%0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e68233 %T Physiotherapists’ User Acceptance of a Lower Limb Robotic Exoskeleton in Specialized Rehabilitation: Qualitative Exploratory Study %A Olimb Hillkirk,Anstein %A Skavberg Roaldsen,Kirsti %A Johnsen,Hege Mari %+ Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Jon Lilletuns vei 9, Grimstad, 4879, Norway, 47 97515773, hege.mari.johnsen@uia.no %K assistive technology %K clinical implementation %K deductive analysis %K robot-assisted gait training therapy %K RAGT %K user experiences %K unified theory of acceptance and use of technology %K UTAUT %K rehabilitation %D 2025 %7 16.4.2025 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Robotic lower limb exoskeletons have emerged as promising tools in the clinical rehabilitation of patients with lower limb paralysis due to neurological disease, stroke, or spinal cord injury. Identified benefits in gait function rehabilitation include improved gait function, cardiovascular effects, enhanced training quality, patient motivation, and reduced physical and psychological workload for therapists. Despite the identified benefits, the successful adoption of this technology largely depends on therapists’ user acceptance. Objective: This study aims to explore physiotherapists’ perceptions of using robot-assisted lower-limb gait training in specialized neurological rehabilitation using the unified theory of acceptance and use of technology framework. Methods: A qualitative, exploratory research design with a deductive approach was used. Semistructured interviews were conducted with 7 expert physiotherapists in a Norwegian specialized rehabilitation hospital. Data collection and analysis were guided by the unified theory of acceptance and use of technology framework. Results: The physiotherapists’ use of lower limb exoskeletons was greatly influenced by perceived benefits for patients or challenges, such as usability issues, the time required for adjustment to each patient, and the lack of personnel resources to facilitate their use. Thus, perceived usefulness and facilitating conditions (or lack thereof) had a great influence on the physiotherapists’ intentions to use and the actual use of the exoskeleton. Conclusions: This study identified several factors influencing the physiotherapists’ acceptance and integration of the lower limb exoskeleton. Available resources, such as time and personnel, were emphasized as important factors to increase the use of the exoskeleton in specialized rehabilitation. Our findings may inform service providers and engineers in specialized neurological rehabilitation settings. %M 40238235 %R 10.2196/68233 %U https://rehab.jmir.org/2025/1/e68233 %U https://doi.org/10.2196/68233 %U http://www.ncbi.nlm.nih.gov/pubmed/40238235 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e59688 %T Understanding Patient and Physiotherapist Requirements for a Personalized Automated Smartphone Telemonitored App for Posttotal Knee Arthroplasty Rehabilitation: Qualitative Study %A Chew,Eleanor Shuxian %A Scully,Aileen Eugenia %A Koh,Samanth Shi-Man %A Woon,Ee-Lin %A Low,Juanita Krysten Miao-Shi %A Kwan,Yu-Heng %A Tan,John Wei-Ming %A Pua,Yong-Hao %A Tan,Celia Ia-Choo %A Haseler,Luke Jonathan %K knee replacement %K knee arthroplasty %K mobile %K application %K interview %K telemonitored %K smartphone rehabilitation %K mobile phone %D 2025 %7 14.4.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Total knee arthroplasty (TKA) is a cost-effective surgical intervention for painful knee osteoarthritis in older adults, but postsurgery rehabilitation access is limited. Telerehabilitation offers a solution, but existing models require significant therapist involvement and a costly setup. A personalized smartphone-based automated program could be a cost-effective alternative. Objective: This study aimed to understand the requirements of both patients and physiotherapists in developing an automated telemonitored rehabilitation smartphone app for individuals undergoing TKA. To ensure uptake and long-term sustainability, this study adopted a person-based approach. Methods: A multistakeholder qualitative study of user needs was conducted. Physiotherapists and patients who underwent TKA were recruited via purposive sampling. Individual in-depth, hour-long interviews were conducted via Zoom by an experienced, trained female interviewer with a Master of Arts in Sociology. Data were audio-recorded and transcribed by the same interviewer. Two reviewers (ESC and SSK) independently analyzed the data using thematic analysis, with data triangulation achieved through cross-checking of data sources by 3 reviewers (ESC, SSK, and AES). Interviews were conducted to data saturation. Results: Six patients and 4 physiotherapists participated. For the patient interface, patients emphasized ease of use and specified features like a search function and multilingual options. For the physiotherapist interface, physiotherapists stated ease of accessing patient data and outcome measures for effective monitoring as important. Both patients and physiotherapists highlighted the need for timely, condition-specific information, supplemented by visual aids to support exercises, pain management, and recovery goals. They also stressed the significance of progress tracking, feedback, and the ability to access health care professionals for reassurance. Motivational features, including reminders, prompts, and exercise logs, were recommended to improve adherence. Both groups similarly identified the need for initial training to ensure confident use of the app. Conclusion: This study provided insights into the requirements of potential end users of a smartphone app for automated telemonitored rehabilitation following TKA. This is useful for steering the development of a user-centric smartphone app. %R 10.2196/59688 %U https://rehab.jmir.org/2025/1/e59688 %U https://doi.org/10.2196/59688 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e72466 %T The Effectiveness of Telerehabilitation in Managing Pain, Strength, and Balance in Adult Patients With Knee Osteoarthritis: Systematic Review %A Plavoukou,Theodora %A Iosifidis,Michail %A Papagiannis,Georgios %A Stasinopoulos,Dimitrios %A Georgoudis,Georgios %+ University of West Attica, 196 Alexandras Avenue, Athens, 11521, Greece, 30 210 538 748, tplavoukou@uniwa.gr %K telerehabilitation %K knee osteoarthritis %K pain management %K remote physiotherapy %K digital health %K remote therapy %K physiotherapy %K pain management %K strength %K balance %K functional mobility %K rehabilitation technology %D 2025 %7 8.4.2025 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Knee osteoarthritis (KOA) is a chronic, degenerative joint disease characterized by pain, stiffness, and functional impairment, significantly affecting mobility and quality of life. Traditional rehabilitation, mainly through in-person physiotherapy, is widely recommended for KOA management. However, access to these services is often limited due to geographic, financial, and mobility constraints. Telerehabilitation has emerged as an alternative, providing remote rehabilitation through digital platforms. Despite its increasing adoption, its effectiveness in improving key functional parameters such as pain, strength, and balance remains uncertain. While previous studies have focused primarily on pain relief and overall functional improvement, a broader assessment of its impact on mobility and fall prevention is needed. Objective: This systematic review examines the effectiveness of telerehabilitation in improving pain, strength, and balance in adults with KOA compared with traditional rehabilitation or no intervention. In addition, it evaluates the impact of different telerehabilitation models, such as therapist-guided versus self-managed programs, and explores the feasibility of integrating telerehabilitation as an alternative in KOA management. Methods: A systematic search of 4 databases (PubMed, PEDro, Cochrane, and Scopus) was conducted to identify randomized controlled trials (RCTs) published from May 2004 to May 2024. Inclusion criteria consisted of adults with KOA, evaluation of telerehabilitation either as a stand-alone intervention or in comparison to traditional rehabilitation or no intervention, and measurement of at least one primary outcome (pain, strength, or balance). A total of 2 independent reviewers assessed the risk of bias using validated tools. Due to variations in intervention programs and assessment methods, a narrative synthesis was performed instead of a meta-analysis. The review followed established guidelines, and data extraction was conducted using appropriate software. Results: A total of 6 RCTs (N=581 participants) met the inclusion criteria. The results indicate that telerehabilitation effectively reduces pain and improves strength and balance, although the extent of benefits varies. Some studies reported similar pain reductions between telerehabilitation and traditional rehabilitation, while others highlighted greater functional improvements in telerehabilitation groups. Therapist-guided telerehabilitation was associated with higher adherence rates and better functional outcomes compared with self-managed programs. The risk of bias assessment showed that most studies were of moderate to good quality, though common issues included selection bias, performance bias, and participant attrition. Conclusions: Telerehabilitation is a promising alternative for KOA management, especially for individuals facing barriers to in-person therapy. It is effective in reducing pain and improving strength and balance, though its success depends on patient engagement, intervention delivery, and rehabilitation protocols. Therapist-guided programs yield better outcomes than self-managed approaches. Further research is needed to standardize intervention protocols, integrate emerging technologies, and evaluate cost-effectiveness to guide clinical practice and health care policies. Trial Registration: PROSPERO CRD42024564141; https://tinyurl.com/25ykvy7d %M 40198917 %R 10.2196/72466 %U https://rehab.jmir.org/2025/1/e72466 %U https://doi.org/10.2196/72466 %U http://www.ncbi.nlm.nih.gov/pubmed/40198917 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e65342 %T Assessment of Pelvic Motion During Single-Leg Weight-Bearing Tasks Using Smartphone Sensors: Validity Study %A Xi,Yu %A Li,Zhongsheng %A Vatatheeswaran,Surendran %A Devecchi,Valter %A Gallina,Alessio %K smartphone %K kinematics %K acceleration %K exercise %K squat %D 2025 %7 1.4.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Clinicians and athletic training specialists often assess the performance of single-leg, weight-bearing tasks to monitor rehabilitation progress and guide exercise progression. Some of the key metrics assessed are excessive pelvic motion, balance, and duration of each repetition of the exercise. Motion can be objectively characterized using motion capture (MOCAP); however, MOCAP is often not available in clinics due to the high costs and complexity of the analyses. Smartphones have built-in sensors that can be used to measure changes in body segment orientation and acceleration, which may make them a more feasible and affordable technology to use in practice. Objective: This study aimed to determine if, compared to gold-standard MOCAP, smartphone sensors can provide valid measures of pelvic orientation, acceleration, and repetition duration during single-leg tasks in healthy individuals. Methods: Overall, 52 healthy participants performed single-leg squats and step-down tasks from heights of 15 and 20 cm. Pelvic motion was assessed using MOCAP and a smartphone placed over the sacrum. The MATLAB (MathWorks) mobile app was used to collect smartphone acceleration and orientation data. Individual repetitions of each exercise were manually identified, and the following outcomes were extracted: duration of the repetition, mediolateral acceleration, and 3D pelvic orientation at peak squat. Validity was assessed by comparing metrics assessed with a smartphone and MOCAP using intraclass correlation coefficients (ICCs) and paired Wilcoxon tests. Differences between tasks were compared using 1-way ANOVA or the Friedman test. Results: Across the 3 single-leg tasks, smartphone estimates demonstrated consistently high agreement with the MOCAP for all metrics (ICC point estimates: >0.8 for mediolateral acceleration and frontal plane orientation; >0.9 for squat duration and orientation on the sagittal and transverse plane). Bias was identified for most outcomes (multiple P<.001). Both smartphone and MOCAP recordings identified clear differences between tasks, with step-down tasks usually requiring larger changes in pelvic orientation and larger mediolateral sways. Duration did not differ between tasks. Conclusions: Despite a consistent bias, the smartphone demonstrated good to excellent validity relative to gold-standard MOCAP for most outcomes. This demonstrates that smartphones offer an accessible and affordable tool to objectively characterize pelvic motion during different single-leg weight-bearing tasks in healthy participants. Together with earlier reports of good between-day reliability of similar measures during single-leg squats, our results suggest that smartphone sensors can be used to assess and monitor single-leg task performance. Future studies should investigate whether smartphone sensors can aid in the assessment and treatment of people with musculoskeletal disorders. More user-friendly interfaces and data analysis procedures may also facilitate the implementation of this technology in practice. %R 10.2196/65342 %U https://rehab.jmir.org/2025/1/e65342 %U https://doi.org/10.2196/65342 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e64729 %T Home-Based Nonimmersive Virtual Reality Training After Discharge From Inpatient or Outpatient Stroke Rehabilitation: Parallel Feasibility Randomized Controlled Trial %A Sheehy,Lisa %A Taillon-Hobson,Anne %A Sveistrup,Heidi %A Bilodeau,Martin %A Yang,Christine %A Welch,Vivian %A Finestone,Hillel %+ , Bruyère Health Research Institute, 43 Bruyère St, Ottawa, ON, K1N5C8, Canada, 1 613 562 6262 ext 1593, lsheehy@bruyere.org %K virtual reality %K telerehabilitation %K stroke %K home %K exercises %K physical activity %K physiotherapy %K exergames %K rehabilitation intensity %K randomized controlled feasibility trial %K motor %K movement %K patient care %K patient engagement %K health intervention %K stroke rehabilitation %K interactive games %K game therapy %K interactive therapy %K rehabilitation %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy. Objective: The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait. Methods: Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor. Results: NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups. Conclusions: Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required. Trial Registration: ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3438-9 %M 40153779 %R 10.2196/64729 %U https://rehab.jmir.org/2025/1/e64729 %U https://doi.org/10.2196/64729 %U http://www.ncbi.nlm.nih.gov/pubmed/40153779 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58393 %T Effect of Clinic-Based and Asynchronous Video-Based Exercise on Clinic and Psychosocial Outcomes in Patients With Knee Osteoarthritis: Quasi-Experimental Study %A Mbada,Chidozie E %A Awosika,Henry Akintunji %A Sonuga,Oluwatobi Ademola %A Akande,Micheal %A Gebrye,Tadesse %A Woolf,Richard %A Fatoye,Francis %+ Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6GX, United Kingdom, 44 161 247 2963, c.mbada@mmu.ac.uk %K knee osteoarthritis %K video %K physiotherapy %K exercise %K mobile phone %K telehealth %K telemedicine %K randomized %K controlled trial %K asynchronous %K rehabilitation %K knees %K joints %K osteoarthritis %K musculoskeletal %K rheumatology %K physical therapy %D 2025 %7 26.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Telerehabilitation is promising for improving knee osteoarthritis, but the effect of different telerehabilitation strategies on knee osteoarthritis is unclear. Objective: This study aimed to examine the effect of a clinic-based strengthening exercise (CbSE) and asynchronous video-based strengthening exercise (AVbSE) on pain, range of motion, muscle strength, quality of life, and physical function among patients with knee osteoarthritis. Methods: A total of 52 consenting patients participated in this 8-week experimental study; they were assigned to the CbSE or AVbSE group at 2 different study sites. CbSE is a circuit exercise module comprising knee flexion and extension warm-up in sitting, quadriceps isometric setting, quadriceps strengthening exercise, hamstring clenches, wall squat, and a cooldown of knee flexion and extension. The AVbSE is an asynchronous video-based version of the CbSE. Results: This study spanned from March 31, 2021, to November 26, 2021. Eight out of 62 participants discontinued participation. Data collection and analysis have been completed. Significant differences were only observed in the mental health (t50=–3, P=.004), pain (t39.4=–3.6, P<.001), social support (t50=–2.7, P=.009), and social activities (t50=2.2, P=.03) domains of the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire with higher scores in the AVbSE group at the end of week 4. At the end of week 8, significant differences were observed in mental health (t50=–2.1, P=.04) and pain (t37.3=–2.8, P=.008) measures with higher scores in AVbSE; however, a significantly higher score was observed in the CbSE group for the Quadruple Visual Analog Scale. No significant main effect of time was observed in this study, except in the muscle strength (F2100=1.5, P=.24), social support (F2100=2.5, P=.09), and social activity (F2100=0.7, P=.48) domains of the OAKHQoL questionnaire and activity limitation (F2100=0.1, P=.90), and performance restriction (F2100=1.3, P=.27) domains of the Ibadan Knee and Hip Osteoarthritis Outcome Measure (IKHOAM) questionnaire. There was no significant difference between groups in all OAKHQoL domains except social activities (mean 17.6, SD 1.2 vs 22.8, SD 1.2; P=.003) and average pain (2.8, SD 1.6 vs 2.3, SD 1.6; P=.03) with higher AVbSE mean scores. However, a higher score was observed for the CbSE group in the Quadruple Visual Analog Scale’s least pain domain (1.2, SD 0.2 vs 0.7, SD 0.2; P=.04). Also, interaction effects showed that AVbSE scores were significantly higher for the OAKHQoL questionnaire’s physical activity and mental health domains at all time points. However, the CbSE score was higher for the physical performance domain of the IKHOAM questionnaire in the eighth week. Conclusions: CbSE circuit training and its AVbSE variant effectively improve treatment outcomes and increase the quality of life of patients. While AVbSE was associated with higher improvement in most health-related quality of life domains, CbSE led to higher improvement in average pain. Trial Registration: Pan African Clinical Trial Registry PACTR202208515182119, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23943 %M 40138680 %R 10.2196/58393 %U https://www.jmir.org/2025/1/e58393 %U https://doi.org/10.2196/58393 %U http://www.ncbi.nlm.nih.gov/pubmed/40138680 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 4 %N %P e67779 %T A Game-Based Mechatronic Device for Digital Rehabilitation of Hand Function After a Stroke: Design, Prototyping, and Feasibility Study %A Kanitkar,Anuprita %A Sepehri,Nariman %A Lezen,Ariel %A Parmar,Sanjay Tejraj %A Hin,Cherry Kit-Fong %A Szturm,Tony Joseph %K stroke %K manual dexterity %K hand function %K poststroke %K fine motor %K thumb %K finger %K wrist %K movement %K motor rehabilitation %K assistive technology %K smart monitoring %K pilot %K feasibility %K prototyping %K prototype %K nervous system %K nerve %K motor neuron %D 2025 %7 19.3.2025 %9 %J JMIR Neurotech %G English %X Background: This paper presents an easy-to-use, affordable robotic manipulandum device (RMD) equipped with smart monitoring and assistive technologies to engage in game-based exercise and repetitive task practice. The RMD has been designed to enhance a wide range of fine motor manual dexterity skills, including thumb, finger, and wrist movements. By focusing on finger and hand functions, it extends its utility beyond basic reaching or object transfer movements. Various interchangeable 3D-printed therapy handles of different shapes and sizes can be easily attached to the RMD drive shaft. These handle movements can be used to engage with numerous affordable, commercially available computer games, allowing patients to practice tasks that involve varying movement amplitudes, speeds, precision, and cognitive challenges. Additionally, the device is capable of automatically recording and storing the patient’s real-time performance data on any given computer, integrating assessment into treatment. Objective: A pilot study was conducted with 5 patients with stroke to examine the feasibility and benefits of a 6-week game-based exercise program using the proposed device. Methods: A feasibility study was conducted with 5 participants. Data were collected using the computer game–based upper extremity assessment of manual dexterity and Wolf Motor Function Test (WMFT) before and after the intervention lasting 6 weeks. Results: The pilot study demonstrated that clients’ expectations related to manual dexterity were met. The average improvement in the functional ability score of the WMFT was 14 (SD 3) points, with all participants exceeding the minimal clinically important difference. The average reduction in total time was 30 (SD 14) seconds, with 4 of 5 participants surpassing the minimal clinically important difference. For the computer game–based upper extremity assessment, the average improvement in success rate was 23% (SD 12%), and the average decrease in response time was 105 (SD 44) milliseconds. Conclusions: Findings revealed acceptable, engaging, game-based, and task-oriented training with a high level of compliance. Substantial improvements from pre- to postintervention were observed using the WMFT and assessments of manual dexterity. Trial Registration: ClinicalTrials.gov NCT05071885; https://clinicaltrials.gov/study/NCT05071885 %R 10.2196/67779 %U https://neuro.jmir.org/2025/1/e67779 %U https://doi.org/10.2196/67779 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69150 %T Kinetic Pattern Recognition in Home-Based Knee Rehabilitation Using Machine Learning Clustering Methods on the Slider Digital Physiotherapy Device: Prospective Observational Study %A Twumasi,Clement %A Aktas,Mikail %A Santoni,Nicholas %+ Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, United Kingdom, 44 7411484454, clement.twumasi@ndm.ox.ac.uk %K machine learning %K cluster analysis %K force measurement %K knee replacement %K musculoskeletal %K physical therapy %K Slider device %K knee osteoarthritis %K digital health %K telerehabilitation %D 2025 %7 18.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advancements in rehabilitation sciences have progressively used computational techniques to improve diagnostic and treatment approaches. However, the analysis of high-dimensional, time-dependent data continues to pose a significant problem. Prior research has used clustering techniques on rehabilitation data to identify movement patterns and forecast recovery outcomes. Nonetheless, these initiatives have not yet used force or motion datasets obtained outside a clinical setting, thereby limiting the capacity for therapeutic decisions. Biomechanical data analysis has demonstrated considerable potential in bridging these gaps and improving clinical decision-making in rehabilitation settings. Objective: This study presents a comprehensive clustering analysis of multidimensional movement datasets captured using a novel home exercise device, the “Slider”. The aim is to identify clinically relevant movement patterns and provide answers to open research questions for the first time to inform personalized rehabilitation protocols, predict individual recovery trajectories, and assess the risks of potential postoperative complications. Methods: High-dimensional, time-dependent, bilateral knee kinetic datasets were independently analyzed from 32 participants using four unsupervised clustering techniques: k-means, hierarchical clustering, partition around medoids, and CLARA (Clustering Large Applications). The data comprised force, laser-measured distance, and optical tracker coordinates from lower limb activities. The optimal clusters identified through the unsupervised clustering methods were further evaluated and compared using silhouette analysis to quantify their performance. Key determinants of cluster membership were assessed, including demographic factors (eg, gender, BMI, and age) and pain levels, by using a logistic regression model with analysis of covariance adjustment. Results: Three distinct, time-varying movement patterns or clusters were identified for each knee. Hierarchical clustering performed best for the right knee datasets (with an average silhouette score of 0.637), while CLARA was the most effective for the left knee datasets (with an average silhouette score of 0.598). Key predictors of the movement cluster membership were discovered for both knees. BMI was the most influential determinant of cluster membership for the right knee, where higher BMI decreased the odds of cluster-2 membership (odds ratio [OR] 0.95, 95% CI 0.94-0.96; P<.001) but increased the odds for cluster-3 assignment relative to cluster 1 (OR 1.05, 95% CI 1.03-1.06; P<.001). For the left knee, all predictors of cluster-2 membership were significant (.001≤P≤.008), whereas only BMI (P=.81) could not predict the likelihood of an individual belonging to cluster 3 compared to cluster 1. Gender was the strongest determinant for the left knee, with male participants significantly likely to belong to cluster 3 (OR 3.52, 95% CI 2.91-4.27; P<.001). Conclusions: These kinetic patterns offer significant insights for creating personalized rehabilitation procedures, potentially improving patient outcomes. These findings underscore the efficacy of unsupervised clustering techniques in the analysis of biomechanical data for clinical rehabilitation applications. %M 40100262 %R 10.2196/69150 %U https://formative.jmir.org/2025/1/e69150 %U https://doi.org/10.2196/69150 %U http://www.ncbi.nlm.nih.gov/pubmed/40100262 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57957 %T Poststroke eHealth Technologies–Based Rehabilitation for Upper Limb Recovery: Systematic Review %A Rampioni,Margherita %A Leonzi,Sara %A Antognoli,Luca %A Mura,Anna %A Stara,Vera %+ Innovative Models for Aging Care and Technology, IRCCS-INRCA, Istituto Nazionale di Riposo e Cura per Anziani, via Santa Margherita 5, Ancona, 60124, Italy, 39 +39 071 8004614, m.rampioni@inrca.it %K stroke %K rehabilitation %K technology-based interventions %K upper limb %K technologies-based rehabilitation %K limb %K systematic review %K cerebral vascular diseases %K patient %K effectiveness %K database %K therapy %K conventional therapy %K mobile phone %D 2025 %7 4.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Stroke is one of the most common cerebral vascular diseases, usually affecting people aged 60 years and older. It leads to a variety of disabilities requiring motor and cognitive rehabilitation. Poststroke rehabilitation is critical for recovery, particularly for upper limb impairments, which affect approximately 80% of stroke survivors. Conventional rehabilitation often faces barriers such as cost, accessibility, and patient adherence. In contrast, eHealth technologies offer a promising alternative by providing accessible, cost-effective, and engaging rehabilitation solutions. Objective: While numerous systematic reviews have explored various aspects of technology-based rehabilitation for poststroke upper limb recovery, there is a notable lack of comprehensive synthesis of these findings. This gap presents challenges, primarily due to the focus on specific technologies, which complicates understanding the overall effectiveness of these interventions. Consequently, clinicians and researchers may find it difficult to assess the field holistically, potentially hindering informed decision-making in clinical practice. This review synthesizes evidence from systematic reviews evaluating the effectiveness of eHealth technology–based interventions for upper limb recovery in poststroke individuals. Two main questions are examined: (1) Are eHealth technology–based therapies more or equally effective than conventional therapies for stroke rehabilitation? (2) What are the main clinical considerations for low-cost eHealth technology–based rehabilitation? Methods: Comprehensive literature searches were conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar using predefined inclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework. Systematic reviews published in English without date restrictions were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart guided study selection. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) criteria. Results: A total of 1792 records were screened, resulting in 7 systematic reviews published between 2019 and 2023 being included. These reviews encompassed 95 studies involving 2995 participants with a mean age of 58.8 years across acute, subacute, and chronic stroke phases. Interventions included telerehabilitation, mobile health (mHealth) apps, augmented reality (AR), virtual reality (VR), wearable devices, and exergames. While AR and VR demonstrated potential benefits when combined with conventional therapies (eg, AR showing significant improvements in upper limb function with a standardized mean difference 0.657; P<.001), evidence for stand-alone effectiveness remained inconclusive due to heterogeneity in study designs, intervention protocols, and outcome measures. Most reviews were rated as critically low quality due to methodological limitations. Conclusions: eHealth technologies hold promise for enhancing upper limb rehabilitation post stroke by addressing barriers such as cost and accessibility while providing engaging interventions. However, the field remains fragmented with insufficient evidence to establish clear efficacy. Future research should focus on standardizing protocols, optimizing neurorehabilitation principles such as dosage and task specificity, and improving methodological rigor to evaluate these interventions’ long-term impact better. %M 40053744 %R 10.2196/57957 %U https://www.jmir.org/2025/1/e57957 %U https://doi.org/10.2196/57957 %U http://www.ncbi.nlm.nih.gov/pubmed/40053744 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e63512 %T Development of a Mobile App Game for Practicing Lung Exercises: Feasibility Study %A Pearkao,Chatkhane %A Apiratwarakul,Korakot %A Wicharit,Lerkiat %A Potisopha,Wiphawadee %A Jaitieng,Arunnee %A Homvisetvongsa,Sukuman %A Namwaing,Puthachad %A Pudtuan,Peerapon %K mobile app game %K practice lung exercises %K feasibility study %K mobile phone %K pulmo device %K app %D 2025 %7 4.3.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Chest injuries are a leading cause of death and disability, accounting for 10% of hospital admissions and 25% of injury-related deaths. About two-thirds of patients with thoracic injuries experience complications such as blood or air in the pleural space, causing lung deflation and poor gas exchange. Proper breathing management, using tools like incentive spirometers, improves lung function and recovery. However, there is a gap in mobile-based gaming apps designed for lung exercise, which could benefit both the general population and patients recovering from lung injuries. Objective: This research aimed to develop and evaluate a mobile app game for practicing lung exercises, accompanied by a prototype device called the Pulmo device. Methods: The study involved a sample group of 110 participants from the general public. It followed a research and development methodology comprising 4 steps. The research instruments included a mobile app game, a prototype lung exercise device, and questionnaires to assess users’ satisfaction and the feasibility of both the app and the device. Results: The findings revealed that the participants demonstrated a high level of overall satisfaction with both the mobile app game and the prototype lung exercise device (mean 4.4, SD 0.4). The feasibility for the mobile app game and the prototype lung exercise device connected to the game was evaluated. The results indicated that the sample group perceived the overall feasibility to be at a high level (mean 4.4, SD 0.5). Conclusions: The research results reflected that the sample group believed the mobile app game for practicing lung exercises and the prototype device developed in this project have a high potential for practical application in promoting lung rehabilitation through gameplay. The mobile app game and the Pulmo device prototype received positive user feedback, indicating potential practical use; however, further validation is required among patients in need of pulmonary rehabilitation. %R 10.2196/63512 %U https://rehab.jmir.org/2025/1/e63512 %U https://doi.org/10.2196/63512 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66744 %T Patients’ Experience With Evaluation by Both a Musculoskeletal Physician and Physical Therapist in the Same Digital Visit: Survey Study %A O'Connor,Mary I %A Chudy,Carolyn %A Peters,Kaitlyn C %A Ribaudo,Megan %A McCulloch,Carrie %A Aguilar,Jared %A Taylor,Trista %A Grant,Ryan A %K telemedicine %K musculoskeletal care %K patient satisfaction %K multidisciplinary care %K digital visit %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Patients undergoing evaluation for musculoskeletal concerns are often seen by a physician and physical therapist in the in-person setting in a sequential manner. This process typically delays the onset of nonoperative care, inclusive of physical therapy, and creates the risk of inadequate clinical collaboration between physician and physical therapist. To address these issues, we designed a novel initial patient evaluation to a group visit in which both a specialty-trained musculoskeletal physician and physical therapist simultaneously evaluate a patient together in the digital encounter. Objective: The aim of the study is to gain insights from patients on their experience with this innovative digital simultaneous musculoskeletal medical doctor and physical therapist (MD+PT) visit format for the initial evaluation of musculoskeletal concerns. Methods: An electronic 7-question survey was sent to 750 patients who completed an MD+PT visit asking them to comment on prior musculoskeletal evaluations and their experience with the MD+PT format. Results: In total, 195 (26%) patients responded to the survey with the frequent body regions of diagnosis being lumbar spine (n=65), knee (n=32), shoulder (n=21), cervical spine (n=20), hip (n=14), and hand (n=11). Most patients had prior musculoskeletal experience with a physician or nurse practitioner (171/195, 87.7%) or physical therapist (148/195, 75.9%) with nearly all such encounters in the in-person setting (161/171,94.2% for physician or nurse practitioner and 144/148, 97.3% for physical therapy). Only 3.1% (6/193) of patients reported seeing both a physician and physical therapist during the same in-person visit. Patients rated the simultaneous MD+PT visit very favorably: this type of digital evaluation saved them time (179/192, 93.2%) and permitted them to promptly start their treatment plan (174/192, 90.6%). Overall, 87.5% (168/192) rated the MD+PT visit as enjoyable, and 92.2% (177/192) responded that it increased their confidence with understanding their medical condition and how to start treating it. Conclusions: Our early experience with the evaluation of patients with musculoskeletal conditions by both a specialty-trained musculoskeletal physician and physical therapist simultaneously in the same digital visit resulted in patients reporting a very positive experience with high satisfaction, engagement, and confidence in understanding their diagnosis and how to start treating it. %R 10.2196/66744 %U https://formative.jmir.org/2025/1/e66744 %U https://doi.org/10.2196/66744 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e66515 %T Exergame (ExerG)-Based Physical-Cognitive Training for Rehabilitation in Adults With Motor and Balance Impairments: Usability Study %A Herren,Silvia %A Seebacher,Barbara %A Mildner,Sarah %A Riederer,Yanick %A Pachmann,Ulrike %A Böckler,Nija Sonja %A Niedecken,Stephan %A Sgandurra,Sabrina Alicia %A Bonati,Leo %A Hotz,Isabella %A Schättin,Alexandra %A Jurt,Roman %A Brenneis,Christian %A Lenfert,Katharina %A Behrendt,Frank %A Schmidlin,Stefan %A Nacke,Lennart %A Schuster-Amft,Corina %A Martin-Niedecken,Anna Lisa %K exergame %K rehabilitation %K user-centered design %K usability testing %K mixed-methods %K interdisciplinary research %K concept functional model proofs %K exercise %K cognitive training %K technology acceptance %K motor %K cognitive impairment %K safety %K user experience %K balance impairments %K balance %D 2025 %7 14.2.2025 %9 %J JMIR Serious Games %G English %X Background: Exergames are increasingly used in rehabilitation, yet their usability and user experience for patients and therapists, particularly for functional model systems, are underresearched. The diverse needs and preferences of users make conducting usability studies challenging, emphasizing the need for further investigation in real-world settings. Objective: This study aimed to evaluate the usability, safety, and user experience of a novel exergame functional model, the ExerG, from the perspectives of patients and therapists in a rehabilitation setting. Methods: In this mixed methods study, 15 patients undergoing rehabilitation (primary end users [PEUs]) and 20 therapists (secondary end users [SEUs]) from 2 rehabilitation centers in Switzerland and Austria participated in exercising and observation sessions with the ExerG. SEUs received training on system use and technical issue management, enabling them to fulfill their therapist roles while treating patients or mock patients. Rapid Iterative Testing and Evaluation was used and the training software adjusted based on participant feedback. Usability was assessed with questionnaires, semistructured interviews, and through observations during the ExerG testing. System acceptability was evaluated using specific quantitative thresholds based on PEU performance and feedback. An observation protocol tracked SEUs’ correct use, errors, hesitations, task completion time, and needed assistance across scenarios. Results: Patients and therapists reported overall good usability and positive experiences with the exergame. PEUs rated 23/29 (79%) instructions as acceptable, showed good-to-very-good exercise performance in 19/29 (65%) tasks, and completed 28/29 (97%) tasks. Patients reported no adverse events, showing improved performance and enjoyment across ExerG exercising rounds, with 79/90 (88%) expressing positive emotions and reporting median scores of 9 (IQR 7.5‐10) on a 1‐10 user satisfaction scale. Patients were willing to continue using the device if the graphic design was improved (5/15), tracking systems and projector quality were enhanced (each 3/15), instructions clarified (12/15), and the game variety increased (2/15). PEUs felt secure in the safety harness (15/15) but recommended swivel arm movement enhancements (5/15). SEUs effectively executed scenarios, with hesitation and difficulties observed in only 14/41 tasks and 2/41 tasks, across all 20 therapists, accounting for 1.7% and 0.2% of the 820 total task cases, respectively. Therapists’ quantitative usability ratings were high (median System Usability Scale score 82.5, IQR 65‐95). All SEUs expressed their willingness to use the ExerG (20/20) and reported being able to operate the system using the user handbook (20/20). They emphasized the motivation-enhancing effect of video-game based training (12/20) and considered the activities supportive for physical and cognitive skills (20/20). They suggested incorporating daily living task simulations (13/20), more customizable options (6/20), more targeted motivational feedback (9/20), clearer performance ratings (9/20), and more concise activity instructions (6/20). Conclusions: The interdisciplinary, iterative ExerG development approach shows promise. The findings will inform future optimizations. Future work will assess long-term impact. Trial Registration: ClinicalTrials.gov NCT05967078; https://clinicaltrials.gov/study/NCT05967078 and OSF Registries OSFCQ9AT; https://osf.io/cq9at %R 10.2196/66515 %U https://games.jmir.org/2025/1/e66515 %U https://doi.org/10.2196/66515 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e56397 %T Neurotechnology-Based, Intensive, Supplementary Upper-Extremity Training for Inpatients With Subacute Stroke: Feasibility Study %A Binyamin-Netser,Reut %A Handelzalts,Shirley %A Goldhamer,Noy %A Avni,Inbar %A Tayer Yeshurun,Adi %A Koren,Yogev %A Bibas Levy,Ofri %A Kramer,Shilo %A Bar Haim,Simona %A Shmuelof,Lior %K stroke %K rehabilitation %K neurotechnology %D 2025 %7 13.2.2025 %9 %J JMIR Serious Games %G English %X Background: Upper-extremity hemiparesis is a common and debilitating impairment after stroke, severely restricting stroke survivors’ ability to participate in daily activities and function independently. Alarmingly, only a small percentage of stroke patients fully recover upper extremity function. Animal models indicate that high-dose upper extremity training during the early poststroke phase can significantly enhance motor recovery. However, translating such programs for human patients remains challenging due to resource limitations, patient compliance issues, and administrative constraints. Objective: This study aimed to assess the feasibility and potential efficacy of an intensive, video game–based upper-extremity training protocol designed to improve movement quality during inpatient stroke rehabilitation. Additionally, it evaluated the resources required for this intervention. Specifically, the protocol provides high-intensity, high-dose training to facilitate motor recovery by engaging patients in targeted interactive exercises. Methods: Twelve patients with upper-extremity hemiparesis completed a 4-week intensive training program comprising 40 sessions of 60 minutes; the training was conducted for 2 hours per day, 5 days per week. This was delivered in addition to standard care, which included 3 therapeutic sessions daily. Two video game–based platforms were used: one platform (tech 1) targeted proximal movements involving the shoulder and elbow, while the second platform (tech 2) emphasized distal movements of the wrist and fingers. Feasibility was assessed using the measure of time on task and measures of patients’ motivation and engagement. Potential effectiveness was assessed using the Fugl-Meyer Assessment of the upper extremity (FMA-UE) scale, Action Research Arm Test (ARAT), and Stroke Impact Scale (SIS). Results: Of the 12 patients, 8 completed the full protocol, 3 completed 34‐38 sessions, and 1 completed 27 sessions. On average, patients actively engaged in exercises for 35 (SD 4) minutes per hour on the proximal platform (tech 1) and 37 (SD 2) minutes on the distal platform (tech 2). Patients reported high motivation and enjoyment throughout the sessions, with an Intrinsic Motivation Inventory enjoyment score of 6.49 (SD 0.66) out of 7. Pain levels were minimal, with a visual analogue scale (VAS) mean score of 2.00 (SD 2.32). Significant improvements were observed in motor function assessments: the mean improvement in FMA-UE score was 16.5 (SD 10.2) points, ARAT scores increased by 22.9 (SD 13.1) points, and the SIS Hand Function and Recovery score showed a mean delta of 1.23 (SD 0.80) points and a 23.33% (SD 21.5%) improvement, respectively. Conclusions: These findings demonstrate that a high-dose, high-intensity, video game–based training protocol is feasible and can be successfully integrated into subacute stroke rehabilitation. Additionally, preliminary evidence suggests that this supplementary intervention may be effective in enhancing motor recovery. This approach holds promise for future stroke rehabilitation protocols by offering an engaging, high-dose, and high-intensity program during early recovery. Trial Registration: Clinicaltrials.gov NCT04737395, https://clinicaltrials.gov/study/NCT04737395 %R 10.2196/56397 %U https://games.jmir.org/2025/1/e56397 %U https://doi.org/10.2196/56397 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e62809 %T Effectiveness of a New Device for Hand, Wrist, and Forearm Rehabilitation: Feasibility Randomized Controlled Trial %A Ríos Rincón,Adriana M %A Guptill,Christine %A Liubaoerjijin,Yilina %A Figeys,Mathieu %A Koubasi,Farnaz %A Gregson,Geoffrey %A Miguel Cruz,Antonio %K hand %K upper limb %K motion %K movement %K wrist %K therapeutics %K rehabilitation %K musculoskeletal %K musculoskeletal diseases %K stroke %K wrist fractures %K feasibility studies %K randomized controlled trial %K digital health %K physiotherapy %K physical therapy %K occupational therapy %D 2025 %7 27.1.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Forearm, wrist, and hand impairments affect many individuals and impose a significant economic burden on health care systems. The FEPSim (flexion, extension, pronation, and supination) is designed for hand and wrist rehabilitation. It could become part of the standard care for upper extremity rehabilitation, aiming to improve range of motion, dexterity, and strength during therapeutic activities. However, the FEPSim has not yet been tested in a health care setting, highlighting the need for a trial to assess its effectiveness in upper extremity rehabilitation. Objective: We aim to assess the feasibility of conducting a definitive trial investigating the effectiveness of adding a new device for hand therapy exercises, the FEPSim, to standard care for patients with impairments of the hand, wrist, and forearm. Methods: Thirty-eight patients with impairments of distal upper extremities were randomly assigned either to the intervention group (FEPSim and standard care, n=19) or to the control group (standard care, n=19). Therapeutic activities to increase strength, range of motion, resistance, and dexterity were delivered by treating hand therapists using the FEPSim device for the intervention group. Outcome measures included wrist passive and active range of motion, grip strength, pinch grip force, and the Patient-Rated Wrist Evaluation. Results: The trial retention rate (36/38, 95%) and compliance (control group: 100%; intervention group: 89%) were high. The comparisons of the change-from-baseline between groups revealed that in 63.2% (12/19) of the outcome variables, the change was in favor of the FEPSim, with statistically significant improvements in passive wrist flexion (t34=−0.335, P=.008) and grip strength (t34=−1.841, P=.04). Conclusions: The FEPSim was accepted as part of standard care by therapists and patients at 2 hospitals. The trial design was feasible for hand intervention using the FEPSim device. The FEPSim positively affected grip strength, an objective measure of hand functioning. