseases, 700 nurses, and 500 general practitioners (GPs) and medical specialists received a questionnaire. About 30 questions addressed topics about the use of eHealth and experiences with it, including data about telemonitoring. Results: Between 2014 and 2019, the use of telemonitoring remained stable for all groups except medical specialists. In medical specialist departments, the use of telemonitoring increased from 11.2\% (18/161) in 2014 to 19.6\% (36/184) in 2019 ($\chi$24=12.3; P=.02). In 2019, telemonitoring was used by 5.8\% (28/485) of people with chronic disease. This was 18.2\% (41/225) in GP organizations and 40.4\% (44/109), 38.0\% (78/205), and 8.9\% (29/325) in the organizations of nurses working in primary, secondary, and elderly care, respectively. Up to 10\% of the targeted patient group such as diabetics were regarded by health care professionals as suitable for using telemonitoring. The main benefits mentioned by the patients were ``comfort'' (421/1043, 40.4\%) and ``living at home for longer/more comfortably'' (334/1047, 31.9\%). Health care professionals added ``improvement of self-management'' (63/176, 35.8\% to 57/71, 80.3\%), ``better understanding of the patient's condition'' (47/176, 26.7\% to 42/71, 59.2\%), ``reduction of workload'' (53/134, 39.6\% of nurses in elderly care), ``better tailoring of care plan to the patient's situation'' (95/225, 42.2\% of GPs), and ``saves time for patients/caregivers'' (61/176, 34.7\% of medical specialists). Disadvantages mentioned by professionals were that ``it takes time to monitor data'' (13/130, 10\% to 108/225, 48.0\%), ``it takes time to follow up alerts'' (15/130, 11.5\% to 117/225, 52.0\%), and ``it is difficult to estimate which patients can work with telemonitoring'' (22/113, 19.5\% to 94/225, 41.8\%). Conclusions: The uptake of telemonitoring in Dutch chronic care remained stable during 2014-2019 but increased among medical specialists. According to both patients and professionals, telemonitoring improves the quality of life and quality of care. Skills for suitably including eligible patients and for allocating the tasks of data monitoring and follow-up care within the team would help to further increase the use of telemonitoring. ", doi="10.2196/24908", url="https://www.jmir.org/2021/5/e24908", url="http://www.ncbi.nlm.nih.gov/pubmed/33938808" } @Article{info:doi/10.2196/28155, author="Vranceanu, Ana-Maria and Bakhshaie, Jafar and Reichman, Mira and Doorley, James and Elwy, Rani A. and Jacobs, Cale and Chen, Neal and Esposito, John and Laverty, David and Matuszewski, E. Paul and Fatehi, Amirreza and Bowers, C. Lucy and Harris, Mitchel and Ring, David", title="A Live Video Program to Prevent Chronic Pain and Disability in At-Risk Adults With Acute Orthopedic Injuries (Toolkit for Optimal Recovery): Protocol for a Multisite Feasibility Study", journal="JMIR Res Protoc", year="2021", month="Apr", day="28", volume="10", number="4", pages="e28155", keywords="orthopedic", keywords="musculoskeletal", keywords="prevention", keywords="chronic pain", keywords="disability", keywords="intervention", keywords="video", keywords="telehealth", keywords="mobile phone", abstract="Background: Despite the pivotal role of psychosocial factors in pain and disability after orthopedic injury, there are no evidence-based preventive interventions targeting psychosocial factors in patients with acute orthopedic injuries. We developed the first mind-body intervention focused on optimizing recovery and improving pain and disability in patients with acute orthopedic injuries who exhibit high levels of catastrophic thinking about pain and/or pain anxiety (Toolkit for Optimal Recovery [TOR] after orthopedic injury). In a pilot single-site randomized controlled trial (RCT), the TOR met a priori set benchmarks for feasibility, acceptability, and satisfaction. The next step in developing TOR is to conduct a multisite feasibility RCT to set the stage for a scientifically rigorous hybrid efficacy-effectiveness trial. Objective: The objective of this study is to conduct a rigorous multisite feasibility RCT of TOR to determine whether the intervention and study methodology meet a priori set benchmarks necessary for the successful implementation of a future multisite hybrid efficacy-effectiveness trial. In this paper, we describe the study design, manualized treatments, and specific strategies used to conduct this multisite feasibility RCT investigation. Methods: This study will be conducted at 3 geographically diverse level 1 trauma centers, anonymized as sites