@Article{info:doi/10.2196/39543, author="Randriambelonoro, Mirana and Perrin Franck, Caroline and Herrmann, Fran{\c{c}}ois and Carmona, Antonio Gorki and Geissbuhler, Antoine and Graf, Christophe and Frangos, Emilia", title="Gamified Physical Rehabilitation for Older Adults With Musculoskeletal Issues: Pilot Noninferiority Randomized Clinical Trial", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="6", volume="10", pages="e39543", keywords="rehabilitation", keywords="gamification", keywords="emerging technologies", keywords="experimental", keywords="randomized controlled trial", keywords="mobility", keywords="device", keywords="musculoskeletal", keywords="older patients", keywords="elderly", keywords="aging", keywords="functionality", keywords="physical therapy", keywords="computer-aided", keywords="intervention", keywords="serious games", abstract="Background: Resource-rich countries are facing the challenge of aging societies, a high risk of dependence, and a high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like gamified physical rehabilitation to achieve functional targets and prevent rehospitalization. Objective: The purpose of this study is to assess the effectiveness of a personal mobility device compared with standard care in the rehabilitation treatment of patients with musculoskeletal issues. Methods: A total of 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to the control group (n=22) receiving usual standard care. Due to dropout, only 41 patients were included in the postintervention analysis. Outcome measures included the short physical performance battery (SPPB), isometric hand grip strength (IHGS), functional independence measure (FIM), and the number of steps. Results: A noninferiority related to the primary outcome (SPPB) was identified during the hospital stay, and no significant differences were found between the control and intervention groups for any of the secondary outcomes (IHGS, FIM, or steps), which demonstrates the potential of the serious game-based intervention to be as effective as the standard physical rehabilitation at the hospital. The analysis by mixed-effects regression on SPPB showed a group{\texttimes}time interaction (SPPB\_I\_t1=--0.77, 95\% CI --2.03 to 0.50, P=.23; SPPB\_I\_t2=0.21, 95\% CI --1.07 to 0.48, P=.75). Although not significant, a positive IHGS improvement of more than 2 kg (Right: 2.52 kg, 95\% CI --0.72 to 5.37, P=.13; Left: 2.43 kg, 95\% CI --0.18 to 4.23, P=.07) for the patient from the intervention group was observed. Conclusions: Serious game-based rehabilitation could potentially be an effective alternative for older patients to regain their functional capacities. Trial Registration: ClinicalTrials.gov NCT03847454; https://clinicaltrials.gov/ct2/show/NCT03847454 ", doi="10.2196/39543", url="https://rehab.jmir.org/2023/1/e39543", url="http://www.ncbi.nlm.nih.gov/pubmed/36877563" } @Article{info:doi/10.2196/44285, author="Epalte, Klinta and Grjadovojs, Aleksandrs and B?rzi?a, Guna", title="Use of the Digital Assistant Vigo in the Home Environment for Stroke Recovery: Focus Group Discussion With Specialists Working in Neurorehabilitation", journal="JMIR Rehabil Assist Technol", year="2023", month="Apr", day="14", volume="10", pages="e44285", keywords="stroke", keywords="rehabilitation", keywords="digital therapeutic", keywords="focus group", keywords="home-based rehabilitation", keywords="recovery", keywords="efficacy", keywords="application", keywords="rehabilitation program", keywords="functionality", keywords="usability", keywords="development", abstract="Background: There is a lack of resources for the provision of adequate rehabilitation after a stroke, thus creating a challenge to provide the necessary high-quality, patient-centered, and cost-efficient rehabilitation services at a time when they are needed the most. Tablet-based therapeutic programs present an alternative way to access rehabilitation services and show a new paradigm for providing therapeutic interventions following a stroke anytime and anywhere. The digital assistant Vigo is an artificial intelligence--based app that provides an opportunity for a new, more integrative way of carrying out a home-based rehabilitation program. Considering the complexity of the stroke recovery process, factors such as a suitable population, appropriate timing, setting, and the necessary patient-specialist support structure need to be thoroughly researched. There is a lack of qualitative research exploring the perspectives of professionals working in neurorehabilitation of the content and usability of the digital tool for the recovery of patients after a stroke. Objective: The aim of this study is to identify the requirements for a tablet-based home rehabilitation program for stroke recovery from the perspective of a specialist working in stroke rehabilitation. Methods: The focus group study method was chosen to explore specialists' attitudes, experience, and expectations related to the use of the digital assistant Vigo as a home-based rehabilitation program for stroke recovery in domains of the app's functionality, compliance, usability, and content. Results: In total, 3 focus groups were conducted with a participant count of 5-6 per group and the duration of the discussion ranging from 70 to 80 minutes. In total, 17 health care professionals participated in the focus group discussions. The participants represented physiotherapists (n=7, 41.2\%), occupational therapists (n=7, 41.2\%), speech and language therapists (n=2, 11.8\%), and physical medicine and rehabilitation physicians (n=1, 5.9\%). Audio and video recordings of each discussion were created for further transcription and analysis. In total, 4 themes were identified: (1) the clinician's views on using Vigo as a home-based rehabilitation system, (2) patient-related circumstances facilitating and limiting the use of Vigo; (3) Vigo's functionality and use process (program creation, individual use, remote support); and (4) complementary and alternative Vigo use perspectives. The last 3 themes were divided further into 10 subthemes, and 2 subthemes had 2 sub-subthemes each. Conclusions: Health care professionals expressed a positive attitude toward the usability of the Vigo app. It is important that the content and use of the app be coherent with the aim to avoid (1) misunderstanding its practical use and the need for integration in practice and (2) misusing the app. In all focus groups, the importance of close involvement of rehabilitation specialists in the process of app development and research was highlighted. ", doi="10.2196/44285", url="https://rehab.jmir.org/2023/1/e44285", url="http://www.ncbi.nlm.nih.gov/pubmed/37058334" } @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/10.2196/43237, author="Krag, Thea and J{\o}rgensen, H{\o}jgaard Emma and Phanareth, Klaus and Kayser, Lars", title="Experiences With In-Person and Virtual Health Care Services for People With Chronic Obstructive Pulmonary Disease: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="14", volume="10", pages="e43237", keywords="chronic obstructive pulmonary disease", keywords="telemedicine", keywords="telehealth", keywords="virtual RCC service", keywords="rehabilitation", keywords="self-management", keywords="eHealth literacy", keywords="social support", keywords="well-being", abstract="Background: The World Health Organization and the European Commission predict increased use of health technologies in the future care for patients in Europe. Studies have shown that services based on telehealth, which includes components of education, as well as rehabilitation initiatives can support the self-management of individuals living with COPD. This raises an interest in how virtual and in-person interactions and roles can best be organized in a way that suits people living with COPD in relation to their treatment and rehabilitation. Objective: This study aims to investigate how individuals living with COPD experience different combinations of virtual and in-person care, to help us better understand what aspects are valued and how to best combine elements of these services in future care. Methods: Two rounds of semistructured interviews were conducted with 13 and 4 informants, respectively. The individuals were all recruited in relation to a research project led by the telehealth initiative Epital Health. The first round of interviews included 11 informants, as 2 dropped out. Of these, 7 received the telemedicine service provided by Epital Health, 3 participated in a 12-week COPD program provided by their respective municipality, and 1 did not receive any supplementary service besides the usual care. In the second round, which included 4 informants, all had at one point received the telemedicine service and participated in a municipality-based rehabilitation program. A content analysis of the interviews was performed based on deductive coding with 4 categories, namely, (1) Self-management, (2) Health-related support, (3) Digital context, and (4) Well-being. Results: Medical and emotional support from health care professionals is a key aspect of care for individuals with COPD. Acute treatment with at-home medicine, monitoring one's own condition through technology, and having easy access and close contact with health care professionals familiar to them can promote self-management and well-being, as well as provide a feeling of security. Having regular meetings with a network of peers and health care professionals provides education, support, and tools to cope with the condition and improve own health. Furthermore, group-based activity motivates and increases the activity level of the individuals. Continued offers of services are desired as many experience a decrease in achieved benefits after the service ends. More emphasis is placed on the importance of the therapeutic and medical elements of care compared with factors such as technology. The identified barriers related to optimal utilization of the virtual service were related to differentiation in levels of contact depending on disease severity and skills related to the practical use of equipment. Conclusions: A combination of virtual and in-person services providing lasting medical and social support is suggested for the future. This should build upon the preferences and needs of individuals living with COPD and support relationships to caregivers and peers. ", doi="10.2196/43237", url="https://rehab.jmir.org/2023/1/e43237", url="http://www.ncbi.nlm.nih.gov/pubmed/37578832" } @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/10.2196/44489, author="Alaka, Benard and Shibwabo, Bernard", title="Models and Approaches for Comprehension of Dysarthric Speech Using Natural Language Processing: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="27", volume="10", pages="e44489", keywords="dysarthria", keywords="speech comprehension", keywords="speech contextualization", keywords="meaning extraction", keywords="ontology extraction", keywords="familiarity", keywords="topic knowledge", abstract="Background: Speech intelligibility and speech comprehension for dysarthric speech has attracted much attention recently. Dysarthria is characterized by irregularities in the speed, strength, pitch, breath control, range, steadiness, and accuracy of muscle movements required for articulatory aspects of speech production. Objective: This study examined the contributions made by other studies involved in dysarthric speech comprehension. We focused on the modes of meaning extraction used in generalizing speaker-listener underpinnings in light of semantic ontology extraction as a desired technique, applied method types, speech representations used, and databases sourced from. Methods: This study involved a systematic literature review using 7 electronic databases: Cochrane Database of Systematic Reviews, Web of Science Core Collection, Scopus, PubMed, ACM, IEEE Xplore, and Google Scholar. The main eligibility criterion was the extraction of meaning from dysarthric speech using natural language processing or understanding approaches to improve on dysarthric speech comprehension. In total, out of 834 search results, 30 studies that matched the eligibility requirements were acquired following screening by 2 independent reviewers, with a lack of consensus