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 %R 10.2196/62809 %U https://rehab.jmir.org/2025/1/e62809 %U https://doi.org/10.2196/62809 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e64825 %T Multiparametric MRI Assessment of Morpho-Functional Muscle Changes Following a 6-Month FES-Cycling Training Program: Pilot Study in People With a Complete Spinal Cord Injury %A Mastropietro,Alfonso %A Peruzzo,Denis %A Taccogna,Maria Giovanna %A Sanna,Nicole %A Casali,Nicola %A Nossa,Roberta %A Biffi,Emilia %A Ambrosini,Emilia %A Pedrocchi,Alessandra %A Rizzo,Giovanna %K functional electrical stimulation %K FES %K cycling %K exercise %K physical activity %K spinal cord injury %K multiparametric MRI %K skeletal muscle %K rehabilitation %K magnetic resonance imaging %K muscle %K muscular %K musculoskeletal %K spine %K MRI %K mpMRI %K image %K imaging %D 2025 %7 16.1.2025 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Spinal cord injuries (SCIs) cause debilitating secondary conditions such as severe muscle deterioration, cardiovascular, and metabolic dysfunctions, significantly impacting patients’ quality of life. Functional electrical stimulation (FES) combined with cycling exercise (FES-cycling) has shown promise in improving muscle function and health in individuals with SCI. Objective: This pilot study aimed to investigate the potential role of multiparametric magnetic resonance imaging (MRI) to assess muscle health during and after an FES-cycling rehabilitation program. Methods: Four male participants with chronic SCI underwent a 6-month FES-cycling training program, consisting of two 30-minute sessions per week. MRI scans were performed at baseline (T0), after 3 months (T1), at the end of the training (T2), and 1-month posttraining (T3). The MRI protocol included T1-weighted imaging for volume quantification, Dixon imaging for fat fraction, multi-echo spin echo for T2 relaxation times, and diffusion tensor imaging to assess diffusion parameters. Results: Muscle hypertrophy was observed, with an average increase in muscle volume of 22.3% at T1 and 36.7% at T2 compared with baseline. One month posttraining, muscle volume remained 23.2% higher than baseline. Fat fraction decreased from 11.1% at T0 to 9.1% at T2, with a rebound to 10.9% at T3. T2 relaxation times showed a reduction even though this was not consistent among participants. Diffusion tensor imaging parameters revealed subtle changes in muscle tissue microstructure, with a decrease in fractional anisotropy mainly associated to an increase of radial diffusivity. Conclusions: Although preliminary, this study provides evidence that 6 months of low-intensity FES-bike training can increase muscle volume and decrease fat infiltration in individuals with SCI. The study demonstrates that the use of a multiparametric MRI provides comprehensive insights into both macroscopic and microscopic changes within muscle tissues, supporting its integration into clinical practice for assessing the efficacy of rehabilitation interventions. Trial Registration: ClinicalTrials.gov NCT06321172; https://clinicaltrials.gov/study/NCT06321172 %R 10.2196/64825 %U https://rehab.jmir.org/2025/1/e64825 %U https://doi.org/10.2196/64825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60374 %T Advanced Technology in a Real-World Rehabilitation Setting: Longitudinal Observational Study on Clinician Adoption and Implementation %A Pearce,Louise Michelle Nettleton %A Pryor,Julie %A Redhead,Jason %A Sherrington,Catherine %A Hassett,Leanne %+ Institute for Musculoskeletal Health, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, Camperdown, Sydney, Australia, 61 8627 6447, louise.pearce@sydney.edu.au %K rehabilitation %K technology %K digital health %K virtual reality %K robotics %K exoskeleton device %K implementation science %K physiotherapy %K physical therapy %K occupational therapy %K mobile phone %D 2024 %7 30.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. Objective: This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. Methods: This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Results: Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65%), occupational therapists (1396/4208, 33%), and allied health assistants (96/4208, 2%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70%). Devices were typically used to target impairment and activity limitation–related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51%, vs outpatient services, 963/2335, 41%) (χ21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51%, vs all other conditions, between 24%-31%; χ25=16.8, P=.005). Conclusions: The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use. %M 39753210 %R 10.2196/60374 %U https://www.jmir.org/2024/1/e60374 %U https://doi.org/10.2196/60374 %U http://www.ncbi.nlm.nih.gov/pubmed/39753210 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e51771 %T Real-Time Digitized Visual Feedback in Exercise Therapy for Lower Extremity Functional Deficits: Qualitative Study of Usability Factors During Prototype Testing %A Widhalm,Klaus %A Maul,Lukas %A Durstberger,Sebastian %A Putz,Peter %A Klupper,Carissa %A Werner,Franz %+ Research Center Digital Health and Care, FH Campus Wien, University of Applied Sciences, Favoritenstraße 232, Vienna, 1100, Austria, 43 1 606 68 77 ext 4387, lukas.maul@fh-campuswien.ac.at %K visualization %K lower extremity %K digitized visual feedback %K exercise therapy %K functional deficit %K serious game %K rehabilitation %K osteoarthritis %K usability %K physiotherapy %K mobile phone %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Osteoarthritis is one of the most common degenerative diseases of the musculoskeletal system and can ultimately lead to the need for surgery, such as total knee or hip arthroplasty. Functional movement deficits can be a prognostic factor for osteoarthritis in the lower extremities. Thus, training physiological movement patterns may help in the treatment of such functional deficits. Motivation to exercise frequently is of utmost importance and can be promoted by using digital real-time feedback. Objective: This qualitative study aims to gather user recommendations for prototype feedback visualizations in a real-time exercise-feedback system called homeSETT for the treatment of functional deficits. The system provides real-time feedback to participants while performing exercises that focus on functional deficits, such as lateral trunk lean, pelvic drop, and valgus thrust. The findings of this study should help to optimize the prototype feedback visualizations. Thus, the main research questions were how patients, physiotherapists, and physicians evaluate the presented, current state of prototype feedback visualizations for selected functional exercises, and what improvements and variations would be recommended. Methods: Testing of the prototype feedback visualizations took place at a movement laboratory using a 3D optoelectronic movement analysis system. Data on usability factors were acquired using the thinking aloud method during and semistructured interviews after prototype testing. Transcribed audio recordings of semistructured interviews as well as scribing logs of the thinking aloud method were examined using qualitative content analysis. Results: Data were analyzed from 9 participants, comprising 2 (22%) patients, 2 (22%) physicians, and 5 (56%) physiotherapists. The mean age of the participants was 45 (SD 9) years and the mean work experience among the participating physiotherapists and physicians was 22 (SD 5) years. Each participant tested 11 different exercise-feedback combinations. Overall, results indicated that participants enjoyed the prototype feedback visualizations and believed that they could be used in therapeutic settings. Participants appreciated the simplicity, clarity, and self-explanatory nature of the feedback visualizations. While most participants quickly familiarized themselves, some struggled to recognize the feedback goals and connect the visualizations to their movements. Recommendations for improvement included optimizing color schemes, sensitivity, and difficulty adjustments. Adding instructional information and game design elements, such as repetition counting and reward systems, was deemed useful. The main study limitations were the small sample size and the use of feedback on performance as the sole feedback modality. Conclusions: The prototype feedback visualizations were positively perceived by the participants and were considered applicable in therapy settings. Insights were gathered on improving the color scheme, sensitivity, and recognizability of the feedback visualizations. The implementation of additional gamification and instructional elements was emphasized. Future work will optimize the prototype feedback visualizations based on study results and evaluate the homeSETT system’s efficacy in eligible patient populations. %R 10.2196/51771 %U https://games.jmir.org/2024/1/e51771 %U https://doi.org/10.2196/51771 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e57661 %T Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study %A Barnes,Keely %A Sveistrup,Heidi %A Bayley,Mark %A Egan,Mary %A Bilodeau,Martin %A Rathbone,Michel %A Taljaard,Monica %A Karimijashni,Motahareh %A Marshall,Shawn %K brain injury %K virtual %K assessment %K remote %K evaluation %K concussion %K adult %K clinician review %K in-person %K comparison %K sensitivity %K reliability %K acceptability survey %K feasibility study %K psychometric properties %K vestibular/ocular motor screening %K VOMS %K workplace %K clinician %K hospital %K rehabilitation center %K brain %K neurology %K neuroscience %K neurotechnology %K technology %K digital intervention %K digital health %K psychometrics %K physical assessment %K clinical assessment %K workplace safety %K mobile phone %D 2024 %7 27.11.2024 %9 %J JMIR Neurotech %G English %X Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: κ=0.38‐0.49) to excellent (VOMS change in symptoms: κ=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision. International Registered Report Identifier (IRRID): RR2-10.2196/57663 %R 10.2196/57661 %U https://neuro.jmir.org/2024/1/e57661 %U https://doi.org/10.2196/57661 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57873 %T An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study %A Merry,Kohle %A MacPherson,Megan M %A Whittaker,Jackie L %A Napier,Christopher %A Holsti,Liisa %A Scott,Alex %+ Department of Physical Therapy, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 (604) 822 8225, kohle.merry@hiphealth.ca %K exercise therapy %K physical therapy modalities %K rehabilitation %K tendons %K tendinopathy %K mobile health %K mHealth %K mobile phone %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective: This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods: The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results: By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions: Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies. %M 39536312 %R 10.2196/57873 %U https://humanfactors.jmir.org/2024/1/e57873 %U https://doi.org/10.2196/57873 %U http://www.ncbi.nlm.nih.gov/pubmed/39536312 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65354 %T Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study %A Areias,Anabela C %A Janela,Dora %A Molinos,Maria %A Bento,Virgílio %A Moreira,Carolina %A Yanamadala,Vijay %A Cohen,Steven P %A Correia,Fernando Dias %A Costa,Fabíola %+ Sword Health, Inc, 13937 Sprague Lane, Ste 100, Draper, UT, 84020, United States, 1 385 308 8034, f.costa@swordhealth.com %K musculoskeletal pain %K physical therapy %K telerehabilitation %K eHealth %K racial/ethnic concordance %K patient–provider concordance %K physical therapy %K digital rehabilitation %K musculoskeletal conditions %D 2024 %7 29.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. Objective: This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. Methods: This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). Results: Of 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted β coefficient 5.32, 95% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01). Conclusions: Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. Trial Registration: ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946 %M 39470695 %R 10.2196/65354 %U https://www.jmir.org/2024/1/e65354 %U https://doi.org/10.2196/65354 %U http://www.ncbi.nlm.nih.gov/pubmed/39470695 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54451 %T Early In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial %A Heels-Ansdell,Diane %A Kelly,Laurel %A O'Grady,Heather K %A Farley,Christopher %A Reid,Julie C %A Berney,Sue %A Pastva,Amy M %A Burns,Karen EA %A D'Aragon,Frédérick %A Herridge,Margaret S %A Seely,Andrew %A Rudkowski,Jill %A Rochwerg,Bram %A Fox-Robichaud,Alison %A Ball,Ian %A Lamontagne,Francois %A Duan,Erick H %A Tsang,Jennifer %A Archambault,Patrick M %A Verceles,Avelino C %A Muscedere,John %A Mehta,Sangeeta %A English,Shane W %A Karachi,Tim %A Serri,Karim %A Reeve,Brenda %A Thabane,Lehana %A Cook,Deborah %A Kho,Michelle E %+ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main Street West, Institute for Applied Health Sciences (IAHS) Building Room 403, Hamilton, ON, L8S 1C7, Canada, 1 905 525 9140 ext 22867, khome@mcmaster.ca %K rehabilitation %K mechanical ventilation %K cycle ergometry %K critical illness %K exercise therapy %K recovery of function %D 2024 %7 28.10.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Survivors of critical illness are at risk of developing physical dysfunction following intensive care unit (ICU) discharge. ICU-based rehabilitation interventions, such as early in-bed cycle ergometry, may improve patients’ short-term physical function. Objective: Before unblinding and trial database lock, we describe a prespecified statistical analysis plan (SAP) for the CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) randomized controlled trial (RCT). Methods: CYCLE is a 360-patient, international, multicenter, open-label, parallel-group RCT (1:1 ratio) with blinded primary outcome assessment at 3 days post-ICU discharge. The principal investigator and statisticians of CYCLE prepared this SAP with approval from the steering committee and coinvestigators. The SAP defines the primary and secondary outcomes (including adverse events) and describes the planned primary, secondary, and subgroup analyses. The primary outcome of the CYCLE trial is the Physical Function Intensive Care Unit Test-scored (PFIT-s) at 3 days post-ICU discharge. The PFIT-s is a reliable and valid performance-based measure. We plan to use a frequentist statistical framework for all analyses. We will conduct a linear regression to evaluate the primary outcome, incorporating randomization as an independent variable and adjusting for age (≥65 years versus <65 years) and center. The regression results will be reported as mean differences in PFIT-s scores with corresponding 95% CIs and P values. We consider a 1-point difference in PFIT-s score to be clinically important. Additionally, we plan to conduct 3 subgroup analyses: age (≥65 years versus <65 years), frailty (Baseline Clinical Frailty Scale ≥5 versus <5), and sex (male versus female). Results: CYCLE was funded in 2017, and enrollment was completed in May 2023. Data analyses are complete, and the first results were submitted for publication in 2024. Conclusions: We developed and present an SAP for the CYCLE RCT and will adhere to it for all analyses. This study will add to the growing body of evidence evaluating the efficacy and safety of ICU-based rehabilitation interventions. Trial Registration: ClinicalTrials.gov NCT03471247; https://clinicaltrials.gov/ct2/show/NCT03471247 and NCT02377830; https://clinicaltrials.gov/ct2/show/NCT02377830 International Registered Report Identifier (IRRID): RR1-10.2196/54451 %M 39467285 %R 10.2196/54451 %U https://www.researchprotocols.org/2024/1/e54451 %U https://doi.org/10.2196/54451 %U http://www.ncbi.nlm.nih.gov/pubmed/39467285 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e56432 %T Capabilities for Using Telemonitoring in Physiotherapy Treatment: Exploratory Qualitative Study %A van Westerhuis,Charlotte %A Sanders,Astrid F %A Aarden,Jesse J %A Major,Mel E %A de Leeuwerk,Marijke E %A Florisson,Nadine %A Wijbenga,Miriam H %A van der Schaaf,Marike %A van der Leeden,Marike %A van Egmond,Maarten A %K telemedicine %K telemonitoring %K technology %K physical therapy modalities %K education %K physiotherapist %K physiotherapy %K telehealth %D 2024 %7 24.10.2024 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Telemonitoring (TM), as part of telehealth, allows physiotherapists to monitor and coach their patients using remotely collected data. The use of TM requires a different approach compared with face-to-face treatment. Although a telehealth capability framework exists for health care professionals, it remains unclear what specific capabilities are required to use TM during physiotherapy treatments. Objective: This study aims to identify the capabilities required to use TM in physiotherapy treatment. Methods: An exploratory qualitative study was conducted following a constructivist semistructured grounded theory approach. Three heterogeneous focus groups were conducted with 15 lecturers of the School of Physiotherapy (Bachelor of Science Physiotherapy program) from the Amsterdam University of Applied Sciences. Focus group discussions were audiotaped and transcribed verbatim. Capabilities for using TM in physiotherapy treatment were identified during an iterative process of data collection and analysis, based on an existing framework with 4 different domains. Team discussions supported further conceptualization of the findings. Results: Sixteen capabilities for the use of TM in physiotherapy treatment were found addressing 3 different domains. Four capabilities were identified in the “digital health technologies, systems, and policies” domain, 7 capabilities in the “clinical practice and application” domain, and 5 capabilities in the “data analysis and knowledge creation” domain. No capabilities were identified in the “system and technology implementation” domain. Conclusions: The use of TM in physiotherapy treatment requires specific skills from physiotherapists. To best use TM in physiotherapy treatment, it is important to integrate these capabilities into the education of current and future physiotherapists. %R 10.2196/56432 %U https://rehab.jmir.org/2024/1/e56432 %U https://doi.org/10.2196/56432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60496 %T Current State of Connected Sensor Technologies Used During Rehabilitation Care: Protocol for a Scoping Review %A Rauzi,Michelle R %A Akay,Rachael B %A Balakrishnan,Swapna %A Piper,Christi %A Gobert,Denise %A Flach,Alicia %+ Denver/Seattle Center of Innovation for Veteran-centered and Value Driven Care, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, United States, 1 303 724 9590, michelle.rauzi@cuanschutz.edu %K connected sensor technology %K digital health %K rehabilitation %K rehabilitation care %K remote monitoring %K telehealth %K mHealth %K mobile health %K wearables %K wearable technology %D 2024 %7 24.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Connected sensor technologies can capture raw data and analyze them using advanced statistical methods such as machine learning or artificial intelligence to generate interpretable behavioral or physiological outcomes. Previous research conducted on connected sensor technologies has focused on design, development, and validation. Published review studies have either summarized general technological solutions to address specific behaviors such as physical activity or focused on remote monitoring solutions in specific patient populations. Objective: This study aimed to map research that focused on using connected sensor technologies to augment rehabilitation services by informing care decisions. Methods: The Population, Concept, and Context framework will be used to define inclusion criteria. Relevant articles published between 2008 to the present will be included if (1) the study enrolled adults (population), (2) the intervention used at least one connected sensor technology and involved data transfer to a clinician so that the data could be used to inform the intervention (concept), and (3) the intervention was within the scope of rehabilitation (context). An initial search strategy will be built in Embase; peer reviewed; and then translated to Ovid MEDLINE ALL, Web of Science Core Collection, and CINAHL. Duplicates will be removed prior to screening articles for inclusion. Two independent reviewers will screen articles in 2 stages: title/abstract and full text. Discrepancies will be resolved through group discussion. Data from eligible articles relevant to population, concept, and context will be extracted. Descriptive statistics will be used to report findings, and relevant outcomes will include the type and frequency of connected sensor used and method of data sharing. Additional details will be narratively summarized and displayed in tables and figures. Key partners will review results to enhance interpretation and trustworthiness. Results: We conducted initial searches to refine the search strategy in February 2024. The results of this scoping review are expected in October 2024. Conclusions: Results from the scoping review will identify critical areas of inquiry to advance the field of technology-augmented rehabilitation. Results will also support the development of a longitudinal model to support long-term health outcomes. Trial Registration: Open Science Framework jys53; https://osf.io/jys53 International Registered Report Identifier (IRRID): DERR1-10.2196/60496 %M 39446418 %R 10.2196/60496 %U https://www.researchprotocols.org/2024/1/e60496 %U https://doi.org/10.2196/60496 %U http://www.ncbi.nlm.nih.gov/pubmed/39446418 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56480 %T A Behavioral Change–Based Mobile Intervention for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance of Patients With Coronary Artery Disease: Controlled Trial %A Waranski,Melina %A Garbsch,René %A Kotewitsch,Mona %A Teschler,Marc %A Schmitz,Boris %A Mooren,Frank C %+ Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany, 49 23339888156, boris.schmitz@uni-wh.de %K rehabilitation %K eHealth %K mobile health %K mHealth %K telemedicine %K cardiovascular disease %K behavioral change %K mobile phone %D 2024 %7 8.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, but adoption of a healthy postrehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change–based eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ aims to improve postrehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA). Objective: This study aims to evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care. Methods: A total of 169 patients with CAD who had undergone stent implantation or bypass surgery were recruited after completing center-based phase II rehabilitation. They were then divided, without blinding, into 2 groups using a quasi-experimental approach: a case manager–assisted 24-week eHealth program (RehaPlus+; n=84) and a conventional physician-assisted outpatient program (usual care; n=85). The study was designed as a noninferiority trial. RehaPlus+ participants received motivational messages twice weekly for 6 months, and the usual care group engaged in a 6-month outpatient program (twenty-four 90-minute strength and endurance training sessions). The primary outcomes, evaluated using the self-assessed Bewegungs- und Sportaktivität questionnaire, were regular PA (≥150 min/wk) and weekly activities of daily living (ADLs) 6 months after rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (measured by Bewegungs- und Sportaktivität questionnaire), psychological well-being (assessed by the 5-item World Health Organization Well-Being Index), cardiac self-efficacy, health-related quality of life (measured by the 36-Item Short Form Survey), and work ability (using the Work Ability Index). Results: Data of 105 patients (RehaPlus+: n=44, 41.9%; usual care: n=61, 58.1%; male patients: n=80, 76.2%; female patients: n=25, 23.8%; mean age 56.0, SD 7.3 years) were available at the 6-month follow-up. At 6 months after discharge from phase II cardiac rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per week of PA and the usual care group exhibited 119 (SD 175) minutes per week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 (SD 538) minutes per week compared to the usual care group with 308 (SD 412) minutes per week at the 6-month follow-up, with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined 1-sided noninferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P>.05). Conclusions: RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation. Trial Registration: ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793 %M 39378432 %R 10.2196/56480 %U https://www.jmir.org/2024/1/e56480 %U https://doi.org/10.2196/56480 %U http://www.ncbi.nlm.nih.gov/pubmed/39378432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58089 %T Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study %A Elser,Alexander %A Kopkow,Christian %A Schäfer,Axel Georg %+ Faculty of Social Work and Health, HAWK University of Applied Sciences and Arts Hildesheim/Holzminden/Göttingen, Hohnsen 4, Hildesheim, 31134, Germany, 49 5121881 12, alexander.elser@hawk.de %K chronic pain %K implementation %K virtual reality %K VR %K physiotherapy %K virtual reality intervention %K pain %K outpatient %K chronic pain conditions %K evidence-based %D 2024 %7 23.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. Objective: This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. Methods: The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. Results: The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. Conclusions: This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. Trial Registration: German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx International Registered Report Identifier (IRRID): DERR1-10.2196/58089 %M 39312768 %R 10.2196/58089 %U https://www.researchprotocols.org/2024/1/e58089 %U https://doi.org/10.2196/58089 %U http://www.ncbi.nlm.nih.gov/pubmed/39312768 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e54116 %T Usage, Attitudes, Facilitators, and Barriers Toward Digital Health Technologies in Musculoskeletal Care: Survey Among Primary Care Physiotherapists in Norway %A Martinsen,Lars %A Østerås,Nina %A Moseng,Tuva %A Tveter,Anne Therese %+ Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Diakonveien 12, Oslo, 0370, Norway, 47 22451500, lars.martinsen@diakonsyk.no %K physiotherapy %K physiotherapist %K physiotherapists %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K ehealth %K telemedicine %K tele-medicine %K family medicine %K primary care %K primary health care %K musculoskeletal %K musculoskeletal care %K muscle %K skeleton %K musculoskeletal disorders %K MSD %K MSDs %K internet survey %K internet surveys %K online survey %K online surveys %K web-based survey %K web-based surveys %K survey %K surveys %K mobile phone %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Work burden increases for physiotherapists in the primary health care sector as the prevalence of musculoskeletal disorders (MSDs) increases. Digital health technologies (DHTs) are proposed as a viable solution to secure the sustainability of the health care system and have shown promising results in a range of conditions. However, little is known about use of DHTs among physiotherapists in the primary health care sector in Norway. Objective: This study aimed to investigate the use of and attitudes toward DHTs among physiotherapists treating patients with MSDs in primary care, and potential facilitators or barriers for adopting DHTs in clinical practice. Methods: An author-developed web-based questionnaire was distributed to physiotherapists in all Norwegian municipalities in March 2023. The questionnaire included items regarding use of technologies, attitudes, suitability, and factors influencing adoption of DHT. Suitability and agreement on statements were scored on an 11-point numeric rating scale (0=very unsuitable or strongly disagree, 10=very suitable or strongly agree). Differences across employment sites and users versus nonusers of DHT were analyzed using the χ2 test, Fisher exact test, Student t test, and Mann-Whitney U test. Results: Approximately 5000 physiotherapists were invited to participate, of which 6.8% (338) completed the questionnaire. A total of 46.2% (156/338) offered DHTs in their practice, of which 53.2% (83/156) used it on a weekly basis, mostly telephone consultations (105/156, 67.3%). A higher proportion of physiotherapists in private practice offered DHT compared with those employed by municipalities (95/170, 55.9% vs 61/168, 36.3%; P<.001). A majority (272/335, 81.2%) were positive about recommending DHTs to their patients. Suitability of DHTs in physiotherapy was rated an average of 6 (SD 2.1). Apps for smartphones or tablets were rated most suitable (mean rating 6.8, SD 2.4). The most frequently reported advantages were flexibility in how physiotherapy is offered (278/338, 82.3%) and reduced travel time for the patient (235/338, 70%). The highest rated disadvantages were limited scope for physical examination (252/338, 74.6%) and difficulty in building rapport with the patient (227/338, 67.2%). The main facilitators and barriers included a functioning (median rating 10, IQR 8-10) or lack of functioning (median rating 9, IQR 8-10) internet connection, respectively. Lack of training in DHTs was prominent regarding evaluation, diagnosing, and treatment (median rating 0, IQR 0-2), with minor, but significant, differences between nonusers and users (median rating 0, IQR 0-1 vs median rating 1, IQR 0-4); P<.001). Conclusions: Physiotherapists in Norwegian primary care treating patients with MSDs are positive about using DHTs, and almost 50% (156/338) have adopted them in clinical practice. Concerns are related to lack of a physical examination and technical aspects. Training in the use of DHTs should be addressed in implementation processes. %M 39283661 %R 10.2196/54116 %U https://rehab.jmir.org/2024/1/e54116 %U https://doi.org/10.2196/54116 %U http://www.ncbi.nlm.nih.gov/pubmed/39283661 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51898 %T Implementation and Evaluation of a Gait Training Assistant for the Use of Crutches: Usability Study %A Wolf,Milan Anton %A Sauerwald,Leon %A Kosmalla,Felix %A Daiber,Florian %A Krüger,Antonio %A Landgraeber,Stefan %+ Department of Ortopedic Surgery, Saarland University Medical Center, Kirrberger Straße, Homburg, 66421, Germany, 49 068411624500, milan.wolf@uks.eu %K telerehabilitation %K orthopedics %K digital gait trainer %K orthopedic %K gait %K movement %K walk %K walking %K crutch %K crutches %K sensor %K sensors %K rehabilitation %K usability %K digital health %K physiotherapy %K physical therapy %K telehealth %K telemedicine %K eHealth %K virtual %K locomotor %K locomotion %D 2024 %7 16.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Surgical procedures on the lower extremities often require weight-bearing on crutches as part of the rehabilitation process. Orthopedic elective procedures enable patients to learn the correct use of crutches in a controlled preoperative setting. Digital assistance systems can safely circumvent a shortage of skilled staff and any contact restrictions that may be necessary. Objective: The usability of a newly developed gait training assistant (GTA) for the use of crutches will be evaluated. An intervention group trained to use crutches by the digital trainer will be compared with a control group trained to use crutches conventionally by a physiotherapist. Methods: As part of the development and implementation of a novel GTA, 14 patients learned to walk with crutches by completing specific exercises while receiving live feedback. Their movements were detected by a depth sensor and evaluated in real time. Specific parameters (step length, synchronous movement, crutch angle, and crutch distance to the feet) were compared with a control group (n=14) trained to use crutches by physiotherapists. The intervention group was also assessed by a physiotherapist. At the end of the study, the patients completed questionnaires to evaluate the usability of the system (Brooke’s System Usability Scale score) and patient satisfaction. Results: All patients trained by the novel GTA were able to use crutches correctly. The intervention group showed significantly better values for crutch angle (mean –6.3°, SD 3.5° vs mean –12.4°, SD 4.5°; P<.001) and crutch position (mean 3.3, SD 5.1 cm vs mean –8.5, SD 4.9 cm; P=.02). Both groups reported that they felt confident in the use of crutches, were able to follow the instructions, and enjoyed the training. Even though the majority (12/14, 86%) preferred physical therapy over a purely digital approach, most participants enjoyed using the system (13/14, 93%) and were interested in trying out other digital assistants (11/14, 79%). The usability of the GTA was rated above average by the majority (9/14, 64%) of the patients. Conclusions: The newly designed GTA is a safe method of teaching the use of crutches and is statistically superior to training by a physiotherapist. Even if patients prefer interaction with a physiotherapist over a purely digital approach, digital devices provide a safe and motivating opportunity to learn the essential locomotor skills for rehabilitation. %M 39150759 %R 10.2196/51898 %U https://humanfactors.jmir.org/2024/1/e51898 %U https://doi.org/10.2196/51898 %U http://www.ncbi.nlm.nih.gov/pubmed/39150759 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55693 %T Exploring Older Adults' Perceptions of Using Digital Health Platforms for Self-Managing Musculoskeletal Health Conditions: Focus Group Study %A Clohessy,Sophie %A Kempton,Christian %A Ryan,Kate %A Grinbergs,Peter %A Elliott,Mark T %+ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 1214142789, m.elliott.3@bham.ac.uk %K musculoskeletal %K digital health platform %K physiotherapy self-management %K digital triaging %K phone app %K qualitative %K focus group %K mobile phone %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies can assist and optimize health care processes. This is increasingly the case in the musculoskeletal health domain, where digital platforms can be used to support the self-management of musculoskeletal conditions, as well as access to services. However, given a large proportion of the population with musculoskeletal conditions are older adults (aged ≥60 years), it is important to consider the acceptability of such platforms within this demographic. Objective: This study aims to explore participants’ opinions and perceptions on the use of digital platforms for supporting the self-management of musculoskeletal conditions within older adult (aged ≥60 years) populations and to gather their opinions on real examples. Methods: A total of 2 focus groups (focus group 1: 6/15, 40%; focus group 2: 9/15, 60%) were conducted, in which participants answered questions about their thoughts on using digital health platforms to prevent or manage musculoskeletal conditions. Participants were further presented with 2 example scenarios, which were then discussed. Interviews were audio recorded, transcribed, and analyzed thematically. Participants were aged ≥60 years and with or without current musculoskeletal conditions. Prior experience of using smartphone apps or other digital health platforms for musculoskeletal conditions was not required. Focus groups took place virtually using the Teams (Microsoft Corp) platform. Results: A total of 6 themes were identified across both focus groups: “experiences of digital health platforms,” “preference for human contact,” “barriers to accessing clinical services,” “individual differences and digital literacy,” “trust in technology,” and “features and benefits of digital health technologies.” Each theme is discussed in detail based on the interview responses. The findings revealed that most participants had some existing experience with digital health platforms for preventing or managing musculoskeletal conditions. Overall, there was a lack of trust in and low expectations of quality for digital platforms for musculoskeletal health within this age group. While there was some concern about the use of digital platforms in place of in-person health consultations, several benefits were also identified. Conclusions: Results highlighted the need for better communication on the benefits of using digital platforms to support the self-management of musculoskeletal conditions, without the platforms replacing the role of the health care professionals. The concerns about which apps are of suitable quality and trustworthiness lead us to recommend raising public awareness around the role of organizations that verify and assess the quality of digital health platforms. %M 39088803 %R 10.2196/55693 %U https://aging.jmir.org/2024/1/e55693 %U https://doi.org/10.2196/55693 %U http://www.ncbi.nlm.nih.gov/pubmed/39088803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54599 %T The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial %A Johnson,Joshua K. %A Longhurst,Jason K %A Gevertzman,Michael %A Jefferson,Corey %A Linder,Susan M %A Bethoux,Francois %A Stilphen,Mary %+ Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code M83-13, Cleveland, OH, 44915, United States, 1 2169030621, johnsoj8@ccf.org %K rehabilitation %K physical therapy %K PT %K physiotherapy %K telehealth %K Parkinson disease %K tele-rehabilitation %K telerehabilitation %K TR %K exercise %K physical activity %K exercise therapy %K tele-health %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K Parkinson’s disease %K Parkinson %K Parkinsons %K Parkinsonism %K PD %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non–study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as “good” or “very good” across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 %M 39083792 %R 10.2196/54599 %U https://formative.jmir.org/2024/1/e54599 %U https://doi.org/10.2196/54599 %U http://www.ncbi.nlm.nih.gov/pubmed/39083792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56715 %T Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial %A Lowe,Cabella %A Sephton,Ruth %A Marsh,William %A Morrissey,Dylan %+ Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Road, London, E1 4DG, United Kingdom, 44 7976315105, c.lowe@qmul.ac.uk %K mHealth %K eHealth %K digital health %K digital technology %K digital triage %K musculoskeletal %K triage %K physiotherapy triage %K validation %K acceptability %K physiotherapy %K primary care %K randomized controlled trial %K usability %K assess %K assessment %K triaging %K referrals %K crossover %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation. Such innovations are rarely rigorously tested in clinical trials—considered the gold standard for evaluating safety and efficacy. This pilot study is a precursor to a trial assessing DART performance with a physiotherapist-led triage assessment. Objective: The study aims to evaluate trial design, assess procedures, and collect exploratory data to establish the feasibility of delivering an adequately powered, definitive randomized trial, assessing DART safety and efficacy in an NHS primary care setting. Methods: A crossover, noninferiority pilot trial using an integrated knowledge translation approach within a National Health Service England primary care setting. Participants were patients seeking assessment for a musculoskeletal condition, completing a DART assessment and the history-taking element of a face-to-face physiotherapist-led triage in a randomized order. The primary outcome was agreement between DART and physiotherapist triage recommendation. Data allowed analysis of participant recruitment and retention, randomization, blinding, study burden, and potential barriers to intervention delivery. Participant satisfaction was measured using the System Usability Scale. Results: Over 8 weeks, 129 patients were invited to participate. Of these, 92% (119/129) proceeded to eligibility assessment, with 60% (78/129) meeting the inclusion criteria and being randomized into each intervention arm (39/39). There were no dropouts and data were analyzed for all 78 participants. Agreement between physiotherapist and DART across all participants and all primary triage outcomes was 41% (32/78; 95% CI 22-45), intraclass correlation coefficient 0.37 (95% CI 0.16-0.55), indicating that the reliability of DART was poor to moderate. Feedback from the clinical service team led to an adjusted analysis yielding of 78% (61/78; 95% CI 47-78) and an intraclass correlation coefficient of 0.57 (95% CI 0.40-0.70). Participant satisfaction was measured quantitively using amalgamated System Usability Scale scores (n=78; mean score 84.0; 90% CI +2.94 to –2.94), equating to an “excellent” system. There were no study incidents, and the trial burden was acceptable. Conclusions: Physiotherapist-DART agreement of 78%, with no adverse triage decisions and high patient satisfaction, was sufficient to conclude DART had the potential to improve the musculoskeletal pathway. Study validity was enhanced by the recruitment of real-world patients and using an integrated knowledge translation approach. Completion of a context-specific consensus process is recommended to provide definitive definitions of safety criteria, range of appropriateness, noninferiority margin, and sample size. This pilot demonstrated an adequately powered definitive trial is feasible, which would provide evidence of DART safety and efficacy, ultimately informing potential for DART implementation. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): RR2-10.2196/31541 %M 39078682 %R 10.2196/56715 %U https://formative.jmir.org/2024/1/e56715 %U https://doi.org/10.2196/56715 %U http://www.ncbi.nlm.nih.gov/pubmed/39078682 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e52993 %T A Proposed Decision-Making Framework for the Translation of In-Person Clinical Care to Digital Care: Tutorial %A DeLaRosby,Anna %A Mulcahy,Julie %A Norwood,Todd %K clinical decision-making %K digital health %K telehealth %K telerehab %K framework %K digital medicine %K cognitive process %K telemedicine %K clinical training %D 2024 %7 26.6.2024 %9 %J JMIR Med Educ %G English %X The continued demand for digital health requires that providers adapt thought processes to enable sound clinical decision-making in digital settings. Providers report that lack of training is a barrier to providing digital health care. Physical examination techniques and hands-on interventions must be adjusted in safe, reliable, and feasible ways to provide digital care, and decision-making may be impacted by modifications made to these techniques. We have proposed a framework to determine whether a procedure can be modified to obtain a comparable result in a digital environment or whether a referral to in-person care is required. The decision-making framework was developed using program outcomes of a digital physical therapy platform and aims to alleviate barriers to delivering digital care that providers may experience. This paper describes the unique considerations a provider must make when collecting background information, selecting and executing procedures, assessing results, and determining whether they can proceed with clinical care in digital settings. %R 10.2196/52993 %U https://mededu.jmir.org/2024/1/e52993 %U https://doi.org/10.2196/52993 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e54159 %T Stroke Survivors’ Interaction With Hand Rehabilitation Devices: Observational Study %A Wodu,Chioma Obinuchi %A Sweeney,Gillian %A Slachetka,Milena %A Kerr,Andrew %+ Department of Biomedical Engineering, University of Strathclyde, 106 Rottenrow, G4 0NW, Glasgow, , United Kingdom, 44 79 3058 4076, chiomawodu@gmail.com %K stroke %K rehabilitation %K hand rehabilitation devices %K accessibility %K stroke survivors %K rehabilitation technologies %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55% to 75% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function. Objective: In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices. Methods: Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session. Results: A total of 29 participants were included in this study, of whom 10 (34%) had poor hand function, 17 (59%) had moderate hand function, and 2 (7%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness. Conclusions: Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function. %M 38922668 %R 10.2196/54159 %U https://biomedeng.jmir.org/2024/1/e54159 %U https://doi.org/10.2196/54159 %U http://www.ncbi.nlm.nih.gov/pubmed/38922668 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50430 %T A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study %A Papadopoulos,Petros %A Soflano,Mario %A Connolly,Thomas %+ University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 7920756076, petros.papadopoulos@gmail.com %K mobile health %K mHealth %K digital health intervention %K total knee replacement %K TKR %K total hip replacement %K THR %K dynamic hip screw %K DHS %K rehabilitation %K usability %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. Objective: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. Methods: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. Results: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range −3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. Conclusions: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw. %M 38743479 %R 10.2196/50430 %U https://humanfactors.jmir.org/2024/1/e50430 %U https://doi.org/10.2196/50430 %U http://www.ncbi.nlm.nih.gov/pubmed/38743479 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e51508 %T Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study %A Webster,Amy %A Poyade,Matthieu %A Coulter,Elaine %A Forrest,Lisa %A Paul,Lorna %+ School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 141 273 1345, Amy.Webster@gcu.ac.uk %K virtual reality %K multiple sclerosis %K upper limb rehabilitation %K coproduction %K activities of daily living %K exercise games %K upper limb impairment %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. Objective: This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. Methods: Separate focus groups were conducted with people with MS, recruited through the MS Society UK’s research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. Results: People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. Conclusions: VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS. %M 38669680 %R 10.2196/51508 %U https://games.jmir.org/2024/1/e51508 %U https://doi.org/10.2196/51508 %U http://www.ncbi.nlm.nih.gov/pubmed/38669680 %0 Journal Article %@ 2291-9279 %I %V 12 %N %P e44025 %T Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study %A Wu,Shih-Chung %A Chuang,Chia-Wen %A Liao,Wen-Chun %A Li,Chung-Fang %A Shih,Hsin-Hsin %K breast cancer %K rehabilitation %K virtual reality %K VR %K virtual reality design process %K VR design process %K feasibility %K accessibility %D 2024 %7 16.4.2024 %9 %J JMIR Serious Games %G English %X Background: Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. Objective: This study explored patients’ attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. Methods: A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Results: Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. Conclusions: The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation. %R 10.2196/44025 %U https://games.jmir.org/2024/1/e44025 %U https://doi.org/10.2196/44025 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e49550 %T Comparing Walking-Related Everyday Life Tasks of Children with Gait Disorders in a Virtual Reality Setup With a Physical Setup: Cross-Sectional Noninferiority Study %A Rhiel,Sophia %A Kläy,Andrina %A Keller,Urs %A van Hedel,Hubertus J A %A Ammann-Reiffer,Corinne %+ Swiss Children’s Rehab, University Children's Hospital Zurich, University of Zurich, Mühlebergstrasse 104, Affoltern am Albis, 8910, Switzerland, 41 44 762 52 97, sophia.rhiel@kispi.uzh.ch %K adolescent %K child %K gait %K head-mounted display %K motion capture %K neurological rehabilitation %K noninferiority trial %K physical therapy %K virtual reality %K walking %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: A frequent rehabilitation goal for children with gait disorders is to practice daily-life walking activities. Unfortunately, these are often difficult to practice in a conventional therapeutic setting. Virtual reality (VR) with head-mounted displays (HMDs) could be a promising approach in neurorehabilitation to train such activities in a safe environment. First, however, we must know whether obstacles in VR are indeed mastered as obstacles. Objective: This study aimed to provide information on whether VR is feasible and motivating to induce and practice movements needed to master real obstacles in children and adolescents with gait disorders. Furthermore, this project aims to evaluate which kinds of everyday walking activities are appropriate to be practiced in VR. Methods: In this cross-sectional study, participants stepped over a bar, crossed a gap, balanced over a beam, and circumvented stationary obstructions arranged in a course under real physical and virtual conditions wearing a VR HMD. We recorded the respective primary outcomes (step height, step length, step width, and minimal shoulder-obstacle distance) with motion capture. We then calculated the mean differences and 95% CI of the spatiotemporal parameters between the VR and physical setup and later compared them using noninferiority analysis with margins defined a priori by a clinical expert panel. Additionally, the participants responded to a standardized questionnaire while the therapists observed and evaluated their movement performance. Results: We recruited 20 participants (mean age 12.0, range 6.6-17.8 years) with various diagnoses affecting their walking ability. At 3.77 (95% CI 1.28 to 6.26) cm, the mean difference in step height of the leading foot in the overstepping task did not exceed the predefined margin of –2 cm, thus signifying noninferiority of the VR condition compared to mastering the physical obstacles. The same was true for step length (–1.75, 95% CI –4.91 to 1.41 cm; margin –10 cm), step width (1.05, 95% CI 0.20 to –1.90 cm; margin 3 cm), and the minimal shoulder-obstacle distance (0.25, 95% CI –0.85 to 0.35 cm; margin –2 cm) in the other tasks. Only the trailing foot in the overstepping task yielded inconclusive results. Conclusions: Children with gait disorders perform everyday walking tasks like overstepping, crossing, balancing, or circumventing similarly in physical and VR environments, suggesting that VR could be a feasible therapeutic tool to practice everyday walking tasks. %M 38498048 %R 10.2196/49550 %U https://games.jmir.org/2024/1/e49550 %U https://doi.org/10.2196/49550 %U http://www.ncbi.nlm.nih.gov/pubmed/38498048 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e52328 %T Consumer Perceptions of Home-Based Percussive Massage Therapy for Musculoskeletal Concerns: Inductive Thematic Qualitative Analysis %A Butala,Saloni %A Galido,Pearl Valentine %A Woo,Benjamin K P %+ College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 E Second Street, Pomona, CA, 91766, United States, 1 310 765 0324, salonibutala96@g.ucla.edu %K home-based therapy %K injury prevention %K massage guns %K musculoskeletal pain %K pain management %K percussive massage therapy %K rehabilitation %K self-management %K sports medicine %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Musculoskeletal pain is a prevalent concern among diverse populations, from the average individual to the elite athlete. Handheld percussive massage therapy devices like massage guns have gained much popularity in both medical and athletic settings. Its application has been prominently recognized in injury prevention and rehabilitation. The expansion of the market to provide handheld percussive therapy devices with varying features and price points has encouraged professional and novice use. While percussive therapy holds similarities to more studied therapeutic modalities, like vibration therapy and soft tissue mobilization, there is limited evidence-based information on the indications and contraindications. Objective: This study aims to use a qualitative analysis of consumer perceptions to understand the perceived therapeutic potential of percussive massage therapy as a home-based intervention for musculoskeletal concerns of everyday users and elite athletes. Additionally, we aim to gain insight on valuable characteristics supporting its therapeutic potential as well as pertinent limitations. Methods: The TOLOCO massage gun (TOLOCO) was identified as the best-selling percussive massage therapy device on Amazon. We performed an inductive thematic qualitative analysis on the top 100 positive comments and the top 100 critical comments of the device between June 2020 and April 2023 to determine 4 relevant themes. Results: The 4 themes identified upon qualitative analysis were pain management, versatility, accessibility, and safety and user education. Consumer reviews indicated use for this percussive therapy device in adolescents, adults, and older people across a spectrum of activity levels. Consumers reported the therapeutic potential of percussive massage therapy in managing wide-ranging musculoskeletal concerns like acute pain, chronic pain, nonsurgical injury rehabilitation, postsurgical injury rehabilitation, and injury prevention. Consumers highlighted the versatility of the device to address person-specific needs as a key feature in supporting its perceived therapeutic benefits. Additionally, consumers frequently commented on the affordability and availability of this device to increase accessibility to home-based care. Some critical reviews emphasized a concern for the quality of the device itself. However, this concern did not translate to the overall modality of percussive massage therapy. Of note, despite strong approval for its therapeutic potential, consumer reviews lacked evidence-based insights on appropriate usage. Conclusions: Home-based percussive massage therapy holds value with its perceived efficacy in pain management for acute and chronic conditions, as well as in injury prevention and rehabilitation. As a low-cost and readily available device for everyday users and high-performing athletes, percussive massage therapy works toward establishing increased health care accessibility and optimizing health care usage. This home-based intervention can serve to reduce the significant personal and economic burden of prevalent musculoskeletal concerns. However, the limited scientific research on percussive massage therapy raises concerns about the lack of evidence-based care and indicates the need for future studies. %M 38315526 %R 10.2196/52328 %U https://rehab.jmir.org/2024/1/e52328 %U https://doi.org/10.2196/52328 %U http://www.ncbi.nlm.nih.gov/pubmed/38315526 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53412 %T Effects of a Powered Ankle-Foot Prosthesis and Physical Therapy on Function for Individuals With Transfemoral Limb Loss: Rationale, Design, and Protocol for a Multisite Clinical Trial %A Maikos,Jason T %A Pruziner,Alison L %A Hendershot,Brad D %A Herlihy,David V %A Chomack,John M %A Hyre,Michael J %A Phillips,Samuel L %A Sidiropoulos,Alexis N %A Dearth,Christopher L %A Nelson,Leif M %+ Veterans Affairs New York Harbor Healthcare System, 423 E. 23rd Street, New York, NY, 10010, United States, 1 2126867500 ext 7482, jason.maikos@va.gov %K amputation %K limb loss %K physical therapy %K powered prosthetic ankle-foot device %K lower extremity %D 2024 %7 26.