A, B, and C. We will conduct a multisite feasibility RCT of TOR versus the minimally enhanced usual care (MEUC) control (60 patients per site; 30 per arm) targeting a priori set feasibility benchmarks. Adult patients with acute orthopedic injuries who endorse high pain catastrophizing or pain anxiety will be recruited approximately 1-2 months after injury or surgery (baseline). Participants randomized to the TOR will receive a 4-session mind-body treatment delivered via a secure live video by trained clinical psychologists. Participants randomized to the MEUC will receive an educational booklet. Primary outcomes include feasibility of recruitment, appropriateness, feasibility of data collection, acceptability of TOR (adherence to sessions), and treatment satisfaction across all sites. We will also collect data on secondary implementation outcomes, as well as pain severity, physical and emotional function, coping skills, and adverse events. Outcomes will be assessed at baseline, posttreatment, and at the 3-month follow-up. Results: Enrollment for the RCT is estimated to begin in June 2021. The target date of completion of the feasibility RCT is April 2024. The institutional review board approval has been obtained (January 2020). Conclusions: This investigation examines the multisite feasibility of TOR administered via live videoconferencing in adult patients with acute orthopedic injuries. If feasible, the next step is a multisite, hybrid efficacy-effectiveness trial of TOR versus MEUC. Preventive psychosocial interventions can provide a new way to improve patient and provider satisfaction and decrease suffering and health care costs among patients with orthopedic injuries who are at risk for chronic pain and disability. International Registered Report Identifier (IRRID): PRR1-10.2196/28155 ", doi="10.2196/28155", url="https://www.researchprotocols.org/2021/4/e28155", url="http://www.ncbi.nlm.nih.gov/pubmed/33908886" } @Article{info:doi/10.2196/24299, author="Gately, E. Megan and Tickle-Degnen, Linda and Voydetich, J. Deborah and Ward, Nathan and Ladin, Keren and Moo, R. Lauren", title="Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Apr", day="27", volume="8", number="2", pages="e24299", keywords="occupational therapy", keywords="telemedicine", keywords="health services", keywords="older adults", abstract="Background: Occupational therapy (OT) is a vital service that supports older adults' ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood. Objective: This study examines VHA OT practice using video telehealth with older veterans using an implementation framework. Methods: A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth. Results: Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0\% response rate). Most were female (196/259, 75.7\%) occupational therapists (281/305, 92.1\%) with a master's degree (147/259, 56.8\%) and 10 years or fewer (165/305, 54.1\%) of VHA OT practice. Less than half (125/305, 41.0\%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (P<.001), instrumental activities of daily living (P=.004), home safety (P<.001), home exercise or therapeutic exercise (P<.001), veteran or caregiver education (P<.001), durable medical equipment (P<.001), assistive technology (P<.001), education and work (P=.04), and wheelchair clinic or seating and positioning (P<.001). More than half (74/125, 59.2\%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being Inadequate space, physical locations and related equipment. Most (92/125, 73.6\%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84\%) and willingness to try innovative approaches (76/92, 83\%). Conclusions: Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians' attitudes to understand how they are driving the implementation of video telehealth. ", doi="10.2196/24299", url="https://rehab.jmir.org/2021/2/e24299", url="http://www.ncbi.nlm.nih.gov/pubmed/33904825" } @Article{info:doi/10.2196/28256, author="Perrin, B. Paul and McDonald, D. Scott and Watson, D. Jack and Pierce, S. Bradford and Elliott, R. Timothy", title="Telehealth Transition Assistance Program for Acute Spinal Cord Injury Caregivers: Protocol for a Mixed-Methods, Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Mar", day="29", volume="10", number="3", pages="e28256", keywords="spinal cord injury", keywords="telehealth", keywords="caregiver", keywords="methodology", abstract="Background: While spinal cord injury (SCI) caregiving can be a rewarding experience, caregivers often experience reduced mental and physical health. Objective: This article describes