being resolved through joint discussion or consultation with a third party. In order to evaluate the studies' methodological quality, the risk of bias assessment was based on the Cochrane risk-of-bias tool version 2 (RoB2) with 23 of the studies (77\%) registering low risk of bias and 7 studies (33\%) raising some concern over the risk of bias. The overall quality assessment of the study was done using TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis). Results: Following a review of 30 primary studies, this study revealed that the reviewed studies focused on natural language understanding or clinical approaches, with an increase in proposed solutions from 2020 onwards. Most studies relied on speaker-dependent speech features, while others used speech patterns, semantic knowledge, or hybrid approaches. The prevalent use of vector representation aligned with natural language understanding models, while Mel-frequency cepstral coefficient representation and no representation approaches were applied in neural networks. Hybrid representation studies aimed to reconstruct dysarthric speech or improve comprehension. Comprehensive databases, like TORGO and UA-Speech, were commonly used in combination with other curated databases, while primary data was preferred for specific or unique research objectives. Conclusions: We found significant gaps in dysarthric speech comprehension characterized by the lack of inclusion of important listener or speech-independent features in the speech representations, mode of extraction, and data sources used. Further research is therefore proposed regarding the formulation of models that accommodate listener and speech-independent features through semantic ontologies that will be useful in the inclusion of key features of listener and speech-independent features for meaning extraction of dysarthric speech. ", doi="10.2196/44489", url="https://rehab.jmir.org/2023/1/e44489", url="http://www.ncbi.nlm.nih.gov/pubmed/37889538" } @Article{info:doi/10.2196/46959, author="Vaezipour, Atiyeh and Aldridge, Danielle and Koenig, Sebastian and Burns, Clare and Baghaei, Nilufar and Theodoros, Deborah and Russell, Trevor", title="Rehabilitation Supported by Immersive Virtual Reality for Adults With Communication Disorders: Semistructured Interviews and Usability Survey Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="31", volume="10", pages="e46959", keywords="communication disorders", keywords="speech and language therapy", keywords="rehabilitation", keywords="virtual reality", keywords="human-computer interaction", keywords="technology acceptance", keywords="acceptance", keywords="communication", keywords="therapy", keywords="usefulness", keywords="usability", keywords="survey", keywords="barrier", keywords="mobile phone", abstract="Background: Individuals who have acquired communication disorders often struggle to transfer the skills they learn during therapy sessions to real-life situations. Immersive virtual reality (VR) technology has the potential to create realistic communication environments that can be used both in clinical settings and for practice at home by individuals with communication disorders. Objective: This research aims to enhance our understanding of the acceptance, usefulness, and usability of a VR application (SIM:Kitchen), designed for communication rehabilitation. Additionally, this research aims to identify the perceived barriers and benefits of using VR technology from the perspective of individuals with acquired communication disorders. Methods: Semistructured interviews and usability surveys were conducted with 10 individuals with acquired neurogenic communication disorders aged 46-81 (mean 58, SD 9.57) years after trialing an immersive VR application. The audio-recorded interviews were transcribed and analyzed to identify themes. Results: The quantitative data regarding the usability of the system associated with participants' immersion experience in the VR application were promising. Findings from semistructured interviews are discussed across five key thematic areas including (1) participant's attitude toward VR, (2) perceived usefulness of the VR system, (3) perceived ease of use of the VR system, (4) their willingness to continue using VR, and (5) the factors they perceived as challenges or facilitators to adopting this VR technology. Conclusions: Overall, participants in this study found the VR experience to be enjoyable and were impressed by the realism of the VR application designed for communication rehabilitation. This study highlighted personally relevant, immersive VR interventions with different levels of task difficulty that could enhance technology uptake in the context of communication rehabilitation. However, it is essential that VR hand controller technology is refined to be more naturalistic in movement and able to accommodate user capabilities. ", doi="10.2196/46959", url="https://rehab.jmir.org/2023/1/e46959", url="http://www.ncbi.nlm.nih.gov/pubmed/37906228" } @Article{info:doi/10.2196/47541, author="Ummels, Darcy and Cnockaert, Elise and Timmers, Inge and den Hollander, Marlies and Smeets, Rob", title="Use of Virtual Reality in Interdisciplinary Multimodal Pain Treatment With Insights From Health Care Professionals and Patients: Action Research Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="10", volume="10", pages="e47541", keywords="virtual reality", keywords="interdisciplinary multimodal pain treatment", keywords="chronic pain", keywords="pain", keywords="rehabilitation", keywords="digital health", keywords="physiotherapy", keywords="occupational therapy", keywords="physical therapy", abstract="Background: Chronic pain is a widespread global health problem. Interdisciplinary multimodal pain treatment (IMPT) is a treatment option for people with chronic pain. Virtual reality (VR) could be used to broaden IMPT programs. However, despite the advantages of VR, it is rarely used in daily clinical practice. Objective: This research aimed to explore how, when, and with whom VR can be used meaningfully during IMPT, either as an addition or substitution as a component of IMPT. Methods: This research used an action research design to help health care professionals and patients learn how, when, and with whom they can use VR. Data were collected through reflection sessions with health care professionals and semistructured interviews with patients in 2 specialized centers that provide IMPT for chronic pain. Two researchers performed direct content analyses. Results: In total, 4 physiotherapists, 1 occupational therapist, 3 psychologists, and 22 patients participated in this research. Three iteration cycles, including 9 reflection sessions and 8 semistructured interviews, were performed. Both health care professionals and patients considered VR to be useful in therapy as an addition but not a substitution. VR was used as a diagnostic and intervention tool with all patients at the rehabilitation center or home. VR was used to gain insight into patients' pain beliefs, cognitions, and irrational cognitions about additional damage and physical abilities. Considering VR as an intervention tool, the health care professionals had 3 goals: balancing relaxation and competition, grading activities, and exposure in vivo. Conclusions: VR could be a valuable addition to IMPT for both patients with chronic pain and health care professionals. More research should be performed to assess the additional effects of VR on patients' participation in daily life. ", doi="10.2196/47541", url="https://rehab.jmir.org/2023/1/e47541", url="http://www.ncbi.nlm.nih.gov/pubmed/37948109" } @Article{info:doi/10.2196/42258, author="Spang, P. Robert and Haeger, Christine and M{\"u}mken, A. Sandra and Brauer, Max and Voigt-Antons, Jan-Niklas and Gellert, Paul", title="Smartphone Global Positioning System--Based System to Assess Mobility in Health Research: Development, Accuracy, and Usability Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="2", volume="10", pages="e42258", keywords="geographic information system", keywords="rehabilitation", keywords="prevention medicine", keywords="geoinformatics", keywords="out-of-home mobility", abstract="Background: As global positioning system (GPS) measurement is getting more precise and affordable, health researchers can now objectively measure mobility using GPS sensors. Available systems, however, often lack data security and means of adaptation and often rely on a permanent internet connection. Objective: To overcome these issues, we aimed to develop and test an easy-to-use, easy-to-adapt, and offline working app using smartphone sensors (GPS and accelerometry) for the quantification of mobility parameters. Methods: An Android app, a server backend, and a specialized analysis pipeline have been developed (development substudy). Parameters of mobility by the study team members were extracted from the recorded GPS data using existing and newly developed algorithms. Test measurements were performed with participants to complete accuracy and reliability tests (accuracy substudy). Usability was examined by interviewing community-dwelling older adults after 1 week of device use, followed by an iterative app design process (usability substudy). Results: The study protocol and the software toolchain worked reliably and accurately, even under suboptimal conditions, such as narrow streets and rural areas. The developed algorithms had high accuracy (97.4\% correctness, F1-score=0.975) in distinguishing dwelling periods from moving intervals. The accuracy of the stop/trip classification is fundamental to second-order analyses such as the time out of home, as they rely on a precise discrimination between the 2 classes. The usability of the app and the study protocol was piloted with older adults, which showed low barriers and easy implementation into daily routines. Conclusions: Based on accuracy analyses and users' experience with the proposed system for GPS assessments, the developed algorithm showed great potential for app-based estimation of mobility in diverse health research contexts, including mobility patterns of community-dwelling older adults living in rural areas. International Registered Report Identifier (IRRID): RR2-10.1186/s12877-021-02739-0 ", doi="10.2196/42258", url="https://rehab.jmir.org/2023/1/e42258", url="http://www.ncbi.nlm.nih.gov/pubmed/36862498" } @Article{info:doi/10.2196/43403, author="Sakr, Reda Hend and Ahmed, Ali Yahia and Kamel, Mohamed Reham and Abdelhady, Hamdy Reem and Elkalla, Alaa Reham and Georgui, Atef Mina and Abd El-khalek, Osama Wael and El Ebrashy, Hossam Mariam", title="Clitoral Therapy Device for Alleviating Sexual Dysfunction After Female Genital Mutilation: Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2023", month="Apr", day="21", volume="10", pages="e43403", keywords="female genital mutilation", keywords="FGM", keywords="clitoral therapy device", keywords="CTD", keywords="Eros device", keywords="sex therapy", keywords="Female Sexual Function Index", keywords="FSFI", keywords="Middle East", keywords="psychological", keywords="sexual", keywords="women", keywords="sexual dysfunction", abstract="Background: Female genital mutilation is considered a crime but is still practiced today in Africa and the Middle East, despite all the laws that make this procedure illegal due to the long-term physical and psychological harm it causes to women. Millions of girls and women living today have undergone genital mutilation, which involves removing the external female genitalia either partially or totally, based on the belief that it restricts feminine sexuality, thereby ``saving'' a girl for marriage. For girls and women, the surgery offers no health advantages. Girls' right to control critical decisions regarding their sexual and reproductive health is violated because genital mutilation is frequently done against their will and frequently without their consent, leading to lifelong psychic trauma in addition to sexual dysfunction and lack of satisfaction due to distortion of the genitalia that threatens marital stability. Objective: To determine the effect of a clitoral therapy device on improving sexual domains in women suffering from sexual dysfunction after female genital mutilation. Methods: This study examined 80 married