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Powered ankle-foot prosthetic devices can generate net positive mechanical work during gait, which mimics the physiological ankle. However, gait deviations can persist in individuals with transfemoral limb loss because of habit or lack of rehabilitation. Prosthetic research efforts favor the design or evaluation of prosthetic componentry and rarely incorporate any type of rehabilitation, despite evidence suggesting that it is critical for minimizing gait imbalances. Given the accelerated rate of innovation in prosthetics, there is a fundamental knowledge gap concerning how individuals with transfemoral limb loss should learn to correctly use powered ankle-foot devices for maximum functional benefit. Because of the recent advances in prosthetic technology, there is also a critical unmet need to develop guidelines for the prescription of advanced prosthetic devices that incorporate both physical and psychological components to identify appropriate candidates for advanced technology. Objective: The primary goal of this investigation is to examine the roles of advanced prosthetic technology and a device-specific rehabilitative intervention on gait biomechanics, functional efficacy, and pain in individuals with transfemoral limb loss. The secondary goal is to develop preliminary rehabilitation guidelines for advanced lower limb prosthetic devices to minimize gait imbalances and maximize function and to establish preliminary guidelines for powered ankle-foot prosthetic prescription. Methods: This prospective, multisite study will enroll 30 individuals with unilateral transfemoral limb loss. At baseline, participants will undergo a full gait analysis and assessment of function, neurocognition, cognitive load, subjective preferences, and pain using their current passive prosthesis. The participants will then be fitted with a powered ankle-foot device and randomized into 2 equal groups: a powered device with a device-specific rehabilitation intervention (group A) or a powered device with the current standard of practice (group B). Group A will undergo 4 weeks of device-specific rehabilitation. Group B will receive the current standard of practice, which includes basic device education but no further device-specific rehabilitation. Data collection procedures will then be repeated after 4 weeks and 8 weeks of powered ankle use. Results: This study was funded in September 2017. Enrollment began in September 2018. Data collection will conclude by March 2024. The initial dissemination of results is expected in August 2024. Conclusions: The projected trends indicate that the number of individuals with limb loss will dramatically increase in the United States. The absence of effective, evidence-based interventions may make individuals with transfemoral limb loss more susceptible to increased secondary physical conditions and degenerative changes. With this expected growth, considerable resources will be required for prosthetic and rehabilitation services. Identifying potential mechanisms for correcting gait asymmetries, either through advanced prosthetic technology or rehabilitative interventions, can provide a benchmark for understanding the optimal treatment strategies for individuals with transfemoral limb loss. Trial Registration: ClinicalTrials.gov NCT03625921; https://clinicaltrials.gov/study/NCT03625921 International Registered Report Identifier (IRRID): DERR1-10.2196/53412 %M 38277197 %R 10.2196/53412 %U https://www.researchprotocols.org/2024/1/e53412 %U https://doi.org/10.2196/53412 %U http://www.ncbi.nlm.nih.gov/pubmed/38277197 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52661 %T Health Care Professional–Supported Co-Design of a Mime Therapy–Based Serious Game for Facial Rehabilitation %A Sousa,Daniel Lima %A Teixeira,Silmar %A Fontenele,José Everton %A Santos,Renato Mendes %A Pereira,Leynilson %A Baluz,Rodrigo %A Bastos,Victor Hugo %A Teles,Ariel Soares %+ Federal Institute of Maranhão, Campus Araioses, Rua José de Alencar, S/N, Bairro Cumprida, Araioses, 65570-000, Brazil, 55 86995501313, ariel.teles@ifma.edu.br %K serious game %K serious games %K facial recognition %K face estimation %K computer vision %K facial rehabilitation %K face %K rehabilitation %K physiotherapy %K mime therapy %K co-design %K human face estimation %K facial palsy %K facial paralysis %K motor rehabilitation %K exergame %K physiotherapists %K psychologists %K participation %D 2024 %7 24.1.2024 %9 Research Letter %J JMIR Serious Games %G English %X This research letter presents the co-design process for RG4Face, a mime therapy–based serious game that uses computer vision for human facial movement recognition and estimation to help health care professionals and patients in the facial rehabilitation process. %M 38265856 %R 10.2196/52661 %U https://games.jmir.org/2024/1/e52661 %U https://doi.org/10.2196/52661 %U http://www.ncbi.nlm.nih.gov/pubmed/38265856 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e48900 %T Design of Virtual Reality Exergames for Upper Limb Stroke Rehabilitation Following Iterative Design Methods: Usability Study %A Villada Castillo,Julian Felipe %A Montoya Vega,Maria Fernanda %A Muñoz Cardona,John Edison %A Lopez,David %A Quiñones,Leonardo %A Henao Gallo,Oscar Alberto %A Lopez,Jose Fernando %+ Faculty of Basic Sciences, Department of Physics, Universidad Tecnologica de Pereira, Carrera 27 #10-02 Álamos, Pereira, 660003, Colombia, 57 606 3137300, jfvillada@utp.edu.co %K stroke %K user-centered design %K exergame %K design %K virtual reality %K playtest %K upper limb rehabilitation %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Since the early 2000s, there has been a growing interest in using exercise video games (exergames) and virtual reality (VR)–based interventions as innovative methods to enhance physical rehabilitation for individuals with multiple disabilities. Over the past decade, researchers and exercise professionals have focused on developing specialized immersive exercise video games for various populations, including those who have experienced a stroke, revealing tangible benefits for upper limb rehabilitation. However, it is necessary to develop highly engaging, personalized games that can facilitate the creation of experiences aligned with the preferences, motivations, and challenges communicated by people who have had an episode of stroke. Objective: This study seeks to explore the customization potential of an exergame for individuals who have undergone a stroke, concurrently evaluating its usability as a technological tool in the realm of physical therapy and rehabilitation. Methods: We introduce a playtest methodology to enhance the design of a VR exergame developed using a user-centered approach for upper limb rehabilitation in stroke survivors. Over 4 playtesting sessions, stroke survivors interacted with initial game versions using VR headsets, providing essential feedback for refining game content and mechanics. Additionally, a pilot study involving 10 stroke survivors collected data through VR-related questionnaires to assess game design aspects such as mechanics, assistance, experience, motion sickness, and immersion. Results: The playtest methodology was beneficial for improving the exergame to align with user needs, consistently incorporating their perspectives and achieving noteworthy results. The pilot study revealed that users had a positive response. In the first scenario, a carpenter presents a game based on the flexion-extension movement of the elbow; the second scenario includes a tejo game (a traditional Colombian throwing game) designed around game mechanics related to the flexion-extension movement of the shoulder; and in the third scenario, a farmer challenges the player to perform a movement combining elbow flexion and extension with internal and external rotation of the shoulder. These findings suggest the potential of the studied exergame as a tool for the upper limb rehabilitation of individuals who have experienced a stroke. Conclusions: The inclusion of exergames in rehabilitation for stroke-induced hemiparesis has significantly benefited the recovery process by focusing on essential shoulder and elbow movements. These interactive games play a crucial role in helping users regain mobility and restore practical use of affected limbs. They also serve as valuable data sources for researchers, improving the system’s responsiveness. This iterative approach enhances game design and markedly boosts user satisfaction, suggesting exergames have promising potential as adjunctive elements in traditional therapeutic approaches. %M 38206670 %R 10.2196/48900 %U https://games.jmir.org/2024/1/e48900 %U https://doi.org/10.2196/48900 %U http://www.ncbi.nlm.nih.gov/pubmed/38206670 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e50299 %T Results of Gensingen Bracing in Patients With Adolescent Idiopathic Scoliosis: Retrospective Cross-Sectional Feasibility Study %A Nan,Xiaofeng %A Kuru Çolak,Tuğba %A Akçay,Burçin %A Xie,Hua %A Zhao,Liwei %A Borysov,Maksym %+ Nan Xiaofeng's Spinal Orthopedic Workshop, Room 806, Unit 2, Zhongmao Square (15th floor), Beilin District, Xi'an Shaanxi, 710068, China, 86 189 9124 1048, xiaofeng.nann@gmail.com %K scoliosis %K brace treatment %K feasibility study %K outcome %K skeletal %K spine %K back %K musculoskeletal %K curvature %K spinal %K database %K template %K design %K brace %K orthopedics %K injury %K rehabilitation %K Gensingen brace %K conservative brace treatment %K Idiopathic Scoliosis %K orthopedic %K injuries %K data science %K data management %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Bracing is an essential part of scoliosis treatment. The standard of brace treatment for patients with scoliosis today is still very variable in terms of brace quality and outcome. The Gensingen brace is a further developed Chêneau brace derivative with individual design, which can be adapted through computer-aided design. Objective: This study aims to generate a template to obtain a database for prospective multicenter studies study to analyze the results of high-corrective asymmetric Gensingen brace treatment for patients with adolescent idiopathic scoliosis (AIS). Methods: A template for the database was created, which contains the patients' basic data (age, menarcheal status, Risser Sign, curve pattern, and daily brace wearing time), the Cobb angles of curvature, and the cosmetically relevant angles of trunk rotation (ATR). A retrospective review of medical records of patients with AIS, who met the Scoliosis Research Society’s inclusion criteria for brace studies, was performed to test the feasibility of the template. Template items were filled in by the researchers. Results: Out of 115 patients between 2014 and 2018, the complete data of 33 patients followed up at least 3 months after complete Gensingen brace weaning could be analyzed. The mean age was 12 years, the mean Cobb angle was 33.6°, and the mean Risser value was 0.7 at the beginning of the treatment. The mean improvement in the Cobb angle on in-brace x-ray imaging was –26.1० (80% of in-brace correction). The Cobb angle of the major curvature changed as follows: curve stabilization was achieved in 7 (21.2%) cases, and curve improvement was achieved in 26 (78.8%) cases. None of the patients showed a curve progression. The Cobb angle was significantly reduced in the brace at the end of treatment and at follow-up evaluation (P<.001). ATR improved significantly for thoracic (P<.001) and lumbar curves (P<.001). Conclusions: The database proved to be informative in the assessment of radiological and clinical outcome parameters. The example data set we have generated can be a helpful tool for professionals who work in clinics but do not store regular patient data. Especially with regard to different patient collectives worldwide, different results may be achieved with the same standards of care. In addition, the results of this study suggest that above-average correction effects with a full-time brace application lead to significant improvements in the Cobb angle after brace treatment has been completed. %M 38198197 %R 10.2196/50299 %U https://rehab.jmir.org/2024/1/e50299 %U https://doi.org/10.2196/50299 %U http://www.ncbi.nlm.nih.gov/pubmed/38198197 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e53084 %T Potential Effects of an Exoskeleton-Assisted Overground Walking Program for Individuals With Spinal Cord Injury Who Uses a Wheelchair on Imaging and Serum Markers of Bone Strength: Pre-Post Study %A Bass,Alec %A Morin,Suzanne N %A Guidea,Michael %A Lam,Jacqueline T A T %A Karelis,Antony D %A Aubertin-Leheudre,Mylène %A Gagnon,Dany H %A , %+ School of Rehabilitation, Faculty of Medicine, Université de Montréal, PO Box 6128, Station Centre-Ville, Pavillon 7077 Avenue du Parc—Office U-402-32, Montréal, QC, H3C 3J7, Canada, 1 514 343 6111 ext 26382, dany.gagnon.2@umontreal.ca %K assistive technology %K bone architecture %K bone turnover %K osteoporosis %K rehabilitation %K spinal cord injuries %K SCI %K spinal cord injury %K assistive device %K wheelchair %K exoskeleton device %K locomotion %K bone strength %K risk %K fracture %D 2024 %7 1.1.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: As many as 60% of individuals use a wheelchair long term after a spinal cord injury (SCI). This mode of locomotion leads to chronic decline in lower-extremity weight-bearing activities and contributes to the development of severe sublesional osteoporosis and high rates of fragility fracture. Overground exoskeleton-assisted walking programs provide a novel opportunity to increase lower-extremity weight bearing, with the potential to improve bone health. Objective: The aim of the study is to measure the potential effects of an exoskeleton-assisted walking program on lower-extremity bone strength and bone remodeling biomarkers in individuals with chronic (≥18 months) SCI who use a wheelchair. Methods: In total, 10 participants completed a 16-week exoskeleton-assisted walking program (34 individualized 1-hour sessions, progressing from 1 to 3 per week). Bone mineral density and bone strength markers (dual-energy x-ray absorptiometry: total body, left arm, leg, total hip, and femoral neck and peripheral quantitative computed tomography: 25% of left femur and 66% of left tibia) as well as bone remodeling biomarkers (formation=osteocalcin and resorption=C-telopeptide) were measured before and after intervention and compared using nonparametric tests. Changes were considered significant and meaningful if the following criteria were met: P<0.1, effect size ≥0.5, and relative variation >5%. Results: Significant and meaningful increases were observed at the femur (femoral neck bone mineral content, bone strength index, and stress-strain index) and tibia (cortical cross-sectional area and polar moment of inertia) after the intervention (all P<.10). We also noted a decrease in estimated femoral cortical thickness. However, no changes in bone remodeling biomarkers were found. Conclusions: These initial results suggest promising improvements in bone strength markers after a 16-week exoskeleton-assisted walking program in individuals with chronic SCI. Additional research with larger sample sizes, longer interventions (possibly of greater loading intensity), and combined modalities (eg, pharmacotherapy or functional electrical stimulation) are warranted to strengthen current evidence. Trial Registration: ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID): RR2-10.2196/19251 %M 38163294 %R 10.2196/53084 %U https://rehab.jmir.org/2024/1/e53084 %U https://doi.org/10.2196/53084 %U http://www.ncbi.nlm.nih.gov/pubmed/38163294 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e45307 %T Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study %A van Dartel,Dieuwke %A Wang,Ying %A Hegeman,Johannes H %A Vollenbroek-Hutten,Miriam M R %A , %+ Department of Biomedical Signals and Systems, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 645081102, d.vandartel@utwente.nl %K continuous ambulatory monitoring %K physical activity %K pattern prediction %K older patients %K hip fracture rehabilitation %K wearable sensing %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X 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. %M 38032703 %R 10.2196/45307 %U https://rehab.jmir.org/2023/1/e45307 %U https://doi.org/10.2196/45307 %U http://www.ncbi.nlm.nih.gov/pubmed/38032703 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e47541 %T Use of Virtual Reality in Interdisciplinary Multimodal Pain Treatment With Insights From Health Care Professionals and Patients: Action Research Study %A Ummels,Darcy %A Cnockaert,Elise %A Timmers,Inge %A den Hollander,Marlies %A Smeets,Rob %+ Department of Rehabilitation Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, Netherlands, 31 43 388 2160, darcy.ummels@maastrichtuniversity.nl %K virtual reality %K interdisciplinary multimodal pain treatment %K chronic pain %K pain %K rehabilitation %K digital health %K physiotherapy %K occupational therapy %K physical therapy %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X 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. %M 37948109 %R 10.2196/47541 %U https://rehab.jmir.org/2023/1/e47541 %U https://doi.org/10.2196/47541 %U http://www.ncbi.nlm.nih.gov/pubmed/37948109 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49236 %T Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial %A Pak,Sang S %A Janela,Dora %A Freitas,Nina %A Costa,Fabíola %A Moulder,Robert %A Molinos,Maria %A Areias,Anabela C %A Bento,Virgílio %A Cohen,Steven P %A Yanamadala,Vijay %A Souza,Richard B %A Correia,Fernando Dias %+ Department of Physical Therapy and Rehabilitation, University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158, United States, 1 415 514 6779, sam.pak@ucsf.edu %K chronic shoulder %K clinical outcome %K digital care %K digital health intervention %K musculoskeletal pain %K pain management %K physical therapy %K remote sensing technology %K telerehabilitation %D 2023 %7 18.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. Objective: The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. Methods: We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. Results: A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (–1.8, 95% CI –13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. Conclusions: This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. Trial Registration: ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528 %M 37490337 %R 10.2196/49236 %U https://www.jmir.org/2023/1/e49236 %U https://doi.org/10.2196/49236 %U http://www.ncbi.nlm.nih.gov/pubmed/37490337 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e44361 %T Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study %A Deutsch,Judith E %A Palmieri,John L %A Gorin,Holly %A Wendell,Augustus %A Wohn,Donghee Yvette %A Damodaran,Harish %+ Rivers Lab Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, 65 Bergen Street, Newark, NJ, 07101, United States, 1 9739722373, deutsch@rutgers.edu %K physical therapy %K education %K teaching tool %K simulation-based learning %K computer-aided instruction %K standardized assessment %K clinical reasoning %K sensors %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale. Objective: This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability. Methods: A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education. Results: The faculty members’ and students’ positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability. Conclusions: The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption. %M 37561552 %R 10.2196/44361 %U https://mededu.jmir.org/2023/1/e44361 %U https://doi.org/10.2196/44361 %U http://www.ncbi.nlm.nih.gov/pubmed/37561552 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e46217 %T Improving Home-Based Scoliosis Therapy: Findings From a Web-Based Survey %A Günther,Florian %A Schober,Fabian %A Hunger,Sandra %A Schellnock,Julia %A Derlien,Steffen %A Schleifenbaum,Stefan %A Drossel,Welf-Guntram %A Heyde,Christoph-Eckhard %+ Department of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology IWU, Nöthnitzer Straße 44, Dresden, 01187, Germany, 49 351 4772 2160, florian.guenther@iwu.fraunhofer.de %K scoliosis therapy %K Schroth therapy %K home-based exercise %K home program %K physiotherapeutic scoliosis-specific exercises (PSSE) %K adherence %K assistive devices %K exercise system %K digital tools %K eHealth %D 2023 %7 4.8.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X 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 für 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. %M 37540557 %R 10.2196/46217 %U https://rehab.jmir.org/2023/1/e46217 %U https://doi.org/10.2196/46217 %U http://www.ncbi.nlm.nih.gov/pubmed/37540557 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e46619 %T An Intensive Exercise Program Using a Technology-Enriched Rehabilitation Gym for the Recovery of Function in People With Chronic Stroke: Usability Study %A Kerr,Andy %A Keogh,Maisie %A Slachetka,Milena %A Grealy,Madeleine %A Rowe,Philip %+ Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, 106 Rottenrow, Glasgow, G4 0NW, United Kingdom, 1 01415482855, a.kerr@strath.ac.uk %K rehabilitation technology %K stroke %K feasibility %K intensive exercise %K rehabilitation %K exercise %K motor impairment %K feasibility study %K telehealth %K recovery %K telerehabilitation %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X 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 %M 37477954 %R 10.2196/46619 %U https://rehab.jmir.org/2023/1/e46619 %U https://doi.org/10.2196/46619 %U http://www.ncbi.nlm.nih.gov/pubmed/37477954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43888 %T Efficacy of Neck-Specific Exercise With Internet Support Versus Neck-Specific Exercise at a Physiotherapy Clinic in Chronic Whiplash-Associated Disorders: Multicenter Randomized Controlled Noninferiority Trial %A Peterson,Gunnel %A Peolsson,Anneli %+ Centre for Clinical Research Sörmland, Uppsala University, Sveavägen entré 9, Eskilstuna, SE-631 88, Sweden, 46 16105401, gunnel.peterson@liu.se %K internet-based intervention %K telerehabilitation %K whiplash associated disorders %K neck %K whiplash %K physiotherapy %K physiotherapist %K physical therapy %K neck pain %K exercise %K chronic pain %K digital health intervention %K telehealth %K rehabilitation %K pain management %K internet-based %K telemedicine %K digital health %D 2023 %7 20.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Neck-specific exercises (NSE) supervised by a physiotherapist twice a week for 12 weeks have shown good results in chronic whiplash-associated disorders (WADs), but the effect of exercise delivered via the internet is unknown. Objective: This study examined whether NSE with internet support (NSEIT) and 4 physiotherapy sessions for 12 weeks were noninferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE). Methods: In this multicenter randomized controlled noninferiority trial with masked assessors, we recruited adults aged 18-63 years with chronic WAD grade II (ie, neck pain and clinical musculoskeletal signs) or III (ie, grade II plus neurological signs). Outcomes were measured at baseline and at 3- and 15-month follow-ups. The primary outcome was change in neck-related disability, measured with the Neck Disability Index (NDI; 0%-100%), with higher percentages indicating greater disability. Secondary outcomes were neck and arm pain intensity (Visual Analog Scale [VAS]), physical function (Whiplash Disability Questionnaire [WDQ] and Patient-Specific Functional Scale [PSFS]), health-related quality of life (EQ-5D-3L and EQ VAS), and self-rated recovery (Global Rating Scale [GRS]). The analyses were conducted on an intention-to-treat basis and with the per-protocol approach as sensitivity analyses. Results: Between April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90%) and 64 (91%), respectively, were followed up at 3 months, and 56 (80%) and 58 (83%), respectively, at 15 months. NSEIT demonstrated noninferiority to NSE in the primary outcome NDI, as the 1-sided 95% CI of the mean difference in change did not cross the specified noninferiority margin (7 percentage units). There were no significant between-group differences in change in NDI at the 3- or 15-month follow-up, with a mean difference of 1.4 (95% CI –2.5 to 5.3) and 0.9 (95% CI –3.6 to 5.3), respectively. In both groups, the NDI significantly decreased over time (NSEIT: mean change –10.1, 95% CI –13.7 to –6.5, effect size=1.33; NSE: mean change –9.3, 95% CI –12.8 to –5.7, effect size=1.19 at 15 months; P<.001). NSEIT was noninferior to NSE for most of the secondary outcomes except for neck pain intensity and EQ VAS, but post hoc analyses showed no differences between the groups. Similar results were seen in the per-protocol population. No serious adverse events were reported. Conclusions: NSEIT was noninferior to NSE in chronic WAD and required less physiotherapist time. NSEIT could be used as a treatment for patients with chronic WAD grades II and III. Trial Registration: ClinicalTrials.gov NCT03022812; https://clinicaltrials.gov/ct2/show/NCT03022812 %M 37338972 %R 10.2196/43888 %U https://www.jmir.org/2023/1/e43888 %U https://doi.org/10.2196/43888 %U http://www.ncbi.nlm.nih.gov/pubmed/37338972 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e41906 %T The Variability of Lumbar Sequential Motion Patterns: Observational Study %A Caelers,Inge %A Boselie,Toon %A van Hemert,Wouter %A Rijkers,Kim %A De Bie,Rob %A van Santbrink,Henk %+ Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, Netherlands, 31 652593545, inge.caelers@mumc.nl %K lumbar spine %K cinematographic recordings %K sequence %K motion pattern %K flexion %K extension %K rotation %K physiological %K musculoskeletal %K motion %K spine %K upper lumbar %K observational study %K physiological motion %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Physiological motion of the lumbar spine is a topic of interest for musculoskeletal health care professionals since abnormal motion is believed to be related to lumbar complaints. Many researchers have described ranges of motion for the lumbar spine, but only few have mentioned specific motion patterns of each individual segment during flexion and extension, mostly comprising the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion is still lacking. For the lower cervical spine, a consistent pattern of segmental contributions in a flexion-extension movement in young healthy individuals was described, resulting in a definition of physiological motion of the cervical spine. Objective: This study aimed to define the lumbar spines’ physiological motion pattern by determining the sequence of segmental contribution in sagittal rotation of each vertebra during maximum flexion and extension in healthy male participants. Methods: Cinematographic recordings were performed twice in 11 healthy male participants, aged 18-25 years, without a history of spine problems, with a 2-week interval (time point T1 and T2). Image recognition software was used to identify specific patterns in the sequence of segmental contributions per individual by plotting segmental rotation of each individual segment against the cumulative rotation of segments L1 to S1. Intraindividual variability was determined by testing T1 against T2. Intraclass correlation coefficients were tested by reevaluation of 30 intervertebral sequences by a second researcher. Results: No consistent pattern was found when studying the graphs of the cinematographic recordings during flexion. A much more consistent pattern was found during extension, especially in the last phase. It consisted of a peak in rotation in L3L4, followed by a peak in L2L3, and finally, in L1L2. This pattern was present in 71% (15/21) of all recordings; 64% (7/11) of the participants had a consistent pattern at both time points. Sequence of segmental contribution was less consistent in the lumbar spine than the cervical spine, possibly caused by differences in facet orientation, intervertebral discs, overprojection of the pelvis, and muscle recruitment. Conclusions: In 64% (7/11) of the recordings, a consistent motion pattern was found in the upper lumbar spine during the last phase of extension in asymptomatic young male participants. Physiological motion of the lumbar spine is a broad concept, influenced by multiple factors, which cannot be captured in a firm definition yet. Trial Registration: ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID): RR2-10.2196/14741 %M 38875682 %R 10.2196/41906 %U https://biomedeng.jmir.org/2023/1/e41906 %U https://doi.org/10.2196/41906 %U http://www.ncbi.nlm.nih.gov/pubmed/38875682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42901 %T Characteristics and Emerging Trends in Research on Rehabilitation Robots from 2001 to 2020: Bibliometric Study %A Zhang,Ying %A Liu,Xiaoyu %A Qiao,Xiaofeng %A Fan,Yubo %+ School of Biological Science and Medical Engineering, Beihang University, Building 5, 37 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 1082339861, x.y.liu@buaa.edu.cn %K rehabilitation robot %K bibliometric analysis %K interdisciplinary research %K co-occurrence analysis %K co-citation analysis %K rehabilitation %D 2023 %7 31.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The past 2 decades have seen rapid development in the use of robots for rehabilitation. Research on rehabilitation robots involves interdisciplinary activities, making it a great challenge to obtain comprehensive insights in this research field. Objective: We performed a bibliometric study to understand the characteristics of research on rehabilitation robots and emerging trends in this field in the last 2 decades. Methods: Reports on the topic of rehabilitation robots published from January 1, 2001, to December 31, 2020, were retrieved from the Web of Science Core Collection on July 28, 2022. Document types were limited to “article” and “meeting” (excluding the “review” type), to ensure that our analysis of the evolution over time of this research had high validity. We used CiteSpace to conduct a co-occurrence and co-citation analysis and to visualize the characteristics of this research field and emerging trends. Landmark publications were identified using metrics such as betweenness centrality and burst strength. Results: Through data retrieval, cleaning, and deduplication, we retrieved 9287 publications and 110,619 references cited in these publications that were on the topic of rehabilitation robots and were published between 2001 and 2020. Results of the Mann-Kendall test indicated that the numbers of both publications (P<.001; St=175.0) and citations (P<.001; St=188.0) related to rehabilitation robots exhibited a significantly increasing yearly trend. The co-occurrence results revealed 120 categories connected with research on rehabilitation robots; we used these categories to determine research relationships. The co-citation results identified 169 co-citation clusters characterizing this research field and emerging trends in it. The most prominent label was “soft robotic technology” (the burst strength was 79.07), which has become a topic of great interest in rehabilitative recovery for both the upper and lower limbs. Additionally, task-oriented upper-limb training, control strategies for robot-assisted lower limb rehabilitation, and power in exoskeleton robots were topics of great interest in current research. Conclusions: Our work provides insights into research on rehabilitation robots, including its characteristics and emerging trends during the last 2 decades, providing a comprehensive understanding of this research field. %M 37256670 %R 10.2196/42901 %U https://www.jmir.org/2023/1/e42901 %U https://doi.org/10.2196/42901 %U http://www.ncbi.nlm.nih.gov/pubmed/37256670 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43221 %T Combining Intensive Rehabilitation With a Nonfunctional Isokinetic Strengthening Program in Adolescents With Cerebral Palsy: Protocol for a Randomized Controlled Trial %A Guérin,Mathias %A Sijobert,Benoit %A Zaragoza,Benjamin %A Cambon,Flore %A Boyer,Laurence %A Patte,Karine %+ Unité de rééducation, Institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone, Palavas-les-Flots, 34250, France, 33 467077500, mathias.guerin74370@gmail.com %K isokinetic %K cerebral palsy %K gait analysis %K spasticity %K muscle strength %D 2023 %7 3.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cerebral palsy is the most common brain injury in the pediatric population. Patients with cerebral palsy present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with intensive rehabilitation may improve muscle strength and therefore gait efficiency. Objective: The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a nonfunctional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in patients with cerebral palsy. Another goal of this study is to determine whether adding an isokinetic program to intensive rehabilitation is more effective than intensive rehabilitation alone at decreasing spasticity and improving joint position sense in patients with cerebral palsy. Methods: A total of 30 adolescents with spastic diplegia cerebral palsy (Gross Motor Function Classification System levels I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic progressive strengthening group or an intensive rehabilitation control group. Gait parameters, muscle strength, spasticity, and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydrotherapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training sessions focusing on knee flexors and extensors with different execution speeds. Results: The protocol has been accepted by the French National Ethics Committee in October 2022. The inclusion of patients will start in November 2022. Conclusions: The combination of intensive rehabilitation with an isokinetic program on knee flexors and extensors has not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is beneficial for the improvement of gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia. International Registered Report Identifier (IRRID): PRR1-10.2196/43221 %M 36790338 %R 10.2196/43221 %U https://www.researchprotocols.org/2023/1/e43221 %U https://doi.org/10.2196/43221 %U http://www.ncbi.nlm.nih.gov/pubmed/36790338 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e40680 %T Evidence for the Efficacy of Commercially Available Wearable Biofeedback Gait Devices: Consumer-Centered Review %A Mate,Kedar K V %A Abou-Sharkh,Ahmed %A Mansoubi,Maedeh %A Alosaimi,Aeshah %A Dawes,Helen %A Michael,Wright %A Stanwood,Olivia %A Harding,Sarah %A Gorenko,Daniel %A Mayo,Nancy E %+ Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montreal, QC, H3G 2M1, Canada, 1 5149616041, kedar.mate@mail.mcgill.ca %K wearables %K technologies %K walking training %K rehabilitation %K biofeedback %K mobile phone %D 2023 %7 19.4.2023 %9 Review %J JMIR Rehabil Assist Technol %G English %X 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. %M 37074771 %R 10.2196/40680 %U https://rehab.jmir.org/2023/1/e40680 %U https://doi.org/10.2196/40680 %U http://www.ncbi.nlm.nih.gov/pubmed/37074771 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43507 %T The Effect of a Mobile Health App on Treatment Adherence and Revenue at Physical Health Clinics: Retrospective Record Review %A Topp,Robert %A Greenstein,Jay %A Etnoyer-Slaski,Jena %+ College of Nursing, The University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, United States, 1 419 530 4847, robert.topp@utoledo.edu %K physical health %K completion of therapy %K phone app %K clinic charges and payments %K payment %K cost %K physiotherapy %K physical therapy %K adherence %K attrition %K mobile phone %K reminder %K mobile health %K mHealth %K health app %K mobile app %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X 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. %M 36889337 %R 10.2196/43507 %U https://rehab.jmir.org/2023/1/e43507 %U https://doi.org/10.2196/43507 %U http://www.ncbi.nlm.nih.gov/pubmed/36889337 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e35757 %T Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program %A Parel,Ilaria %A Candoli,Valeria %A Filippi,Maria Vittoria %A Padolino,Antonio %A Merolla,Giovanni %A Sanniti,Stefano %A Galassi,Riccardo %A Paladini,Paolo %A Cutti,Andrea Giovanni %+ Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cervesi Hospital, Basement, via Beethoven, 1, Cattolica, 47841, Italy, 39 0541966228, ilaria.parel@auslromagna.it %K rotator cuff tear repair %K wearable sensor %K biomechanic %K eHealth %K rehabilitation %K scapula %K biofeedback %K kinematic %K exercise %K shoulder %D 2023 %7 22.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. Objective: The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. Methods: For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient’s rehabilitation program, a list of operative guidelines is provided. Results: We describe various applications of the ISEO exercise program in terms of frequency and intensity. Conclusions: An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. International Registered Report Identifier (IRRID): DERR1-10.2196/35757 %M 36947146 %R 10.2196/35757 %U https://www.researchprotocols.org/2023/1/e35757 %U https://doi.org/10.2196/35757 %U http://www.ncbi.nlm.nih.gov/pubmed/36947146 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e41091 %T Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study %A Fan,Ting %A Wang,Xiaobei %A Song,Xiaoxi %A Zhao,Gang %A Zhang,Zhichang %+ Department of Computer, School of Intelligent Medicine, China Medical University, No 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China, 86 18900910770, zczhang@cmu.edu.cn %K mobility %K rehabilitation %K virtual reality %K bibliometric %K technology %K training %K interactive %K research %K exercise %K resources %K cerebral palsy %K adult %K video games %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new definitions of VR technologies in rehabilitation, which reveal new situations and requirements. Objective: Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation. Methods: The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots. Results: A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021). Conclusions: Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation. %M 36877556 %R 10.2196/41091 %U https://games.jmir.org/2023/1/e41091 %U https://doi.org/10.2196/41091 %U http://www.ncbi.nlm.nih.gov/pubmed/36877556 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e40283 %T Remotely Delivered Cardiac Rehabilitation Exercise for Coronary Heart Disease: Nonrandomized Feasibility Study %A Giggins,Oonagh M %A Doyle,Julie %A Smith,Suzanne %A Vavasour,Grainne %A Moran,Orla %A Gavin,Shane %A Sojan,Nisanth %A Boyle,Gordon %+ NetwellCASALA, Dundalk Institute of Technology, Dublin Road, Dundalk, A91K584, Ireland, 353 429370200 ext 2114, oonagh.giggins@dkit.ie %K cardiac rehabilitation %K exercise %K coronary heart disease %K CHD %K coronary %K cardiovascular %K virtual rehabilitation %K remote rehabilitation %K digital health %K heart %K rehabilitation %K cardiac %K digital platform %K digital %K intervention %K program %K physical activity %K fitness %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR. Objective: We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre–Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program. Methods: In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed. Results: In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F1,14=.026; P=.87) nor effect for time (F1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study. Conclusions: This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs. International Registered Report Identifier (IRRID): RR2-10.2196/31855 %M 36763453 %R 10.2196/40283 %U https://cardio.jmir.org/2023/1/e40283 %U https://doi.org/10.2196/40283 %U http://www.ncbi.nlm.nih.gov/pubmed/36763453 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e39687 %T Playfully Assessing Lower Extremity Selective Voluntary Motor Control in Children With Cerebral Palsy: Psychometric Study %A Fahr,Annina %A Balzer,Julia %A Keller,Jeffrey W %A van Hedel,Hubertus J A %+ Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, Affoltern a.A., 8910, Switzerland, 41 44 762 52 97, annina.fahr@kispi.uzh.ch %K selective motor control %K mirror movements %K neurorehabilitation %K validity %K reliability %K interactive computer play %K eHealth %K digital health %K rehabilitation %K cerebral palsy %K movement %K child %K pediatric %K game %K accelerometer %K motor %K avatar %K assessment %K limb %K joint %K physiotherapy %K physiotherapist %K lower extremity %K lower extremities %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Objective measures specifically assessing selective voluntary motor control are scarce. Therefore, we have developed an interval-scaled assessment based on accelerometers. Objective: This study provided a preliminary evaluation of the validity and reliability of this novel gamelike assessment measuring lower limb selective voluntary motor control in children with cerebral palsy (CP). Methods: Children with CP and their neurologically intact peers were recruited for this psychometric evaluation of the assessgame. The participants played the assessgame and steered an avatar by selective hip, knee, or ankle joint movements captured with accelerometers. The assessgame’s scores provide information about the accuracy of the selective movement of the target joint and the amplitude and frequency of involuntary movements occurring in uninvolved joints. We established discriminative validity by comparing the assessgame scores of the children with CP with those of the neurologically intact children, concurrent validity by correlations with clinical scores and therapists’ opinions, and relative and absolute test-retest reliability. Results: We included 20 children with CP (mean age 12 years and 5 months, SD 3 years and 4 months; Gross Motor Function Classification System levels I to IV) and 31 neurologically intact children (mean age 11 years and 1 month, SD 3 years and 6 months). The assessgame could distinguish between the children with CP and neurologically intact children. The correlations between the assessgame’s involuntary movement score and the therapist’s rating of the occurrence of involuntary movements during the game were moderate (Spearman ρ=0.56; P=.01), whereas the correlations of the assessgame outcomes with the Selective Control Assessment of the Lower Extremity and Gross Motor Function Classification System were low and not significant (|ρ|≤0.39). The intraclass correlation coefficients were >0.85 and indicated good relative test-retest reliability. Minimal detectable changes amounted to 25% (accuracy) and 44% (involuntary movement score) of the mean total scores. The percentage of children able to improve by the minimal detectable change without reaching the maximum score was 100% (17/17) for the accuracy score and 94% (16/17) for the involuntary movement score. Conclusions: The assessgame proved reliable and showed discriminative validity in this preliminary evaluation. Concurrent validity was moderate with the therapist’s opinion but relatively poor with the Selective Control Assessment of the Lower Extremity. We assume that the assessment’s gamelike character demanded various other motor control aspects that are less considered in current clinical assessments. %M 36525299 %R 10.2196/39687 %U https://rehab.jmir.org/2022/4/e39687 %U https://doi.org/10.2196/39687 %U http://www.ncbi.nlm.nih.gov/pubmed/36525299 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e42385 %T Understanding the Technology Acceptance and Usability of a New Device for Hand Therapy: Qualitative Descriptive Study %A Rios Rincon,Adriana M %A Guptill,Christine %A Guevara Salamanca,Juan David %A Liubaoerjijin,Yilina %A Figeys,Mathieu %A Gregson,Geoff %A Miguel-Cruz,Antonio %+ Department of Occupational Therapy, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada, 1 7802246641, miguelcr@ualberta.ca %K usability %K technology acceptance %K hand therapy, rehabilitation, disability %K medical device %K limb disorder %K chronic disorder %K health care system %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Upper extremity function plays a critical role in completing activities of daily living, employment, and participating in recreational activities. The FEPSim device is a medical device for hand and wrist rehabilitation that can be adjusted according to the patient’s requirements in rehabilitation. Furthermore, the FEPSim can be used to assess the patient’s strength and range of motion of the forearm, wrist, and hand. At present, the acceptance and usability of the FEPSim have not been tested in a clinical setting, with limited perspectives from rehabilitation-providing clinicians. Objective: This study aims to understand the factors related to the acceptance and usability of the FEPSim device. Upper limb disorders are prevalent across populations. The impact of upper limb disorders, both acute and chronic, puts a significant burden on the Canadian health care system. Methods: A qualitative descriptive study was conducted that involved face-to-face semistructured interviews with hand therapists from hand therapy services who used the FEPSim device. We used purposive sampling to recruit 10 participants over a period of 14 months. Semistructured interview questions (topic-guided) examined the technology acceptance and usability of the FEPSim device. Results: We found 6 factors to be critical aspects of the acceptance and usability of the FEPSim device. These factors were (1) useful for therapy, (2) effortlessness, (3) environmental conditions, (4) internal encouragement, (5) technological aesthetics, and (6) use. Conclusions: The FEPSim device was widely accepted by the therapists. The use of the FEPSim device is a feasible alternative for supporting hand therapy. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 %M 36355405 %R 10.2196/42385 %U https://rehab.jmir.org/2022/4/e42385 %U https://doi.org/10.2196/42385 %U http://www.ncbi.nlm.nih.gov/pubmed/36355405 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 3 %P e37229 %T Automated Assessment of Balance Rehabilitation Exercises With a Data-Driven Scoring Model: Algorithm Development and Validation Study %A Tsakanikas,Vassilios %A Gatsios,Dimitris %A Pardalis,Athanasios %A Tsiouris,Kostas M %A Georga,Eleni %A Bamiou,Doris-Eva %A Pavlou,Marousa %A Nikitas,Christos %A Kikidis,Dimitrios %A Walz,Isabelle %A Maurer,Christoph %A Fotiadis,Dimitrios %+ Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, University of Ioannina Campus, Ioannina, 45110, Greece, 30 6972745067, vasilistsakanikas@gmail.com %K balance rehabilitation exercises %K scoring model %K exercise evaluation %K persuasive coaching system %D 2022 %7 31.8.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Balance rehabilitation programs represent the most common treatments for balance disorders. Nonetheless, lack of resources and lack of highly expert physiotherapists are barriers for patients to undergo individualized rehabilitation sessions. Therefore, balance rehabilitation programs are often transferred to the home environment, with a considerable risk of the patient misperforming the exercises or failing to follow the program at all. Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance involves several modules, from rehabilitation program management to augmented reality coach presentation. Objective: The aim of this study was to design, implement, test, and evaluate a scoring model for the accurate assessment of balance rehabilitation exercises, based on data-driven techniques. Methods: The data-driven scoring module is based on an extensive data set (approximately 1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. It can be used as a training and testing data set for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. In that direction, for creating the data set, 2 independent experts monitored (in the clinic) 19 patients performing 1313 balance rehabilitation exercises and scored their performance based on a predefined scoring rubric. On the collected data, preprocessing, data cleansing, and normalization techniques were applied before deploying feature selection techniques. Finally, a wide set of ML algorithms, like random forests and neural networks, were used to identify the most suitable model for each scoring component. Results: The results of the trained model improved the performance of the scoring module in terms of more accurate assessment of a performed exercise, when compared with a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9% for sitting exercises, 20.8% for standing exercises, and 26.8% for walking exercises). Finally, the resulting performance of the model resembled the threshold of the interobserver variability, enabling trustworthy usage of the scoring module in the closed-loop chain of the Holobalance coaching system. Conclusions: The proposed set of ML models can effectively score the balance rehabilitation exercises of the Holobalance system. The models had similar accuracy in terms of Cohen kappa analysis, with interobserver variability, enabling the scoring module to infer the score of an exercise based on the collected signals from sensing devices. More specifically, for sitting exercises, the scoring model had high classification accuracy, ranging from 0.86 to 0.90. Similarly, for standing exercises, the classification accuracy ranged from 0.85 to 0.92, while for walking exercises, it ranged from 0.81 to 0.90. Trial Registration: ClinicalTrials.gov NCT04053829; https://clinicaltrials.gov/ct2/show/NCT04053829 %M 36044258 %R 10.2196/37229 %U https://rehab.jmir.org/2022/3/e37229 %U https://doi.org/10.2196/37229 %U http://www.ncbi.nlm.nih.gov/pubmed/36044258 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 3 %P e38689 %T Detection of Low Back Physiotherapy Exercises With Inertial Sensors and Machine Learning: Algorithm Development and Validation %A Alfakir,Abdalrahman %A Arrowsmith,Colin %A Burns,David %A Razmjou,Helen %A Hardisty,Michael %A Whyne,Cari %+ Holland Bone and Joint Program, Sunnybrook Research Institute, S6 21, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 416 480 6100 ext 5056, cari.whyne@sunnybrook.ca %K low back pain %K rehabilitation %K wearables %K inertial measurement units %K machine learning %K activity recognition %D 2022 %7 23.8.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Physiotherapy is a critical element in the successful conservative management of low back pain (LBP). A gold standard for quantitatively measuring physiotherapy participation is crucial to understanding physiotherapy adherence in managing recovery from LBP. Objective: This study aimed to develop and evaluate a system with wearable inertial sensors to objectively detect the performance of unsupervised exercises for LBP comprising movement in multiple planes and sitting postures. Methods: A quantitative classification design was used within a machine learning framework to detect exercise performance and posture in a cohort of healthy participants. A set of 8 inertial sensors were placed on the participants, and data were acquired as they performed 7 McKenzie low back exercises and 3 sitting posture positions. Engineered time series features were extracted from the data and used to train 9 models by using a 6-fold cross-validation approach, from which the best 2 models were selected for further study. In addition, a convolutional neural network was trained directly on the time series data. A feature importance analysis was performed to identify sensor locations and channels that contributed the most to the models. Finally, a subset of sensor locations and channels was included in a hyperparameter grid search to identify the optimal sensor configuration and best performing algorithms for exercise and posture classification. The final models were evaluated using the F1 score in a 10-fold cross-validation approach. Results: In total, 19 healthy adults with no history of LBP each completed at least one full session of exercises and postures. Random forest and XGBoost (extreme gradient boosting) models performed the best out of the initial set of 9 engineered feature models. The optimal hardware configuration was identified as a 3-sensor setup—lower back, left thigh, and right ankle sensors with acceleration, gyroscope, and magnetometer channels. The XGBoost model achieved the highest exercise (F1 score: mean 0.94, SD 0.03) and posture (F1 score: mean 0.90, SD 0.11) classification scores. The convolutional neural network achieved similar results with the same sensor locations, using only the accelerometer and gyroscope channels for exercise classification (F1 score: mean 0.94, SD 0.02) and the accelerometer channel alone for posture classification (F1 score: mean 0.88, SD 0.07). Conclusions: This study demonstrates the potential of a 3-sensor lower body wearable solution (eg, smart pants) that can identify exercises in multiple planes and proper sitting postures, which is suitable for the treatment of LBP. This technology has the potential to improve the effectiveness of LBP rehabilitation by facilitating quantitative feedback, early problem diagnosis, and possible remote monitoring. %M 35998014 %R 10.2196/38689 %U https://rehab.jmir.org/2022/3/e38689 %U https://doi.org/10.2196/38689 %U http://www.ncbi.nlm.nih.gov/pubmed/35998014 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34588 %T Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach %A Johnson,Rowan W %A White,Becky K %A Gucciardi,Daniel F %A Gibson,Noula %A Williams,Sian A %+ Therapy Services, Ability WA, 106 Bradford Street, Coolbinia, Perth, 6069, Australia, 61 1300106106, rowan.johnson@abilitywa.com.au %K neurodevelopmental disability %K mobile health %K self-determination theory %K gamification %K physiotherapy %K occupational therapy %K speech pathology %K behavior change %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. Objective: The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. Methods: We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. Results: The IM process resulted in the specification of app elements, self-determination theory–informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. Conclusions: mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design. %M 35943782 %R 10.2196/34588 %U https://pediatrics.jmir.org/2022/3/e34588 %U https://doi.org/10.2196/34588 %U http://www.ncbi.nlm.nih.gov/pubmed/35943782 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e33745 %T Rehabilitation of Upper Extremity by Telerehabilitation Combined With Exergames in Survivors of Chronic Stroke: Preliminary Findings From a Feasibility Clinical Trial %A Allegue,Dorra Rakia %A Higgins,Johanne %A Sweet,Shane N %A Archambault,Philippe S %A Michaud,Francois %A Miller,William %A Tousignant,Michel %A Kairy,Dahlia %+ The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, 6363 Chem. Hudson, Montreal, QC, H3S 1M9, Canada, 1 4389901309, dorra.rakia.allegue@umontreal.ca %K stroke %K rehabilitation %K virtual reality %K video games %K telerehabilitation %K upper extremity %K motivation %K mHealth %K mobile health %K personalized care %K stroke rehabilitation %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Exergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician. Objective: This study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy. Methods: This study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention). Results: A total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants. Conclusions: The VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae. International Registered Report Identifier (IRRID): RR2-10.2196/14629 %M 35731560 %R 10.2196/33745 %U https://rehab.jmir.org/2022/2/e33745 %U https://doi.org/10.2196/33745 %U http://www.ncbi.nlm.nih.gov/pubmed/35731560 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e38442 %T Uneven Treadmill Training for Rehabilitation of Lateral Ankle Sprains and Chronic Ankle Instability: Protocol for a Pragmatic Randomized Controlled Trial %A Russell Esposito,Elizabeth %A Farrokhi,Shawn %A Shuman,Benjamin R %A Sessoms,Pinata H %A Szymanek,Eliza %A Hoppes,Carrie W %A Bechard,Laura %A King,David %A Fraser,John J %+ Operational Readiness and Health Directorate, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA, 92106-3521, United States, 1 757 438 0390, john.j.fraser8.mil@mail.mil %K military personnel %K ankle injuries %K rehabilitation %K recovery of function %K secondary prevention %K ankle sprain %K treadmill %D 2022 %7 22.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lateral ankle sprains (LASs) are common injuries among military service members. Approximately 40% of individuals with an LAS progress to develop chronic ankle instability (CAI), a condition that results in substantial mechanical and neurophysiological impairment and activity limitation. Since proprioceptive and balance training improve functional outcomes and prevent secondary injury following LAS, they are recommended in clinical practice. Uneven treadmills are an innovative modality that challenge the sensorimotor system while performing an ecologically valid task simulating environments frequently encountered by service members with LAS and CAI. Objective: The aim of this study is to evaluate whether the inclusion of uneven treadmill training in standard rehabilitation can improve clinical, functional, biomechanical, and patient-reported outcomes compared with the standard of care alone in service members with LAS and CAI. The prophylactic effects of treatment on secondary injury and identification of any contributing or mediating factors that influence outcomes following treatment will also be evaluated. We hypothesize that service members receiving uneven treadmill training will demonstrate greater improvements in clinical and instrumented measures of impairment, patient-reported function, and lower risk of injury recurrence than the control group immediately post and 18 months following treatment. Methods: A multisite, parallel randomized clinical trial will be performed among service members aged 18-49 years being treated for LAS and CAI in military treatment facilities in the United States. Participants randomly assigned and allocated to receive the experimental intervention will be provided up to 12 sessions of training on an uneven terrain treadmill over a 6-week treatment course to supplement standard rehabilitation care. Treatment intensity of the rehabilitation exercises and treadmill training will be progressed on the basis of patient-perceived intensity and treatment responses. Outcome measures will include patient-reported outcomes, functional assessments, performance measures, and biomechanical measures. Investigators collecting outcome measures will be blinded to treatment allocation. Reinjury rates and patient-reported outcomes of function will be tracked over 18 months following treatment. Results: The project was funded in September 2020. Patient recruitment began in November 2021, with 3 participants enrolled as of February 2022. Dissemination of the main study findings is anticipated in 2024. Conclusions: This study will assess the impact of an innovative uneven-terrain treadmill on treatment outcomes in the rehabilitation of service members with LAS and CAI. The results of this study will be used to inform rehabilitation practices and to potentially improve functional outcomes and secondary prevention in this patient population. Trial Registration: ClinicalTrials.gov NCT04999904; https://clinicaltrials.gov/ct2/show/NCT04999904?term=NCT04999904 International Registered Report Identifier (IRRID): DERR1-10.2196/38442 %M 35731551 %R 10.2196/38442 %U https://www.researchprotocols.org/2022/6/e38442 %U https://doi.org/10.2196/38442 %U http://www.ncbi.nlm.nih.gov/pubmed/35731551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34307 %T Technology-Based Compensation Assessment and Detection of Upper Extremity Activities of Stroke Survivors: Systematic Review %A Wang,Xiaoyi %A Fu,Yan %A Ye,Bing %A Babineau,Jessica %A Ding,Yong %A Mihailidis,Alex %+ School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Room 519, East 8th Building, Huazhong University of Science and Technology, Wuhan, China, 86 15071320900, laura_fy@mail.hust.edu.cn %K stroke %K upper extremity rehabilitation %K UE rehabilitation %K compensation %K assessment %K technology %K sensor %K artificial intelligence %K AI %D 2022 %7 13.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Upper extremity (UE) impairment affects up to 80% of stroke survivors and accounts for most of the rehabilitation after discharge from the hospital release. Compensation, commonly used by stroke survivors during UE rehabilitation, is applied to adapt to the loss of motor function and may impede the rehabilitation process in the long term and lead to new orthopedic problems. Intensive monitoring of compensatory movements is critical for improving the functional outcomes during rehabilitation. Objective: This review analyzes how technology-based methods have been applied to assess and detect compensation during stroke UE rehabilitation. Methods: We conducted a wide database search. All studies were independently screened by 2 reviewers (XW and YF), with a third reviewer (BY) involved in resolving discrepancies. The final included studies were rated according to their level of clinical evidence based on their correlation with clinical scales (with the same tasks or the same evaluation criteria). One reviewer (XW) extracted data on publication, demographic information, compensation types, sensors used for compensation assessment, compensation measurements, and statistical or artificial intelligence methods. Accuracy was checked by another reviewer (YF). Four research questions were presented. For each question, the data were synthesized and tabulated, and a descriptive summary of the findings was provided. The data were synthesized and tabulated based on each research question. Results: A total of 72 studies were included in this review. In all, 2 types of compensation were identified: disuse of the affected upper limb and awkward use of the affected upper limb to adjust for limited strength, mobility, and motor control. Various models and quantitative measurements have been proposed to characterize compensation. Body-worn technology (25/72, 35% studies) was the most used sensor technology to assess compensation, followed by marker-based motion capture system (24/72, 33% studies) and marker-free vision sensor technology (16/72, 22% studies). Most studies (56/72, 78% studies) used statistical methods for compensation assessment, whereas heterogeneous machine learning algorithms (15/72, 21% studies) were also applied for automatic detection of compensatory movements and postures. Conclusions: This systematic review provides insights for future research on technology-based compensation assessment and detection in stroke UE rehabilitation. Technology-based compensation assessment and detection have the capacity to augment rehabilitation independent of the constant care of therapists. The drawbacks of each sensor in compensation assessment and detection are discussed, and future research could focus on methods to overcome these disadvantages. It is advised that open data together with multilabel classification algorithms or deep learning algorithms could benefit from automatic real time compensation detection. It is also recommended that technology-based compensation predictions be explored. %M 35699982 %R 10.2196/34307 %U https://www.jmir.org/2022/6/e34307 %U https://doi.org/10.2196/34307 %U http://www.ncbi.nlm.nih.gov/pubmed/35699982 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e35569 %T The Current State of Remote Physiotherapy in Finland: Cross-sectional Web-Based Questionnaire Study %A Hellstén,Thomas %A Arokoski,Jari %A Sjögren,Tuulikki %A Jäppinen,Anna-Maija %A Kettunen,Jyrki %+ Faculty of Medicine, University of Helsinki, P O Box 63, Haartmaninkatu 8, Helsinki, 00014, Finland, 358 407733154, thomas.hellsten@helsinki.fi %K COVID-19 %K remote physiotherapy %K COVID-19 pandemic %K current state %K suitability in disease groups %K competence of physiotherapist %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The ongoing COVID-19 pandemic has required social, health, and rehabilitation organizations to implement remote physiotherapy (RP) as a part of physiotherapists’ daily practice. RP may improve access to physiotherapy as it delivers physiotherapy services to rehabilitees through information and communications technology. Even if RP has already been introduced in this century, physiotherapists’ opinion, amount of use, and form in daily practice have not been studied extensively. Objective: This study aims to investigate physiotherapists’ opinions of the current state of RP in Finland. Methods: A quantitative, cross-sectional, web-based questionnaire was sent to working-aged members of the Finnish Association of Physiotherapists (n=5905) in March 2021 and to physiotherapists in a private physiotherapy organization (n=620) in May 2021. The questionnaire included questions on the suitability of RP in different diseases and the current state and implementation of RP in work among physiotherapists. Results: Of the 6525 physiotherapists, a total of 9.9% (n=662; n=504, 76.1% female; mean age 46.1, SD 12 years) answered the questionnaire. The mean suitability “score” (0=not suitable at all to 10=fully suitable) of RP in different disease groups varied from 3.3 (neurological diseases) to 6.1 (lung diseases). Between early 2020 (ie, just before the COVID-19 pandemic) and spring 2021, the proportion of physiotherapists who used RP increased from 33.8% (21/62) to 75.4% (46/61; P<.001) in the public sector and from 19.7% (42/213) to 76.6% (163/213; P<.001) in the private sector. However, only 11.7% (32/274) of physiotherapists reported that they spent >20% of their practice time for RP in 2021. The real-time method was the most common RP method in both groups (public sector 46/66, 69.7% vs private sector 157/219, 71.7%; P=.47). The three most commonly used technical equipments were computers/tablets (229/290, 79%), smartphones (149/290, 51.4%), and phones (voice call 51/290, 17.6%). The proportion of physiotherapists who used computers/tablets in RP was higher in the private sector than in the public sector (183/221, 82.8% vs 46/68, 67.6%; P=.01). In contrast, a higher proportion of physiotherapists in the public sector than in the private sector used phones (18/68, 26.5% vs 33/221, 14.9%; P=.04). Conclusions: During the COVID-19 pandemic, physiotherapists increased their use of RP in their everyday practice, although practice time in RP was still low. When planning RP for rehabilitees, it should be considered that the suitability of RP in different diseases seems to vary in the opinion of physiotherapists. Furthermore, our results brought up important new information for developing social, health, and rehabilitation education for information and communications technologies. %M 3560 %R 10.2196/35569 %U https://rehab.jmir.org/2022/2/e35569 %U https://doi.org/10.2196/35569 %U http://www.ncbi.nlm.nih.gov/pubmed/3560 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e26990 %T Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports %A Burdea,Grigore %A Kim,Nam %A Polistico,Kevin %A Kadaru,Ashwin %A Grampurohit,Namrata %A Hundal,Jasdeep %A Pollack,Simcha %+ Corporate Laboratories, Bright Cloud International Corp, 675 US Hwy 1, Suite B203, New Jersey Bioscience Center, North Brunswick, NJ, 08902, United States, 1 732 640 0400, diplomatru@yahoo.com %K subacute stroke %K virtual reality %K gamification %K therapeutic game controller %K integrative rehabilitation %K BrightArm Duo %K BrightArm Compact %K upper extremity %K cognition %K depression %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. Objective: The aim of this study is to design and test a robotic rehabilitation table–based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. Methods: A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. Results: The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225% and 100% increase), grasp strength (27% and 16% increase), and pinch strength (31% and 15% increase). The shoulder flexion range increased by 17% and 18% and elbow supination range by 75% and 58%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). Conclusions: The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. Trial Registration: ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170 %M 35416787 %R 10.2196/26990 %U https://rehab.jmir.org/2022/2/e26990 %U https://doi.org/10.2196/26990 %U http://www.ncbi.nlm.nih.gov/pubmed/35416787 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e26825 %T Proposal for Post Hoc Quality Control in Instrumented Motion Analysis Using Markerless Motion Capture: Development and Usability Study %A Röhling,Hanna Marie %A Althoff,Patrik %A Arsenova,Radina %A Drebinger,Daniel %A Gigengack,Norman %A Chorschew,Anna %A Kroneberg,Daniel %A Rönnefarth,Maria %A Ellermeyer,Tobias %A Rosenkranz,Sina Cathérine %A Heesen,Christoph %A Behnia,Behnoush %A Hirano,Shigeki %A Kuwabara,Satoshi %A Paul,Friedemann %A Brandt,Alexander Ulrich %A Schmitz-Hübsch,Tanja %+ Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, Berlin, 13125, Germany, 49 30 450539718, hanna-marie.roehling@charite.de %K instrumented motion analysis %K markerless motion capture %K visual perceptive computing %K quality control %K quality reporting %K gait analysis %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Instrumented assessment of motor symptoms has emerged as a promising extension to the clinical assessment of several movement disorders. The use of mobile and inexpensive technologies such as some markerless motion capture technologies is especially promising for large-scale application but has not transitioned into clinical routine to date. A crucial step on this path is to implement standardized, clinically applicable tools that identify and control for quality concerns. Objective: The main goal of this study comprises the development of a systematic quality control (QC) procedure for data collected with markerless motion capture technology and its experimental implementation to identify specific quality concerns and thereby rate the usability of recordings. Methods: We developed a post hoc QC pipeline that was evaluated using a large set of short motor task recordings of healthy controls (2010 recordings from 162 subjects) and people with multiple sclerosis (2682 recordings from 187 subjects). For each of these recordings, 2 raters independently applied the pipeline. They provided overall usability decisions and identified technical and performance-related quality concerns, which yielded respective proportions of their occurrence as a main result. Results: The approach developed here has proven user-friendly and applicable on a large scale. Raters’ decisions on recording usability were concordant in 71.5%-92.3% of cases, depending on the motor task. Furthermore, 39.6%-85.1% of recordings were concordantly rated as being of satisfactory quality whereas in 5.0%-26.3%, both raters agreed to discard the recording. Conclusions: We present a QC pipeline that seems feasible and useful for instant quality screening in the clinical setting. Results confirm the need of QC despite using standard test setups, testing protocols, and operator training for the employed system and by extension, for other task-based motor assessment technologies. Results of the QC process can be used to clean existing data sets, optimize quality assurance measures, as well as foster the development of automated QC approaches and therefore improve the overall reliability of kinematic data sets. %M 35363150 %R 10.2196/26825 %U https://humanfactors.jmir.org/2022/2/e26825 %U https://doi.org/10.2196/26825 %U http://www.ncbi.nlm.nih.gov/pubmed/35363150 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32027 %T A Virtual Reality Game Suite for Graded Rehabilitation in Patients With Low Back Pain and a High Fear of Movement: Within-Subject Comparative Study %A Peebles,Alexander T %A van der Veen,Susanne %A Stamenkovic,Alexander %A France,Christopher R %A Pidcoe,Peter E %A Thomas,James S %+ Department of Physical Therapy, Virginia Commonwealth University, 900 E. Leigh St, 4th Floor, Richmond, VA, 23298, United States, 1 740 541 6324, jthomas32@vcu.edu %K virtual reality %K reaching %K intervention %K rehabilitation %K exergaming %K biomechanics %K serious games %K gamification %K movement %K physiotherapy %K lumbar %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Complex movement pathologies that are biopsychosocial in nature (eg, back pain) require a multidimensional approach for effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality–based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic contact targets. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments. Objective: This study aims to compare lumbar flexion excursion and velocity across our previous and newly developed virtual reality tools in a healthy control cohort. Methods: A total of 31 healthy participants (16 males, 15 females) took part in 3 gamified virtual reality therapies (ie, Reachality, Fishality, and Dodgeality), while whole-body 3D kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task and between the 4 anthropometrically defined intended target impact locations using separate 2-way repeated measures analysis of variance models. Results: There was an interaction between game and impact height for each outcome (all P<.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to that during Dodgeality for the 2 higher impact heights but was greater during Reachality than during Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality than during Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to those during Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality compared to that for Fishality and for Fishality relative to that for Dodgeality. Conclusions: Lumbar flexion velocity was reduced during Fishality relative to that during Dodgeality and resembled velocity demands more similar to those for a self-paced reaching task (ie, Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar to those during Reachality than to those during Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with low back pain and a high fear of movement. %M 35319471 %R 10.2196/32027 %U https://games.jmir.org/2022/1/e32027 %U https://doi.org/10.2196/32027 %U http://www.ncbi.nlm.nih.gov/pubmed/35319471 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31164 %T The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study %A Gulde,Philipp %A Rieckmann,Peter %+ Center for Clinical Neuroplasticity, Medical Park Loipl, Medical Park Societas Europaea, Thanngasse 15, Bischofswiesen, 83483, Germany, 49 865289522, p.gulde@medicalpark.de %K multiple sclerosis %K actigraphy %K cluster analysis %K fatigue %K physical activity %K neurology %K neurorehabilitation %K rehabilitation %K digital health %K health technology %K digital tools %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Persons with multiple sclerosis frequently report increased levels of fatigue and fatigability. However, behavioral surrogates that are strongly associated with self-reports are lacking, which limits research and treatment. Objective: The aim of this study was to derive distinct behavioral syndromes that are reflected by self-reports concerning fatigue and fatigability. Methods: We collected actigraphic data of 30 persons with multiple sclerosis over a period of 1 week during an inpatient stay at a neurorehabilitation facility. Further, participants completed the German fatigue severity scale. A principal component analysis of actigraphic parameters was performed to extract the latent component levels of behaviors that reflect fatigue (quantity of activity) and fatigability (fragmentation of activity). The resulting components were used in a cluster analysis. Results: Analyses suggested 3 clusters, one with high activity (d=0.65-1.57) and low clinical disability levels (d=0.91-1.39), one with high levels of sedentary behavior (d=1.06-1.58), and one with strong activity fragmentation (d=1.39-1.94). The cluster with high levels of sedentary behavior further revealed strong differences from the other clusters concerning participants’ reported levels of fatigue (d=0.99-1.28). Conclusions: Cluster analysis data proved to be feasible to meaningfully differentiate between different behavioral syndromes. Self-reports reflected the different behavioral syndromes strongly. Testing of additional domains (eg, volition or processing speed) and assessments during everyday life seem warranted to better understand the origins of reported fatigue symptomatology. %M 35297774 %R 10.2196/31164 %U https://rehab.jmir.org/2022/1/e31164 %U https://doi.org/10.2196/31164 %U http://www.ncbi.nlm.nih.gov/pubmed/35297774 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e33609 %T An Investigation Into the Use of mHealth in Musculoskeletal Physiotherapy: Scoping Review %A Agnew,Jonathon M R %A Hanratty,Catherine E %A McVeigh,Joseph G %A Nugent,Chris %A Kerr,Daniel P %+ Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 07576629548, agnew-j10@ulster.ac.uk %K physiotherapy %K musculoskeletal %K mHealth %K rehabilitation %K scoping review %K mobile phone %D 2022 %7 11.3.2022 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. Objective: The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. Methods: A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. Results: Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. Conclusions: mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available. %M 35275089 %R 10.2196/33609 %U https://rehab.jmir.org/2022/1/e33609 %U https://doi.org/10.2196/33609 %U http://www.ncbi.nlm.nih.gov/pubmed/35275089 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e28875 %T Comparison of the Impact of Conventional and Web-Based Pulmonary Rehabilitation on Physical Activity in Patients With Chronic Obstructive Pulmonary Disease: Exploratory Feasibility Study %A Chaplin,Emma %A Barnes,Amy %A Newby,Chris %A Houchen-Wolloff,Linzy %A Singh,Sally J %+ Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre- Respiratory, University Hospitals of Leicester National Health Service Trust, Groby Road, Leicester, LE3 9QP, United Kingdom, 44 116 258 3181, emma.chaplin@uhl-tr.nhs.uk %K SPACE for COPD %K internet %K web-based %K chronic obstructive pulmonary disease %K pulmonary rehabilitation %K physical activity %K exercise %K chronic disease %K COPD %K rehabilitation %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Pulmonary Rehabilitation (PR) increases exercise capacity, with less clear evidence regarding physical activity (PA). The World Health Organization recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA per week to reduce the risks of chronic disease. Objective: The objective of this study was to assess the effectiveness of conventional PR versus web-based PR with respect to changes in PA. Methods: Patients with COPD were randomized to either conventional PR classes (n=51) or a web-based PR program (n=52) for 7 weeks in a feasibility study. Accelerometers (Sensewear) were worn before and after the intervention, and PA was measured as steps per day and mean bouts of moderate activity for ≥2, ≥5, ≥10, and ≥20 minutes. Measures were derived for patients with ≥8 hours of data per day for ≥4 days, using the R package for statistical analysis. Variables were explored to examine their relationships with bouts of activity. Results: Baseline characteristics did not differ significantly between groups. Complete PA data were available for the groups receiving web-based (n=20) and conventional (n=34) PR interventions. The web-based PR group demonstrated a nonsignificant increase in the number of steps per day, which mainly comprised short bouts of moderate to vigorous intensity PA when compared to the conventional PR group (P=.20). The conventional PR group demonstrated increased 20-minute bouts of PA by 49.1%, although this was not significant (P=.07). At baseline, age (r=–0.21, P=.04), BMI (r=–0.311, P=.004), and FEV1 (forced expiratory volume in 1 second; % predicted; r=–0.248, P=.048) were significantly correlated with 10-minute bouts of PA; however, this was not observed post intervention. Conclusions: The analysis revealed a nonsignificant difference in the pattern of PA between groups receiving conventional vs web-based PR—the former being associated with an increase in 20-minute bouts, while the latter having demonstrated an increase in the number of steps per day. There appears to be a differing response emerging between the two interventions. Trial Registration: International Clinical Trials Registry ISRCTN03142263; https://tinyurl.com/y4dmfyrb %M 35266871 %R 10.2196/28875 %U https://rehab.jmir.org/2022/1/e28875 %U https://doi.org/10.2196/28875 %U http://www.ncbi.nlm.nih.gov/pubmed/35266871 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34537 %T Rehabilitation Supported by Technology: Protocol for an International Cocreation and User Experience Study %A Bernaerts,Sylvie %A De Witte,Nele A J %A Van der Auwera,Vicky %A Bonroy,Bert %A Muraru,Luiza %A Bamidis,Panagiotis %A Frantzidis,Christos %A Kourtidou-Papadeli,Chrysoula %A Azevedo,Nancy %A Garatea,Jokin %A Muñoz,Idoia %A Almeida,Rosa %A Losada,Raquel %A Fung,Joyce %A Kehayia,Eva %A Lamontagne,Anouk %A de Guise,Elaine %A Duclos,Cyril %A Higgins,Johanne %A Nadeau,Sylvie %A Beaudry,Lucie %A Konstantinidis,Evdokimos %+ LiCalab, Thomas More University of Applied Sciences, Kleinhoefstraat 4, Geel, 2440, Belgium, 32 034324050, sylvie.bernaerts@thomasmore.be %K cocreation %K harmonization %K living lab %K rehabilitation %K small-scale real-life testing %K technology %D 2022 %7 10.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Living labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. Objective: With this joint research activity, this study primarily aims to gain insight into each living lab’s infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. Methods: This study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. Results: Phase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. Conclusions: The knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/34537 %M 35266874 %R 10.2196/34537 %U https://www.researchprotocols.org/2022/3/e34537 %U https://doi.org/10.2196/34537 %U http://www.ncbi.nlm.nih.gov/pubmed/35266874 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e33157 %T Remote Assessments of Hand Function in Neurological Disorders: Systematic Review %A Gopal,Arpita %A Hsu,Wan-Yu %A Allen,Diane D %A Bove,Riley %+ Weill Institute of Neurosciences, University of California San Francisco, 1651 4th Street, Room 622A, San Francisco, CA, 94143, United States, 1 415 353 8903, arpita.gopal@ucsf.edu %K neurological disease %K hand function %K remote assessment %K assessment %K telemedicine %K rehabilitation %K telerehabilitation %K review %K neurological %K hand %K function %K diagnosis %K intervention %K dysfunction %K feasibility %K mobile phone %D 2022 %7 9.3.2022 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be regularly assessed to monitor loss of fine motor skills in people with central nervous system disorders; however, there are challenges to in-clinic assessments. Remotely assessing hand function could facilitate monitoring and supporting of early diagnosis and intervention when warranted. Objective: Remote assessments can facilitate the tracking of limitations, aiding in early diagnosis and intervention. This study aims to systematically review existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction. Methods: PubMed and MEDLINE, CINAHL, Web of Science, and Embase were searched for studies that reported remote assessment of hand function (ie, outside of traditional in-person clinical settings) in adults with chronic central nervous system disorders. We excluded studies that included participants with orthopedic upper limb dysfunction or used tools for intervention and treatment. We extracted data on the evaluated hand function domains, validity and reliability, feasibility, and stage of development. Results: In total, 74 studies met the inclusion criteria for Parkinson disease (n=57, 77% studies), stroke (n=9, 12%), multiple sclerosis (n=6, 8%), spinal cord injury (n=1, 1%), and amyotrophic lateral sclerosis (n=1, 1%). Three assessment modalities were identified: external device (eg, wrist-worn accelerometer), smartphone or tablet, and telerehabilitation. The feasibility and overall participant acceptability were high. The most common hand function domains assessed included finger tapping speed (fine motor control and rigidity), hand tremor (pharmacological and rehabilitation efficacy), and finger dexterity (manipulation of small objects required for daily tasks) and handwriting (coordination). Although validity and reliability data were heterogeneous across studies, statistically significant correlations with traditional in-clinic metrics were most commonly reported for telerehabilitation and smartphone or tablet apps. The most readily implementable assessments were smartphone or tablet-based. Conclusions: The findings show that remote assessment of hand function is feasible in neurological disorders. Although varied, the assessments allow clinicians to objectively record performance in multiple hand function domains, improving the reliability of traditional in-clinic assessments. Remote assessments, particularly via telerehabilitation and smartphone- or tablet-based apps that align with in-clinic metrics, facilitate clinic to home transitions, have few barriers to implementation, and prompt remote identification and treatment of hand function impairments. %M 35262502 %R 10.2196/33157 %U https://rehab.jmir.org/2022/1/e33157 %U https://doi.org/10.2196/33157 %U http://www.ncbi.nlm.nih.gov/pubmed/35262502 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33579 %T Device- and Nondevice-Guided Slow Breathing to Reduce Blood Pressure in Patients with Hypertension: Protocol for a Systematic Review and Meta-analysis %A de Freitas Gonçalves,Kamila Shelry %A Queiroz Godoy Daniel,Ana Carolina %A Tatagiba Lamas,José Luiz %A Ceretta Oliveira,Henrique %A Silveira,Renata C C P %A Cloutier,Lyne %A Velludo Veiga,Eugenia %+ WHO Collaborating Centre for Nursing Research Development, University of São Paulo, R Prof Hélio Lourenço 3900 Vila Monte Alegre, Ribeirão Preto, 14040-902, Brazil, 55 16 33154321, kamilashelry@icloud.com %K hypertension %K breathing exercises %K device-guided breathing %K respirate %K systematic review %K physical therapy %K blood pressure %K clinical decision making %K health care professional %K physiotherapy %D 2022 %7 4.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physiotherapy can include both device-guided slow breathing (DGSB) and nondevice-guided slow breathing (NDGSB) in the treatment of systemic arterial hypertension. Objective: The aim of this study is to summarize the effects of DGSB on blood pressure levels of patients with hypertension based on the published literature to date. Methods: A systematic search of all published randomized controlled trials (RCTs) on the effects of device-guided and nondevice-guided slow breathing in patients with hypertension, without language restriction, was carried out up to a publication date of January 2020 in nine databases: PubMed/MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Physiotherapy Evidence Database (PEDro), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Web of Science, and Livivo. Clinical trial records databases (ClinicalTrials.gov), and bases for the open gray literature, including Gray Literature Report and ProQuest Central (Citation, Abstract or Indexing, and Dissertations and Theses), were also searched for potentially eligible RCTs. The quality assessment of the included studies will be performed using the Cochrane Risk of Bias Tool for Randomized Trials. The overall quality of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendations, Development and Evaluation) system. Results: As of December 2021, the review was completed and all data from continuous variables referring to blood pressure values (mmHg) were synthesized. Conclusions: This systematic review will provide a summary of the current evidence on the effects of both DGSB and NDGSB on blood pressure levels. This information can contribute to decision-making by health professionals related to the use of these interventions in patients with hypertension. Trial Registration: PROSPERO (Prospective International Register of Systematic Reviews) CRD42020147554; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=147554 International Registered Report Identifier (IRRID): RR1-10.2196/33579 %M 35254284 %R 10.2196/33579 %U https://www.researchprotocols.org/2022/3/e33579 %U https://doi.org/10.2196/33579 %U http://www.ncbi.nlm.nih.gov/pubmed/35254284 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e32163 %T Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial %A Dodson,John A %A Schoenthaler,Antoinette %A Sweeney,Greg %A Fonceva,Ana %A Pierre,Alicia %A Whiteson,Jonathan %A George,Barbara %A Marzo,Kevin %A Drewes,Wendy %A Rerisi,Elizabeth %A Mathew,Reena %A Aljayyousi,Haneen %A Chaudhry,Sarwat I %A Hajduk,Alexandra M %A Gill,Thomas M %A Estrin,Deborah %A Kovell,Lara %A Jennings,Lee A %A Adhikari,Samrachana %+ Geriatric Cardiology Program, Medicine and Population Health, Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, Translational Research Building, 227 East 30th Street, New York, NY, 10016, United States, 1 646 501 2714, john.dodson@nyulangone.org %K mobile health %K cardiac rehabilitation %K clinical trial %K rehabilitation %K cardiology %K heart disease %K ambulatory care %K mHealth %K health outcomes %K older adults %D 2022 %7 3.