the methodology of a study examining the efficacy of a newly developed telehealth Transition Assistance Program (TAP) for caregivers of individuals with acute SCI. Methods: A mixed-methods, randomized controlled trial is comparing TAP outcomes to that of a standard-of-care control. The study is recruiting for 48 months and incorporating quantitative outcome measures. Results: This study was funded by the Craig H. Neilsen Foundation in April 2017. It was approved by the institutional review boards at Virginia Commonwealth University and the Hunter Holmes McGuire Veterans Affairs Medical Center that same year. Participant recruitment and data collection began in 2018. Conclusions: This study is implementing and testing an SCI caregiver intervention unlike any created before, targeting a critical time period that, until now, other SCI caregiver interventions have overlooked. Research personnel intend to disseminate the intervention and study findings through the publication of manuscripts and presentations at conferences. If the current study shows improvements in caregiver or patient well-being, the TAP for SCI caregivers could become part of the standard of care for acute SCI. Trial Registration: ClinicalTrials.gov NCT03244098; https://www.clinicaltrials.gov/ct2/show/NCT03244098 International Registered Report Identifier (IRRID): DERR1-10.2196/28256 ", doi="10.2196/28256", url="https://www.researchprotocols.org/2021/3/e28256", url="http://www.ncbi.nlm.nih.gov/pubmed/33779569" } @Article{info:doi/10.2196/18739, author="Cornelis, Nils and Buys, Roselien and Dewit, Tijl and Benoit, Dries and Claes, Jomme and Fourneau, Inge and Cornelissen, V{\'e}ronique", title="Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="22", volume="8", number="1", pages="e18739", keywords="eHealth", keywords="telerehabilitation", keywords="intermittent claudication", keywords="pilot", abstract="Background: Current guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice. Objective: The aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises. Methods: A total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests. Results: All patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients' questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered. Conclusions: Patients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking. Trial Registration: ClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546 ", doi="10.2196/18739", url="https://rehab.jmir.org/2021/1/e18739", url="http://www.ncbi.nlm.nih.gov/pubmed/33749616" } @Article{info:doi/10.2196/20405, author="V{\"o}lter, Christiane and St{\"o}ckmann, Carolin and Schirmer, Christiane and Dazert, Stefan", title="Tablet-Based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: Prospective Intervention Pilot Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="12", volume="8", number="1", pages="e20405", keywords="computer-based auditory training", keywords="correction of hearing impairment", keywords="cochlear implant", keywords="effectivity", keywords="intervention study", keywords="telerehabilitation", keywords="pandemic", abstract="Background: Technologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people's access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic's impact on health care, the need for new therapeutic settings has intensified. Objective: The aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic. Methods: In total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants' subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists. Results: Greater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program's usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment. Conclusions: The proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics. ", doi="10.2196/20405", url="https://rehab.jmir.org/2021/1/e20405", url="http://www.ncbi.nlm.nih.gov/pubmed/33709934" } @Article{info:doi/10.2196/21107, author="Elgert, Lena and Steiner, Bianca and Saalfeld, Birgit and Marschollek, Michael and Wolf, Klaus-Hendrik", title="Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Feb", day="4", volume="8", number="1", pages="e21107", keywords="shoulder", keywords="upper extremity", keywords="musculoskeletal diseases", keywords="exercises", keywords="physical therapy", keywords="telerehabilitation", keywords="technology-assisted therapy", keywords="assistive technologies", keywords="mobile phone", abstract="Background: Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. Objective: This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. Methods: The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. Results: Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient's range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients' evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. Conclusions: There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects. ", doi="10.2196/21107", url="http://rehab.jmir.org/2021/1/e21107/", url="http://www.ncbi.nlm.nih.gov/pubmed/33538701" } @Article{info:doi/10.2196/23386, author="Lawford, Joan Belinda and Bennell, L. Kim and Campbell, K. Penny and Kasza, Jessica and Hinman, S. Rana", title="Association Between Therapeutic Alliance and Outcomes Following Telephone-Delivered Exercise by a Physical Therapist for People With Knee Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2021", month="Jan", day="18", volume="8", number="1", pages="e23386", keywords="osteoarthritis", keywords="physiotherapy", keywords="physical therapy", keywords="tele-rehabilitation", keywords="telephone", keywords="therapeutic alliance", keywords="exercise", keywords="knee", keywords="pain", abstract="Background: The therapeutic alliance between patients and physical therapists has been shown to influence clinical outcomes in patients with chronic low back pain when consulting in-person. However, no studies have examined whether the therapeutic alliance developed between patients with knee osteoarthritis and physical therapists during telephonic consultations influences clinical outcomes. Objective: This study aims to investigate whether the therapeutic alliance between patients with knee osteoarthritis and physical therapists measured after the second consultation is associated with outcomes following telephone-delivered exercise and advice. Methods: Secondary analysis of 87 patients in the intervention arm of a randomized controlled trial allocated to receive 5 to 10 telephone consultations with one of 8 physical therapists over a period of 6 months, involving education and prescription of a strengthening and physical activity program. Separate regression models investigated the association between patient and therapist ratings of therapeutic alliance (measured after the second consultation using the Working Alliance Inventory Short Form) and outcomes (pain, function, self-efficacy, quality of life, global change, adherence to prescribed exercise, physical activity) at 6 and 12 months, with relevant covariates included. Results: There was some evidence of a weak association between patient ratings of the alliance and some outcomes at 6 months (improvements in average knee pain: regression coefficient ?0.10, 95\% CI ?0.16 to ?0.03; self-efficacy: 0.16, 0.04-0.28; global improvement in function: odds ratio 1.26, 95\% CI 1.04-1.39, and overall improvement: odds ratio 1.26, 95\% CI 1.06-1.51; but also with worsening in fear of movement: regression coefficient ?0.13, 95\% CI ?0.23 to ?0.04). In addition, there was some evidence of a weak association between patient ratings of the alliance and some outcomes at 12 months (improvements in self-efficacy: regression coefficient 0.15, 95\% CI 0.03-0.27; global improvement in both function, odds ratio 1.19, 95\% CI 0.03-1.37; and pain, odds ratio 1.14, 95\% CI 1.01-1.30; and overall improvement: odds ratio 1.21, 95\% CI 1.02-1.42). The data suggest that associations between therapist ratings of therapeutic alliance and outcomes were not strong, except for improved quality of life at 12 months (regression coefficient 0.01, 95\% CI 0.0003-0.01). Conclusions: Higher patient ratings, but not higher therapist ratings, of the therapeutic alliance were weakly associated with improvements in some clinical outcomes and with worsening in one outcome. Although the findings suggest that patients who perceive a stronger alliance with their therapist may achieve better clinical outcomes, the observed relationships were generally weak and unlikely to be clinically significant. The limitations include the fact that measures of therapeutic alliance have not been validated for use in musculoskeletal physical therapy settings. There was a risk of type 1 error; however, findings were interpreted on the basis of clinical significance rather than statistical significance alone. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000054415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369204 ", doi="10.2196/23386", url="http://rehab.jmir.org/2021/1/e23386/", url="http://www.ncbi.nlm.nih.gov/pubmed/33459601" } @Article{info:doi/10.2196/19690, 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" }