women aged from 20 to 45 years who were referred from the gynecology outpatient clinic of the Faculty of Medicine, Suez University, for sexual dysfunction resulting from female genital mutilation. The women were divided into 2 equal groups: the study group received a clitoral therapy device and traditional psychosexual education and were closely followed for 3 months, while the control group received only traditional psychosexual education for 3 months. The Arabic version of the Female Sexual Function Index (FSFI) questionnaire was used to assess sexual outcomes pre- and posttreatment in the 2 groups. Results: Our findings revealed a significant increase in the 6 domains of the FSFI pretreatment in both groups compared to posttreatment (P>.001), except the orgasm domain in the control group, which showed only a nonsignificant increase (P=.16). Conclusions: Clitoral therapy devices may be an effective, safe, noninvasive rehabilitation method for sexual dysfunction following female genital mutilation. Trial Registration: ClinicalTrials.gov NCT05039775; https://clinicaltrials.gov/ct2/show/NCT05039775 ", doi="10.2196/43403", url="https://rehab.jmir.org/2023/1/e43403", url="http://www.ncbi.nlm.nih.gov/pubmed/37083562" } @Article{info:doi/10.2196/45307, author="van Dartel, Dieuwke and Wang, Ying and Hegeman, H. Johannes and Vollenbroek-Hutten, R. Miriam M. and ", title="Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="30", volume="10", pages="e45307", keywords="continuous ambulatory monitoring", keywords="physical activity", keywords="pattern prediction", keywords="older patients", keywords="hip fracture rehabilitation", keywords="wearable sensing", abstract="Background: Building up physical activity is a highly important aspect in an older patient's rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients' recovery for timely adaptive interventions. Objective: This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home. Methods: The physical activity of patients aged ?70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F1-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F1-score for all physical activity patterns together. Results: The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F1-score=1) and a 100\% correct classification of the 2 most common physical activity patterns. Conclusions: Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves. ", doi="10.2196/45307", url="https://rehab.jmir.org/2023/1/e45307", url="http://www.ncbi.nlm.nih.gov/pubmed/38032703" } @Article{info:doi/10.2196/44239, author="Lancioni, E. Giulio and Singh, N. Nirbhay and O'Reilly, F. Mark and Sigafoos, Jeff and Alberti, Gloria and Chiariello, Valeria and Desideri, Lorenzo and Buono, Serafino", title="Low-Cost Technology-Aided Programs for Supporting People With Motor, Visual, and Intellectual Disabilities in Functional Forms of Occupation and Communication: Proof-of-Concept Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="24", volume="10", pages="e44239", keywords="technology", keywords="smartphone", keywords="tablet", keywords="motor impairment", keywords="visual impairment", keywords="intellectual disability", keywords="leisure", keywords="communication", keywords="stories", abstract="Background: People with motor, visual, and intellectual disabilities may have serious problems in independently accessing various forms of functional daily occupation and communication. Objective: The study was aimed at developing and assessing new, low-cost technology-aided programs to help people with motor or visual-motor and intellectual disabilities independently engage in functional forms of occupation and communication with distant partners. Methods: Two programs were set up using a smartphone interfaced with a 2-switch device and a tablet interfaced with 2 pressure sensors, respectively. Single-subject research designs were used to assess (1) the first program with 2 participants who were blind, had moderate hand control, and were interested in communicating with distant partners through voice messages; and (2) the second program with 2 participants who possessed functional vision, had no or poor hand control, and were interested in communicating with their partners through video calls. Both programs also supported 2 forms of occupational engagement, that is, choosing and accessing preferred leisure events consisting of songs and music videos, and listening to brief stories about relevant daily topics and answering questions related to those stories. Results: During the baseline phase (when only a conventional smartphone or tablet was available), 2 participants managed sporadic access to leisure or leisure and communication events. The other 2 participants did not show any independent leisure or communication engagement. During the intervention (when the technology-aided programs were used), all participants managed to independently engage in multiple leisure and communication events throughout the sessions and to listen to stories and answer story-related questions. Conclusions: The findings, which need to be interpreted with caution given the nature of the study and the small number of participants, seem to suggest that the new programs may be viable tools for helping people with motor or visual-motor and intellectual disabilities independently access leisure, communication, and other forms of functional engagement. ", doi="10.2196/44239", url="https://rehab.jmir.org/2023/1/e44239", url="http://www.ncbi.nlm.nih.gov/pubmed/36961483" } @Article{info:doi/10.2196/41993, author="Mendonca, J. Christen and Malone, A. Laurie and Mohanraj, Sangeetha and Thirumalai, Mohanraj", title="The Usability of a Touchpad Active Video Game Controller for Individuals With Impaired Mobility: Observational Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="3", volume="10", pages="e41993", keywords="active video games", keywords="exergames", keywords="usability", keywords="enjoyment", keywords="disability", keywords="mobility limitation", keywords="mobility impairment", abstract="Background: Video games are a popular sedentary activity among people with impaired mobility; however, active video game hardware typically lacks accessibility and customization options for individuals with mobility impairments. A touchpad video game system can elicit moderate physical activity in healthy adults; however, it is unclear if this system is usable by adults with impaired mobility. Objective: The purpose of this study was to assess the usability of a touchpad video game controller system adapted for adults with impaired mobility. Additional outcomes explored were enjoyment, perceived exertion, self-efficacy, participant feedback, and researcher observations of gameplay. Methods: Participants played several video game titles for 20 minutes with a touchpad video game controller as they stood or sat in a chair or their wheelchair. Usability was assessed with the System Usability Scale (SUS) and the Health Information Technology Usability Evaluation Scale (Health-ITUES) surveys after gameplay. After each video game, participants reported enjoyment using a visual analog scale (0 to 100 mm) and a rating of perceived exertion using the OMNI 0 to 10 scale. Self-efficacy was measured before and after gameplay. Participants provided feedback at the end of their session. Results: In total, 21 adults (6 females and 15 males) with a mean age of 48.8 (SD 13.8) years with various mobility impairments participated in this study. The touchpads received mean usability scores on the SUS 80.1 (SD 18.5) and Health-ITUES 4.23 (SD 0.67). Conclusions: The SUS scores reported suggest the touchpad system is ``usable''; however, the Health-ITUES scores were slightly below a suggested benchmark. Participants reported moderate to high enjoyment but perceived the exertion as ``somewhat easy.'' Self-efficacy was moderate to high and did not differ pre- to postgame play. The participants regarded the touchpads as novel, fun, and entertaining. The generalizability of our results is limited due to the heterogenous sample; however, our participants identified several areas of improvement for future iteration. ", doi="10.2196/41993", url="https://rehab.jmir.org/2023/1/e41993", url="http://www.ncbi.nlm.nih.gov/pubmed/37535411" } @Article{info:doi/10.2196/50474, author="Prochaska, Eveline and Ammenwerth, Elske", title="A Digital Box and Block Test for Hand Dexterity Measurement: Instrument Validation Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Sep", day="15", volume="10", pages="e50474", keywords="assessment", keywords="Box and Block Test", keywords="BBT", keywords="concurrent validity", keywords="dexterity", keywords="digital Box and Block Test", keywords="dBBT", keywords="hand dexterity assessment", keywords="interrater reliability", keywords="test-retest reliability", keywords="validate", keywords="validity", abstract="Background: The Box and Block Test (BBT) measures unilateral gross manual dexterity and is widely used in clinical settings with a wide range of populations, including older people and clients with neurological disorders. Objective: In this study, we present a newly developed digitized version of the BBT, called the digital BBT (dBBT). The physical design is similar to the original BBT, but the dBBT contains digital electronics that automate the test procedure, timing, and score measurement. The aim of this study is to investigate the validity and reliability of the dBBT. Methods: We performed measurements at 2 time points for 29 healthy participants. BBT and dBBT were used at the first measurement time point, and dBBT was used again at the second measurement time point. Concurrent validity was assessed using the correlation between BBT and dBBT, the paired t test, and the Bland-Altman analysis. Test-retest reliability and interrater reliability were examined using the interclass correlation coefficient (ICC) by repeated measures with the dBBT within an interval of 10 days. Results: Our results showed moderate concurrent validity (r=0.48, P=.008), moderate test-retest reliability (ICC 0.72, P<.001), a standard error of measurement of 3.1 blocks, and the smallest detectable change at a 95\% CI of 8.5 blocks. Interrater reliability was moderate with an ICC of 0.67 (P=.02). The Bland-Altman analysis showed sufficient accuracy of the dBBT in comparison with the conventional BBT. Conclusions: The dBBT can contribute to objectifying the measurement of gross hand dexterity without losing its important characteristics and is simple to implement. ", doi="10.2196/50474", url="https://rehab.jmir.org/2023/1/e50474", url="http://www.ncbi.nlm.nih.gov/pubmed/37713251" } @Article{info:doi/10.2196/49750, author="Ebuenyi, D. Ikenna and Flocks-Monaghan, Celina and Rai, S. Sarju and Vries, de Ralph and Bhuyan, S. Soumitra and Pearlman, Jonathan and Jones, Nev", title="Use of Assistive Technology for Persons with Psychosocial Disability: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="15", volume="10", pages="e49750", keywords="assistive technology", keywords="assistive products", keywords="psychosocial disability", keywords="inclusion", keywords="participation", keywords="rehabilitation", keywords="psychosocial", keywords="health policy", keywords="socioeconomic", keywords="well-being", abstract="Background: Assistive technology (AT) refers to assistive products (AP) and associated systems and services that are relevant for function, independence, well-being, and quality of life for individuals with disabilities. There is a high unmet need for AT for persons with disabilities and this is worse for persons with cognitive and mental or psychosocial disabilities (PDs). Further, information and knowledge on AT for PDs is limited. Objective: The aim of this review was to explore the pattern of AT use among persons with PDs and its associated socioeconomic and health benefits. Methods: The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), and we conducted systematic searches in the 4 databases: PubMed, Embase.com, APA PsycInfo (Ebsco), and Web of Science (Core Collection) with the following index terms: ``Assistive Technology,'' ``Self-Help Devices,'' ``Quality of Life,'' ``Activities of Daily Living,'' ``Mental Disorders.'' We included only AT individuals with PDs can independently use without reliance