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults’ uptake, and efficacy data are currently lacking. Objective: This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. Methods: RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ≥65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). Results: As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. Conclusions: The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. Trial Registration: ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130 International Registered Report Identifier (IRRID): DERR1-10.2196/32163 %M 35238793 %R 10.2196/32163 %U https://www.researchprotocols.org/2022/3/e32163 %U https://doi.org/10.2196/32163 %U http://www.ncbi.nlm.nih.gov/pubmed/35238793 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31504 %T A Novel Body Weight–Supported Postural Perturbation Module for Gait and Balance Rehabilitation After Stroke: Preliminary Evaluation Study %A Meyer,Amanda %A Hrdlicka,Henry Charles %A Cutler,Erica %A Hellstrand,Jill %A Meise,Emily %A Rudolf,Kaitlyn %A Grevelding,Pete %A Nankin,Matthew %+ Department of Inpatient Occupational Therapy, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, CT, 06492, United States, 1 203 284 2875, ameyer@gaylord.org %K stroke rehabilitation %K postural balance %K gait and ambulation %K balance perturbation %K postural perturbation %K body weight support system %K occupational therapy %K physical therapy %K long-term acute care hospital, Berg Balance Scale %K Activities-Specific Balance Confidence Scale %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. Objective: This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. Methods: This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. Results: The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95% (SD 43.78%) and that for the BWSS control sample (n=15) was 53.29% (SD 24.13%). These values were greater than those for the standard of care group (n=30; mean 28.31%, SD 17.25%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). Conclusions: Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. Trial Registration: ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161 %M 35080495 %R 10.2196/31504 %U https://rehab.jmir.org/2022/1/e31504 %U https://doi.org/10.2196/31504 %U http://www.ncbi.nlm.nih.gov/pubmed/35080495 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e24946 %T Evaluation of a Digitally Guided Self-Rehabilitation Device Coupled With Telerehabilitation Monitoring in Patients With Parkinson Disease (TELEP@RK): Open, Prospective Observational Study %A Blanc,Margaux %A Roy,Anne-Laure %A Fraudet,Bastien %A Piette,Patrice %A Le Toullec,Elodie %A Nicolas,Benoit %A Gallien,Philippe %A Leblong,Emilie %+ Hospital Center (CH) Saint Malo, 1 rue de la Marne, Saint Malo, 35403, France, 33 299212121, M.BLANC@ch-stmalo.fr %K Parkinson's disease %K telerehabilitation %K serious games %K UTAUT %K physiotherapist %K acceptability %K acceptance %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Parkinson disease is a neurodegenerative disease causing a progressive loss of autonomy. This requires long-term rehabilitation care. Currently, new technologies are being developed for use in daily life, and there is a progressive implementation of telerehabilitation. Objective: The aim of this study (the TELEP@RK study) is to evaluate the uses of a digital self-rehabilitation device in patients with Parkinson disease and their independent physiotherapists on the scale of a health territory. Methods: A total of 10 independent physiotherapists and 31 patients with Parkinson disease were followed for 1 year to evaluate the use of a telerehabilitation tool (digital tablet and inertial sensor) via questionnaires of the Unified Theory of Acceptance and Use of Technology (UTAUT). The questionnaires were submitted to participants at 0, 2, and 12 months from the start of follow-up. The averages of the scores of the different determinants and constructs of the UTAUT questionnaires were compared at the different follow-up times. Results: Among professionals, the averages of the various determinants were generally high at the beginning of the study with an average (out of 5) performance expectancy of 4.19, effort expectancy of 3.88, social influence of 3.95, facilitating conditions of 4, and intention to use of 3.97. These averages decreased over time. Conclusions: Acceptability, acceptance, and appropriation of the tool were very high among the physiotherapists as well as the patients, despite the tool’s lack of evolution during the study. In the current health care context, these results allow us to envision a new organization of the care pathway for patients with chronic diseases, with the increased use of new technologies associated with telecare. %M 35129449 %R 10.2196/24946 %U https://games.jmir.org/2022/1/e24946 %U https://doi.org/10.2196/24946 %U http://www.ncbi.nlm.nih.gov/pubmed/35129449 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31349 %T The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study %A Beresford,Lauren %A Norwood,Todd %+ Omada Health Inc, 500 Sansome Street, Suite 200, San Francisco, CA, 94111, United States, 1 6197642287, lauren.beresford@omadahealth.com %K physical therapy %K mobile apps %K engagement %K health care delivery %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Musculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes. Objective: Drawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction. It then evaluates the effects of patient-provider relationships forged through in-app messages or video visits and timely, direct access to care on patients’ engagement in their recovery. Methods: We conducted an observational, retrospective study of 814 pre- and postsurveyed participants enrolled in a mobile app physical therapy program where physical therapists prescribed workouts, education, and therapeutic activities after a video evaluation from February 2019 to December 2020. We estimated generalized linear models with logit functions to evaluate the effect of program engagement on clinical outcomes, minimal clinically important differences (MCIDs) in pain (ΔVisual Analogue Scale ≤−1.5) and function (ΔPatient Specific Functional Scale ≥1.3), and the effects of patient-provider relationships and clinical outcomes on patient satisfaction—participant reported likelihood to recommend the program (Net Promoter Scores of 9-10). We estimated Poisson generalized linear models to evaluate the effects of stronger patient-provider relationships and timely access to physical therapy within 24 hours on engagement including the number of weekly workouts and weeks in the program. Results: The odds that participants (N=814) had a pain MCID increased by 13% (odds ratio [OR] 1.13, 95% CI 1.04-1.23; P=.003) with each weekly workout and the odds of a function MCID by 4% (OR 1.04, 95% CI 1.00-1.08; P=.03) with each week in the program. Participants with MCIDs in function and large changes in pain (Δ Visual Analogue Scale ≤−3.5) were 1.85 (95% CI 1.17-2.93; P=.01) and 2.84 times (95% CI 1.68-4.78; P<.001) more satisfied, respectively. Those with video follow-up visits were 2 to 3 times (P=.01) more satisfied. Each physical therapist’s message increased weekly workouts by 11% (OR 1.11, 95% CI 1.07-1.16; P<.001). Video follow-up visits increased weekly workouts by at least 16% (OR 1.16, 95% CI 1.04-1.29; P=.01) and weeks in the program at least 8% (OR 1.08, 95% CI 1.01-1.14; P=.02). Access was associated with a 14% increase (OR 1.14, 95% CI 1.05-1.24; P=.003) in weekly workouts. Conclusions: Similar to in-person care, program engagement positively affects clinical outcomes, and strong patient-provider relationships positively affect satisfaction. In app-based physical therapy, clinical outcomes positively affect patient satisfaction. Timely access to care and strong patient-provider relationships, particularly those forged through video visits, affect engagement. %M 35107436 %R 10.2196/31349 %U https://rehab.jmir.org/2022/1/e31349 %U https://doi.org/10.2196/31349 %U http://www.ncbi.nlm.nih.gov/pubmed/35107436 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e27637 %T Accuracy of Heart Rate Measurement by the Fitbit Charge 2 During Wheelchair Activities in People With Spinal Cord Injury: Instrument Validation Study %A Hoevenaars,Dirk %A Yocarini,Iris E %A Paraschiakos,Stylianos %A Holla,Jasmijn F M %A de Groot,Sonja %A Kraaij,Wessel %A Janssen,Thomas W J %+ Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 643259225, dirkhoevenaars@hotmail.com %K Fitbit Charge 2 %K heart rate %K accuracy %K photoplethysmography %K spinal cord injury %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Heart rate (HR) is an important and commonly measured physiological parameter in wearables. HR is often measured at the wrist with the photoplethysmography (PPG) technique, which determines HR based on blood volume changes, and is therefore influenced by blood pressure. In individuals with spinal cord injury (SCI), blood pressure control is often altered and could therefore influence HR accuracy measured by the PPG technique. Objective: The objective of this study is to investigate the HR accuracy measured with the PPG technique with a Fitbit Charge 2 (Fitbit Inc) in wheelchair users with SCI, how the activity intensity affects the HR accuracy, and whether this HR accuracy is affected by lesion level. Methods: The HR of participants with (38/48, 79%) and without (10/48, 21%) SCI was measured during 11 wheelchair activities and a 30-minute strength exercise block. In addition, a 5-minute seated rest period was measured in people with SCI. HR was measured with a Fitbit Charge 2, which was compared with the HR measured by a Polar H7 HR monitor used as a reference device. Participants were grouped into 4 groups—the no SCI group and based on lesion level into the T1 (cervical) group. Mean absolute percentage error (MAPE) and concordance correlation coefficient were determined for each group for each activity type, that is, rest, wheelchair activities, and strength exercise. Results: With an overall MAPEall lesions of 12.99%, the accuracy fell below the standard acceptable MAPE of –10% to +10% with a moderate agreement (concordance correlation coefficient=0.577). The HR accuracy of Fitbit Charge 2 seems to be reduced in those with cervical lesion level in all activities (MAPEno SCI=8.09%; MAPET1=20.43%). The accuracy of the Fitbit Charge 2 decreased with increasing intensity in all lesions (MAPErest=6.5%, MAPEactivity=12.97%, and MAPEstrength=14.2%). Conclusions: HR measured with the PPG technique showed lower accuracy in people with SCI than in those without SCI. The accuracy was just above the acceptable level in people with paraplegia, whereas in people with tetraplegia, a worse accuracy was found. The accuracy seemed to worsen with increasing intensities. Therefore, high-intensity HR data, especially in people with cervical lesions, should be used with caution. %M 35044306 %R 10.2196/27637 %U https://rehab.jmir.org/2022/1/e27637 %U https://doi.org/10.2196/27637 %U http://www.ncbi.nlm.nih.gov/pubmed/35044306 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 1 %P e30516 %T Telerehabilitation for People With Physical Disabilities and Movement Impairment: A Survey of United Kingdom Practitioners %A Buckingham,Sarah A %A Anil,Krithika %A Demain,Sara %A Gunn,Hilary %A Jones,Ray B %A Kent,Bridie %A Logan,Angela %A Marsden,Jonathan %A Playford,E Diane %A Freeman,Jennifer %+ School of Health Professions, University of Plymouth, Peninsula Allied Health Centre, Derriford Road, Plymouth, PL6 8BH, United Kingdom, 44 07928573193, sarah.buckingham@plymouth.ac.uk %K telerehabilitation %K physical disabilities %K movement impairment %K remote assessments %K telehealth %K rehabilitation %K training %K health care practitioners %K physiotherapy %K occupational therapy %D 2022 %7 3.1.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Telerehabilitation is a feasible and potentially effective alternative to face-to-face rehabilitation. However, specific guidance, training, and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment are limited. Objective: The aims of this survey of United Kingdom–based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practices in telerehabilitation for physical disabilities and movement impairment. The aim will be to use the findings to inform a practical tool kit and training package for telerehabilitation use. Methods: UK rehabilitation practitioners were invited to complete an online questionnaire from November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups, and via social media. Closed questionnaire items were analyzed using descriptive statistics. Qualitative inductive analysis using NVivo was used for open responses. Results: There were 247 respondents, of which 177 (72%) were physiotherapists and occupational therapists. Most (n=207, 84%) had used video-based consultations (typically supported by telephone and email), and the use of this method had increased in frequency since the COVID-19 pandemic. Practitioners perceived telerehabilitation positively overall and recognized benefits for patients including a reduced infection risk, convenience and flexibility, and reduced travel and fatigue. Common obstacles were technology related (eg, internet connection), practical (eg, difficulty positioning the camera), patient related (eg, health status), practitioner related (eg, lack of technical skills), and organizational (eg, lack of access to technology). Support from family members or carers was a major facilitator for successful remote consultations. Of the 207 respondents who had used video-based consultations, 103 (50%) had assessed physical impairments using this method, 107 (52%) had assessed physical function, and 121 (59%) had used patient-reported outcome measures. Although practitioners generally felt confident in delivering video-based consultations, they felt less proficient in undertaking remote physical assessments, expressing concerns about validity, reliability, and safety. Only 46 of the 247 (19%) respondents had received any training in telerehabilitation or video consultations, and some felt they were “feeling their way in the dark.” Practitioners desired training and guidance on physical assessment tools suitable for remote use, when to use video-based consultations or alternative methods, governance issues, digital platforms, and signposting to digital skills training for themselves and their patients. Conclusions: In response to the COVID-19 pandemic, practitioners rapidly adopted telerehabilitation for people with physical disabilities and movement impairment. However, there are technical, practical, and organizational obstacles to overcome, and a clear need for improved guidance and training in remote physical assessments. The findings of this survey will inform the development of a tool kit of resources and a training package for the current and future workforce in telerehabilitation. %M 37725532 %R 10.2196/30516 %U https://med.jmirx.org/2022/1/e30516 %U https://doi.org/10.2196/30516 %U http://www.ncbi.nlm.nih.gov/pubmed/37725532 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30985 %T Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis %A Vinolo Gil,Maria Jesus %A Gonzalez-Medina,Gloria %A Lucena-Anton,David %A Perez-Cabezas,Veronica %A Ruiz-Molinero,María Del Carmen %A Martín-Valero,Rocío %+ Department of Nursing and Physical Therapy, University of Cadiz, Avda Ana de Viya 52, Cadiz, 11009, Spain, 34 670609656, gloriagonzalez.medina@uca.es %K augmented reality %K physical therapy %K rehabilitation %K functionality %D 2021 %7 15.12.2021 %9 Review %J JMIR Serious Games %G English %X Background: Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective: This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods: A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation. The Cochrane Collaboration tool was used to evaluate the risk of bias. Results: In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36%) contributed information to the meta-analysis. Overall, 64% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95% CI −0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change −1.211, 95% CI −3.2005 to 0.7768; z=−1.194; P=.23). Conclusions: AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020180766; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=180766 %M 34914611 %R 10.2196/30985 %U https://games.jmir.org/2021/4/e30985 %U https://doi.org/10.2196/30985 %U http://www.ncbi.nlm.nih.gov/pubmed/34914611 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31541 %T Validation of a Musculoskeletal Digital Assessment Routing Tool: Protocol for a Pilot Randomized Crossover Noninferiority Trial %A Lowe,Cabella %A Hanuman Sing,Harry %A Marsh,William %A Morrissey,Dylan %+ Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, United Kingdom, 44 07976315105, c.lowe@qmul.ac.uk %K mHealth %K mobile health %K eHealth %K digital health %K digital technology %K musculoskeletal %K triage %K physiotherapy triage %K validation %K mobile phone %D 2021 %7 13.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on millions of patients and an increasing demand for health care use. Digital technologies to improve health care outcomes and efficiency are considered a priority; however, innovations are rarely tested with sufficient rigor in clinical trials, which is the gold standard for clinical proof of safety and efficacy. We have developed a new musculoskeletal digital assessment routing tool (DART) that allows users to self-assess and be directed to the right care. DART requires validation in a real-world setting before implementation. Objective: This pilot study aims to assess the feasibility of a future trial by exploring the key aspects of trial methodology, assessing the procedures, and collecting exploratory data to inform the design of a definitive randomized crossover noninferiority trial to assess DART safety and effectiveness. Methods: We will collect data from 76 adults with a musculoskeletal condition presenting to general practitioners within a National Health Service (NHS) in England. Participants will complete both a DART assessment and a physiotherapist-led triage, with the order determined by randomization. The primary analysis will involve an absolute agreement intraclass correlation (A,1) estimate with 95% CI between DART and the clinician for assessment outcomes signposting to condition management pathways. Data will be collected to allow the analysis of participant recruitment and retention, randomization, allocation concealment, blinding, data collection process, and bias. In addition, the impact of trial burden and potential barriers to intervention delivery will be considered. The DART user satisfaction will be measured using the system usability scale. Results: A UK NHS ethics submission was done during June 2021 and is pending approval; recruitment will commence in early 2022, with data collection anticipated to last for 3 months. The results will be reported in a follow-up paper in 2022. Conclusions: This study will inform the design of a randomized controlled crossover noninferiority study that will provide evidence concerning mobile health DART system clinical signposting in an NHS setting before real-world implementation. Success should produce evidence of a safe, effective system with good usability, potentially facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This rigorous approach to mobile health system testing could be used as a guide for other developers of similar applications. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): PRR1-10.2196/31541 %M 34898461 %R 10.2196/31541 %U https://www.researchprotocols.org/2021/12/e31541 %U https://doi.org/10.2196/31541 %U http://www.ncbi.nlm.nih.gov/pubmed/34898461 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e29047 %T Patient-Facing Mobile Apps to Support Physiotherapy Care: Protocol for a Systematic Review of Apps Within App Stores %A Merolli,Mark %A Francis,Jill J %A Vallance,Patrick %A Bennell,Kim L %A Malliaras,Peter %A Hinman,Rana S %+ Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Melbourne, 3053, Australia, 61 408513984, merollim@unimelb.edu.au %K physiotherapy %K physical therapy %K digital health intervention %K mobile app %K eHealth %K behavior change technique %K behavior change %K exercise %K digital health %K mHealth %D 2021 %7 9.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Care delivered by physiotherapists aims to facilitate engagement in positive health behaviors by patients (eg, adherence to exercise). However, research suggests that behavioral interventions are frequently omitted from care. Hence, better understanding of strategies that can be used by physiotherapists to support patients to engage in positive behaviors is important and likely to optimize outcomes. Digital health interventions delivered via mobile apps are garnering attention for their ability to support behavior change. They have potential to incorporate numerous behavior change techniques (BCTs) to support goals of physiotherapy care, including but not limited to self-monitoring, goal setting, and prompts/alerts. Despite their potential to support physiotherapy care, much is still unknown about what apps are available to consumers, the BCTs they use, their quality, and their potential to change behaviors. Objective: The primary aim of this study is to systematically review the mobile apps available in app stores that are intended for use by patients to support physiotherapy care, including the BCTs within these apps. The secondary aims are to evaluate the quality and behavior change potential of these apps. Methods: A systematic review of mobile apps in app stores will be undertaken. This will be guided by recommendations for systematic reviews in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement but adapted to suit our app store search, consistent with similar systematic reviews of apps published in the Journal of Medical Internet Research. Apple Store and Google Play will be searched with a two-step search strategy, using terms relevant to physiotherapy, physiotherapists, and common physiotherapy care. Key eligibility criteria will include apps that are intended for use by patients and are self-contained or stand-alone without the need of additional wearable devices or other add-ons. Included apps will be coded for BCTs and rated for quality using the Mobile Application Rating Scale (MARS) and for potential to change behavior using the App Behavior Change Scale (ABACUS). Results: App store search and screening are expected to be completed in 2021. Data extraction and quality appraisal are expected to commence by November 2021. The study results are expected to be published in a subsequent paper in 2022. Conclusions: Knowledge gained from this review will support clinical practice and inform research by providing a greater understanding of the quality of currently available mobile apps and their potential to support patient behavior change goals of physiotherapy care. International Registered Report Identifier (IRRID): PRR1-10.2196/29047 %M 34889767 %R 10.2196/29047 %U https://www.researchprotocols.org/2021/12/e29047 %U https://doi.org/10.2196/29047 %U http://www.ncbi.nlm.nih.gov/pubmed/34889767 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e27186 %T Identification and Description of Balance, Mobility, and Gait Assessments Conducted via Telerehabilitation for Individuals With Neurological Conditions: Protocol for a Scoping Review %A O'Neil,Jennifer %A Barnes,Keely %A Morgan Donnelly,Erin %A Sheehy,Lisa %A Sveistrup,Heidi %+ School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada, 1 613 562 5800, joneil@uottawa.ca %K telerehabilitation %K remote assessment %K outcome measures %K neurology %K rehabilitation %D 2021 %7 9.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 global pandemic pushed many rehabilitation practitioners to pivot their in-person practice to adopt telerehabilitation as their main method of delivery. In addition to documenting information on interventions used with clients, it is best practice for therapists to use reliable and validated outcome measures to inform their interventions. Objective: Through this scoping review, we aim to identify (1) which outcomes are being used remotely to assess balance, mobility, and gait in patients with neurological conditions, and (2) what psychometric data (validity, reliability, etc.) for remotely administered outcomes are available. Methods: Three main concepts will be included in our search: (1) neurological conditions; (2) administration by telerehabilitation; and (3) outcome measures for balance, mobility, and gait. Studies reporting remote assessment of neurological conditions published since 1990 will be included. The database search will be completed in MEDLINE (Ovid), CINAHL, PubMed, PsycINFO, EMBASE, and Cochrane. Gray literature including dissertations, conference papers, and protocol papers will also be sourced. Two reviewers will independently screen each title and abstract using pre-established inclusion and exclusion criteria. Manuscripts that appear to meet the criteria will be subject to further review, and full-text extraction using a pre-piloted extraction sheet if all criteria are met. The data will be categorized by assessment types describing impairments (such as balance, strength, and mobility) or activity limitations or participation restriction (such as functional mobility, ambulatory functions, and activities of daily living). Results: This scoping review will document outcome measures currently used in the remote assessment of neurological conditions. To date, 235 titles and abstracts were screened. We are in the process of finalizing the full text screening for the inclusion of articles. We expect the full screening to be completed in November 2021 and data analysis in January 2022. Our results are expected to be published in early 2022. Conclusions: The optimal use of telerehabilitation as a mode to deliver rehabilitation intervention should be coupled with the completion of validated outcome measures. Therefore, it is crucial to further our knowledge on remote outcome measures and therapeutic assessments. International Registered Report Identifier (IRRID): PRR1-10.2196/27186 %M 34889765 %R 10.2196/27186 %U https://www.researchprotocols.org/2021/12/e27186 %U https://doi.org/10.2196/27186 %U http://www.ncbi.nlm.nih.gov/pubmed/34889765 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e24950 %T Investigating the Use of Virtual Reality Headsets for Postural Control Assessment: Instrument Validation Study %A Sylcott,Brian %A Lin,Chia-Cheng %A Williams,Keith %A Hinderaker,Mark %+ Department of Engineering, East Carolina University, 1000 East 5th Street, Greenville, NC, 27858, United States, 1 2527374652, sylcottb15@ecu.edu %K postural sway %K virtual reality %K force plate %K center of pressure %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Accurately measuring postural sway is an important part of balance assessment and rehabilitation. Although force plates give accurate measurements, their costs and space requirements make their use impractical in many situations. Objective: The work presented in this paper aimed to address this issue by validating a virtual reality (VR) headset as a relatively low-cost alternative to force plates for postural sway measurement. The HTC Vive (HTC Corporation) VR headset has built-in sensors that allow for position and orientation tracking, making it a potentially effective tool for balance assessments. Methods: Participants in this study were asked to stand upright on a force plate (NeuroCom; Natus Medical Incorporated) while wearing the HTC Vive. Position data were collected from the headset and force plate simultaneously as participants experienced a custom-built VR environment that covered their entire field of view. The intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of the postural control variables, which included the normalized path length, root mean square (RMS), and peak-to-peak (P2P) value. These were computed from the VR position output data and the center of pressure (COP) data from the force plate. Linear regression was used to investigate the correlations between the VR and force plate measurements. Results: Our results showed that the test-retest reliability of the RMS and P2P value of VR headset outputs (ICC: range 0.285-0.636) was similar to that of the RMS and P2P value of COP outputs (ICC: range 0.228-0.759). The linear regression between VR and COP measures showed significant correlations in RMSs and P2P values. Conclusions: Based on our results, the VR headset has the potential to be used for postural control measurements. However, the further development of software and testing protocols for balance assessments is needed. %M 34779789 %R 10.2196/24950 %U https://rehab.jmir.org/2021/4/e24950 %U https://doi.org/10.2196/24950 %U http://www.ncbi.nlm.nih.gov/pubmed/34779789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28315 %T A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study %A Goh,Lina %A Allen,Natalie E %A Ahmadpour,Naseem %A Ehgoetz Martens,Kaylena A %A Song,Jooeun %A Clemson,Lindy %A Lewis,Simon J G %A MacDougall,Hamish G %A Canning,Colleen G %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 7 Susan Wakil Health Building D18, Camperdown, 2006, Australia, 61 9351 9016, natalie.allen@sydney.edu.au %K Parkinson disease %K freezing of gait %K action observation %K video self-modelling %K virtual reality %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective: The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods: The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results: The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions: Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease. %M 34730537 %R 10.2196/28315 %U https://formative.jmir.org/2021/11/e28315 %U https://doi.org/10.2196/28315 %U http://www.ncbi.nlm.nih.gov/pubmed/34730537 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32134 %T Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial %A Gaboury,Isabelle %A Tousignant,Michel %A Corriveau,Hélène %A Menear,Matthew %A Le Dorze,Guylaine %A Rochefort,Christian %A Vachon,Brigitte %A Rochette,Annie %A Gosselin,Sylvie %A Michaud,François %A Bollen,Jessica %A Dean,Sarah %+ Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada, 1 4504665000, isabelle.gaboury@usherbrooke.ca %K adherence %K interprofessional shared decision making %K rehabilitation %K stroke %K telerehabilitation %D 2021 %7 28.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Strong evidence supports beginning stroke rehabilitation as soon as the patient’s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients’ adherence to a rehabilitation plan and on their level of reintegration into normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration into normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured with clinicians. Methods: In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will be comprised of 220 patients who will take part in stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation group) versus face-to-face standard of care (control group: n=110 patients). Results: Our Research Ethics Board approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. Conclusions: This study will contribute to the minimization of both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practice guidelines regarding telecare services and the provision of telerehabilitation, including recommendations for effective interdisciplinary collaboration regarding stroke rehabilitation. Trial Registration: ClinicalTrials.gov NCT04440215; https://clinicaltrials.gov/ct2/show/NCT04440215 International Registered Report Identifier (IRRID): DERR1-10.2196/32134 %M 34709196 %R 10.2196/32134 %U https://www.researchprotocols.org/2021/10/e32134 %U https://doi.org/10.2196/32134 %U http://www.ncbi.nlm.nih.gov/pubmed/34709196 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e31855 %T Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial %A Giggins,Oonagh M %A Doyle,Julie %A Smith,Suzanne %A Moran,Orla %A Gavin,Shane %A Sojan,Nisanth %A Boyle,Gordon %+ NetwellCASALA, Dundalk Institute of Technology, Dublin Road, Dundalk, A91 K584, Ireland, 353 429370200 ext 2114, oonagh.giggins@dkit.ie %K cardiac rehabilitation %K exercise %K cardiovascular disease %K virtual rehabilitation %K digital health %K self-management %K pilot study %K platform %K feasibility %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. Objective: The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering – Cardiac Rehabilitation (ECME-CR) platform. Methods: A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. Results: Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. Conclusions: This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. International Registered Report Identifier (IRRID): PRR1-10.2196/31855 %M 34617908 %R 10.2196/31855 %U https://www.researchprotocols.org/2021/10/e31855 %U https://doi.org/10.2196/31855 %U http://www.ncbi.nlm.nih.gov/pubmed/34617908 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32085 %T Noisy Galvanic Vestibular Stimulation Combined With a Multisensory Balance Program in Older Adults With Moderate to High Fall Risk: Protocol for a Feasibility Study for a Randomized Controlled Trial %A McLaren,Ruth %A Smith,Paul F %A Lord,Sue %A Kaur,Preet Kamal %A Zheng,Yiwen %A Taylor,Denise %+ Rehabilitation Innovation Centre, School of Clinical Sciences, Auckland University of Technology, AA115, AA Building, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 9 9210 9680, denise.taylor@aut.ac.nz %K older adult %K balance %K rehabilitation %K noisy galvanic vestibular stimulation %K nGVS %K brain stimulation %D 2021 %7 5.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reduced mobility and falls are common among older adults. Balance retraining programs are effective in reducing falls and in improving balance and mobility. Noisy galvanic vestibular stimulation is a low-level electrical stimulation used to reduce the threshold for the firing of vestibular neurons via a mechanism of stochastic resonance. Objective: This study aims to determine the feasibility of using noisy galvanic vestibular stimulation to augment a balance training program for older adults at risk of falls. We hypothesize that noisy galvanic vestibular stimulation will enhance the effects of balance retraining in older adults at risk of falls Methods: In this 3-armed randomized controlled trial, community dwelling older adults at risk of falling will be randomly assigned to a noisy galvanic vestibular stimulation plus balance program (noisy galvanic vestibular stimulation group), sham plus balance program (sham group), or a no treatment group (control). Participants will attend the exercise group twice a week for 8 weeks with assessment of balance and gait pretreatment, posttreatment, and at 3 months postintervention. Primary outcome measures include postural sway, measured by center of pressure velocity, area and root mean square, and gait parameters such as speed, step width, step variability, and double support time. Spatial memory will also be measured using the triangle completion task and the 4 Mountains Test. Results: Recruitment began in November 2020. Data collection and analysis are expected to be completed by December 2022. Conclusions: This study will evaluate the feasibility of using noisy galvanic vestibular stimulation alongside balance retraining in older adults at risk of falls and will inform the design of a fully powered randomized controlled trial. Trial Registration: New Zealand Clinical Trials Registry (ACTRN12620001172998); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379944 International Registered Report Identifier (IRRID): DERR1-10.2196/32085 %M 34609323 %R 10.2196/32085 %U https://www.researchprotocols.org/2021/10/e32085 %U https://doi.org/10.2196/32085 %U http://www.ncbi.nlm.nih.gov/pubmed/34609323 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 3 %P e31247 %T Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study %A Correia,Fernando D %A Molinos,Maria %A Neves,Carlos %A Janela,Dora %A Carvalho,Diana %A Luis,Sara %A Francisco,Gerard E %A Lains,Jorge %A Bento,Virgilio %+ Neurology Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, Porto, 4099-001, Portugal, 351 966557789, fanacorreia@gmail.com %K acute ankle sprains %K physical rehabilitation %K home-based digital rehabilitation %K digital therapy %K rehabilitation %K sprain %K digital health %K therapy %K rehabilitation %K prospective %K longitudinal %K cohort %K ankle %K soft tissue %K physical therapy %K pain %K outcome %K fatigue %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective: We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods: We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results: In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions: Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration: ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022 %M 34499038 %R 10.2196/31247 %U https://rehab.jmir.org/2021/3/e31247 %U https://doi.org/10.2196/31247 %U http://www.ncbi.nlm.nih.gov/pubmed/34499038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27602 %T Versatile GCH Control Software for Correction of Loads Applied to Forearm Crutches During Gait Recovery Through Technological Feedback: Development and Implementation Study %A Chamorro-Moriana,Gema %A Sevillano,Jose Luis %A Perez-Cabezas,V %+ Department of Physiotherapy, Area of Physiotherapy Research Group CTS-305, University of Seville, Calle Avicena, S/N, Seville, 41009, Spain, 34 954486554, gchamorro@us.es %K control and monitoring software %K feedback technology %K motor control %K gait %K crutches %K assisted gait for partial weight-bearing %K functional recovery of the gait %K unloading of lower limb musculoskeletal injury %K rehabilitation %K physical therapy %K lower limb %K injury %K injuries %K feedback technology %K crutches %D 2021 %7 22.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring weight bearing is an essential aspect of clinical care for lower limb injuries such as sprains or meniscopathy surgeries. This care often involves the use of forearm crutches for partial loads progressing to full loads. Therefore, feasible methods of load monitoring for daily clinical use are needed. Objective: The main objective of this study was to design an innovative multifunctional desktop load-measuring software that complements GCH System 2.0–instrumented forearm crutches and monitors the applied loads, displaying real-time graphical and numerical information, and enabling the correction of inaccuracies through feedback technology during assisted gait. The secondary objective was to perform a preliminary implementation trial. Methods: The software was designed for indoor use (clinics/laboratories). This software translates the crutch sensor signal in millivolts into force units, records and analyzes data (10-80 Hz), and provides real-time effective curves of the loads exerted on crutches. It covers numerous types of extrinsic feedback, including visual, acoustic (verbal/beeps), concurrent, terminal, and descriptive feedback, and includes a clinical and research use database. An observational descriptive pilot study was performed with 10 healthy subjects experienced in bilateral assisted gait. The Wilcoxon matched-pairs signed-rank test was used to evaluate the load accuracy evolution of each subject (ie, changes in the loads exerted on crutches for each support) among various walks, which was interpreted at the 95% confidence level. Results: GCH Control Software was developed as a multifunctional desktop tool complementing GCH System 2.0–instrumented forearm crutches. The pilot implementation of the feedback mechanism observed 96/100 load errors at baseline (walk 0, no feedback) with 7/10 subjects exhibiting crutch overloading. Errors ranged from 61.09% to 203.98%, demonstrating heterogeneity. The double-bar feedback found 54/100 errors in walk 1, 28/100 in walk 2, and 14/100 in walk 3. The first walk with double-bar feedback (walk 1) began with errors similar to the baseline walk, generally followed by attempts at correction. The Wilcoxon matched-pairs signed-rank test used to evaluate each subject’s progress showed that all participants steadily improved the accuracy of the loads applied to the crutches. In particular, Subject 9 required extra feedback with two single-bar walks to focus on the total load. The participants also corrected the load balance between crutches and fluency errors. Three subjects made one error of load balance and one subject made six fluctuation errors during the three double-bar walks. The latter subject performed additional feedback with two balance-bar walks to focus on the load balance. Conclusions: GCH Control Software proved to be useful for monitoring the loads exerted on forearm crutches, providing a variety of feedback for correcting load accuracy, load balance between crutches, and fluency. The findings of the complementary implementation were satisfactory, although clinical trials with larger samples are needed to assess the efficacy of the different feedback mechanisms and to select the best alternatives in each case. %M 34550073 %R 10.2196/27602 %U https://www.jmir.org/2021/9/e27602 %U https://doi.org/10.2196/27602 %U http://www.ncbi.nlm.nih.gov/pubmed/34550073 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e25177 %T Digital Health Interventions in Physiotherapy: Development of Client and Health Care Provider Survey Instruments %A Merolli,Mark %A Hinman,Rana S %A Lawford,Belinda J %A Choo,Dawn %A Gray,Kathleen %+ Centre for Digital Transformation of Health, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Level 7, 161 Barry St, Carlton, Melbourne, Victoria, 3053, Australia, 61 383443689, merollim@unimelb.edu.au %K digital health interventions %K surveys and questionnaires %K World Health Organization %K physiotherapy %K physical therapy %K musculoskeletal %K mobile phone %D 2021 %7 28.7.2021 %9 Early Report %J JMIR Res Protoc %G English %X Background: The advancement of digital health has widened the scope of technology use across multiple frontiers of health care services, including personalized therapeutics, mobile health, eHealth record management, and telehealth consultations. The World Health Organization (WHO) responded to this in 2018 by publishing an inaugural broad classification framework of digital health interventions (DHIs) used to address contemporary health system needs. Objective: This study aims to describe the systematic development of dual survey instruments (clinician and patient) to support data collection, administered in a physiotherapy setting, about perceptions toward DHIs. This is achieved by adapting the WHO framework classification for DHIs for application in real-world research. Methods: Using a qualitative item review approach, WHO DHI descriptors were adapted and refined systematically to be used in a survey form. This approach was designed to align with the processes of delivering and receiving care in clinical practice, using musculoskeletal physiotherapy as a practical case scenario. Results: Complementary survey instruments (for health care providers and clients) were developed by adapting descriptor items. These instruments will be used in a larger study exploring the willingness of physiotherapists and patients to use digital technologies in the management of musculoskeletal conditions. Conclusions: This study builds on the WHO-standardized DHI framework. We developed dual novel survey instruments by adapting and refining the functions of DHIs. These may be deployed to explore the perceived usefulness and application of DHIs for different clinical care functions. Researchers may wish to use these survey instruments to examine digital health use systematically in a variety of clinical fields or technology scenarios in a way that is standardized and generalizable. %M 34319242 %R 10.2196/25177 %U https://www.researchprotocols.org/2021/7/e25177 %U https://doi.org/10.2196/25177 %U http://www.ncbi.nlm.nih.gov/pubmed/34319242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26658 %T App-Based Feedback for Rehabilitation Exercise Correction in Patients With Knee or Hip Osteoarthritis: Prospective Cohort Study %A Biebl,Johanna Theresia %A Rykala,Marzena %A Strobel,Maximilian %A Kaur Bollinger,Pawandeep %A Ulm,Bernhard %A Kraft,Eduard %A Huber,Stephan %A Lorenz,Andreas %+ Department of Orthopaedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilians University of Munich, Marchioninistr. 15, Munich, 81377, Germany, 49 89440074070, johanna.biebl@med.uni-muenchen.de %K mHealth %K digital health %K digital rehabilitation %K machine learning %K smartphone %K osteoarthritis %K exercise therapy %D 2021 %7 13.