on a provider. Identified papers were exported to EndNote (Clarivate) and we undertook a narrative synthesis of the included studies. Results: In total, 5 studies were included in the review which reported use of different AT for schizophrenia, bipolar disorder, depression and anxiety disorders. The APs described in the included studies are Palm tungsten T3 handheld computer, MOBUS, personal digital assistant, automated pill cap, weighted chain blankets, and smartphone function. All the AT products identified in the studies were found to be easily usable by individuals with PDs. The APs reported in the included studies have broad impact and influence on social function, productivity, and treatment or management. The studies were heterogeneous and were all conducted in high-income countries. Conclusions: Our study contributes to and strengthens existing evidence on the relevance of AT for PDs and its potential to support socioeconomic participation and health. Although AT has the potential to improve function and participation for individuals with PDs; this review highlights that research on the subject is limited. Further research and health policy changes are needed to improve research and AT service provision for individuals with PDs especially in low-income settings. Trial Registration: PROSPERO CRD42022343735; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=343735 ", doi="10.2196/49750", url="https://rehab.jmir.org/2023/1/e49750", url="http://www.ncbi.nlm.nih.gov/pubmed/37966875" } @Article{info:doi/10.2196/48031, author="Tanner, Alexandra and Urech, Andreas and Schulze, Hartmut and Manser, Tanja", title="Older Adults' Engagement and Mood During Robot-Assisted Group Activities in Nursing Homes: Development and Observational Pilot Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="25", volume="10", pages="e48031", keywords="human-robot interaction", keywords="social robot", keywords="nursing home", keywords="observational research", keywords="group activity", keywords="observational", keywords="pilot study", keywords="robot", keywords="engagement", keywords="mood", keywords="well-being", keywords="cognitive", keywords="elderly", keywords="nursing", keywords="aging", abstract="Background: Promoting the well-being of older adults in an aging society requires new solutions. One resource might be the use of social robots for group activities that promote physical and cognitive stimulation. Engaging in a robot-assisted group activity may help in the slowdown of physical and cognitive decline in older adults. Currently, our knowledge is limited on whether older adults engage in group activities with humanlike social robots and whether they experience a positive affect while doing so. Both are necessary preconditions to achieve the intended effects of a group activity. Objective: Our pilot study has 2 aims. First, we aimed to develop and pilot an observational coding scheme for robot-assisted group activities because self-report data on engagement and mood of nursing home residents are often difficult to obtain, and the existing observation instruments do have limitations. Second, we aimed to investigate older adults' engagement and mood during robot-assisted group activities in 4 different nursing care homes in the German-speaking part of Switzerland. Methods: We developed an observation system, inspired by existing tools, for a structured observation of engagement and mood of older adults during a robot-assisted group activity. In this study, 85 older adult residents from 4 different care homes in Switzerland participated in 5 robot-assisted group activity sessions, and they were observed using our developed system. The data were collected in the form of video clips that were assessed by 2 raters regarding engagement (direction of gaze, posture as well as body expression, and activity) and mood (positive and negative affects). Both variables were rated on a 5-point rating scale. Results: Our pilot study findings show that the engagement and mood of older adults can be assessed reliably by using the proposed observational coding scheme. Most participants actively engaged in robot-assisted group activities (mean 4.19, SD 0.47; median 4.0). The variables used to measure engagement were direction of gaze (mean 4.65, SD 0.49; median 5.0), posture and body expression (mean 4.03, SD 0.71; median 4.0), and activity (mean 3.90, SD 0.65; median 4.0). Further, we observed mainly positive affects in this group. Almost no negative affect was observed (mean 1.13, SD 0.20; median 1.0), while the positive affect (mean 3.22, SD 0.55; median 3.2) was high. Conclusions: The developed observational coding system can be used and further developed in future studies on robot-assisted group activities in the nursing home context and potentially in other settings. Additionally, our pilot study indicates that cognitive and physical stimulation of older adults can be promoted by social robots in a group setting. This finding encourages future technological development and improvement of social robots and points to the potential of observational research to systematically evaluate such developments. ", doi="10.2196/48031", url="https://rehab.jmir.org/2023/1/e48031", url="http://www.ncbi.nlm.nih.gov/pubmed/38145484" } @Article{info:doi/10.2196/44715, author="Rochette, Annie and Thomas, Aliki and Salbach, M. Nancy and Vachon, Brigitte and Menon, Anita and Poissant, Lise and Boutin, Maurane and Grad, Roland and Pluye, Pierre", title="Expected Health Benefits as the Ultimate Outcome of Information Available on Stroke Engine, a Knowledge Translation Stroke Rehabilitation Website: Web-Based Survey", journal="JMIR Rehabil Assist Technol", year="2023", month="May", day="8", volume="10", pages="e44715", keywords="crowdsourcing", keywords="health-related information", keywords="internet", keywords="knowledge translation", keywords="rehabilitation", keywords="stroke", abstract="Background: Electronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week. Objective: With the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users' perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted. Methods: A web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments. Results: The sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22\%) and students (2784/6634, 41.97\%) represented 97.18\% (6447/6634) of the total responses. The remaining 2.82\% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31\%) and their relatives (100/6634, 1.51\%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64\%) and students (1228/2437, 50.39\%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59\%) and their relatives (57/91, 63\%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67\%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4\%) and a feeling of being reassured for individuals with stroke (26/75, 35\%) and their relatives (28/97, 29\%). Conclusions: Valuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development. ", doi="10.2196/44715", url="https://rehab.jmir.org/2023/1/e44715", url="http://www.ncbi.nlm.nih.gov/pubmed/37155228" } @Article{info:doi/10.2196/50438, author="Smayda, Elisabeth Kirsten and Cooper, Hodsdon Sarah and Leyden, Katie and Ulaszek, Jackie and Ferko, Nicole and Dobrin, Annamaria", title="Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="20", volume="10", pages="e50438", keywords="chronic stroke", keywords="walking", keywords="InTandem", keywords="MR-001", keywords="neurorehabilitation", keywords="human factors engineering", keywords="usability", keywords="rhythmic auditory stimulation", keywords="validation", keywords="neurotherapeutic", abstract="Background: Persistent walking impairment following a stroke is common. Although rehabilitative interventions exist, few exist for use at home in the chronic phase of stroke recovery. InTandem (MedRhythms, Inc) is a neurorehabilitation system intended to improve walking and community ambulation in adults with chronic stroke walking impairment. Objective: Using design best practices and human factors engineering principles, the research presented here was conducted to validate the safe and effective use of InTandem. Methods: In total, 15 participants in the chronic phase of stroke recovery (?6 months after stroke) participated in this validation study. Participants were scored on 8 simulated use tasks, 4 knowledge assessments, and 7 comprehension assessments in a simulated home environment. The number and types of use errors, close calls, and operational difficulties were evaluated. Analyses of task performances, participant behaviors, and follow-up interviews were conducted to determine the root cause of use errors and difficulties. Results: During this validation study, 93\% (14/15) of participants were able to successfully complete the critical tasks associated with the simulated use of the InTandem system. Following simulated use task assessments, participants' knowledge and comprehension of the instructions for use and key safety information were evaluated. Overall, participants were able to find and correctly interpret information in the materials in order to answer the knowledge assessment questions. During the comprehension assessment, participants understood warning statements associated with critical tasks presented in the instructions for use. Across the entire study, 3 ``use errors'' and 1 ``success with difficulty'' were recorded. No adverse events, including slips, trips, or falls, occurred in this study. Conclusions: In this validation study, people in the chronic phase of stroke recovery were able to safely and effectively use InTandem in the intended use environment. This validation study contributes to the overall understanding of residual use--related risks of InTandem in consideration of the established benefits. ", doi="10.2196/50438", url="https://rehab.jmir.org/2023/1/e50438", url="http://www.ncbi.nlm.nih.gov/pubmed/37983080" } @Article{info:doi/10.2196/49702, author="Alder, Gemma and Taylor, Denise and Rashid, Usman and Olsen, Sharon and Brooks, Thonia and Terry, Gareth and Niazi, Khan Imran and Signal, Nada", title="A Brain Computer Interface Neuromodulatory Device for Stroke Rehabilitation: Iterative User-Centered Design Approach", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="11", volume="10", pages="e49702", keywords="user-centered design", keywords="stroke", keywords="rehabilitation technology", keywords="wearable technology", keywords="brain computer interface", keywords="BCI", keywords="mobile app", keywords="think-aloud", keywords="near live", keywords="semistructured interviews", abstract="Background: Rehabilitation technologies for people with stroke are rapidly evolving. These technologies have the potential to support higher volumes of rehabilitation to improve outcomes for people with stroke. Despite growing evidence of their efficacy, there is a lack of uptake and sustained use in stroke rehabilitation and a call for user-centered design approaches during technology design and development. This study focuses on a novel rehabilitation technology called exciteBCI, a complex neuromodulatory wearable technology in the prototype stage that augments locomotor rehabilitation for people with stroke. The exciteBCI consists of a brain computer interface, a muscle electrical stimulator, and a mobile app. Objective: This study presents the evaluation phase of an iterative user-centered design approach supported by a qualitative descriptive methodology that sought to (1) explore users' perspectives and experiences of exciteBCI and how well it fits with rehabilitation, and (2) facilitate modifications to exciteBCI design features. Methods: The iterative usability evaluation of exciteBCI was conducted in 2 phases. Phase 1 consisted of 3 sprint cycles consisting of single usability sessions with people with stroke (n=4) and physiotherapists (n=4). During their interactions with exciteBCI, participants used a ``think-aloud'' approach, followed by a semistructured interview. At the end of each sprint cycle, device requirements were gathered and the device was modified in preparation for the next cycle. Phase 2 focused on a ``near-live'' approach in which 2 people with stroke and 1 physiotherapist participated in a 3-week program of rehabilitation augmented by exciteBCI (n=3). Participants completed a semistructured interview at the end of the program. Data were analyzed from both phases using conventional content analysis. Results: Overall, participants perceived and experienced exciteBCI positively, while providing guidance for iterative changes. Five interrelated themes were identified from the data: (1) ``This is rehab'' illustrated that participants viewed exciteBCI as having a good fit with rehabilitation practice; (2) ``Getting the most out of rehab'' highlighted that exciteBCI was perceived as a means to enhance rehabilitation through increased engagement and challenge; (3) ``It is a tool not a therapist,'' revealed views that the technology could either enhance or disrupt the therapeutic relationship; and (4) ``Weighing up the benefits versus the burden'' and (5) ``Don't make me look different'' emphasized important design considerations related to device set-up, use, and social acceptability. Conclusions: This study offers several important findings that can inform the design and implementation of rehabilitation technologies. These include (1) the design of rehabilitation technology should support the therapeutic relationship between the patient and therapist, (2) social acceptability is a design priority in rehabilitation technology but its importance varies depending on the use context, and (3) there is value in using design research methods that support understanding usability in the context of sustained use. ", doi="10.2196/49702", url="https://rehab.jmir.org/2023/1/e49702", url="http://www.ncbi.nlm.nih.gov/pubmed/38079202" } @Article{info:doi/10.2196/43507, author="Topp, Robert and Greenstein, Jay and Etnoyer-Slaski, Jena", title="The Effect of a Mobile Health App on Treatment Adherence and Revenue at Physical Health Clinics: Retrospective Record Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="28", volume="10", pages="e43507", keywords="physical health", keywords="completion of therapy", keywords="phone app", keywords="clinic charges and payments", keywords="payment", keywords="cost", keywords="physiotherapy", keywords="physical therapy", keywords="adherence", keywords="attrition", keywords="mobile phone", keywords="reminder", keywords="mobile health", keywords="mHealth", keywords="health app", keywords="mobile app", abstract="Background: A significant number of patients do not adhere to their prescribed course of physical therapy or discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contributes to patients achieving the goals of therapy including reducing pain and increasing functionality. Web-based platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain, similar to managing them in person. Behavior change techniques introduced through digital or web-based platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. Literature also indicates that a phone-based app provided to patients, which includes a reward-incentive gamification to complement their care, contributed to a greater number of kept appointments in a physical therapy clinic. Objective: This study aims to compare the rate of provider discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. Methods: A retrospective analysis of all new outpatient medical records (N=5328) from a multisite physical health practice was conducted between January 2018 and December 2019. Patients in the sample self-selected the 2018 Usual Care, the 2019 Usual Care, or the 2019 Kanvas App groups. Kanvas is a customized private practice app, designed for patient engagement with their specific health care provider. This app included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record, each patient was classified as completing their prescribed therapy (provider discharged) or not completing their prescribed therapy (self-discharged). Additionally, the total number of clinic visits each patient attended, the total charges for services, and the total payments received by the clinic per patient were extracted from each patient's medical record. Results: Patients in the 2019 Kanvas App Group exhibited a higher rate of provider discharge compared to patients who did not adopt the app. This greater rate of provider discharges among the patients who adopted the Kanvas app likely contributed to this group attending more clinic visits (13.21, SD 12.09) than the other study groups who did not download the app (10.72, SD 9.80 to 11.35, SD 11.10). This greater number of clinic visits in turn contributed to the patients who adopted the app generating more clinic charges and payments. Conclusions: Future investigators need to employ more rigorous methods to confirm these findings, and clinicians need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas app. ", doi="10.2196/43507", url="https://rehab.jmir.org/2023/1/e43507", url="http://www.ncbi.nlm.nih.gov/pubmed/36889337" } @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/10.2196/46217, author="G{\"u}nther, Florian and Schober, Fabian and Hunger, Sandra and Schellnock, Julia and Derlien, Steffen and Schleifenbaum, Stefan and Drossel, Welf-Guntram and Heyde, Christoph-Eckhard", title="Improving Home-Based Scoliosis Therapy: Findings From a Web-Based Survey", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="4", volume="10", pages="e46217", keywords="scoliosis therapy", keywords="Schroth therapy", keywords="home-based exercise", keywords="home program", keywords="physiotherapeutic scoliosis-specific exercises (PSSE)", keywords="adherence", keywords="assistive devices", keywords="exercise system", keywords="digital tools", keywords="eHealth", abstract="Background: Conservative scoliosis therapy in the form of assisted physiotherapeutic scoliosis exercises is supplemented by self-contained training at home, depending on the approach (eg, Schroth, the Scientific Exercises Approach to Scoliosis). Complex exercises, lack of awareness of the importance of training, and missing supervision by therapists often lead to uncertainty and reduced motivation, which in turn reduces the success of home-based therapy. Increasing digitalization in the health care sector offers opportunities to close this gap. However, research is needed to analyze the requirements and translate the potential of digital tools into concrete solution concepts. Objective: The aim of this study is to evaluate the potential for optimizing home-based scoliosis therapy in terms of motivation, assistive devices, and digital tools. Methods: In collaboration with the Institute of Physiotherapy at the Jena University Hospital, a survey was initiated to address patients with scoliosis and physical therapists. A digital questionnaire was created for each target group and distributed via physiotherapies, scoliosis forums, the Bundesverband f{\"u}r Skoliose Selbsthilfe e. V. newsletter via a link, and a quick response code. The survey collected data on demographics, therapy, exercise habits, motivation, assistive devices, and digital tools. Descriptive statistics were used for evaluation. Results: Of 141 survey participants, 72 (51.1\%; n=62, 86.1\%, female; n=10, 13.9\%, male) patients with scoliosis with an average age of 40 (SD 17.08) years and 30 scoliosis therapists completed the respective questionnaires. The analysis of home-based therapy showed that patients with scoliosis exercise less per week (2 times or less; 45/72, 62.5\%) than they are recommended to do by therapists (at least 3 times; 53/72, 73.6\%). Patients indicated that their motivation could be increased by practicing together with friends and acquaintances (54/72, 75\%), a supporting therapy device (48/72, 66.7\%), or a digital profile (46/72, 63.9\%). The most important assistive devices, which are comparatively rarely used in home-based therapy, included balance boards (20/72, 27.8\%), wall bars (23/72, 31.9\%), mirrors (36/72, 50\%), and long bars (40/72, 55.6\%). Therapists saw the greatest benefit of digital tools for scoliosis therapy in increasing motivation (26/30, 87\%), improving home therapy (25/30, 83\%), monitoring therapy progress (25/30, 83\%), and demonstrating exercise instructions (24/30, 80\%). Conclusions: In this study, we investigated whether there is any potential for improvement in home-based scoliosis therapy. For this purpose, using online questionnaires, we asked patients with scoliosis and therapists questions about the following topics: exercise habits, outpatient and home-based therapy, motivation, supportive devices, and digital tools. The results showed that a lack of motivation, suitable training equipment, and tools for self-control leads to a low training workload. From the perspective of the patients surveyed, this problem can be addressed through community training with friends or acquaintances, a supportive therapy device, and digital elements, such as apps, with training instructions and user profiles. ", doi="10.2196/46217", url="https://rehab.jmir.org/2023/1/e46217", url="http://www.ncbi.nlm.nih.gov/pubmed/37540557" } @Article{info:doi/10.2196/40680, author="Mate, V. Kedar K. and Abou-Sharkh, Ahmed and Mansoubi, Maedeh and Alosaimi, Aeshah and Dawes, Helen and Michael, Wright and Stanwood, Olivia and Harding, Sarah and Gorenko, Daniel and Mayo, E. Nancy", title="Evidence for the Efficacy of Commercially Available Wearable Biofeedback Gait Devices: Consumer-Centered Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Apr", day="19", volume="10", pages="e40680", keywords="wearables", keywords="technologies", keywords="walking training", keywords="rehabilitation", keywords="biofeedback", keywords="mobile phone", abstract="Background: The number of wearable technological devices or sensors that are commercially available for gait training is increasing. These devices can fill a gap by extending therapy outside the clinical setting. This was shown to be important during the COVID-19 pandemic when people could not access one-on-one treatment. These devices vary widely in terms of mechanisms of therapeutic effect, as well as targeted gait parameters, availability, and strength of the evidence supporting the claims. Objective: This study aimed to create an inventory of devices targeting improvement in gait pattern and walking behavior and identify the strength of the evidence underlying the claims of effectiveness for devices that are commercially available to the public. Methods: As there is no systematic or reproducible way to identify gait training technologies available to the public, we used a pragmatic, iterative approach using both the gray and published literature. Four approaches were used: simple words, including some suggested by laypersons; devices endorsed by condition-specific organizations or charities; impairment-specific search terms; and systematic reviews. A findable list of technological devices targeting walking was extracted separately by 3 authors. For each device identified, the evidence for efficacy was extracted from material displayed on the websites, and full-text articles were obtained from the scientific databases PubMed, Ovid MEDLINE, Scopus, or Google Scholar. Additional information on the target population, mechanism of feedback, evidence for efficacy or effectiveness, and commercial availability was obtained from the published material or websites. A level of evidence was assigned to each study involving the device using the Oxford Centre for Evidence-Based Medicine classification. We also proposed reporting guidelines for the clinical appraisal of devices targeting movement and mobility. Results: The search strategy for this consumer-centered review yielded 17 biofeedback devices that claim to target gait quality improvement through various sensory feedback mechanisms. Of these 17 devices, 11 (65\%) are commercially available, and 6 (35\%) are at various stages of research and development. Of the 11 commercially available devices, 4 (36\%) had findable evidence for efficacy potential supporting the claims. Most of these devices were targeted to people living with Parkinson disease. The reporting of key information about the devices was inconsistent; in addition, there was no summary of research findings in layperson's language. Conclusions: The amount of information that is currently available to the general public to help them make an informed choice is insufficient, and, at times, the