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of digital therapeutic solutions for rehabilitation of conditions such as osteoarthritis provides scalable access to rehabilitation. Few validated technological solutions exist to ensure supervision of users while they exercise at home. Motion Coach (Kaia Health GmbH) provides audiovisual feedback on exercise execution in real time on conventional smartphones. Objective: We hypothesized that the interrater agreement between physiotherapists and Motion Coach would be noninferior to physiotherapists’ interrater agreement for exercise evaluations in a cohort with osteoarthritis. Methods: Patients diagnosed with osteoarthritis of the knee or hip were recruited at a university hospital to perform a set of 6 exercises. Agreement between Motion Coach and 2 physiotherapists’ corrections for segments of the exercises were compared using Cohen κ and percent agreement. Results: Participants (n=24) were enrolled and evaluated. There were no significant differences between interrater agreements (Motion Coach app vs physiotherapists: percent agreement 0.828; physiotherapist 1 vs physiotherapist 2: percent agreement 0.833; P<.001). Age (70 years or under, older than 70 years), gender (male, female), or BMI (30 kg/m2 or under, greater than 30 kg/m2) subgroup analysis revealed no detectable difference in interrater agreement. There was no detectable difference in levels of interrater agreement between Motion Coach vs physiotherapists and between physiotherapists in any of the 6 exercises. Conclusions: The results demonstrated that Motion Coach is noninferior to physiotherapist evaluations. Interrater agreement did not differ between 2 physiotherapists or between physiotherapists and the Motion Coach app. This finding was valid for all investigated exercises and subgroups. These results confirm the ability of Motion Coach to detect user form during exercise and provide valid feedback to users with musculoskeletal disorders. %M 34255677 %R 10.2196/26658 %U https://www.jmir.org/2021/7/e26658 %U https://doi.org/10.2196/26658 %U http://www.ncbi.nlm.nih.gov/pubmed/34255677 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e28708 %T Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation %A Wickerson,Lisa %A Helm,Denise %A Gottesman,Chaya %A Rozenberg,Dmitry %A Singer,Lianne G %A Keshavjee,Shaf %A Sidhu,Aman %+ Toronto Lung Transplant Program, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada, 1 437 229 0049, lisa.wickerson@uhn.ca %K telerehabilitation %K lung %K transplant %K rehabilitation %K COVID-19 %K usage %K satisfaction %K app %K outcome %K telemedicine %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. Objective: The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. Methods: This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. Results: In total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered ≥10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ≥4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8). Conclusions: We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic. %M 34048354 %R 10.2196/28708 %U https://mhealth.jmir.org/2021/6/e28708 %U https://doi.org/10.2196/28708 %U http://www.ncbi.nlm.nih.gov/pubmed/34048354 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e25569 %T Home-Based Telehealth Exercise Intervention in Early-On Survivors of Childhood Acute Lymphoblastic Leukemia: Feasibility Study %A Lambert,Genevieve %A Alos,Nathalie %A Bernier,Pascal %A Laverdière,Caroline %A Kairy,Dahlia %A Drummond,Kenneth %A Dahan-Oliel,Noémi %A Lemay,Martin %A Veilleux,Louis-Nicolas %+ Motion Analysis Center, Shriners Hospital for Children - Canada, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada, 1 514 282 7175, ln.veilleux@mcgill.ca %K exercise therapy %K rehabilitation %K acute lymphoblastic leukemia %K intervention study %K telehealth %K mobile phone %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Acute lymphoblastic leukemia is the most common type of pediatric cancer. Acute lymphoblastic leukemia causes an altered bone mineral homeostasis state, which can contribute to osteopenia, and bone fractures, most commonly vertebral fractures. With the increasing number of childhood cancer survivors, late adverse effects such as musculoskeletal comorbidities are often reported and are further influenced by inactive lifestyle habits. Physical activity has been shown to increase the mechanical workload of the bone, mitigating bone impairment in other cancer-specific populations. Objective: This interventional pilot study aims to investigate the use of telehealth to deliver a home-based exercise intervention for early-on survivors of bone marrow–related hematological malignancies and to assess its impact on survivors’ musculoskeletal and functional health. Methods: We aimed to recruit a group of 12 early-on survivors of acute lymphoblastic leukemia, within 6 months to 5 years of treatment, to participate in and complete the proposed telehealth intervention with a parent. The 16-week intervention included 40 potential home-based physical activity interventions supervised by a kinesiologist through a telehealth internet platform, with monthly progression. Patients were recruited to the cohort if they were able to participate in the intervention during the first month (minimum 12 weeks of intervention). Evaluation before and after the intervention protocol highlighted differences in functional capacities and musculoskeletal health of patients using mechanography, peripheral quantitative computed tomography, 6-minute walk test, and grip force test. Results: The recruitment rate for the intervention was low (12/57, 21% of contacted patients). Of 12 patients, 3 were excluded (1=relapse, 1=failure to meet technical requirements, and 1=abandoned). The 9 patients who completed the intervention (6 girls; mean age 10.93, SD 2.83 years; mean BMI 21.58, SD 6.55 kg/m2; mean time since treatment completion 36.67, SD 16.37 months) had a mean adherence of 89% and a completion rate of 75%. In addition, these patients showed functional improvements in lower limb muscle force and power as well as in the 6-minute walk test distance. Participants also showed improved bone health after the intervention on the following parameters: bone mineral content, stress-strain index, total and cortical cross-sectional area at the 14% site (P=.03, P=.01, P=.01, and P=.001, respectively) and 38% site of the tibia (P=.003, P=.04, P=.001, and P=.003, respectively). Conclusions: High adherence and participation rates suggest that telehealth is a feasible method to deliver exercise interventions to young early-on survivors of acute lymphoblastic leukemia. The proposed intervention seems promising in providing benefits to patients’ functional performance and bone health, but a large-scale study is needed to confirm this assumption. %M 34132645 %R 10.2196/25569 %U https://cancer.jmir.org/2021/2/e25569 %U https://doi.org/10.2196/25569 %U http://www.ncbi.nlm.nih.gov/pubmed/34132645 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e24337 %T Parents' Perspectives on a Computer Game–Assisted Rehabilitation Program for Manual Dexterity in Children With Cerebral Palsy: Qualitative Analysis of Expectations, Child Engagement, and Benefits %A Kanitkar,Anuprita %A Parmar,Sanjay Tejraj %A Szturm,Tony J %A Restall,Gayle %A Rempel,Gina %A Sepehri,Nariman %+ University of Manitoba, 800 Sherbrook Street, RR327, Winnipeg, MB, Canada, 1 2048813112, anuprita.kan@gmail.com %K cerebral palsy %K parents' expectations %K fine motor function %K object manipulation %K computer game–based treatment protocol %K parents %K motor function %K computer games, rehabilitation %K game-based rehabilitation %K gross movement %K children %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Children with motor impairments affecting the upper extremity benefit from task-specific therapy, such as constraint-induced movement therapy. However, there is a need to improve engagement and compliance with task-specific exercise programs that target manual dexterity for children with cerebral palsy (CP). A computer game–based rehabilitation (GRP) platform was developed that combines fine manipulation and gross movement exercises with engaging game activities appropriate for young children with CP. Objective: The objectives of this qualitative analysis were to compare parents’ perspectives and opinions about expectations, challenges, and benefits between 2 interventions. Methods: A mixed methods, randomized controlled trial (RCT) was conducted to examine the feasibility and estimate the effect size of 2 exercise programs for rehabilitation of manual dexterity of children with CP using either GRP or conventional therapy. Parents of 26 of the children who completed the GRP program (n=33) and parents of 15 of the children who completed the conventional therapy program (n=27) participated in the interviews. A general conductive approach was used to analyze the data recorded during the parents’ interviews. Results: Five themes captured the range of the parent’s experiences, viewpoints, and ideas: (1) parents’ expectations, (2) child’s engagement with therapy, (3) positive effects of the interventions, (4) challenges, and (5) improving the protocol. Conclusions: Parents from both groups recognized that their expectations related to improving children’s object handling and manipulation skills including participation in activities of daily life were addressed during the 16-week therapy program. Parents perceived a change in the children’s level of independence in their daily tasks at home, school, and leisure activities. Trial Registration: ClinicalTrials.gov NCT02728375; https://clinicaltrials.gov/ct2/show/NCT02728375 %M 34057424 %R 10.2196/24337 %U https://rehab.jmir.org/2021/2/e24337 %U https://doi.org/10.2196/24337 %U http://www.ncbi.nlm.nih.gov/pubmed/34057424 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e22145 %T Determining the Effectiveness of a New Device for Hand Therapy (The FEPSim Device): Feasibility Protocol for a Randomized Controlled Trial Study %A Miguel-Cruz Sr,Antonio %A Guptill,Christine %A Gregson,Geoffrey %A Ladurner,Anna-Maria %A Holmes,Cindy %A Yeung,Daniel %A Siebert,Justine %A Dziwenko,Gwen %A Ríos Rincón,Adriana %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 St, 2-64 Corbett Hall, Edmonton, AB, T6G 2G4, Canada, 1 780 492 5108, miguelcr@ualberta.ca %K technology assessment %K hand therapy %K technology for rehabilitation %K clinical engineering %K biomedical engineering %D 2021 %7 27.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Impairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted. Objective: This study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device. Methods: The trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age≥18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study’s primary outcome variables are related to patients’ range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients’ perceived wrist pain and disability in activities of daily living. The patients’ perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10). Results: The FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020. Conclusions: This study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim. Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 International Registered Report Identifier (IRRID): PRR1-10.2196/22145 %M 34042597 %R 10.2196/22145 %U https://www.researchprotocols.org/2021/5/e22145 %U https://doi.org/10.2196/22145 %U http://www.ncbi.nlm.nih.gov/pubmed/34042597 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26133 %T Immersive Virtual Reality to Improve Outcomes in Veterans With Stroke: Protocol for a Single-Arm Pilot Study %A Tran,Johanna E %A Fowler,Christopher A %A Delikat,Jemy %A Kaplan,Howard %A Merzier,Marie M %A Schlesinger,Michelle R %A Litzenberger,Stefan %A Marszalek,Jacob M %A Scott,Steven %A Winkler,Sandra L %+ Physical Medicine and Rehabilitation Service, James A Haley Veterans' Hospital, 13000 Bruce B Downs Blvd, Tampa, FL, 33612, United States, 1 (813) 972 2000 ext 5421, Johanna.Tran@va.gov %K stroke %K immersive virtual reality %K feasibility %K veterans affairs %K veterans %K pilot %K recovery %K upper extremity %D 2021 %7 10.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Over the last decade, virtual reality (VR) has emerged as a cutting-edge technology in stroke rehabilitation. VR is defined as a type of computer-user interface that implements real-time simulation of an activity or environment allowing user interaction via multiple sensory modalities. In a stroke population, VR interventions have been shown to enhance motor, cognitive, and psychological recovery when utilized as a rehabilitation adjunct. VR has also demonstrated noninferiority to usual care therapies for stroke rehabilitation. Objective: The proposed pilot study aims to (1) determine the feasibility and tolerability of using a therapeutic VR platform in an inpatient comprehensive stroke rehabilitation program and (2) estimate the initial clinical efficacy (effect size) associated with the VR platform using apps for pain distraction and upper extremity exercise for poststroke neurologic recovery. Methods: This study will be conducted in the Comprehensive Integrated Inpatient Rehabilitation Program at the James A Haley Veterans’ Hospital. Qualitative interviews will be conducted with 10 clinical staff members to assess the feasibility of the VR platform from the clinician perspective. A prospective within-subject pretest-posttest pilot design will be used to examine the tolerability of the VR platform and the clinical outcomes (ie, upper extremity neurologic recovery, hand dexterity, pain severity) in 10 veteran inpatients. A VR platform consisting of commercially available pain distraction and upper extremity apps will be available at the participants’ bedside for daily use during their inpatient stay (approximately 4-6 weeks). Clinician interviews will be analyzed using qualitative descriptive analysis. Cohen d effect sizes with corresponding 95% CIs will be calculated for upper extremity neurologic recovery, hand dexterity, and pain. The proportion of participants who achieve minimal clinically important difference after using the VR platform will be calculated for each clinical outcome. Results: This study was selected for funding in August 2020. Institutional review board approval was received in October 2020. The project start date was December 2020. The United States Department has issued a moratorium on in-person research activities secondary to COVID-19. Data collection will commence once this moratorium is lifted. Conclusions: Our next step is to conduct a large multi-site clinical trial that will incorporate the lessons learned from this pilot feasibility study to test the efficacy of a VR intervention in inpatient rehabilitation and transition to home environments. When VR is used in patients’ rooms, it serves to provide additional therapy and may reduce clinician burden. VR also presents an opportunity similar to home-based practice exercises. VR can be implemented in both clinical settings and people’s own homes, where engagement in ongoing self-management approaches is often most challenging. This unique experience offers the potential for seamless transition from inpatient rehabilitation to the home. International Registered Report Identifier (IRRID): PRR1-10.2196/26133 %M 33970110 %R 10.2196/26133 %U https://www.researchprotocols.org/2021/5/e26133 %U https://doi.org/10.2196/26133 %U http://www.ncbi.nlm.nih.gov/pubmed/33970110 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e21924 %T Exergaming as a Functional Test Battery in Patients Who Received Arthroscopic Ankle Arthrodesis: Cross-sectional Pilot Study %A Hendrickx,Roel %A van der Avoird,Tim %A Pilot,Peter %A Kerkhoffs,Gino %A Schotanus,Martijn %+ Zuyderland Medical Centre, Dr H van der Hoffplein 1, Sittard, 6261 BG, Netherlands, 31 641862491, r.hendrickx@zuyderland.nl %K arthroscopic ankle arthrodesis %K exergaming %K functional test battery %K exergames %K serious games %K ankle %K function %K game %K exercise %K physical activity %K rehabilitation %K gait %K quality of care %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Recently, movement-based videogames (exergames) have gained popularity in improving the rehabilitation process after surgery. During exergaming, participants are physically challenged as the game component stimulates adherence to the training program. There is no literature on the effect of exergame training interventions in patients who received arthroscopic ankle arthrodesis. Objective: This pilot study assessed the potency of an existing exergaming tool for the rehabilitation program of patients who received arthroscopic ankle arthrodesis. Methods: A cross-sectional pilot study was performed, in which patients who received arthroscopic ankle arthrodesis (n=8) were subjected to an exergaming protocol. Gait analysis was performed with a treadmill system. A healthy age-matched control group (n=10) was used as the control group. Results: The patient group was capable of performing exergaming exercises and they showed no floor or ceiling effect. Only in case of the overall stability, the patient group performed significantly less better than the control group (P=.03). Gait analysis showed equal step length with increased external rotation of the affected limb. Conclusions: Exergaming seems to be a valuable tool for measuring the ability of patients who received AAA to perform activities of daily living and it has the potential to individualize rehabilitation programs. When exergaming is systematically integrated with patient-reported outcome measures and activity tracking, it has the potential to improve the quality of care. %M 33949311 %R 10.2196/21924 %U https://rehab.jmir.org/2021/2/e21924 %U https://doi.org/10.2196/21924 %U http://www.ncbi.nlm.nih.gov/pubmed/33949311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25872 %T Evaluation of a Novel e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis via Telehealth: Qualitative Study Nested in the PEAK (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis) Randomized Controlled Trial %A Jones,Sarah E %A Campbell,Penny K %A Kimp,Alexander J %A Bennell,Kim %A Foster,Nadine E %A Russell,Trevor %A Hinman,Rana S %+ Department of Physiotherapy, School of Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Alan Gilbert Building, 161 Barry St, The University of Melbourne, Melbourne, 3010, Australia, 61 03 8344 3223, ranash@unimelb.edu.au %K osteoarthritis %K knee %K physiotherapy %K exercise %K e-learning %K qualitative %K telehealth %K pain %K education %D 2021 %7 30.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The delivery of physiotherapy via telehealth could provide more equitable access to services for patients. Videoconference-based telehealth has been shown to be an effective and acceptable mode of service delivery for exercise-based interventions for chronic knee pain; however, specific training in telehealth is required for physiotherapists to effectively and consistently deliver care using telehealth. The development and evaluation of training programs to upskill health care professionals in the management of osteoarthritis (OA) has also been identified as an important priority to improve OA care delivery. Objective: This study aims to explore physiotherapists’ experiences with and perceptions of an e-learning program about best practice knee OA management (focused on a structured program of education, exercise, and physical activity) that includes telehealth delivery via videoconferencing. Methods: We conducted a qualitative study using individual semistructured telephone interviews, nested within the Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis randomized controlled trial, referred to as the PEAK trial. A total of 15 Australian physiotherapists from metropolitan and regional private practices were interviewed following the completion of an e-learning program. The PEAK trial e-learning program involved self-directed learning modules, a mock video consultation with a researcher (simulated patient), and 4 audited practice video consultations with pilot patients with chronic knee pain. Interviews were audio recorded and transcribed verbatim. Data were thematically analyzed. Results: A total of five themes (with associated subthemes) were identified: the experience of self-directed e-learning (physiotherapists were more familiar with in-person learning; however, they valued the comprehensive, self-paced web-based modules. Unwieldy technological features could be frustrating); practice makes perfect (physiotherapists benefited from the mock consultation with the researcher and practice sessions with pilot patients alongside individualized performance feedback, resulting in confidence and preparedness to implement new skills); the telehealth journey (although inexperienced with telehealth before training, physiotherapists were confident and able to deliver remote care following training; however, they still experienced some technological challenges); the whole package (the combination of self-directed learning modules, mock consultation, and practice consultations with pilot patients was felt to be an effective learning approach, and patient information booklets supported the training package); and impact on broader clinical practice (training consolidated and refined existing OA management skills and enabled a switch to telehealth when the COVID-19 pandemic affected in-person clinical care). Conclusions: Findings provide evidence for the perceived effectiveness and acceptability of an e-learning program to train physiotherapists (in the context of a clinical trial) on best practice knee OA management, including telehealth delivery via videoconferencing. The implementation of e-learning programs to upskill physiotherapists in telehealth appears to be warranted, given the increasing adoption of telehealth service models for the delivery of clinical care. %M 33929326 %R 10.2196/25872 %U https://www.jmir.org/2021/4/e25872 %U https://doi.org/10.2196/25872 %U http://www.ncbi.nlm.nih.gov/pubmed/33929326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26232 %T Attitudes of Health Care Professionals Toward Older Adults’ Abilities to Use Digital Technology: Questionnaire Study %A Mannheim,Ittay %A Wouters,Eveline J M %A van Boekel,Leonieke C %A van Zaalen,Yvonne %+ School for Allied Health Professions, Fontys University of Applied Science, 2 Dominee Theodor Fliednerstraat, Eindhoven, 5631 BN, Netherlands, 31 62 8754948, ittay.mannheim@gmail.com %K ageism %K attitudes %K stereotype activation %K digital technology %D 2021 %7 21.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies (DTs) for older adults focus mainly on health care and are considered to have the potential to improve the well-being of older adults. However, adoption rates of these DTs are considered low. Although previous research has investigated possible reasons for adoption and acceptance of DT, age-based stereotypes (eg, those held by health care professionals) toward the abilities of older adults to use DTs have yet to be considered as possible barriers to adoption. Objective: The aim of this study was to investigate the influencing role of ageism in the context of health care professionals attitudes toward older adults’ abilities to use health care DT. A further goal was to examine if social comparison and stereotype activation affect and moderate this association. Methods: A new measurement to assess health care professionals’ attitudes toward older adults using technology (ATOAUT-10) was developed and used in 2 studies. Study 1 involved the development of the ATOAUT-10 scale using a principal component analysis and further examined health care professionals’ attitudes toward the use of health care DTs and correlations with ageism. Study 2 further explored the correlation between ageism and ATOAUT in an experimental design with health care professionals. Results: In study 1, physiotherapists (N=97) rated older adults as young as 50 years as less able to use health care DT compared to younger adults (P<.001). A multiple regression analysis revealed that higher levels of ageism, beyond other predictors, were predictive of more negative ATOAUT, (β=.36; t=3.73; P<.001). In study 2, the salience of age was manipulated. Health care professionals (N=93) were randomly assigned to rate the abilities of a young or old person to use health care DT. Old age salience moderated the correlation between ageism and ATOAUT (R2=0.19; F6,85=3.35; P=.005), such that higher levels of ageism correlated with more negative ATOAUT in the old age salient condition, but not the young condition. Stereotype activation accounted for health care professionals’ attitudes more than did the experience of working with older patients or the professionals’ age. Conclusions: Negative and ageist attitudes of health care professionals can potentially affect how older adults are viewed in relation to DT and consequently might influence actual use and adoption of technology-based treatment. Future studies should broaden the validation of the ATOAUT-10 scale on more diverse samples and focus on the discriminatory aspect of ageism and self-ageism of older adults. This study calls for a focus on ageism as a determinant of adoption of DT. %M 33881408 %R 10.2196/26232 %U https://www.jmir.org/2021/4/e26232 %U https://doi.org/10.2196/26232 %U http://www.ncbi.nlm.nih.gov/pubmed/33881408 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25717 %T Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: Randomized Controlled Trial %A Bientzle,Martina %A Restle,Anne %A Kimmerle,Joachim %+ Leibniz-Institut für Wissensmedien, Schleichstr. 6, Tuebingen, 72076, Germany, 49 7071 979 120, m.bientzle@iwm-tuebingen.de %K smartphone use %K phubbing %K physiotherapy %K smartphone %K therapy %K patients %K therapists %K therapeutic %K treatment %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any purpose. This also applies to patients and therapists in treatment situations. Objective: The aim of this study was to investigate how purposeful smartphone use compared with recreational smartphone use (by a physiotherapist or by a patient) influenced the perception of a physiotherapeutic treatment situation. We examined the impact of smartphone use during a physiotherapy session on the perception of the physiotherapist, evaluation of attentiveness, and evaluation of smartphone use in physiotherapy in general. Methods: Members of various music and sports clubs were invited to participate in an online randomized controlled trial. Participants were randomly assigned to one of four conditions. They watched a video in which a physiotherapeutic treatment was shown and in which a smartphone was used or not used in the following four different ways: (1) therapeutically purposeful use, (2) recreational use by the physiotherapist (looking at the phone from time to time with no therapeutic purpose), (3) recreational use by the patient, and (4) no smartphone use (control condition). After watching the video, the participants indicated their perception of the physiotherapist’s professional competence, social competence, and empathetic behavior. They also rated the physiotherapist’s and patient’s attentiveness and evaluated the usage of smartphones generally in physiotherapy. Results: The analysis included 118 participants (63 women and 55 men). When the physiotherapist used the smartphone in a purposeful way, the physiotherapist was perceived as more professionally competent (P=.007), socially competent (P=.03), and empathetic (P=.04) than if the physiotherapist used it with no therapeutic purpose. These effects occurred because recreational smartphone use by the physiotherapist was evaluated more negatively than the behavior in the control condition (professional competence: P=.001; social competence: P=.03; empathy: P=.04). Moreover, when the physiotherapist used the smartphone in a recreational way, the physiotherapist was perceived as being less attentive (P<.001). Likewise, when the patient used the smartphone in a recreational way, the patient was perceived as being less attentive (P<.001). Finally, smartphone use in physiotherapy was rated as more positive in general when the smartphone was used in a purposeful way compared with the conditions in which the physiotherapist or patient looked at the smartphone with no therapeutic purpose (P<.001). This positive evaluation occurred because purposeful use led to a more positive rating than no smartphone use (P<.001, R=0.42). Conclusions: Smartphones are only appropriate for therapists and patients if they are used directly for a therapeutic purpose. Otherwise, it is better not to use smartphones during treatment. Trial Registration: AsPredicted (aspredicted.org) #24740; https://aspredicted.org/blind.php?x=vv532i %M 33881402 %R 10.2196/25717 %U https://mhealth.jmir.org/2021/4/e25717 %U https://doi.org/10.2196/25717 %U http://www.ncbi.nlm.nih.gov/pubmed/33881402 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e23822 %T Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review %A Demers,Marika %A Fung,Karen %A Subramanian,Sandeep K %A Lemay,Martin %A Robert,Maxime T %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Department of Rehabilitation, Faculty of Medicine, Université Laval, 525 boul Hamel, Quebec, QC, G1M 2S8, Canada, 1 418 529 9141 ext 6121, maxime.robert@fmed.ulaval.ca %K virtual rehabilitation %K upper limb %K brain damage %K feedback %K active video games %K learning %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Increasing evidence supports the use of virtual reality systems to improve upper limb motor functions in individuals with cerebral palsy. While virtual reality offers the possibility to include key components to promote motor learning, it remains unclear if and how motor learning principles are incorporated into the development of rehabilitation interventions using virtual reality. Objective: The objective of this study was to determine the extent to which motor learning principles are integrated into virtual reality interventions targeting upper limb function in individuals with cerebral palsy. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was performed in 10 databases using a combination of keywords related to cerebral palsy, virtual reality, video games, and rehabilitation. Studies were divided into 2 categories: commercial video game platforms and devices and custom virtual reality systems. Study quality was assessed using the modified Downs and Black checklist. Results: The initial search yielded 1497 publications. A total of 26 studies from 30 publications were included, with most studies classified as “fair” according to the modified Downs and Black checklist. The majority of studies provided enhanced feedback and variable practice and used functionally relevant and motivating virtual tasks. The dosage varied greatly (total training time ranged from 300 to 3360 minutes), with only 6 studies reporting the number of movement repetitions per session. The difficulty progression and the assessment of skills retention and transfer were poorly incorporated, especially for the commercial video games. Conclusions: Motor learning principles should be better integrated into the development of future virtual reality systems for optimal upper limb motor recovery in individuals with cerebral palsy. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020151982; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151982 %M 33825690 %R 10.2196/23822 %U https://games.jmir.org/2021/2/e23822 %U https://doi.org/10.2196/23822 %U http://www.ncbi.nlm.nih.gov/pubmed/33825690 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 1 %P e21105 %T Monitoring of Sitting Postures With Sensor Networks in Controlled and Free-living Environments: Systematic Review %A Kappattanavar,Arpita Mallikarjuna %A Steckhan,Nico %A Sachs,Jan Philipp %A Freitas da Cruz,Harry %A Böttinger,Erwin %A Arnrich,Bert %+ Hasso-Plattner-Institut, University of Potsdam, Rudolf-Breitscheid-Straße 187, Potsdam, 14482, Germany, 49 33155094895, Arpita.Kappattanavar@hpi.de %K classification %K algorithms %K sitting position %K spine %K technology %K machine learning %K back pain %K movement %K extremities %D 2021 %7 1.3.2021 %9 Review %J JMIR Biomed Eng %G English %X Background: A majority of employees in the industrial world spend most of their working time in a seated position. Monitoring sitting postures can provide insights into the underlying causes of occupational discomforts such as low back pain. Objective: This study focuses on the technologies and algorithms used to classify sitting postures on a chair with respect to spine and limb movements, using sensors and wearables such as inertial measurement units, pressure or piezoresistive sensors, accelerometers or gyroscopes, combined with machine learning approaches. Methods: A total of three electronic literature databases were surveyed to identify studies classifying sitting postures in adults. Quality appraisal was performed to extract critical details and assess biases in the shortlisted papers. Results: A total of 14 papers were shortlisted from 952 papers obtained after a systematic search. The majority of the studies used pressure sensors to measure sitting postures, whereas neural networks were the most frequently used approaches for classification tasks in this context. Only 2 studies were performed in a free-living environment. Most studies presented ethical and methodological shortcomings. Moreover, the findings indicate that the strategic placement of sensors can lead to better performance and lower costs. Conclusions: The included studies differed in various aspects of design and analysis. The majority of studies were rated as medium quality according to our assessment. Our study suggests that future work for posture classification can benefit from using inertial measurement unit sensors, since they make it possible to differentiate among spine movements and similar postures, considering transitional movements between postures, and using three-dimensional cameras to annotate the data for ground truth. Finally, comparing such studies is challenging, as there are no standard definitions of sitting postures that could be used for classification. In addition, this study identifies five basic sitting postures along with different combinations of limb and spine movements to help guide future research efforts. %M 38907372 %R 10.2196/21105 %U http://biomedeng.jmir.org/2021/1/e21105/ %U https://doi.org/10.2196/21105 %U http://www.ncbi.nlm.nih.gov/pubmed/38907372 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e26007 %T Game-Based Learning Outcomes Among Physiotherapy Students: Comparative Study %A Molina-Torres,Guadalupe %A Rodriguez-Arrastia,Miguel %A Alarcón,Raquel %A Sánchez-Labraca,Nuria %A Sánchez-Joya,María %A Roman,Pablo %A Requena,Mar %+ Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carretera de Sacramento s/n, Almeria, 04120, Spain, 34 950 21 45 63, pablo.roman@ual.es %K gamification %K board game–based approach %K health sciences %K physiotherapy %K teaching innovation %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: University teaching methods are changing, and in response to a classical teacher-centered approach, new methods continue to strengthen knowledge acquisition by involving students more actively in their learning, thus achieving greater motivation and commitment. Objective: This study aimed to analyze the degree of satisfaction of physiotherapy students who used a board game–based approach, as well as to compare the difference between traditional and gamification teaching methods and their influence on the final evaluation of these students. Methods: A comparative study was conducted. Participants were physiotherapy students who were enrolled in the subject of “physiotherapy in geriatric and adult psychomotricity” (n=59). They were divided into two groups (experimental [n=29] and control [n=30] groups) through convenience sampling. The experimental group received gamification lessons, where the students performed different tests adapted from Party&Co, and the control group received traditional lessons. A total of 16 theoretical lessons were received in both groups. Results: The scores in the final examination of the subject were higher in the experimental group (mean 7.53, SD 0.95) than in the control group (mean 6.24, SD 1.34), showing a statistically significant difference between the two groups (P=.001). Conclusions: Overall, the “Physiotherapy Party” game not only stimulated learning and motivated students, but also improved learning outcomes among participants, and the improvements were greater than those among students who received traditional teaching. %M 33759800 %R 10.2196/26007 %U https://games.jmir.org/2021/1/e26007 %U https://doi.org/10.2196/26007 %U http://www.ncbi.nlm.nih.gov/pubmed/33759800 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e19519 %T Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study %A Richardson,Julie %A Letts,Lori %A Sinclair,Susanne %A Chan,David %A Miller,Jordan %A Donnelly,Catherine %A Smith-Turchyn,Jenna %A Wojkowski,Sarah %A Gravesande,Janelle %A Loyola Sánchez,Adalberto %+ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main Street West, IAHS Room 403, Hamilton, ON, L8S 1C7, Canada, 1 905 525 9140 ext 27811, jrichard@mcmaster.ca %K rehabilitation %K physiotherapy %K occupational therapy %K self-management %K function %K web-based application %K usability %K user-centered design %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ≥45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. %M 33734090 %R 10.2196/19519 %U https://rehab.jmir.org/2021/1/e19519 %U https://doi.org/10.2196/19519 %U http://www.ncbi.nlm.nih.gov/pubmed/33734090 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e21374 %T Adherence Patterns and Dose Response of Physiotherapy for Rotator Cuff Pathology: Longitudinal Cohort Study %A Burns,David %A Boyer,Philip %A Razmjou,Helen %A Richards,Robin %A Whyne,Cari %+ Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room S620, Toronto, ON, M4N 3M5, Canada, 1 4164806100, d.burns@utoronto.ca %K rehabilitation %K treatment adherence and compliance %K wearable electronic devices %K machine learning %K rotator cuff %D 2021 %7 11.3.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Physiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; however, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown. Objective: The purpose of this study was to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose response between physiotherapy activity and recovery, and explore patient factors predictive of physiotherapy participation. Methods: We report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smartwatch that recorded inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from smartwatch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand and numeric pain rating scale assessed every 4 weeks until 12 weeks follow-up. The relationships between participation, outcomes, and clinical patient variables were assessed in univariable analyses. Results: Mean physiotherapy exercise participation in clinic and at home were 11 minutes per week and 33 minutes per week, respectively, with patients participating in physiotherapy on 41% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P=.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery demonstrated by pain scores at 8 weeks (P=.02) and 12 weeks (P=.05) and disability scores at 8 weeks (P=.04) and 12 weeks (P=.04). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation. Conclusions: There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders. International Registered Report Identifier (IRRID): RR2-10.2196/17841 %M 33704076 %R 10.2196/21374 %U https://rehab.jmir.org/2021/1/e21374 %U https://doi.org/10.2196/21374 %U http://www.ncbi.nlm.nih.gov/pubmed/33704076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23612 %T Hybrid Ubiquitous Coaching With a Novel Combination of Mobile and Holographic Conversational Agents Targeting Adherence to Home Exercises: Four Design and Evaluation Studies %A Kowatsch,Tobias %A Lohse,Kim-Morgaine %A Erb,Valérie %A Schittenhelm,Leo %A Galliker,Helen %A Lehner,Rea %A Huang,Elaine M %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, WEV-G, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 712247244, tkowatsch@ethz.ch %K ubiquitous coaching %K augmented reality %K health care %K treatment adherence %K design science research %K physiotherapy %K chronic back pain %K pain %K chronic pain %K exercise %K adherence %K treatment %K conversational agent %K smartphone %K mobile phone %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. Objective: To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. Methods: We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients’ perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. Results: Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality–based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. Conclusions: The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders. %M 33461957 %R 10.2196/23612 %U https://www.jmir.org/2021/2/e23612 %U https://doi.org/10.2196/23612 %U http://www.ncbi.nlm.nih.gov/pubmed/33461957 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e21107 %T Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review %A Elgert,Lena %A Steiner,Bianca %A Saalfeld,Birgit %A Marschollek,Michael %A Wolf,Klaus-Hendrik %+ Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany, 49 511 532 19333, lena.elgert@plri.de %K shoulder %K upper extremity %K musculoskeletal diseases %K exercises %K physical therapy %K telerehabilitation %K technology-assisted therapy %K assistive technologies %K mobile phone %D 2021 %7 4.2.2021 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. Objective: This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. Methods: The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. Results: Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient’s range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients’ evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. Conclusions: There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects. %M 33538701 %R 10.2196/21107 %U http://rehab.jmir.org/2021/1/e21107/ %U https://doi.org/10.2196/21107 %U http://www.ncbi.nlm.nih.gov/pubmed/33538701 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e23386 %T Association Between Therapeutic Alliance and Outcomes Following Telephone-Delivered Exercise by a Physical Therapist for People With Knee Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial %A Lawford,Belinda Joan %A Bennell,Kim L %A Campbell,Penny K %A Kasza,Jessica %A Hinman,Rana S %+ Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Level 7, Alan Gilbert Building, Building 104, 161 Barry Street, Melbourne, 3010, Australia, 61 383442045, belinda.lawford@unimelb.edu.au %K osteoarthritis %K physiotherapy %K physical therapy %K tele-rehabilitation %K telephone %K therapeutic alliance %K exercise %K knee %K pain %D 2021 %7 18.1.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The therapeutic alliance between patients and physical therapists has been shown to influence clinical outcomes in patients with chronic low back pain when consulting in-person. However, no studies have examined whether the therapeutic alliance developed between patients with knee osteoarthritis and physical therapists during telephonic consultations influences clinical outcomes. Objective: This study aims to investigate whether the therapeutic alliance between patients with knee osteoarthritis and physical therapists measured after the second consultation is associated with outcomes following telephone-delivered exercise and advice. Methods: Secondary analysis of 87 patients in the intervention arm of a randomized controlled trial allocated to receive 5 to 10 telephone consultations with one of 8 physical therapists over a period of 6 months, involving education and prescription of a strengthening and physical activity program. Separate regression models investigated the association between patient and therapist ratings of therapeutic alliance (measured after the second consultation using the Working Alliance Inventory Short Form) and outcomes (pain, function, self-efficacy, quality of life, global change, adherence to prescribed exercise, physical activity) at 6 and 12 months, with relevant covariates included. Results: There was some evidence of a weak association between patient ratings of the alliance and some outcomes at 6 months (improvements in average knee pain: regression coefficient −0.10, 95% CI −0.16 to −0.03; self-efficacy: 0.16, 0.04-0.28; global improvement in function: odds ratio 1.26, 95% CI 1.04-1.39, and overall improvement: odds ratio 1.26, 95% CI 1.06-1.51; but also with worsening in fear of movement: regression coefficient −0.13, 95% CI −0.23 to −0.04). In addition, there was some evidence of a weak association between patient ratings of the alliance and some outcomes at 12 months (improvements in self-efficacy: regression coefficient 0.15, 95% CI 0.03-0.27; global improvement in both function, odds ratio 1.19, 95% CI 0.03-1.37; and pain, odds ratio 1.14, 95% CI 1.01-1.30; and overall improvement: odds ratio 1.21, 95% CI 1.02-1.42). The data suggest that associations between therapist ratings of therapeutic alliance and outcomes were not strong, except for improved quality of life at 12 months (regression coefficient 0.01, 95% CI 0.0003-0.01). Conclusions: Higher patient ratings, but not higher therapist ratings, of the therapeutic alliance were weakly associated with improvements in some clinical outcomes and with worsening in one outcome. Although the findings suggest that patients who perceive a stronger alliance with their therapist may achieve better clinical outcomes, the observed relationships were generally weak and unlikely to be clinically significant. The limitations include the fact that measures of therapeutic alliance have not been validated for use in musculoskeletal physical therapy settings. There was a risk of type 1 error; however, findings were interpreted on the basis of clinical significance rather than statistical significance alone. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000054415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369204 %M 33459601 %R 10.2196/23386 %U http://rehab.jmir.org/2021/1/e23386/ %U https://doi.org/10.2196/23386 %U http://www.ncbi.nlm.nih.gov/pubmed/33459601 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e19747 %T Physiotherapists’ Use of Web-Based Information Resources to Fulfill Their Information Needs During a Theoretical Examination: Randomized Crossover Trial %A Doherty,Cailbhe %A Joorabchi,Arash %A Megyesi,Peter %A Flynn,Aileen %A Caulfield,Brian %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, A308, Health Science Building, Belfield, Dublin, D4, Ireland, 353 17166511, cailbhe.doherty@ucd.ie %K evidence-based medicine %K knowledge discovery %K information seeking behavior %K information dissemination %K information literacy %K online systems %K point-of-care systems %K mobile phone %D 2020 %7 17.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread availability of internet-connected smart devices in the health care setting has the potential to improve the delivery of research evidence to the care pathway and fulfill health care professionals’ information needs. Objective: This study aims to evaluate the frequency with which physiotherapists experience information needs, the capacity of digital information resources to fulfill these needs, and the specific types of resources they use to do so. Methods: A total of 38 participants (all practicing physiotherapists; 19 females, 19 males) were randomly assigned to complete three 20-question multiple-choice questionnaire (MCQ) examinations under 3 conditions in a randomized crossover study design: assisted by a web browser, assisted by a federated search portal system, and unassisted. MCQ scores, times, and frequencies of information needs were recorded for overall examination-level and individual question-level analyses. Generalized estimating equations were used to assess differences between conditions for the primary outcomes. A log file analysis was conducted to evaluate participants’ web search and retrieval behaviors. Results: Participants experienced an information need in 55.59% (845/1520) MCQs (assisted conditions only) and exhibited a mean improvement of 10% and 16% in overall examination scores for the federated search and web browser conditions, respectively, compared with the unassisted condition (P<.001). In the web browser condition, Google was the most popular resource and the only search engine used, accounting for 1273 (64%) of hits, followed by PubMed (195 hits; 10% of total). In the federated search condition, Wikipedia and PubMed were the most popular resources with 1518 (46% of total) and 1273 (39% of total) hits, respectively. Conclusions: In agreement with the findings of previous research studies among medical physicians, the results of this study demonstrate that physiotherapists frequently experience information needs. This study provides new insights into the preferred digital information resources used by physiotherapists to fulfill these needs. Future research should clarify the implications of physiotherapists’ apparent high reliance on Google, whether these results reflect the authentic clinical environment, and whether fulfilling clinical information needs alters practice behaviors or improves patient outcomes. %M 33331826 %R 10.2196/19747 %U http://www.jmir.org/2020/12/e19747/ %U https://doi.org/10.2196/19747 %U http://www.ncbi.nlm.nih.gov/pubmed/33331826 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21704 %T Attitudes and Expectations of Health Care Professionals Toward App-Based Therapy in Patients with Osteoarthritis of the Hip or Knee: Questionnaire Study %A Biebl,Johanna Theresia %A Huber,Stephan %A Rykala,Marzena %A Kraft,Eduard %A Lorenz,Andreas %+ Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, Munich, 81377, Germany, 49 89 4400 74070, johanna.biebl@med.uni-muenchen.de %K mobile health %K digital health %K self-management %K osteoarthritis %K smartphone %K patient education %K exercise therapy %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) apps is becoming increasingly widespread. However, little is known about the attitudes, expectations, and basic acceptance of health care professionals toward such treatment options. As physical activity and behavior modification are crucial in osteoarthritis management, app-based therapy could be particularly useful for the self-management of this condition. Objective: The objective of the study was to determine the expectations and attitudes of medical professionals toward app-based therapy for osteoarthritis of the hip or knee. Methods: Health care professionals attending a rehabilitation congress and employees of a university hospital were asked to fill out a questionnaire consisting of 16 items. A total of 240 questionnaires were distributed. Results: A total of 127 participants completed the questionnaire. At 95.3% (121/127), the approval rate for app-based therapy for patients with osteoarthritis of the hip or knee was very high. Regarding possible concerns, aspects related to data protection and privacy were primarily mentioned (41/127, 32.3%). Regarding potential content, educational units, physiotherapeutic exercise modules, and practices based on motivation psychology were all met with broad approval. Conclusions: The study showed a high acceptance of app-based therapy for osteoarthritis, indicating a huge potential of this form of treatment to be applied, prescribed, and recommended by medical professionals. It was widely accepted that the content should reflect a multimodal therapy approach. %M 33112255 %R 10.2196/21704 %U http://mhealth.jmir.org/2020/10/e21704/ %U https://doi.org/10.2196/21704 %U http://www.ncbi.nlm.nih.gov/pubmed/33112255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18233 %T Effectiveness of Human Versus Computer-Based Instructions for Exercise on Physical Activity–Related Health Competence in Patients with Hip Osteoarthritis: Randomized Noninferiority Crossover Trial %A Durst,Jennifer %A Roesel,Inka %A Sudeck,Gorden %A Sassenberg,Kai %A Krauss,Inga %+ Department of Sports Medicine, University Hospital, University of Tuebingen, Hoppe-Seyler-Str. 6, Tuebingen, 72076, Germany, 49 7071 2986486, inga.krauss@med.uni-tuebingen.de %K digital app %K exercise %K movement control %K self-efficacy %K control competence %K mHealth %K osteoarthritis %K tablet %D 2020 %7 28.