information presented is misleading. The evidence supporting the effectiveness does not cover all aspects of technology uptake. Commercially available technologies help to provide continuity of therapy outside the clinical setting, but there is a need to demonstrate effectiveness to support claims made by the technologies. ", doi="10.2196/40680", url="https://rehab.jmir.org/2023/1/e40680", url="http://www.ncbi.nlm.nih.gov/pubmed/37074771" } @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/10.2196/46408, author="G{\aa}sv{\ae}r, Inge Jo and Jepsen, Randi and Heldal, Ilona and Sudmann, Tobba", title="Supporting Collaboration in Rehabilitation Trajectories With Information and Communication Technologies: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="11", volume="10", pages="e46408", keywords="rehabilitation", keywords="shared decision-making", keywords="ICT system", keywords="decision support systems", keywords="remote dialogue", keywords="patient participation", abstract="Background: Despite a surge in health information and communication technology (ICT), there is little evidence of lowered cost or increased quality of care. ICT may support patients, health care providers, and other stakeholders through complex rehabilitation trajectories by offering digital platforms for collaboration, shared decision-making, and safe storage of data. Yet, the questions on how ICT can become a useful tool and how the complex intersection between producers and users of ICT should be solved are challenging. Objective: This study aims to review the literature on how ICTs are used to foster collaboration among the patient, the provider, and other stakeholders. Methods: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies were identified by searching MEDLINE (OVID), Embase (OVID), CINAHL (EBSCOhost), AMED (EBSCOhost), and Scopus. Unpublished studies were extracted from OAIster, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, NARIC, and Google Scholar. Eligible papers addressed or described a remote dialogue between stakeholders using ICT to address goals and means, provide decision support, or evaluate certain treatment modalities within a rehabilitation context. Due to the rapid development of ICTs, searches included studies published in the period of 2018-2022. Results: In total, 3206 papers (excluding duplicates) were screened. Three papers met all inclusion criteria. The papers varied in design, key findings, and key challenges. These 3 studies reported outcomes such as improvements in activity performance, participation, frequency of leaving the house, improved self-efficacy, change in patients' perspective on possibilities, and change in professionals' understanding of patients' priorities. However, a misfit between the participants' needs and the technology offered, complexity and lack of availability of the technology, difficulties with implementation and uptake, and lack of flexibility in setup and maintenance reduced the value of ICT for those involved in the studies. The low number of included papers is probably due to the complexity of remote collaboration with ICT. Conclusions: ICT has the potential to facilitate communication among stakeholders in the complex and collaborative context of rehabilitation trajectories. This scoping review indicates that there is a paucity of research considering remote ICT-supported collaboration in health care and rehabilitation trajectories. Furthermore, current ICT builds on eHealth literacy, which may differ among stakeholders, and the lack of sufficient eHealth literacy and ICT knowledge creates barriers for access to health care and rehabilitation. Lastly, the aim and results of this review are probably most relevant in high-income countries. ", doi="10.2196/46408", url="https://rehab.jmir.org/2023/1/e46408", url="http://www.ncbi.nlm.nih.gov/pubmed/37432715" } @Article{info:doi/10.2196/41359, author="Alhasani, Rehab and George, Nicole and Radman, Dennis and Auger, Claudine and Ahmed, Sara", title="Methodologies for Evaluating the Usability of Rehabilitation Technologies Aimed at Supporting Shared Decision-Making: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="15", volume="10", pages="e41359", keywords="usability", keywords="technology", keywords="rehabilitation", keywords="shared decision-making", keywords="mobile phone", abstract="Background: The field of rehabilitation has seen a recent rise in technologies to support shared decision-making (SDM). Usability testing during the design process of SDM technologies is needed to optimize adoption and realize potential benefits. There is variability in how usability is defined and measured. Given the complexity of usability, a thorough examination of the methodologies used to measure usability to develop the SDM technologies used in rehabilitation care is needed. Objective: This scoping review aims to answer the following research questions: which methods and measures have been used to produce knowledge about the usability of rehabilitation technologies aimed at supporting SDM at the different phases of development and implementation? Which parameters of usability have been measured and reported? Methods: This review followed the Arksey and O'Malley framework. An electronic search was performed in the Ovid MEDLINE, Embase, CINAHL, and PsycINFO databases from January 2005 up to November 2020. In total, 2 independent reviewers screened all retrieved titles, abstracts, and full texts according to the inclusion criteria and extracted the data. The International Organization for Standardization framework was used to define the scope of usability (effectiveness, efficiency, and satisfaction). The characteristics of the studies were outlined in a descriptive summary. Findings were categorized based on usability parameters, technology interventions, and measures of usability. Results: A total of 38 articles were included. The most common SDM technologies were web-based aids (15/33, 46\%). The usability of SDM technologies was assessed during development, preimplementation, or implementation, using 14 different methods. The most frequent methods were questionnaires (24/38, 63\%) and semistructured interviews (16/38, 42\%). Satisfaction (27/38, 71\%) was the most common usability parameter mapped to types of SDM technologies and usability evaluation methods. User-centered design (9/15, 60\%) was the most frequently used technology design framework. Conclusions: The results from this scoping review highlight the importance and the complexity of usability evaluation. Although various methods and measures were shown to be used to evaluate the usability of technologies to support SDM in rehabilitation, very few evaluations used in the included studies were found to adequately span the selected usability domains. This review identified gaps in usability evaluation, as most studies (24/38, 63\%) relied solely on questionnaires rather than multiple methods, and most questionnaires simply focused on the usability parameter of satisfaction. The consideration of end users (such as patients and clinicians) is of particular importance for the development of technologies to support SDM, as the process of SDM itself aims to improve patient-centered care and integrate both patient and clinician voices into their rehabilitation care. ", doi="10.2196/41359", url="https://rehab.jmir.org/2023/1/e41359", url="http://www.ncbi.nlm.nih.gov/pubmed/37581911" } @Article{info:doi/10.2196/47172, 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/10.2196/47114, 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/10.2196/51124, author="Borgnis, Francesca and Desideri, Lorenzo and Converti, Maria Rosa and Salatino, Claudia", title="Available Assistive Technology Outcome Measures: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="15", volume="10", pages="e51124", keywords="assistive technology", keywords="AT", keywords="AT assessment", keywords="AT outcome measures", keywords="rehabilitation", abstract="Background: The World Health Organization claimed that measuring outcomes is necessary to understand the benefits of assistive technology (AT) and create evidence-based policies and systems to ensure universal access to it. In clinical practice, there is an increasing need for standardized methods to track AT interventions using outcome assessments. Objective: This review provides an overview of the available outcome measures that can be used at the follow-up stage of any AT intervention and integrated into daily clinical or service practice. Methods: We systematically searched for original manuscripts regarding available and used AT outcome measures by searching for titles and abstracts in the PubMed, Scopus, and Web of Science databases up to March 2023. Results: We analyzed 955 articles, of which 50 (5.2\%) were included in the review. Within these, 53 instruments have been mentioned and used to provide an AT outcome assessment. The most widely used tool is the Quebec User Evaluation of Satisfaction with Assistive Technology, followed by the Psychosocial Impact of Assistive Technology Scale. Moreover, the identified measures addressed 8 AT outcome domains: functional efficacy, satisfaction, psychosocial impact, caregiver burden, quality of life, participation, confidence, and usability. The AT category Assistive products for activities and participation relating to personal mobility and transportation was the most involved in the reviewed articles. Conclusions: Among the 53 cited instruments, only 17 (32\%) scales were designed to evaluate specifically assistive devices. Moreover, 64\% (34/53) of the instruments were only mentioned once to denote poor uniformity and concordance in the instruments to be used, limiting the possibility of comparing the results of studies. This work could represent a good guide for promoting the use of validated AT outcome measures in clinical practice that can be helpful to AT assessment teams in their everyday activities and the improvement of clinical practice. ", doi="10.2196/51124", url="https://rehab.jmir.org/2023/1/e51124", url="http://www.ncbi.nlm.nih.gov/pubmed/37782310" } @Article{info:doi/10.2196/43813, author="Weber, Franziska and Kloek, Corelien and Arntz, Angela and Gr{\"u}neberg, Christian and Veenhof, Cindy", title="Blended Care in Patients With Knee and Hip Osteoarthritis in Physical Therapy: Delphi Study on Needs and Preconditions", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="7", volume="10", pages="e43813", keywords="telerehabilitation", keywords="osteoarthritis", keywords="physical therapy", keywords="knee", keywords="hip", keywords="blended", keywords="preconditions", keywords="Delphi", keywords="focus group", keywords="user need", abstract="Background: Osteoarthritis is a major public health concern. Despite existing evidence-based treatment options, the health care situation remains unsatisfactory. Digital care options, especially when combined with in-person sessions, seem to be promising. Objective: The aim of this study was to investigate the needs, preconditions, barriers, and facilitators of blended physical therapy for osteoarthritis. Methods: This Delphi study consisted of interviews, an online questionnaire, and focus groups. Participants were physical therapists, patients with hip and/or knee osteoarthritis with or without experience in digital care, and stakeholders of the health care system. In the first phase, interviews were conducted with patients and physical therapists. The interview guide was based on the Consolidated Framework For Implementation Research. The interviews focused on experiences with digital and blended care. Furthermore, needs, facilitators, and barriers were discussed. In the second phase, an online questionnaire and focus groups served the process to confirm the needs and collect preconditions. The online questionnaire contained statements drawn by the results of the interviews. Patients and physical therapists were invited to complete the questionnaire and participate in one of the three focus groups including (1) patients; (2) physical therapists; and (3) a patient, a physical therapist, and stakeholders from the health care system. The focus groups were used to determine concordance with the results of the interviews and the online questionnaire. Results: Nine physical therapists, seven patients, and six stakeholders confirmed that an increase of acceptance of the digital care part by physical therapists and patients is crucial. One of the most frequently mentioned facilitators was conducting regular in-person sessions. Physical therapists and patients concluded that blended physical therapy must be tailored to the patients' needs. Participants of the last focus group stated that the reimbursement of blended physical therapy needs to be clarified. Conclusions: Most importantly, it is necessary to strengthen the acceptance of patients and physical therapists toward digital care. Overall, for development and usage purposes, it is crucial to take the needs and preconditions into account. Trial Registration: German Clinical Trials Register DRKS00023386; https://drks.de/search/en/trial/DRKS00023386 ", doi="10.2196/43813", url="https://rehab.jmir.org/2023/1/e43813", url="http://www.ncbi.nlm.nih.gov/pubmed/37418301" } @Article{info:doi/10.2196/50571, author="Ota, Hirofumi and Mukaino, Masahiko and Inoue, Yukari and Matsuura, Shoh and Yagi, Senju and Kanada, Yoshikiyo and Saitoh, Eiichi and Otaka, Yohei", title="Movement Component Analysis of Reaching Strategies in Individuals With Stroke: Preliminary Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="5", volume="10", pages="e50571", keywords="stroke", keywords="upper limb paresis", keywords="compensatory movements", keywords="three-dimensional motion analysis", keywords="reaching movement", keywords="rehabilitation", keywords="motion analysis", keywords="reaching", keywords="3D", keywords="three dimensional", keywords="motion capture", keywords="motion", keywords="movement", keywords="limb", keywords="extremity", keywords="extremities", keywords="mobility", keywords="hemiparesis", keywords="paralysis", keywords="compensate", keywords="compensatory", abstract="Background: Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings. Objective: This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action. Methods: A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger's MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated. Results: A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5\%, SD 24.5\% vs mean 85.2\%, SD 4.5\%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0\%, SD 28.5\% vs mean 3.0\%, SD 2.8\%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8\%, SD 23.7\% vs mean 90.7\%, SD 11.8\%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5\%, SD 5.7\% vs mean 6.5\%, SD 3.0\%; P=.02 and mean 16.5\%, SD 18.7\% vs mean 3.0\%, SD 10.4\%; P=.02, respectively). Conclusions: Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation. ", doi="10.2196/50571", url="https://rehab.jmir.org/2023/1/e50571", url="http://www.ncbi.nlm.nih.gov/pubmed/38051570" } @Article{info:doi/10.2196/46575, author="Brehon, Katelyn and MacIsaac, Rob and Bhatia, Zahra and Buck, Taryn and Charbonneau, Rebecca and Crochetiere, Steven and Donia, Scott and Daoust, Jason and Ho, Chester and Kainth, Hardeep and Loewen, Janee and Lorch, Brandice and Mastrodimos, Kiesha and Neunzig, Brittney and Papathanassoglou, Elizabeth and Parmar, Rajvir and Pohar Manhas, Kiran and Tenove, Terry and Velji, Elysha and Loyola-Sanchez, Adalberto", title="Outcomes of Implementing a Webinar-Based Strategy to Improve Spinal Cord Injury Knowledge and Community Building: Convergent Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Jun", day="23", volume="10", pages="e46575", keywords="spinal cord injury", keywords="telehealth", keywords="webinars", keywords="mixed methods", keywords="implementation", abstract="Background: COVID-19 disrupted services received by persons with spinal cord injury (SCI) worldwide. The International Disability Alliance declared the need for a disability-inclusive response to the COVID-19 crisis, as decreased access to health care services for individuals living with varying levels of function was unacceptable. As a result, an SCI community in Canada created a novel webinar-based strategy aimed at improving access to self-management information for people living with SCI and other stakeholders. However, although telehealth practices have previously been used effectively in SCI management and rehabilitation, little to no scholarship has investigated the outcomes of implementing a webinar-based telehealth strategy in this population. Objective: This study aims to understand the outcomes of implementing the webinar series. Specifically, the authors aimed to determine the reach of the series; understand its impact on social connectedness, perceptions of disability, and overall quality of interactions among persons with SCI, their families, service providers, and the public at large; and explore the long-term sustainability of the initiative. Methods: The authors implemented a community-based participatory strategy to define a convergent mixed methods design to triangulate qualitative and quantitative data collected simultaneously. Quantitative methods included pop-up questions administered during the live webinars, surveys administered following webinars, and an analysis of YouTube analytics. Qualitative methods included semistructured interviews with persons with SCI and health care providers who attended at least one webinar. The results were integrated, following methods adapted from Creswell and Clark. Results: A total of 234 individuals attended at least 1 of the 6 webinars that took place during the 6-month study period. In total, 13.2\% (31/234) of the participants completed the postwebinar survey, and 23\% (7/31) participated in the semistructured interviews. The reach of the webinar series was mainly to persons with SCI, followed by health professionals, with most of them living in urban areas. The topics sexuality and research were the most viewed on YouTube. The knowledge disseminated during the webinars was mainly perceived as valid and useful, related to the fact that the presentation format involved people with lived experience and clinical experts. The webinars did not necessarily help build a new extended community of people involved in SCI but helped strengthen the existing community of people with SCI in Alberta. The webinar positively influenced the perceptions of normality and disability regarding people with SCI. The webinar format was perceived as highly usable and accessible. Conclusions: The webinar series was associated with improved participant knowledge of what is possible to achieve after an SCI and their perceptions of disability. The long-term implementation of this initiative is feasible, but further considerations to increase its reach to rural areas and ensure the integration of diverse individuals should be taken. ", doi="10.2196/46575", url="https://rehab.jmir.org/2023/1/e46575", url="http://www.ncbi.nlm.nih.gov/pubmed/37351945" } @Article{info:doi/10.2196/49813, author="Vos-Draper, L. Tamara and Morrow, B. Melissa M. and Ferguson, E. John and Mathiowetz, G. Virgil", title="Effects of Real-Time Pressure Map Feedback on Confidence in Pressure Management in Wheelchair Users With Spinal Cord Injury: Pilot Intervention Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Oct", day="12", volume="10", pages="e49813", keywords="spinal cord injury", keywords="wheelchair", keywords="pressure injury prevention", keywords="self-efficacy", keywords="pressure mapping", keywords="pressure", keywords="mapping", keywords="map", keywords="interface", keywords="spine", keywords="spinal cord", keywords="feedback", keywords="real time", keywords="mobile phone", abstract="Background: Wheelchair users with a spinal cord injury (SCI) are at a high risk for developing pressure injuries (PIs). Performing weight shifts is a primary method of pressure management for PI prevention; however, individuals with SCI may lack confidence in their abilities to perform adequate pressure relief due to their lack of sensation. Real-time seat interface pressure mapping feedback may provide partial substitution for sensory feedback such that an individual's confidence is improved. Objective: We aim to examine how confidence for pressure management by wheelchair users with SCI was impacted by providing access to real-time, on-demand seat interface pressure mapping feedback. Methods: Adults with SCI (N=23) completed self-efficacy questions addressing confidence around 4 factors related to performing weight shifts in this longitudinal, repeated-measures study. We evaluated the impact of providing standard PI prevention education and access to live pressure map feedback on confidence levels for performing weight shifts. Results: Access to live pressure map feedback while learning how to perform weight shifts resulted in significantly higher confidence about moving far enough to relieve pressure at high-risk areas. Confidence for adhering to the recommended weight shift frequency and duration was not significantly impacted by in-clinic education or use of pressure map feedback. Confidence that performing weight shifts reduces PI risk increased most following education, with slight additional increase when pressure map feedback was added. Conclusions: Access to live pressure mapping feedback improves confidence about performing weight shifts that relieve pressure when provided in the clinical setting and demonstrates potential for the same in the home. This preliminary exploration of a smartphone-based pressure mapping intervention highlights the value of access to continuous pressure mapping feedback to improve awareness and confidence for managing pressure. Trial Registration: ClinicalTrials.gov NCT03987243; https://clinicaltrials.gov/study/NCT03987243 ", doi="10.2196/49813", url="https://rehab.jmir.org/2023/1/e49813", url="http://www.ncbi.nlm.nih.gov/pubmed/37824188" } @Article{info:doi/10.2196/44591, 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/10.2196/45247, 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/10.2196/49673, 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/10.2196/47542, 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/10.2196/43985, author="Afzal, Waqar M. and Ahmad, Ashfaq and Hanif, Bilal Hafiz Muhammad and Chaudhary, Nauman and Gilani, Amir Syed", title="Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Sep", day="15", volume="10", pages="e43985", keywords="low back pain, lumbar range of motion", keywords="pain", keywords="Oswestry disability index", keywords="virtual reality", keywords="exercise", keywords="back pain", keywords="lumbar", keywords="range of motion", keywords="VR", keywords="rehabilitation", keywords="gaming", keywords="serious game", abstract="Background: Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation. Objective: This study aimed to compare the effects of VR games on chronic low back pain. Methods: This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P?.05. Results: The study comprised a sample of 40 patients with low back pain; 12 (40\%) were female and 28 (60\%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were --.60 (P=.76), --2.30 (P<.001), and --1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects. Conclusions: VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups. Trial Registration: Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916 ", doi="10.2196/43985", url="https://rehab.jmir.org/2023/1/e43985", url="http://www.ncbi.nlm.nih.gov/pubmed/37713252" } @Article{info:doi/10.2196/47227, author="Melman, Alla and Vella, P. Simon and Dodd, H. Rachael and Coombs, M. Danielle and Richards, Bethan and Rogan, Eileen and Teng, Jiat Min and Maher, G. Chris and Ghinea, Narcyz and Machado, C. Gustavo", title="Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="21", volume="10", pages="e47227", keywords="back", keywords="barrier", keywords="barriers", keywords="care model", keywords="eHealth", keywords="e-Health", keywords="enabler", keywords="enablers", keywords="facilitator", keywords="facilitators", keywords="health services research", keywords="healthcare delivery", keywords="implementation", keywords="interview", keywords="interviews", keywords="low back pain", keywords="model of care", keywords="pain", keywords="qualitative", keywords="remote care", keywords="service delivery", keywords="service", keywords="services", keywords="telehealth", keywords="telemedicine", keywords="virtual