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Hip and knee osteoarthritis is ranked as the 11th highest contributor to global disability. Exercise is a core treatment in osteoarthritis. The model for physical activity–related health competence describes possibilities to empower patients to perform physical exercises in the best possible health-promoting manner while taking into account their own physical condition. Face-to-face supervision is the gold standard for exercise guidance. Objective: The aim of this study was to evaluate whether instruction and guidance via a digital app is not inferior to supervision by a physiotherapist with regard to movement quality, control competence for physical training, and exercise-specific self-efficacy. Methods: Patients with clinically diagnosed hip osteoarthritis were recruited via print advertisements, emails and flyers. The intervention consisted of two identical training sessions with one exercise for mobility, two for strength, and one for balance. One session was guided by a physiotherapist and the other was guided by a fully automated tablet computer-based app. Both interventions took place at a university hospital. Outcomes were assessor-rated movement quality, and self-reported questionnaires on exercise-specific self-efficacy and control competence for physical training. Participants were randomly assigned to one of two treatment sequences. One sequence started with the app in the first session followed by the physiotherapist in the second session after a minimum washout phase of 27 days (AP group) and the other sequence occurred in the reverse order (PA group). Noninferiority was defined as a between-treatment effect (gIG)<0.2 in favor of the physiotherapist-guided training, including the upper confidence interval. Participants, assessors, and the statistician were neither blinded to the treatment nor to the treatment sequence. Results: A total of 54 participants started the first training session (32 women, 22 men; mean age 62.4, SD 8.2 years). The treatment sequence groups were similar in size (PA: n=26; AP: n=28). Seven subjects did not attend the second training session (PA: n=3; AP: n=4). The app was found to be inferior to the physiotherapist in all outcomes considered, except for movement quality of the mobility exercise (gIG –0.13, 95% CI –0.41-0.16). In contrast to the two strengthening exercises in different positions (supine gIG 0.76, 95% CI 0.39-1.13; table gIG 1.19, 95% CI 0.84-1.55), movement quality of the balance exercise was close to noninferiority (gIG 0.15, 95% CI –0.17-0.48). Exercise-specific self-efficacy showed a strong effect in favor of the physiotherapist (gIG 0.84, 95% CI 0.46-1.22). In terms of control competence for physical training, the app was only slightly inferior to the physiotherapist (gIG 0.18, 95% CI –0.14-0.50). Conclusions: Despite its inferiority in almost all measures of interest, exercise-specific self-efficacy and control competence for physical training did improve in patients who used the digital app. Movement quality was acceptable for exercises that are easy to conduct and instruct. The digital app opens up possibilities as a supplementary tool to support patients in independent home training for less complex exercises; however, it cannot replace a physiotherapist. Trial Registration: German Clinical Trial Register: DRKS00015759; http://www.drks.de/DRKS00015759 %M 32985991 %R 10.2196/18233 %U http://www.jmir.org/2020/9/e18233/ %U https://doi.org/10.2196/18233 %U http://www.ncbi.nlm.nih.gov/pubmed/32985991 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e19296 %T Telerehabilitation to Address the Rehabilitation Gap in Anterior Cruciate Ligament Care: Survey of Patients %A Dunphy,Emma %A Gardner,Elizabeth C %+ eHealth Unit, Department of Primary Care and Population Health, University College London, Upper Third Floor UCL Medical School (Royal Free Campus), Rowland Hill Street, NW3 2PF, United Kingdom, 44 07510146528, emmalouise75@hotmail.com %K anterior cruciate ligament %K telerehabilitation %K rehabilitation %K eHealth %K knee %K survey %K telehealth %K patient experience %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence shows that after anterior cruciate ligament (ACL) reconstruction, patients may have varied access to physical therapy. In particular, physical therapy input may end many months before patients reach full recovery. Telerehabilitation may provide an opportunity to address this rehabilitation gap and improve access to evidence-based rehabilitation alongside physical therapy at all stages of care. Objective: This study aims to understand the opinions of patients who have undergone ACL surgery and rehabilitation on the use of telerehabilitation as part of ACL care and define the population and explore their experiences and views on the acceptability of telerehabilitation after ACL reconstruction. Methods: This study was a cross-sectional, voluntary, web-based survey combining both closed and open questions. Ethical approval was obtained from the Yale School of Medicine Institutional Review Board. Participants were aged 16 years or older at the time of recruitment and had undergone ACL reconstruction within the past 5 years. A 26-item survey was developed using the Qualtrics survey platform. No items were mandatory. Responses were multiple choice, binary, and qualitative. The CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure the quality of reporting of surveys in the medical literature. Data were analyzed using Stata version 15. Qualitative data were analyzed using NVivo 11. The theoretical framework for this analysis is based on the Capability, Opportunity, and Motivation-Behavior model of behavior change. Results: A total of 100 participants opened the survey. All completers were unique. The participation and completion rates were each 96% (96/100). Patients reported their physical therapy care ended at an average of 6.4 months and that they felt fully recovered at an average of 13.2 months. Only 26% (25/96) of patients felt fully recovered at the end of physical therapy. Of these 96 patients, 54 (60%) were younger than 30 years, 71 (74%) were recreational athletes, 24 (24%) were competitive athletes, 72 (75%) had private insurance, 74 (77%) were not familiar at all with telerehabilitation, and 89% (85/96) felt capable. They preferred to use telerehabilitation at different stages of care. Reported benefits included resource saving, improved access to care, improved learning, and greater engagement. Concerns included incorrect performance of exercises or unmanaged pain being missed and less access to manual therapy, motivation, and opportunities to ask questions. Participants’ priorities for a future telerehabilitation intervention included its use as an adjunct to physical therapy rather than a replacement, with content available for each stage of care, especially return to sports. Participants stressed that the intervention should be personalized to them and include measures of progress. Conclusions: These findings helped understand and define the ACL reconstruction population. Participants found telerehabilitation acceptable in principle and highlighted the key user requirements and scope of future interventions. %M 32945776 %R 10.2196/19296 %U http://formative.jmir.org/2020/9/e19296/ %U https://doi.org/10.2196/19296 %U http://www.ncbi.nlm.nih.gov/pubmed/32945776 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 2 %P e18508 %T Data-Driven Personalization of a Physiotherapy Care Pathway: Case Study of Posture Scanning %A Korhonen,Olli %A Väyrynen,Karin %A Krautwald,Tino %A Bilby,Glenn %A Broers,Hedwig Anna Theresia %A Giunti,Guido %A Isomursu,Minna %+ University of Oulu, Pentti Kaiteran katu 1, Oulu, 90014, Finland, 358 294481952, olli.korhonen@oulu.fi %K digital health services %K information systems %K case reports %K qualitative research %K physiotherapy %K posture %D 2020 %7 15.9.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Advanced sensor, measurement, and analytics technologies are enabling entirely new ways to deliver health care. The increased availability of digital data can be used for data-driven personalization of care. Data-driven personalization can complement expert-driven personalization by providing support for decision making or even by automating some parts of decision making in relation to the care process. Objective: The aim of this study was to analyze how digital data acquired from posture scanning can enhance physiotherapy services and enable more personalized delivery of physiotherapy. Methods: A case study was conducted with a company that designed a posture scan recording system (PSRS), which is an information system that can digitally record, measure, and report human movement for use in physiotherapy. Data were collected through interviews with different stakeholders, such as health care professionals, health care users, and the information system provider, and were analyzed thematically. Results: Based on the results of our thematic analysis, we propose three different types of support that posture scanning data can provide to enhance and enable more personalized delivery of physiotherapy: 1) modeling the condition, in which the posture scanning data are used to detect and understand the health care user’s condition and the root cause of the possible pain; 2) visualization for shared understanding, in which the posture scanning data are used to provide information to the health care user and involve them in more collaborative decision-making regarding their care; and 3) evaluating the impact of the intervention, in which the posture scanning data are used to evaluate the care progress and impact of the intervention. Conclusions: The adoption of digital tools in physiotherapy has remained low. Physiotherapy has also lacked digital tools and means to inform and involve the health care user in their care in a person-centered manner. In this study, we gathered insights from different stakeholders to provide understanding of how the availability of digital posture scanning data can enhance and enable personalized physiotherapy services. %M 32930667 %R 10.2196/18508 %U http://rehab.jmir.org/2020/2/e18508/ %U https://doi.org/10.2196/18508 %U http://www.ncbi.nlm.nih.gov/pubmed/32930667 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 2 %P e18589 %T Rhythmic Haptic Cueing Using Wearable Devices as Physiotherapy for Huntington Disease: Case Study %A Georgiou,Theodoros %A Islam,Riasat %A Holland,Simon %A van der Linden,Janet %A Price,Blaine %A Mulholland,Paul %A Perry,Allan %+ School of Mathematical and Computer Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, EH14 4AS, United Kingdom, 44 131 451 4132, t.georgiou@hw.ac.uk %K physiotherapy %K rhythm %K haptic %K tactile %K wearable %K cueing %K Huntington %K gait %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Huntington disease (HD) is an inherited genetic disorder that results in the death of brain cells. HD symptoms generally start with subtle changes in mood and mental abilities; they then degenerate progressively, ensuing a general lack of coordination and an unsteady gait, ultimately resulting in death. There is currently no cure for HD. Walking cued by an external, usually auditory, rhythm has been shown to steady gait and help with movement coordination in other neurological conditions. More recently, work with other neurological conditions has demonstrated that haptic (ie, tactile) rhythmic cues, as opposed to audio cues, offer similar improvements when walking. An added benefit is that less intrusive, more private cues are delivered by a wearable device that leaves the ears free for conversation, situation awareness, and safety. This paper presents a case study where rhythmic haptic cueing (RHC) was applied to one person with HD. The case study has two elements: the gait data we collected from our wearable devices and the comments we received from a group of highly trained expert physiotherapists and specialists in HD. Objective: The objective of this case study was to investigate whether RHC can be applied to improve gait coordination and limb control in people living with HD. While not offering a cure, therapeutic outcomes may delay the onset or severity of symptoms, with the potential to improve and prolong quality of life. Methods: The approach adopted for this study includes two elements, one quantitative and one qualitative. The first is a repeated-measures design with three conditions: before haptic rhythm (ie, baseline), with haptic rhythm, and after exposure to haptic rhythm. The second element is an in-depth interview with physiotherapists observing the session. Results: In comparison to the baseline, the physiotherapists noted a number of improvements to the participant’s kinematics during her walk with the haptic cues. These improvements continued in the after-cue condition, indicating some lasting effects. The quantitative data obtained support the physiotherapists’ observations. Conclusions: The findings from this small case study, with a single participant, suggest that a haptic metronomic rhythm may have immediate, potentially therapeutic benefits for the walking kinematics of people living with HD and warrants further investigation. %M 32924955 %R 10.2196/18589 %U http://rehab.jmir.org/2020/2/e18589/ %U https://doi.org/10.2196/18589 %U http://www.ncbi.nlm.nih.gov/pubmed/32924955 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e19914 %T Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review %A Steiner,Bianca %A Elgert,Lena %A Saalfeld,Birgit %A Wolf,Klaus-Hendrik %+ Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Muehlenpfordtstr 23, Braunschweig, 38106, Germany, 49 531 391 9518, bianca.steiner@plri.de %K shoulder %K upper extremity %K musculoskeletal diseases %K rehabilitation %K gamification %K serious games %K exergames %K scoping review %D 2020 %7 25.8.2020 %9 Review %J JMIR Serious Games %G English %X Background: Gamification has become increasingly important both in research and in practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. Objective: This scoping review aims to identify and analyze information and communication technologies that use game design elements to support the rehabilitation processes of patients with musculoskeletal diseases of the shoulder. The state of the art with regard to fields of application, game design elements, and motivation concepts will be determined. Methods: We conducted a scoping review to identify relevant application systems. The search was performed in 3 literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO (population, intervention, comparison, outcome) framework, keywords and Medical Subject Headings for shoulder, rehabilitation, and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified by the search strategy. There was no restriction on year of publication. Data synthesis was done by deductive-inductive coding based on qualitative content analysis. Results: A total of 1994 articles were screened; 31 articles in English, published between 2006 and 2019, were included. Within, 27 application systems that support patients with musculoskeletal diseases of the shoulder in exercising, usually at home but also in inpatient or outpatient rehabilitation clinics, were described. Only 2 application systems carried out monitoring of adherence. Almost all were based on in-house developed software. The most frequently used game components were points, tasks, and avatars. More complex game components, such as collections and teams, were rarely used. When selecting game components, patient-specific characteristics, such as age and gender, were only considered in 2 application systems. Most were described as motivating, though an evaluation of motivational effects was usually not conducted. Conclusions: There are only a few application systems supporting patients with musculoskeletal diseases of the shoulder in rehabilitation by using game design elements. Almost all application systems are exergames for supporting self-exercising. Application systems for multiple rehabilitation phases seem to be nonexistent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics. %M 32840488 %R 10.2196/19914 %U http://games.jmir.org/2020/3/e19914/ %U https://doi.org/10.2196/19914 %U http://www.ncbi.nlm.nih.gov/pubmed/32840488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17032 %T Wearable Motion Sensor Device to Facilitate Rehabilitation in Patients With Shoulder Adhesive Capsulitis: Pilot Study to Assess Feasibility %A Chen,Yu-Pin %A Lin,Chung-Ying %A Tsai,Ming-Jr %A Chuang,Tai-Yuan %A Lee,Oscar Kuang-Sheng %+ Institute of Clinical Medicine, National Yang Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, 886 2 28200183, oscarlee9203@gmail.com %K motion sensor %K adhesive capsulitis %K rehabilitation %K home-based exercise %K telerehabilitation %K telehealth, telemonitoring %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Adhesive capsulitis (AC) of the shoulder is a common disorder that painfully reduces the shoulder range of motion (ROM) among middle-aged individuals. Although physical therapy with home-based exercises is widely advised to restore ROM in the treatment of AC, clinical results vary owing to inconsistent patient compliance. Objective: In this study, we aimed to verify the feasibility of a treatment model that involves applying a wearable motion sensor device to assist patients conduct home-based exercises to improve training compliance and the accuracy of exercises, with the ultimate goal of improving the functional recovery of patients with AC. Methods: The motion sensor device was comprised of inertial measurement unit–based sensors and mobile apps for patients and physicians, offering shoulder mobility tracing, home-based exercise support, and progress monitoring. The interrater reliability of shoulder mobility measurement using the motion sensor device on 10 healthy participants and 15 patients with AC was obtained using an intraclass correlation coefficient analysis and compared with the assessments performed by two highly experienced physicians. A pilot prospective control trial was then carried out to allocate the 15 patients with AC to two groups: home-based exercise group and motion sensor–assisted rehabilitation group. Changes in active and passive shoulder ROM, pain and functional scores, and exercise completion rates were compared between the groups during a treatment period of 3 months. Results: Shoulder ROM, as measured using the motion sensor device, exhibited good to excellent reliability based on the comparison with the measurements of two physicians (intraclass correlation coefficient range, 0.771 to 0.979). Compared with patients with AC in the home-based exercise group, those in the motion sensor–assisted rehabilitation group exhibited better shoulder mobility and functional recovery and a higher exercise completion rate during and after 3 months of rehabilitation. Conclusions: Motion sensor device–assisted home-based rehabilitation for the treatment of AC is a useful treatment model for telerehabilitation that enhances the compliance of patients through training, thus improving functional recovery. This helps overcome important obstacles in physiotherapy at home by providing comprehensible and easily accessible exercise instructions, enhancing compliance, ensuring the correctness of exercise, and monitoring the progress of patients. %M 32457026 %R 10.2196/17032 %U http://www.jmir.org/2020/7/e17032/ %U https://doi.org/10.2196/17032 %U http://www.ncbi.nlm.nih.gov/pubmed/32457026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16380 %T Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study %A Mehra,Sumit %A van den Helder,Jantine %A Visser,Bart %A Engelbert,Raoul H H %A Weijs,Peter J M %A Kröse,Ben J A %+ Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Wibautstraat 3b, Amsterdam, 1091 GH, Netherlands, 31 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K health behavior %K telemedicine %K mobile devices %K tablet computers %K usability testing %K evaluation %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. %M 32459652 %R 10.2196/16380 %U http://www.jmir.org/2020/7/e16380/ %U https://doi.org/10.2196/16380 %U http://www.ncbi.nlm.nih.gov/pubmed/32459652 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17841 %T Adherence Tracking With Smart Watches for Shoulder Physiotherapy in Rotator Cuff Pathology: Protocol for a Longitudinal Cohort Study %A Burns,David %A Razmjou,Helen %A Shaw,James %A Richards,Robin %A McLachlin,Stewart %A Hardisty,Michael %A Henry,Patrick %A Whyne,Cari %+ Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave Room S-621, Toronto, ON, Canada, 1 4164806100, d.burns@utoronto.ca %K rehabilitation %K treatment adherence and compliance %K wearable electronic devices %K machine learning %K rotator cuff %D 2020 %7 5.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physiotherapy is essential for the successful rehabilitation of common shoulder injuries and following shoulder surgery. Patients may receive some training and supervision for shoulder physiotherapy through private pay or private insurance, but they are typically responsible for performing most of their physiotherapy independently at home. It is unknown how often patients perform their home exercises and if these exercises are performed correctly without supervision. There are no established tools for measuring this. It is, therefore, unclear if the full benefit of shoulder physiotherapy treatments is being realized. Objective: The proposed research will (1) validate a smartwatch and machine learning (ML) approach for evaluating adherence to shoulder exercise participation and technique in a clinical patient population with rotator cuff pathology; (2) quantify the rate of home physiotherapy adherence, determine the effects of adherence on recovery, and identify barriers to successful adherence; and (3) develop and pilot test an ethically conscious adherence-driven rehabilitation program that individualizes patient care based on their capacity to effectively participate in their home physiotherapy. Methods: This research will be conducted in 2 phases. The first phase is a prospective longitudinal cohort study, involving 120 patients undergoing physiotherapy for rotator cuff pathology. Patients will be issued a smartwatch that will record 9-axis inertial sensor data while they perform physiotherapy exercises both in the clinic and in the home setting. The data collected in the clinic under supervision will be used to train and validate our ML algorithms that classify shoulder physiotherapy exercise. The validated algorithms will then be used to assess home physiotherapy adherence from the inertial data collected at home. Validated outcome measures, including the Disabilities of the Arm, Shoulder, and Hand questionnaire; Numeric Pain Rating Scale; range of motion; shoulder strength; and work status, will be collected pretreatment, monthly through treatment, and at a final follow-up of 12 months. We will then relate improvement in patient outcomes to measured physiotherapy adherence and patient baseline variables in univariate and multivariate analyses. The second phase of this research will involve the evaluation of a novel rehabilitation program in a cohort of 20 patients. The program will promote patient physiotherapy engagement via the developed technology and support adherence-driven care decisions. Results: As of December 2019, 71 patients were screened for enrollment in the noninterventional validation phase of this study; 65 patients met the inclusion and exclusion criteria. Of these, 46 patients consented and 19 declined to participate in the study. Only 2 patients de-enrolled from the study and data collection is ongoing for the remaining 44. Conclusions: This study will provide new and important insights into shoulder physiotherapy adherence, the relationship between adherence and recovery, barriers to better adherence, and methods for addressing them. International Registered Report Identifier (IRRID): DERR1-10.2196/17841 %M 32623366 %R 10.2196/17841 %U https://www.researchprotocols.org/2020/7/e17841 %U https://doi.org/10.2196/17841 %U http://www.ncbi.nlm.nih.gov/pubmed/32623366 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16631 %T A Blended Physiotherapy Intervention for Persons With Hemophilic Arthropathy: Development Study %A Timmer,Merel A %A Kloek,Corelien J J %A de Kleijn,Piet %A Kuijlaars,Isolde A R %A Schutgens,Roger E G %A Veenhof,Cindy %A Pisters,Martijn F %+ van Creveldkliniek, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, Netherlands, 31 88 755 1709, m.a.timmer@umcutrecht.nl %K hemophilia %K physiotherapy %K exercise %K eHealth %K blended care %K mobile phone %D 2020 %7 19.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Joint bleeds are the hallmark of hemophilia, leading to a painful arthritic condition called as hemophilic arthropathy (HA). Exercise programs are frequently used to improve the physical functioning in persons with HA. As hemophilia is a rare disease, there are not many physiotherapists who are experienced in the field of hemophilia, and regular physiotherapy sessions with an experienced physiotherapist in the field of hemophilia are not feasible for persons with HA. Blended care is an innovative intervention that can support persons with HA at home to perform the advised physical activities and exercises and provide self-management information. Objective: The aim of this study was to develop a blended physiotherapy intervention for persons with HA. Methods: The blended physiotherapy intervention, namely, e-Exercise HA was developed by cocreation with physiotherapists, persons with HA, software developers, and researchers. The content of e-Exercise HA was compiled using the first 3 steps of the Center for eHealth Research roadmap model (ie, contextual inquiry, value specification, and design), including people with experience in the development of previous blended physiotherapy interventions, a literature search, and focus groups. Results: A 12-week blended intervention was developed, integrating face-to-face physiotherapy sessions with a web-based app. The intervention consists of information modules for persons with HA and information modules for physiotherapists, a graded activity program using a self-chosen activity, and personalized video-supported exercises. The information modules consist of text blocks, videos, and reflective questions. The patients can receive pop-ups as reminders and give feedback on the performance of the prescribed activities. Conclusions: In this study, we developed a blended physiotherapy intervention for persons with HA, which consists of information modules, a graded activity program, and personalized video-supported exercises. %M 32558654 %R 10.2196/16631 %U http://www.jmir.org/2020/6/e16631/ %U https://doi.org/10.2196/16631 %U http://www.ncbi.nlm.nih.gov/pubmed/32558654 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17872 %T A Nonproprietary Movement Analysis System (MoJoXlab) Based on Wearable Inertial Measurement Units Applicable to Healthy Participants and Those With Anterior Cruciate Ligament Reconstruction Across a Range of Complex Tasks: Validation Study %A Islam,Riasat %A Bennasar,Mohamed %A Nicholas,Kevin %A Button,Kate %A Holland,Simon %A Mulholland,Paul %A Price,Blaine %A Al-Amri,Mohammad %+ School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Room 13.17, 13th Floor, Eastgate House, 35-43 Newport Road, Cardiff, CF24 0AB, United Kingdom, 44 2920687115, al-amrim@cardiff.ac.uk %K gait %K algorithms %K motion trackers %K lower extremity %K wearable electronic devices %K exercise therapy %K digital physiotherapy %K kinematics %K wearables %K range of motion %K anterior cruciate ligament %D 2020 %7 16.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Movement analysis in a clinical setting is frequently restricted to observational methods to inform clinical decision making, which has limited accuracy. Fixed-site, optical, expensive movement analysis laboratories provide gold standard kinematic measurements; however, they are rarely accessed for routine clinical use. Wearable inertial measurement units (IMUs) have been demonstrated as comparable, inexpensive, and portable movement analysis toolkits. MoJoXlab has therefore been developed to work with generic wearable IMUs. However, before using MoJoXlab in clinical practice, there is a need to establish its validity in participants with and without knee conditions across a range of tasks with varying complexity. Objective: This paper aimed to present the validation of MoJoXlab software for using generic wearable IMUs for calculating hip, knee, and ankle joint angle measurements in the sagittal, frontal, and transverse planes for walking, squatting, and jumping in healthy participants and those with anterior cruciate ligament (ACL) reconstruction. Methods: Movement data were collected from 27 healthy participants and 20 participants with ACL reconstruction. In each case, the participants wore seven MTw2 IMUs (Xsens Technologies) to monitor their movement in walking, jumping, and squatting tasks. The hip, knee, and ankle joint angles were calculated in the sagittal, frontal, and transverse planes using two different software packages: Xsens’ validated proprietary MVN Analyze and MoJoXlab. The results were validated by comparing the generated waveforms, cross-correlation (CC), and normalized root mean square error (NRMSE) values. Results: Across all joints and activities, for data of both healthy and ACL reconstruction participants, the CC and NRMSE values for the sagittal plane are 0.99 (SD 0.01) and 0.042 (SD 0.025); 0.88 (SD 0.048) and 0.18 (SD 0.078) for the frontal plane; and 0.85 (SD 0.027) and 0.23 (SD 0.065) for the transverse plane (hip and knee joints only). On comparing the results from the two different software systems, the sagittal plane was very highly correlated, with frontal and transverse planes showing strong correlation. Conclusions: This study demonstrates that nonproprietary software such as MoJoXlab can accurately calculate joint angles for movement analysis applications comparable with proprietary software for walking, squatting, and jumping in healthy individuals and those following ACL reconstruction. MoJoXlab can be used with generic wearable IMUs that can provide clinicians accurate objective data when assessing patients’ movement, even when changes are too small to be observed visually. The availability of easy-to-setup, nonproprietary software for calibration, data collection, and joint angle calculation has the potential to increase the adoption of wearable IMU sensors in clinical practice, as well as in free living conditions, and may provide wider access to accurate, objective assessment of patients’ progress over time. %M 32543446 %R 10.2196/17872 %U http://mhealth.jmir.org/2020/6/e17872/ %U https://doi.org/10.2196/17872 %U http://www.ncbi.nlm.nih.gov/pubmed/32543446 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16056 %T Physiotherapy With Telerehabilitation in Patients With Complicated Postoperative Recovery After Esophageal Cancer Surgery: Feasibility Study %A van Egmond,Maarten A %A Engelbert,Raoul H H %A Klinkenbijl,Jean H G %A van Berge Henegouwen,Mark I %A van der Schaaf,Marike %+ Department of Rehabiltation, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 621157870, m.a.vanegmond@amsterdamumc.nl %K physical therapy modalities %K telerehabilitation %K telemedicine %K esophageal neoplasms %K surgical oncology %D 2020 %7 9.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Improvement of functional status with physiotherapy is an important goal for patients with postoperative complications and an increased length of hospital stay (LoS) after esophagectomy. Supervised physiotherapy with telerehabilitation instead of conventional face-to-face care could be an alternative to treat these patients in their home environment after hospital discharge (T0), but its feasibility has not yet been investigated in detail. Objective: The aim of this study was to investigate the feasibility of a 12-week supervised postoperative physiotherapy intervention with telerehabilitation for patients with esophageal cancer who underwent esophagectomy and had postoperative complications or who had an increased LoS. The secondary objective was to investigate the preliminary effectiveness of telerehabilitation on functional recovery compared with usual care. Methods: A prospective feasibility study with a matched historical comparison group was performed. Feasibility outcomes included willingness and adherence to participate, refusal rate, treatment duration, occurrence of adverse events, and patient satisfaction. Secondary outcome measures were measurements of musculoskeletal and cardiovascular functions and activities according to the domains of the International Classification of Functioning, Disability and Health. Results: A total of 22 patients with esophageal cancer who underwent esophagectomy and had postoperative complications or an increased LoS were included. The mean age at surgery was 64.55 (SD 6.72) years, and 77% (17/22) of patients were male. Moreover, 15 patients completed the intervention. Patient adherence was 99.8% in the first 6 weeks and dropped to 75.6% in the following 6 weeks, with a mean difference of −24.3% (95% CI 1.3 to 47.2; P=.04). At 3 months post operation, no differences in functional status were found between the intervention group and the matched historical comparison group. Conclusions: This study showed that a postoperative physiotherapeutic intervention with telerehabilitation is feasible for patients with postoperative complications or an increased LoS after esophageal cancer surgery up to 6 weeks after T0. %M 32515742 %R 10.2196/16056 %U http://www.jmir.org/2020/6/e16056/ %U https://doi.org/10.2196/16056 %U http://www.ncbi.nlm.nih.gov/pubmed/32515742 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16605 %T A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile–Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation %A Stevens,Timothy %A McGinnis,Ryan S %A Hewgill,Blake %A Choquette,Rebecca H %A Tourville,Timothy W %A Harvey,Jean %A Lachapelle,Richard %A Beynnon,Bruce D %A Toth,Michael J %A Skalka,Christian %+ Department of Medicine, University of Vermont, Health Science Research Facility Rm 126B, 149 Beaumont Ave, Burlington, VT, 05405, United States, 1 (802) 656 7989, michael.toth@med.uvm.edu %K device use tracking %K internet of things %K neuromuscular electrical stimulation %K exercise %K smart devices %K mHealth %K rehabilitation %K mobile health %K digital health %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System–based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software–tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. %M 32384052 %R 10.2196/16605 %U http://humanfactors.jmir.org/2020/2/e16605/ %U https://doi.org/10.2196/16605 %U http://www.ncbi.nlm.nih.gov/pubmed/32384052 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19462 %T Considerations for Postacute Rehabilitation for Survivors of COVID-19 %A Sheehy,Lisa Mary %+ Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N5C8, Canada, 1 6135626262 ext 1593, lsheehy@bruyere.org %K covid-19 %K rehabilitation %K subacute care %K inpatient rehabilitation %K public health %K infectious disease %K virus %K patient outcome %K geriatric %K treatment %K recovery %D 2020 %7 8.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible. %M 32369030 %R 10.2196/19462 %U http://publichealth.jmir.org/2020/2/e19462/ %U https://doi.org/10.2196/19462 %U http://www.ncbi.nlm.nih.gov/pubmed/32369030 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 1 %P e14139 %T Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls %A Wijnen,Annet %A Hoogland,Jildou %A Munsterman,Tjerk %A Gerritsma,Carina LE %A Dijkstra,Baukje %A Zijlstra,Wierd P %A Dekker,Johan S %A Annegarn,Janneke %A Ibarra,Francisco %A Slager,Geranda EC %A Zijlstra,Wiebren %A Stevens,Martin %+ Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands, 31 50 3611221, a.wijnen@umcg.nl %K remote coaching %K internet %K osteoarthritis %K total hip arthroplasty %K home-based rehabilitation program %K physiotherapy %K usual care %K tablet app %K total hip replacement %K rehabilitation %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales “function in sport and recreational activities” and “hip-related quality of life” of HOOS, and on the subscale “physical role limitations” of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes. Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care. Trial Registration: ClinicalTrials.gov NCT03846063; https://clinicaltrials.gov/ct2/show/NCT03846063 and German Registry of Clinical Trials DRKS00011345; https://tinyurl.com/yd32gmdo %M 32338621 %R 10.2196/14139 %U http://rehab.jmir.org/2020/1/e14139/ %U https://doi.org/10.2196/14139 %U http://www.ncbi.nlm.nih.gov/pubmed/32338621 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 1 %P e15428 %T The Practical Work of Ensuring the Effective Use of Serious Games in a Rehabilitation Clinic: Qualitative Study %A Almeida,João %A Nunes,Francisco %+ Fraunhofer Portugal AICOS, Rua Alfredo Allen 455/461, Porto, 4200-135, Portugal, 351 220430328, francisco.nunes@fraunhofer.pt %K serious games %K exergames %K physiotherapy rehabilitation %K practical rehabilitation work %K qualitative research %D 2020 %7 28.2.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Many rehabilitation clinics adopted serious games to support their physiotherapy sessions. Serious games can monitor and provide feedback on exercises and are expected to improve therapy and help professionals deal with more patients. However, there is little understanding of the impacts of serious games on the actual work of physiotherapists. Objective: This study aimed to understand the impact of an electromyography-based serious game on the practical work of physiotherapists. Methods: This study used observation sessions in an outpatient rehabilitation clinic that recently started using a serious game based on electromyography sensors. In total, 44 observation sessions were performed, involving 3 physiotherapists and 22 patients. Observation sessions were documented by audio recordings or fieldnotes and were analyzed for themes using thematic analysis. Results: The findings of this study showed that physiotherapists played an important role in enabling the serious game to work. Physiotherapists briefed patients, calibrated the system, prescribed exercises, and supported patients while they played the serious game, all of which amounted to relevant labor. Conclusions: The results of this work challenge the idea that serious games reduce the work of physiotherapists and call for an overall analysis of the different impacts a serious game can have. Adopting a serious game that creates more work can be entirely acceptable, provided the clinical outcomes or other advantages enabled by the serious game are strong; however, those impacts will have to be assessed on a case-by-case basis. Moreover, this work motivates the technology development community to better investigate physiotherapists and their context, offering implications for technology design. %R 10.2196/15428 %U http://rehab.jmir.org/2020/1/e15428/ %U https://doi.org/10.2196/15428 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14619 %T A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel %A Nelligan,Rachel K %A Hinman,Rana S %A Atkins,Lou %A Bennell,Kim L %+ Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, 3010, Australia, 61 3 8344 0556, k.bennell@unimelb.edu.au %K text messaging %K mobile phone %K knee osteoarthritis %K exercise %D 2019 %7 18.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. Objective: The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. Methods: The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. Results: The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. Conclusions: This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise. %M 31628786 %R 10.2196/14619 %U https://mhealth.jmir.org/2019/10/e14619 %U https://doi.org/10.2196/14619 %U http://www.ncbi.nlm.nih.gov/pubmed/31628786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e11617 %T A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment %A Welbie,Marlies %A Wittink,Harriet %A Westerman,Marjan J %A Topper,Ilse %A Snoei,Josca %A Devillé,Walter L J M %+ Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Postbus 12011, Utrecht, 3501 AA, Netherlands, 31 638192100, marlies.welbie@hu.nl %K mHealth %K eHealth %K surveys and questionnaires %K physical therapy specialty %K qualitative research %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective: The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results: All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions: The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies. %M 31573909 %R 10.2196/11617 %U https://formative.jmir.org/2019/3/e11617 %U https://doi.org/10.2196/11617 %U http://www.ncbi.nlm.nih.gov/pubmed/31573909 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12293 %T Design and Implementation of a Novel System for Correcting Posture Through the Use of a Wearable Necklace Sensor %A Chung,Hung-Yuan %A Chung,Yao-Liang %A Liang,Chih-Yen %+ Department of Communications, Navigation and Control Engineering, National Taiwan Ocean University, No. 2, Beining Rd, Jhongjheng District, Keelung, 20224, Taiwan, 886 928738102, ylchung@email.ntou.edu.tw %K wearable sensing technology %K necklace %K posture correction %K image recognition %K internet of things %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To our knowledge, few studies have examined the use of wearable sensing devices to effectively integrate information communication technologies and apply them to health care issues (particularly those pertaining to posture correction). Objective: A novel system for posture correction involving the application of wearable sensing technology was developed in this study. The system was created with the aim of preventing the unconscious development of bad postures (as well as potential spinal diseases over the long term). Methods: The newly developed system consists of a combination of 3 subsystems, namely, a smart necklace, notebook computer, and smartphone. The notebook computer is enabled to use a depth camera to read the relevant data, to identify the skeletal structure and joint reference points of a user, and to compute calculations relating to those reference points, after which the computer then sends signals to the smart necklace to enable calibration of the smart necklace’s standard values (base values for posture assessment). The gravitational acceleration data of the user are collected and analyzed by a microprocessor unit-6050 sensor housed in the smart necklace when the smart necklace is worn, with those data being used by the smart necklace to determine the user’s body posture. When poor posture is detected by the smart necklace, the smart necklace sends the user’s smartphone a reminder to correct his or her posture; a mobile app that was also developed as part of the study allows the smart necklace to transmit such messages to the smartphone. Results: The system effectively enables a user to monitor and correct his or her own posture, which in turn will assist the user in preventing spine-related diseases and, consequently, in living a healthier life. Conclusions: The proposed system makes it possible for (1) the user to self-correct his or her posture without resorting to the use of heavy, thick, or uncomfortable corrective clothing; (2) the smart necklace’s standard values to be quickly calibrated via the use of posture imaging; and (3) the need for complex wiring to be eliminated through the effective application of the Internet of Things as well as by implementing wireless communication between the smart necklace, notebook computer, and smartphone. %M 31140439 %R 10.2196/12293 %U https://mhealth.jmir.org/2019/5/e12293/ %U https://doi.org/10.2196/12293 %U http://www.ncbi.nlm.nih.gov/pubmed/31140439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12708 %T The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation %A Barak Ventura,Roni %A Nakayama,Shinnosuke %A Raghavan,Preeti %A Nov,Oded %A Porfiri,Maurizio %+ Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, 6 MetroTech Center, Brooklyn, NY, 11201, United States, 1 646 997 3681, mporfiri@nyu.edu %K citizen science %K social interactions %K telerehabilitation %K physical therapy %D 2019 %7 15.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients’ motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. Objective: Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. Methods: We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. Results: We found that users’ engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). Conclusions: Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively. %M 31094338 %R 10.2196/12708 %U http://www.jmir.org/2019/5/e12708/ %U https://doi.org/10.2196/12708 %U http://www.ncbi.nlm.nih.gov/pubmed/31094338 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e10970 %T Concentric and Eccentric Pedaling-Type Interval Exercise on a Soft Robot for Stable Coronary Artery Disease Patients: Toward a Personalized Protocol %A Fitze,Daniel P %A Franchi,Martino %A Popp,Werner L %A Ruoss,Severin %A Catuogno,Silvio %A Camenisch,Karin %A Lehmann,Debora %A Schmied,Christian M %A Niederseer,David %A Frey,Walter O %A Flück,Martin %+ Laboratory for Muscle Plasticity, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Balgrist Campus, Lengghalde 5, Zurich, 8008, Switzerland, 41 445107350, mflueck@research.balgrist.ch %K cardiovascular rehabilitation %K concentric and eccentric exercise %K high-intensity interval training %K muscle oxygen saturation %K near-infrared spectroscopy %K peak oxygen uptake %K ramp test %K skeletal muscle power %K soft robot %D 2019 %7 27.03.2019 %9 Early Report %J JMIR Res Protoc %G English %X Background: Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. Objective: We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO2peak), peak aerobic power output (Ppeak), and parameters of muscle oxygen saturation (SmO2) during exercise, and anaerobic muscle power. Methods: We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO2. Moreover, the aerobic skeletal muscle power (Ppeak) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. Results: The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO2peak (+26% vs −6%), and Ppeak (+20% vs 0%), and exaggerated muscle deoxygenation during the ramp test (248% vs 49%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (−9% vs +20%) and peak SmO2 (+7% vs −7%). Anaerobic muscle power only improved after the CON protocol (+18% vs −15%). Conclusions: This study indicates the potential of the implemented CON and ECC protocols of pedaling-type interval exercise to improve oxygen metabolism of exercised muscle groups while maintaining or even increasing the Ppeak. The ECC training protocol seemingly provided a lower cardiovascular stimulus in patients with CAD while specifically enhancing the reoxygenation and blood lactate clearance in recruited muscle groups during recovery from exercise. Trial Registration: ClinicalTrials.gov NCT02845063; https://clinicaltrials.gov/ct2/show/NCT02845063 %M 30916659 %R 10.2196/10970 %U https://www.researchprotocols.org/2019/3/e10970/ %U https://doi.org/10.2196/10970 %U http://www.ncbi.nlm.nih.gov/pubmed/30916659 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e10798 %T Smartphone-Delivered Peer Physical Activity Counseling Program for Individuals With Spinal Cord Injury: Protocol for Development and Pilot Evaluation %A Best,Krista L %A Routhier,François %A Sweet,Shane N %A Lacroix,Emilie %A Arbour-Nicitopoulos,Kelly P %A Borisoff,Jaimie F %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale National, 525 Blvd Hamel, Quebec, QC,, Canada, 1 418 529 9141 ext 6256, francois.routhier@rea.ulaval.ca %K smartphone %K mobile phone %K behavior change %K digital peer training %K leisure-time physical activity %K spinal cord injury %K Medical Research Council framework %D 2019 %7 22.