care", keywords="virtual hospital", abstract="Background: Alternate ``hospital avoidance'' models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called ``Back@Home'' and use qualitative interviews with stakeholders to develop and refine the model. Objective: We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. Methods: We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. Results: A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. Conclusions: The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups. ", doi="10.2196/47227", url="https://rehab.jmir.org/2023/1/e47227", url="http://www.ncbi.nlm.nih.gov/pubmed/37988140" } @Article{info:doi/10.2196/43309, author="Evans, Eric and Zengul, Ayse and Knight, Amy and Willig, Amanda and Cherrington, Andrea and Mehta, Tapan and Thirumalai, Mohanraj", title="Stakeholders' Perspectives, Needs, and Barriers to Self-Management for People With Physical Disabilities Experiencing Chronic Conditions: Focus Group Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="18", volume="10", pages="e43309", keywords="self-management", keywords="physical disabilities", keywords="physical disability", keywords="chronic condition", keywords="chronic illness", keywords="mental health", keywords="physical activity", keywords="barrier", keywords="disability", keywords="chronic", keywords="technology", keywords="interview", keywords="data", keywords="symptom", keywords="support", keywords="digital", keywords="development", keywords="need", keywords="perspective", keywords="qualitative", keywords="focus group", keywords="assistive technology", keywords="assistive technologies", abstract="Background: While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies. Objective: This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies. Methods: Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders' experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data. Results: A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties. Conclusions: The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders. Trial Registration: ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593 ", doi="10.2196/43309", url="https://rehab.jmir.org/2023/1/e43309", url="http://www.ncbi.nlm.nih.gov/pubmed/38109170" } @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/10.2196/39512, author="K{\"u}hn, Lukas and Lindert, Lara and Kuper, Paulina and Choi, Anna Kyung-Eun", title="SARS-CoV-2--Related Adaptation Mechanisms of Rehabilitation Clinics Affecting Patient-Centered Care: Qualitative Study of Online Patient Reports", journal="JMIR Rehabil Assist Technol", year="2023", month="Apr", day="13", volume="10", pages="e39512", keywords="patient-led care", keywords="patient autonomy", keywords="patient report", keywords="satisfaction", keywords="pandemic", keywords="coronavirus", keywords="inpatient", keywords="health care delivery", keywords="service delivery", keywords="rehabilitation", keywords="internet", keywords="web-based", keywords="reviews", keywords="complaint", keywords="rating", keywords="COVID-19", abstract="Background: The SARS-CoV-2 pandemic impacted access to inpatient rehabilitation services. At the current state of research, it is unclear to what extent the adaptation of rehabilitation services to infection-protective standards affected patient-centered care in Germany. Objective: The aim of this study was to determine the most relevant aspects of patient-centered care for patients in inpatient rehabilitation clinics under early phase pandemic conditions. Methods: A deductive-inductive framework analysis of online patient reports posted on a leading German hospital rating website, Klinikbewertungen (Clinic Reviews), was performed. This website is a third-party, patient-centered commercial platform that operates independently of governmental entities. Following a theoretical sampling approach, online reports of rehabilitation stays in two federal states of Germany (Brandenburg and Saarland) uploaded between March 2020 and September 2021 were included. Independent of medical specialty groups, all reports were included. Keywords addressing framework domains were analyzed descriptively. Results: In total, 649 online reports reflecting inpatient rehabilitation services of 31 clinics (Brandenburg, n=23; Saarland, n=8) were analyzed. Keywords addressing the care environment were most frequently reported (59.9\%), followed by staff prerequisites (33.0\%), patient-centered processes (4.5\%), and expected outcomes (2.6\%). Qualitative in-depth analysis revealed SARS-CoV-2--related reports to be associated with domains of patient-centered processes and staff prerequisites. Discontinuous communication of infection protection standards was perceived to threaten patient autonomy. This was amplified by a tangible gratification crisis of medical staff. Established and emotional supportive relationships to clinicians and peer groups offered the potential to mitigate the adverse effects of infection protection standards. Conclusions: Patients predominantly reported feedback associated with the care environment. SARS-CoV-2--related reports were strongly affected by increased staff workloads as well as patient-centered processes addressing discontinuous communication and organizationally demanding implementation of infection protection standards, which were perceived to threaten patient autonomy. Peer relationships formed during inpatient rehabilitation had the potential to mitigate these mechanisms. ", doi="10.2196/39512", url="https://rehab.jmir.org/2023/1/e39512", url="http://www.ncbi.nlm.nih.gov/pubmed/36947585" } @Article{info:doi/10.2196/43250, author="Briggs, S. Matthew and Kolbus, Shevawn Erin and Patterson, Michael Kevin and Harmon-Matthews, Elizabeth Lindsay and McGrath, Shana and Quatman-Yates, C. Catherine and Meirelles, Cristiane and Salsberry, Jean Marka", title="Role of Oral Intake, Mobility, and Activity Measures in Informing Discharge Recommendations for Hospitalized Inmate and Noninmate Patients With COVID-19: Retrospective Analysis", journal="JMIR Rehabil Assist Technol", year="2023", month="Jun", day="27", volume="10", pages="e43250", keywords="incarceration", keywords="Functional Oral Intake", keywords="Activity Measure for Postacute Care", keywords="speech language pathology", keywords="physical therapy", keywords="occupational therapy", keywords="COVID-19", abstract="Background: Patients who were incarcerated were disproportionately affected by COVID-19 compared with the general public. Furthermore, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. Objective: We aimed to compare the functional outcomes of oral intake, mobility, and activity between inmates and noninmates diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. Methods: A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including the Functional Oral Intake Scale and Activity Measure for Postacute Care (AM-PAC) were collected and compared between inmates and noninmates. Binary logistic regression models were used to evaluate the odds of whether patients were discharged to the same place they were admitted from and whether patients were being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95\% CIs of the odds ratios (ORs) did not include 1.0. Results: A total of 83 patients (inmates: n=38; noninmates: n=45) were included in the final analysis. There were no differences between inmates and noninmates in the initial (P=.39) and final Functional Oral Intake Scale scores (P=.35) or in the initial (P=.06 and P=.46), final (P=.43 and P=.79), or change scores (P=.97 and P=.45) on the AM-PAC mobility and activity subscales, respectively. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR 0.922, 95\% CI 0.875-0.972 and OR 0.918, 95\% CI 0.871-0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR 5.285, 95\% CI 1.334-20.931 and OR 6.083, 95\% CI 1.548-23.912), ``Other'' race (OR 7.596, 95\% CI 1.203-47.968 and OR 8.515, 95\% CI 1.311-55.291), and female sex (OR 4.671, 95\% CI 1.086-20.092 and OR 4.977, 95\% CI 1.146-21.615). Conclusions: The results of this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and noninmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic. ", doi="10.2196/43250", url="https://rehab.jmir.org/2023/1/e43250", url="http://www.ncbi.nlm.nih.gov/pubmed/37224276" } @Article{info:doi/10.2196/43615, author="Arntz, Angela and Weber, Franziska and Handgraaf, Marietta and L{\"a}ll{\"a}, Kaisa and Korniloff, Katariina and Murtonen, Kari-Pekka and Chichaeva, Julija and Kidritsch, Anita and Heller, Mario and Sakellari, Evanthia and Athanasopoulou, Christina and Lagiou, Areti and Tzonichaki, Ioanna and Salinas-Bueno, Iosune and Mart{\'i}nez-Bueso, Pau and Velasco-Rold{\'a}n, Olga and Schulz, Ralf-Joachim and Gr{\"u}neberg, Christian", title="Technologies in Home-Based Digital Rehabilitation: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="27", volume="10", pages="e43615", keywords="digital rehabilitation", keywords="digital technologies", keywords="home-based rehabilitation", keywords="digital health intervention", keywords="scoping review", keywords="artificial intelligence", keywords="AI", keywords="machine learning", keywords="COVID-19 pandemic", keywords="mobile app", keywords="remote health", keywords="mobile phone", abstract="Background: Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. Objective: In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. Methods: The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. Results: A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. Conclusions: Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic. ", doi="10.2196/43615", url="https://rehab.jmir.org/2023/1/e43615", url="http://www.ncbi.nlm.nih.gov/pubmed/37253381" } @Article{info:doi/10.2196/43436, author="Churchill, Laura and Morrow, Mary and Capin, J. Jacob and Jolley, E. Sarah and Hare, Kristine and MaWhinney, Samantha and Stevens-Lapsley, E. Jennifer and Erlandson, M. Kristine", title="Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="20", volume="10", pages="e43436", keywords="Fitbit", keywords="steps", keywords="COVID-19", keywords="hospitalization", keywords="rehabilitation", keywords="digital health intervention", keywords="physical activity", keywords="step count", keywords="mHealth application", keywords="tele-rehabilitation", abstract="Background: Knowledge on physical activity recovery after COVID-19 survival is limited. The AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors randomized participants, following hospital discharge, to either education and unstructured physical activity or a telerehabilitation program. Step count data were collected as a secondary outcome, and we found no significant differences in total step count trajectories between groups at 6 weeks. Further step count data were not analyzed. Objective: The purpose of this analysis was to examine step count trajectories and correlates among all participants (combined into a single group) across the 12-week study period. Methods: Linear mixed models with random effects were used to model daily steps over the number of study days. Models with 0, 1, and 2 inflection points were considered, and the final model was selected based on the highest log-likelihood value. Results: Participants included 44 adults (41 with available Fitbit [Fitbit LLC] data). Initially, step counts increased by an average of 930 (95\% CI 547-1312; P<.001) steps per week, culminating in an average daily step count of 7658 (95\% CI 6257-9059; P<.001) at the end of week 3. During the remaining 9 weeks of the study, weekly step counts increased by an average of 67 (95\% CI ?30 to 163; P<.001) steps per week, resulting in a final estimate of 8258 (95\% CI 6933-9584; P<.001) steps. Conclusions: Participants showed a marked improvement in daily step counts during the first 3 weeks of the study, followed by more gradual improvement in the remaining 9 weeks. Physical activity data and step count recovery trajectories may be considered surrogates for physiological recovery, although further research is needed to examine this relationship. Trial Registration: ClinicalTrials.gov NCT04663945; https://tinyurl.com/2p969ced ", doi="10.2196/43436", url="https://rehab.jmir.org/2023/1/e43436", url="http://www.ncbi.nlm.nih.gov/pubmed/36939818" }