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Leisure-time physical activity (LTPA) is a critical component of a healthy lifestyle for individuals with spinal cord injury (SCI). However, most individuals are not sufficiently active to accrue health benefits. The Active Living Lifestyles program for individuals with SCI who use manual wheelchairs (ALLWheel) targets important psychological factors that are associated with LTPA uptake and adherence while overcoming some barriers associated with participation restrictions. Objective: The goal of the paper is to describe the protocol for the development and evaluation of the ALLWheel program for individuals with SCI who use manual wheelchairs. Methods: The first three stages of the Medical Research Council framework for developing and evaluating complex interventions (ie, preclinical, modeling, exploratory) are described. The preclinical phase will consist of scoping and systematic reviews and review of theory. The intervention will be modeled by expert opinions and consensus through focus groups and Delphi surveys with individuals with SCI, clinicians, and community partners. Finally, the feasibility and potential influence of the ALLWheel program on LTPA and psychological outcomes will be evaluated. Results: This project is funded by the Craig H Neilsen Foundation, the Fonds de Recherche du Québec–Santé, and the Canadian Disability Participation Project and is currently underway. Conclusions: Using peer trainers and mobile phone technology may help to cultivate autonomy-supportive environments that also enhance self-efficacy. Following a framework for developing and evaluating a novel intervention that includes input from stakeholders at all stages will ensure the final product (ie, a replicable intervention) is desirable to knowledge users and ready for evaluation in a randomized controlled trial. If effective, the ALLWheel program has the potential to reach a large number of individuals with SCI to promote LTPA uptake and adherence. International Registered Report Identifier (IRRID): DERR1-10.2196/10798 %M 30901001 %R 10.2196/10798 %U http://www.researchprotocols.org/2019/3/e10798/ %U https://doi.org/10.2196/10798 %U http://www.ncbi.nlm.nih.gov/pubmed/30901001 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11123 %T Evaluation of an E-Learning Training Program to Support Implementation of a Group-Based, Theory-Driven, Self-Management Intervention For Osteoarthritis and Low-Back Pain: Pre-Post Study %A Hurley,Deirdre A %A Keogh,Alison %A Mc Ardle,Danielle %A Hall,Amanda M %A Richmond,Helen %A Guerin,Suzanne %A Magdalinski,Tara %A Matthews,James %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, D4, Ireland, 353 17166524, deirdre.hurleyosing@ucd.ie %K technology-enhanced learning %K evaluation %K e-learning %K digital learning %K program evaluation %K effectiveness %K physiotherapy %K implementation %K osteoarthritis %K low-back pain %D 2019 %7 07.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: By adaptation of the face-to-face physiotherapist-training program previously used in the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) feasibility trial, an asynchronous, interactive, Web-based, e-learning training program (E-SOLAS) underpinned by behavior and learning theories was developed. Objective: This study investigated the effect of the E-SOLAS training program on relevant outcomes of effective training and implementation. Methods: Thirteen physiotherapists from across Ireland were trained via E-SOLAS by using mixed methods, and seven physiotherapists progressed to implementation of the 6-week group-based SOLAS intervention. The effectiveness of E-SOLAS was evaluated using the Kirkpatrick model at the levels of reaction (physiotherapist engagement and satisfaction with E-SOLAS training methods and content), learning (pre- to posttraining changes in physiotherapists’ confidence and knowledge in delivering SOLAS content and self-determination theory-based communication strategies, administered via a SurveyMonkey questionnaire), and behavior (fidelity to delivery of SOLAS content using physiotherapist-completed weekly checklists). During implementation, five physiotherapists audio recorded delivery of one class, and the communication between physiotherapists and clients was assessed using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behaviour Scale (CCBS), and an intervention-specific measure (ISM; 7-point Likert scale). A range of implementation outcomes were evaluated during training and delivery (ie, acceptability, appropriateness, feasibility, fidelity, and sustainability of E-SOLAS) using a posttraining feedback questionnaire and individual semistructured telephone interviews. Results: With regard to their reaction, physiotherapists (n=13) were very satisfied with E-SOLAS posttraining (median 5.0; interquartile range 1.0; min-max 4.0-5.0) and completed training within 3-4 weeks. With regard to learning, there were significant increases in physiotherapists’ confidence and knowledge in delivery of all SOLAS intervention components (P<.05). Physiotherapists’ confidence in 7 of 10 self-determination theory-based communication strategies increased (P<.05), whereas physiotherapists’ knowledge of self-determination theory-based strategies remained high posttraining (P>.05). In terms of behavior, physiotherapists delivered SOLAS in a needs supportive manner (HCCQ: median 5.2, interquartile range 1.3, min-max 3.7-5.8; CCBS: median 6.6, interquartile range 1.0, min-max 5.6-7.0; ISM: median 4.5, interquartile range 1.2, min-max 2.8-4.8). Fidelity scores were high for SOLAS content delivery (total %mean fidelity score 93.5%; SD 4.9%). The posttraining questionnaire and postdelivery qualitative interviews showed that physiotherapists found E-SOLAS acceptable, appropriate, feasible, and sustainable within primary care services to support the implementation of the SOLAS intervention. Conclusions: This study provides preliminary evidence of the effectiveness, acceptability, and feasibility of an e-learning program to train physiotherapists to deliver a group-based self-management complex intervention in primary care settings, which is equivalent to face-to-face training outcomes and would support inclusion of physiotherapists in a definitive trial of SOLAS. %M 30843863 %R 10.2196/11123 %U https://www.jmir.org/2019/3/e11123/ %U https://doi.org/10.2196/11123 %U http://www.ncbi.nlm.nih.gov/pubmed/30843863 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10342 %T Feasibility and Patient Experience of a Home-Based Rehabilitation Program Driven by a Tablet App and Mobility Monitoring for Patients After a Total Hip Arthroplasty %A Hoogland,Jildou %A Wijnen,Annet %A Munsterman,Tjerk %A Gerritsma,Carina LE %A Dijkstra,Baukje %A Zijlstra,Wierd P %A Annegarn,Janneke %A Ibarra,Francisco %A Zijlstra,Wiebren %A Stevens,Martin %+ Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands, 31 50 3613271, m.stevens@umcg.nl %K home-based rehabilitation %K mobile phone %K osteoarthritis %K physiotherapy %K total hip arthroplasty %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent developments in technology are promising for providing home-based exercise programs. Objective: The objective of this study was to evaluate the feasibility and patient experience of a home-based rehabilitation program after total hip arthroplasty (THA) delivered using videos on a tablet personal computer (PC) and a necklace-worn motion sensor to continuously monitor mobility-related activities. Methods: We enrolled 30 independently living patients aged 18-75 years who had undergone THA as a treatment for primary or secondary osteoarthritis (OA) between December 2015 and February 2017. Patients followed a 12-week exercise program with video instructions on a tablet PC and daily physical activity registration through a motion sensor. Patients were asked to do strengthening and walking exercises at least 5 days a week. There was weekly phone contact with a physiotherapist. Adherence and technical problems were recorded during the intervention. User evaluation was done in week 4 (T1) and at the end of the program (T2). Results: Overall, 26 patients completed the program. Average adherence for exercising 5 times a week was 92%. Reasons mentioned most often for nonadherence were vacation or a day or weekend off 25% (33/134) and work 15% (20/134). The total number of technical issues was 8. The average score on the user evaluation questionnaire (range 0-5) was 4.6 at T1 and 4.5 at T2. The highest score was for the subscale “coaching” and the lowest for the subscale “sensor.” Conclusions: A home-based rehabilitation program driven by a tablet app and mobility monitoring seems feasible for THA patients. Adherence was good and patient experience was positive. The novel technology was well accepted. When the home-based rehabilitation program proves to be effective, it could be used as an alternative to formal physiotherapy. However, further research on its effectiveness is needed. %M 30702438 %R 10.2196/10342 %U http://mhealth.jmir.org/2019/1/e10342/ %U https://doi.org/10.2196/10342 %U http://www.ncbi.nlm.nih.gov/pubmed/30702438 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 2 %P e11748 %T Use of a Low-Cost, Chest-Mounted Accelerometer to Evaluate Transfer Skills of Wheelchair Users During Everyday Activities: Observational Study %A Barbareschi,Giulia %A Holloway,Catherine %A Bianchi-Berthouze,Nadia %A Sonenblum,Sharon %A Sprigle,Stephen %+ University College London Interaction Centre, 2nd Floor, 66-72 Gower Street, London, WC1E 6EA, United Kingdom, 44 20 31087192, giulia.barbareschi.14@ucl.ac.uk %K wheelchair transfers %K movement evaluation %K machine learning %K activity monitoring %K accelerometer %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Transfers are an important skill for many wheelchair users (WU). However, they have also been related to the risk of falling or developing upper limb injuries. Transfer abilities are usually evaluated in clinical settings or biomechanics laboratories, and these methods of assessment are poorly suited to evaluation in real and unconstrained world settings where transfers take place. Objective: The objective of this paper is to test the feasibility of a system based on a wearable low-cost sensor to monitor transfer skills in real-world settings. Methods: We collected data from 9 WU wearing triaxial accelerometer on their chest while performing transfers to and from car seats and home furniture. We then extracted significant features from accelerometer data based on biomechanical considerations and previous relevant literature and used machine learning algorithms to evaluate the performance of wheelchair transfers and detect their occurrence from a continuous time series of data. Results: Results show a good predictive accuracy of support vector machine classifiers when determining the use of head-hip relationship (75.9%) and smoothness of landing (79.6%) when the starting and ending of the transfer are known. Automatic transfer detection reaches performances that are similar to state of the art in this context (multinomial logistic regression accuracy 87.8%). However, we achieve these results using only a single sensor and collecting data in a more ecological manner. Conclusions: The use of a single chest-placed accelerometer shows good predictive accuracy for algorithms applied independently to both transfer evaluation and monitoring. This points to the opportunity for designing ubiquitous-technology based personalized skill development interventions for WU. However, monitoring transfers still require the use of external inputs or extra sensors to identify the start and end of the transfer, which is needed to perform an accurate evaluation. %M 30573447 %R 10.2196/11748 %U http://rehab.jmir.org/2018/2/e11748/ %U https://doi.org/10.2196/11748 %U http://www.ncbi.nlm.nih.gov/pubmed/30573447 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 2 %P e10307 %T A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation %A Levac,Danielle %A Dumas,Helene M %A Meleis,Waleed %+ Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States, 1 6173735198, d.levac@northeastern.edu %K equipment design %K rehabilitation %K pediatrics %K tablets %K software %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Therapy Board (FITBoard), a movement toy bridging digital and physical interactions for children with disabilities. Methods: The FITBoard is a tablet app involving games controlled by hand, head, or foot touch of configurable, wired surfaces. Usability evaluation involved a cognitive walkthrough and think-aloud processes. Participants verbalized aloud while completing a series of 26 task actions involved in selecting a game and configuring the FITBoard to achieve the therapeutic goal. Therapists then responded to questions about usability perceptions. Unsuccessful actions were categorized as goal or action failures. Qualitative content analysis supported understanding of usability problems. Results: Participants included 5 pediatric physical therapists and 2 occupational therapists from 2 clinical sites. Goal failure was experienced by all participants in 2 tasks, and action failure was experienced by all participants in 2 tasks. For 14 additional tasks, 1 or more patients experienced goal or action failure, with an overall failure rate of 69% (18 of 26 tasks). Content analysis revealed 4 main categories: hardware usability, software usability, facilitators of therapy goals, and improvement suggestions. Conclusions: FITBoard hardware and software changes are needed to address goal and action failures to rectify identified usability issues. Results highlight potential FITBoard applications to address therapeutic goals and outline important practical considerations for product use by therapists. Subsequent research will evaluate therapist, parent, and child perspectives on FITBoard clinical utility when integrated within regular therapy interventions. %M 30478025 %R 10.2196/10307 %U http://rehab.jmir.org/2018/2/e10307/ %U https://doi.org/10.2196/10307 %U http://www.ncbi.nlm.nih.gov/pubmed/30478025 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 2 %P e10099 %T Patient-Reported Outcome of Physical Therapy in Amyotrophic Lateral Sclerosis: Observational Online Study %A Meyer,Robert %A Spittel,Susanne %A Steinfurth,Laura %A Funke,Andreas %A Kettemann,Dagmar %A Münch,Christoph %A Meyer,Thomas %A Maier,André %+ Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30450560132, Andre.Maier@charite.de %K ALS %K amyotrophic lateral sclerosis %K physical therapy %K MYMOP %K net promoter score %K NPS %K online self-assessment %D 2018 %7 12.11.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Physical therapy is an essential component of multidisciplinary treatment in amyotrophic lateral sclerosis (ALS). However, the meaning of physical therapy beside preservation of muscular strength and functional maintenance is not fully understood. Objective: The purpose of this study was to examine patients’ perception of physical therapy during symptom progression using an internet assessment approach. Methods: A prospective, longitudinal, observational study was performed. Recruitment took place in an ALS center in Berlin, Germany. Online self-assessment was established on a case management platform over 6 months. Participants self-assessed the progression of the disease with the ALS Functional Rating Scale-Revised (ALSFRS-R) and tracked the efficacy of targeted physical therapy using Measure Yourself Medical Outcome Profile (MYMOP). We used the net promoter score (NPS) to inquire into recommendation levels of physical therapy. Results: Forty-five participants with ALS were included in the study. Twenty-seven (60.0%) started the online assessment. The mean duration of physical therapy sessions per week was 142.7 minutes (SD 60.4) with a mean frequency of 2.9 (SD 1.2) per week. As defined by MYMOP input, the most concerning symptoms were reported in the legs (62.2%), arms (31.1%), and less frequently in the torso (6.7%). As expected for a progressive disease, there was a functional decline of 3 points in the ALSFRS-R at the end of the observation period (n=20). Furthermore, the MYMOP showed a significant loss of 0.8 in the composite score, 0.9 in the activity score and 0.8 in the targeted symptom. In spite of functional decline, the recommendation for physical therapy jumped from a baseline value of 20 NPS points to a very high 50 points at the end of study (P=.05). Conclusions: Physical therapy is perceived as an important treatment method by patients with ALS. Despite functional deterioration, patients are satisfied with physical therapy and recommend this intervention. The results also underline how the meaning of physical therapy changes throughout the disease. Physical therapy in ALS has to be regarded as a supportive and palliative health care intervention beyond functional outcome parameters. %M 30425026 %R 10.2196/10099 %U http://rehab.jmir.org/2018/2/e10099/ %U https://doi.org/10.2196/10099 %U http://www.ncbi.nlm.nih.gov/pubmed/30425026 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 3 %P e10522 %T Determining Physiological and Psychological Predictors of Time to Task Failure on a Virtual Reality Sørensen Test in Participants With and Without Recurrent Low Back Pain: Exploratory Study %A Applegate,Megan E %A France,Christopher R %A Russ,David W %A Leitkam,Samuel T %A Thomas,James S %+ Wyss Institute for Biologically Inspired Engineering, 60 Oxford Street, Cambridge, MA, 02138, United States, 1 815 474 6743, applegate@seas.harvard.edu %K fatigue %K low back pain %K Sørensen test %K trunk mass %K virtual reality %D 2018 %7 10.09.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sørensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. Performance may greatly depend on psychological factors, such as kinesiophobia, self-efficacy, and motivation. Virtual reality video games have been used in people with low back pain to encourage physical activity that would otherwise be avoided out of fear of pain or harm. Accordingly, we developed a virtual reality video game to assess the influence of immersive gaming on the Sørensen test performance. Objective: The objective of our study was to determine the physiological and psychological predictors of time to task failure (TTF) on a virtual reality Sørensen test in participants with and without a history of recurrent low back pain. Methods: We recruited 24 individuals with a history of recurrent low back pain and 24 sex-, age-, and body mass index–matched individuals without a history of low back pain. Participants completed a series of psychological measures, including the Center for Epidemiological Studies-Depression Scale, Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and a self-efficacy measure. The maximal isometric strength of trunk and hip extensors and TTF on a virtual reality Sørensen test were measured. Electromyography of the erector spinae, gluteus maximus, and biceps femoris was recorded during the strength and endurance trials. Results: A two-way analysis of variance revealed no significant difference in TTF between groups (P=.99), but there was a trend for longer TTF in females on the virtual reality Sørensen test (P=.06). Linear regression analyses were performed to determine predictors of TTF in each group. In healthy participants, the normalized median power frequency slope of erector spinae (beta=.450, P=.01), biceps femoris (beta=.400, P=.01), and trunk mass (beta=−.32, P=.02) predicted TTF. In participants with recurrent low back pain, trunk mass (beta=−.67, P<.001), Tampa Scale for Kinesiophobia (beta=−.43, P=.01), and self-efficacy (beta=.35, P=.03) predicted TTF. Conclusions: Trunk mass appears to be a consistent predictor of performance. Kinesiophobia appears to negatively influence TTF for those with a history of recurrent low back pain, but does not influence healthy individuals. Self-efficacy is associated with better performance in individuals with a history of recurrent low back pain, whereas a less steep median power frequency slope of the trunk and hip extensors is associated with better performance in individuals without a history of low back pain. %M 30201604 %R 10.2196/10522 %U http://games.jmir.org/2018/3/e10522/ %U https://doi.org/10.2196/10522 %U http://www.ncbi.nlm.nih.gov/pubmed/30201604 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 2 %P e15 %T Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study %A Kerr,Andrew %A Smith,Mark %A Reid,Lynn %A Baillie,Lynne %+ Centre of Excellence in Rehabilitation Research, Department of Biomedical Engineering, University of Strathclyde, Biomedical Engineering, University of Strathclyde, Glasgow, G1 0QX, United Kingdom, 44 01415482855, a.kerr@strath.ac.uk %K stroke %K rehabilitation %K technology %K priorities %D 2018 %7 17.08.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation. Objective: This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption. Methods: We invited stakeholders (n=60), comprising stroke survivors (20/60, 33%), therapists (20/60, 33%), caregivers, and technology developers (including researchers; 20/60, 33%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions to enhance adoption. Results: A total of 25 priorities were generated from the survey; these were reduced to 10 nonranked priorities through discussion, consensus activities, and voting at Workshop 1: access to technologies, ease of use, awareness of available technologies, technologies focused on function, supports self-management, user training, evidence of effectiveness, value for money, knowledgeable staff, and performance feedback. The second workshop provided recommendations for improving the adoption of technologies in stroke rehabilitation: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies, and a user network to inspire and test new technologies. Conclusions: The key outcomes from this series of stakeholder workshops provides a starting point for an integrated approach to promoting greater adoption of technologies in stroke rehabilitation. Bringing technology developers and users together to shape future and evaluate current technologies is critical to achieving evidence-based stroke rehabilitation. %M 30120086 %R 10.2196/rehab.9219 %U http://rehab.jmir.org/2018/2/e15/ %U https://doi.org/10.2196/rehab.9219 %U http://www.ncbi.nlm.nih.gov/pubmed/30120086 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e47 %T Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? %A Argent,Rob %A Daly,Ailish %A Caulfield,Brian %+ Beacon Hospital, University College Dublin Beacon Academy, Sandyford, Dublin, D18, Ireland, 353 01 540 4646, rob.argent@insight-centre.org %K patient compliance %K rehabilitation %K exercise therapy %K biomedical technology %K review %D 2018 %7 01.03.2018 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Adherence to home exercise in rehabilitation is a significant problem, with estimates of nonadherence as high as 50%, potentially having a detrimental effect on clinical outcomes. In this viewpoint, we discuss the many reasons why patients may not adhere to a prescribed exercise program and explore how connected health technologies have the ability to offer numerous interventions to enhance adherence; however, it is hard to judge the efficacy of these interventions without a robust measurement tool. We highlight how well-designed connected health technologies, such as the use of mobile devices, including mobile phones and tablets, as well as inertial measurement units, provide us with the opportunity to better support the patient and clinician, with a data-driven approach that incorporates features designed to increase adherence to exercise such as coaching, self-monitoring and education, as well as remotely monitor adherence rates more objectively. %M 29496655 %R 10.2196/mhealth.8518 %U https://mhealth.jmir.org/2018/3/e47/ %U https://doi.org/10.2196/mhealth.8518 %U http://www.ncbi.nlm.nih.gov/pubmed/29496655 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 4 %P e19 %T Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study %A Ling,Yun %A Ter Meer,Louis P %A Yumak,Zerrin %A Veltkamp,Remco C %+ Utrecht University, Princetonplein 5, Utrecht, 3584 CC, Netherlands, 31 302534116, yunlingcn@gmail.com %K rehabilitation exercise %K computer games %K hip replacement %K elderly %K physical therapists %D 2017 %7 12.10.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. Objective: The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient’s personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient’s medical status. Methods: This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. Results: The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further rehabilitation, and expressed that they would like to use the game in the future. The therapists indicated that the exercise games highly meet the criteria of motor rehabilitation, and they intend to continue using the game as part of their rehabilitation treatment of patients. Comments from the patients and physiotherapists suggest that real-time corrective feedback when patients perform the exercises wrongly and a more personalized user interface with options for increasing or decreasing cognitive load are needed. Conclusions: The results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery. Lunges and squats are found to be more beneficial for patients who have relatively better balance skills. A follow-up randomized controlled study will be conducted to test the effectiveness of the Fietsgame to investigate how motivating it is over a longer period of time. %M 29025696 %R 10.2196/games.7969 %U http://games.jmir.org/2017/4/e19/ %U https://doi.org/10.2196/games.7969 %U http://www.ncbi.nlm.nih.gov/pubmed/29025696 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e9 %T How Therapists Use Visualizations of Upper Limb Movement Information From Stroke Patients: A Qualitative Study With Simulated Information %A Ploderer,Bernd %A Fong,Justin %A Klaic,Marlena %A Nair,Siddharth %A Vetere,Frank %A Cofré Lizama,L. Eduardo %A Galea,Mary Pauline %+ School of Electrical Engineering and Computer Science, Queensland University of Technology, GPO Box 2434, Brisbane, 4001, Australia, 61 73138 ext 4927, b.ploderer@qut.edu.au %K stroke %K upper-limb rehabilitation %K therapy %K information visualization %K dashboard %K wearable technology %D 2016 %7 05.10.2016 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Stroke is a leading cause of disability worldwide, with upper limb deficits affecting an estimated 30% to 60% of survivors. The effectiveness of upper limb rehabilitation relies on numerous factors, particularly patient compliance to home programs and exercises set by therapists. However, therapists lack objective information about their patients’ adherence to rehabilitation exercises as well as other uses of the affected arm and hand in everyday life outside the clinic. We developed a system that consists of wearable sensor technology to monitor a patient’s arm movement and a Web-based dashboard to visualize this information for therapists. Objective: The aim of our study was to evaluate how therapists use upper limb movement information visualized on a dashboard to support the rehabilitation process. Methods: An interactive dashboard prototype with simulated movement information was created and evaluated through a user-centered design process with therapists (N=8) at a rehabilitation clinic. Data were collected through observations of therapists interacting with an interactive dashboard prototype, think-aloud data, and interviews. Data were analyzed qualitatively through thematic analysis. Results: Therapists use visualizations of upper limb information in the following ways: (1) to obtain objective data of patients’ activity levels, exercise, and neglect outside the clinic, (2) to engage patients in the rehabilitation process through education, motivation, and discussion of experiences with activities of daily living, and (3) to engage with other clinicians and researchers based on objective data. A major limitation is the lack of contextual data, which is needed by therapists to discern how movement data visualized on the dashboard relate to activities of daily living. Conclusions: Upper limb information captured through wearable devices provides novel insights for therapists and helps to engage patients and other clinicians in therapy. Consideration needs to be given to the collection and visualization of contextual information to provide meaningful insights into patient engagement in activities of daily living. These findings open the door for further work to develop a fully functioning system and to trial it with patients and clinicians during therapy. %M 28582257 %R 10.2196/rehab.6182 %U http://rehab.jmir.org/2016/2/e9/ %U https://doi.org/10.2196/rehab.6182 %U http://www.ncbi.nlm.nih.gov/pubmed/28582257 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 3 %N 2 %P e8 %T Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series %A Lai,Byron %A Rimmer,James %A Barstow,Beth %A Jovanov,Emil %A Bickel,C Scott %+ School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL,, United States, 1 205 934 5904, bickel@uab.edu %K exercise %K physical activity %K telehealth %K spinal cord injury %K persons with disabilities %D 2016 %7 14.07.2016 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home. Objective: To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report. Methods: Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO2 peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase. Results: Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts. Conclusion: A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample. %M 28582252 %R 10.2196/rehab.5524 %U http://rehab.jmir.org/2016/2/e8/ %U https://doi.org/10.2196/rehab.5524 %U http://www.ncbi.nlm.nih.gov/pubmed/28582252 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e122 %T TRAK App Suite: A Web-Based Intervention for Delivering Standard Care for the Rehabilitation of Knee Conditions %A Spasić,Irena %A Button,Kate %A Divoli,Anna %A Gupta,Satyam %A Pataky,Tamas %A Pizzocaro,Diego %A Preece,Alun %A van Deursen,Robert %A Wilson,Chris %+ School of Computer Science & Informatics, Cardiff University, Queen's Buildings, 5 The Parade, Cardiff, CF24 3AA, United Kingdom, 44 029 2087 0320, i.spasic@cs.cardiff.ac.uk %K internet %K social media %K web applications %K mobile applications %K usability testing %K knee %K rehabilitation %K exercise %K self-management %D 2015 %7 16.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Standard care for the rehabilitation of knee conditions involves exercise programs and information provision. Current methods of rehabilitation delivery struggle to keep up with large volumes of patients and the length of treatment required to maximize the recovery. Therefore, the development of novel interventions to support self-management is strongly recommended. Such interventions need to include information provision, goal setting, monitoring, feedback, and support groups, but the most effective methods of their delivery are poorly understood. The Internet provides a medium for intervention delivery with considerable potential for meeting these needs. Objective: The objective of this study was to demonstrate the feasibility of a Web-based app and to conduct a preliminary review of its practicability as part of a complex medical intervention in the rehabilitation of knee disorders. This paper describes the development, implementation, and usability of such an app. Methods: An interdisciplinary team of health care professionals and researchers, computer scientists, and app developers developed the TRAK app suite. The key functionality of the app includes information provision, a three-step exercise program based on a standard care for the rehabilitation of knee conditions, self-monitoring with visual feedback, and a virtual support group. There were two types of stakeholders (patients and physiotherapists) that were recruited for the usability study. The usability questionnaire was used to collect both qualitative and quantitative information on computer and Internet usage, task completion, and subjective user preferences. Results: A total of 16 patients and 15 physiotherapists participated in the usability study. Based on the System Usability Scale, the TRAK app has higher perceived usability than 70% of systems. Both patients and physiotherapists agreed that the given Web-based approach would facilitate communication, provide information, help recall information, improve understanding, enable exercise progression, and support self-management in general. The Web app was found to be easy to use and user satisfaction was very high. The TRAK app suite can be accessed at http://apps.facebook.com/kneetrak/. Conclusions: The usability study suggests that a Web-based intervention is feasible and acceptable in supporting self-management of knee conditions. %M 26474643 %R 10.2196/resprot.4091 %U http://www.researchprotocols.org/2015/4/e122/ %U https://doi.org/10.2196/resprot.4091 %U http://www.ncbi.nlm.nih.gov/pubmed/26474643 %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T Mobile Functional Reach Test in People Who Suffer Stroke: A Pilot Study %A Merchán-Baeza,Jose Antonio %A González-Sánchez,Manuel %A Cuesta-Vargas,Antonio %+ Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Andalucia Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetria (FE-14), Universidad de Málaga, Av/ Arquitecto Peñalosa, Málaga, , Spain, 34 951 952, acuesta.var@gmail.com %K mobile health %K reliability and validity %K elderly %K stroke %K postural balance %D 2015 %7 11.06.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Postural instability is one of the major complications found in people who survive a stroke. Parameterizing the Functional Reach Test (FRT) could be useful in clinical practice and basic research, as this test is a clinically accepted tool (for its simplicity, reliability, economy, and portability) to measure the semistatic balance of a subject. Objective: The aim of this study is to analyze the reliability in the FRT parameterization using inertial sensor within mobile phones (mobile sensors) for recording kinematic variables in patients who have suffered a stroke. Our hypothesis is that the sensors in mobile phones will be reliable instruments for kinematic study of the FRT. Methods: This is a cross-sectional study of 7 subjects over 65 years of age who suffered a stroke. During the execution of FRT, the subjects carried two mobile phones: one placed in the lumbar region and the other one on the trunk. After analyzing the data obtained in the kinematic registration by the mobile sensors, a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the mobile sensors were distance, maximum angular lumbosacral/thoracic displacement, time for maximum angular lumbosacral/thoracic displacement, time of return to the initial position, and total time. Using these data, we calculated speed and acceleration of each. A descriptive analysis of all kinematic outcomes recorded by the two mobile sensors (trunk and lumbar) was developed and the average range achieved in the FRT. Reliability measures were calculated by analyzing the internal consistency of the measures with 95% confidence interval of each outcome variable. We calculated the reliability of mobile sensors in the measurement of the kinematic variables during the execution of the FRT. Results: The values in the FRT obtained in this study (2.49 cm, SD 13.15) are similar to those found in other studies with this population and with the same age range. Intrasubject reliability values observed in the use of mobile phones are all located above 0.831, ranging from 0.831 (time B_C trunk area) and 0.894 (displacement A_B trunk area). Likewise, the observed intersubject values range from 0.835 (time B_C trunk area) and 0.882 (displacement A_C trunk area). On the other hand, the reliability of the FRT was 0.989 (0.981-0.996) and 0.978 (0.970-0.985), intrasubject and intersubject respectively. Conclusions: We found that mobile sensors in mobile phones could be reliable tools in the parameterization of the Functional Reach Test in people who have had a stroke. %M 28582239 %R 10.2196/rehab.4102 %U http://rehab.jmir.org/2015/1/e6/ %U https://doi.org/10.2196/rehab.4102 %U http://www.ncbi.nlm.nih.gov/pubmed/28582239 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 3 %N 1 %P e2 %T Therapists’ Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation %A Tatla,Sandy K %A Shirzad,Navid %A Lohse,Keith R %A Virji-Babul,Naznin %A Hoens,Alison M %A Holsti,Liisa %A Li,Linda C %A Miller,Kimberly J %A Lam,Melanie Y %A Van der Loos,HF Machiel %+ Sunny Hill Health Centre for Children, 3644 Slocan Avenue, Vancouver, BC, V5M 3E8, Canada, 1 604 453 8300, statla2@cw.bc.ca %K virtual reality %K technology adoption %K rehabilitation %K therapy %K social media %K gaming %K stroke %K cerebral palsy %K hemiplegia %D 2015 %7 10.03.2015 %9 Original Paper %J JMIR Serious Games %G English %X Background: The application of technologies, such as video gaming and social media for rehabilitation, is garnering interest in the medical field. However, little research has examined clinicians’ perspectives regarding technology adoption by their clients. Objective: The objective of our study was to explore therapists’ perceptions of how young people and adults with hemiplegia use gaming and social media technologies in daily life and in rehabilitation, and to identify barriers to using these technologies in rehabilitation. Methods: We conducted two focus groups comprised of ten occupational therapists/physiotherapists who provide neurorehabilitation to individuals with hemiplegia secondary to stroke or cerebral palsy. Data was analyzed using inductive thematic analysis. The diffusion of innovations theory provided a framework to interpret emerging themes. Results: Therapists were using technology in a limited capacity. They identified barriers to using social media and gaming technology with their clients, including a lack of age appropriateness, privacy issues with social media, limited transfer of training, and a lack of accessibility of current systems. Therapists also questioned their role in the context of technology-based interventions. The opportunity for social interaction was perceived as a major benefit of integrated gaming and social media. Conclusions: This study reveals the complexities associated with adopting new technologies in clinical practice, including the need to consider both client and clinician factors. Despite reporting several challenges with applying gaming and social media technology with clinical populations, therapists identified opportunities for increased social interactions and were willing to help shape the development of an upper limb training system that could more readily meet the needs of clients with hemiplegia. By considering the needs of both therapists and clients, technology developers may increase the likelihood that clinicians will adopt innovative technologies. %M 25759148 %R 10.2196/games.3401 %U http://games.jmir.org/2015/1/e2/ %U https://doi.org/10.2196/games.3401 %U http://www.ncbi.nlm.nih.gov/pubmed/25759148 %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 1 %P e1 %T Perceptions of Technology and Its Use for Therapeutic Application for Individuals With Hemiparesis: Findings From Adult and Pediatric Focus Groups %A Lam,Melanie Y %A Tatla,Sandy K %A Lohse,Keith R %A Shirzad,Navid %A Hoens,Alison M %A Miller,Kimberly J %A Holsti,Liisa %A Virji-Babul,Naznin %A Van der Loos,HF Machiel %+ Department of Human Kinetics, Saint Francis Xavier University, 5005 Chapel Square, Antigonish, NS, B2G 2W5, Canada, 1 902 867 5854, mlam@stfx.ca %K cerebral palsy %K stroke %K hemiplegia %K rehabilitation %K gaming %K social media %K technology adoption %K qualitative research %D 2015 %7 10.02.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Digital technology is becoming an increasingly popular means of delivering meaningful therapy to individuals with neurological impairments. An understanding of clients’ technology use and their perspectives on incorporating technology into rehabilitation can provide researchers and designers with valuable information to inform development of technologies and technology-based rehabilitation programs. Objective: This study was designed to establish the current use and perceptions of gaming, social media, and robotics technologies for rehabilitative purposes from the perspective of adults and children with upper limb impairments to identify barriers and enablers to their adoption and use. Methods: We conducted three focus groups consisting of pediatric (n=7, mean age 11.0 years) and adult (n=8, mean age 60.8 years) participants with hemiparesis affecting their upper limb. We applied thematic analysis methods to the resulting data. Results: We identified three key themes: (1) clients’ use of technology in everyday life and rehabilitation, (2) barriers to use, and (3) enablers to therapy. Participants had limited exposure to technology for therapeutic purposes, but all acknowledged the potential benefits in providing motivation and interest for the performance of repetitive task practice. Adult participants requested efficacious, simple, and easy-to-use technology for rehabilitation with programs that could be individualized for them and expressed that they wanted these programs to provide a motivating means of repeated practice of therapeutic movements. In contrast, pediatric participants emphasized a desire for technology for rehabilitation that offered opportunities for social interaction and interactive games involving their whole body and not only their affected limb. Perceived safety and privacy were concerns for both groups. Conclusions: Our findings highlight that all participants were open to the integration of technology into rehabilitation. Adult participants were more pragmatically motivated by potential recovery gains, whereas pediatric participants were more intrinsically motivated by access to games. %M 28582236 %R 10.2196/rehab.3484 %U http://rehab.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/rehab.3484 %U http://www.ncbi.nlm.nih.gov/pubmed/28582236 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e281 %T Movement-Based Interaction Applied to Physical Rehabilitation Therapies %A Garrido Navarro,Juan Enrique %A Ruiz Penichet,Victor Manuel %A Lozano Pérez,María Dolores %+ Computer Science Research Institute, University of Castilla-La Mancha, Avenida de España s/n, Albacete, 02071, Spain, 34 967599200 ext 2656, juanenrique.garrido@uclm.es %K exercise movement techniques %K human–computer interaction %K interaction devices %K movement-based interaction %K rehabilitation therapies %D 2014 %7 09.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care environments are continuously improving conditions, especially regarding the use of current technology. In the field of rehabilitation, the use of video games and related technology has helped to develop new rehabilitation procedures. Patients are able to work on their disabilities through new processes that are more motivating and entertaining. However, these patients are required to leave their home environment to complete their rehabilitation programs. Objective: The focus of our research interests is on finding a solution to eliminate the need for patients to interrupt their daily routines to attend rehabilitation therapy. We have developed an innovative system that allows patients with a balance disorder to perform a specific rehabilitation exercise at home. Additionally, the system features an assistive tool to complement the work of physiotherapists. Medical staff are thus provided with a system that avoids the need for them to be present during the exercise in specific cases in which patients are under suitable supervision. Methods: A movement-based interaction device was used to achieve a reliable system for monitoring rehabilitation exercises performed at home. The system accurately utilizes parameters previously defined by the specialist for correct performance of the exercise. Accordingly, the system gives instructions and corrects the patient’s actions. The data generated during the session are collected for assessment by the specialist to adapt the difficulty of the exercise to the patient’s progress. Results: The evaluation of the system was conducted by two experts in balance disorder rehabilitation. They were required to verify the effectiveness of the system, and they also facilitated the simulation of real patient behavior. They used the system freely for a period of time and provided interesting and optimistic feedback. First, they evaluated the system as a tool for real-life rehabilitation therapy. Second, their interaction with the system allowed us to obtain important feedback needed to improve the system. Conclusions: The system improves the rehabilitation conditions of people with balance disorder. The main contribution comes from the fact that it allows patients to carry out the rehabilitation process at home under the supervision of physiotherapists. As a result, patients avoid having to attend medical centers. Additionally, medical staff have access to an assistant, which means their presence is not required in many exercises that involve constant repetition. %M 25491148 %R 10.2196/jmir.3154 %U http://www.jmir.org/2014/12/e281/ %U https://doi.org/10.2196/jmir.3154 %U http://www.ncbi.nlm.nih.gov/pubmed/25491148 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 2 %N 2 %P e12 %T Virtual Rehabilitation for Multiple Sclerosis Using a Kinect-Based System: Randomized Controlled Trial %A Lozano-Quilis,Jose-Antonio %A Gil-Gómez,Hermenegildo %A Gil-Gómez,Jose-Antonio %A Albiol-Pérez,Sergio %A Palacios-Navarro,Guillermo %A Fardoun,Habib M %A Mashat,Abdulfattah S %+ Instituto de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain, 34 963 879 550 ext 83538, jlozano@dsic.upv.es %K multiple sclerosis %K motor rehabilitation %K virtual reality %K natural interfaces %K augmented reality %D 2014 %7 12.11.2014 %9 Original Paper %J JMIR Serious Games %G English %X Background: The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients’ motivation and adherence to treatment. Objective: We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient’s progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers. Methods: A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales. Results: Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system. Conclusions: The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. These results have encouraged us to improve the system with new exercises, which are currently being developed. %M 25654242 %R 10.2196/games.2933 %U http://games.jmir.org/2014/2/e12/ %U https://doi.org/10.2196/games.2933 %U http://www.ncbi.nlm.nih.gov/pubmed/25654242