%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67120 %T Interventions to Reduce Serum Per- and Poly-Fluoroalkyl Substances Levels, Improve Cardiovascular Risk Profiles, and Improve Epigenetic Age Acceleration in US Firefighters: Protocol for Randomized Controlled Trial %A Conner,Reagan %A Porter,Cynthia %A Lutrick,Karen %A Beitel,Shawn C %A Hollister,James %A Healy,Olivia %A Kern,Krystal J %A Wardenaar,Floris %A Gulotta,John J %A Jack,Kepra %A Huentelman,Matthew %A Burgess,Jefferey L %A Furlong,Melissa %+ Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, United States, 1 512 663 1594, mfurlong@arizona.edu %K firefighters %K PFAS %K epigenetics %K phenotype %K heart disease %K cardiovascular disease %K CVD %K atherosclerosis %K occupational health %K RCT %K cardiovascular %K fasting %K exercise %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Occupational cancer and acute cardiac events are the leading causes of death among firefighters. Increased exposure to toxicants on the fire ground, such as polycyclic aromatic hydrocarbons, benzene, and per- and poly-fluoroalkyl substances (PFAS), has been linked to certain cancers, cardiovascular disease, accelerated epigenetic aging, and other adverse health effects. PFAS are a major concern because they are persistent, can bioaccumulate, and are present in several firefighting tools. Compared to the general population, firefighters have elevated serum levels of some types of PFAS. A randomized clinical trial in Australian firefighters found that routine blood and plasma donation for 1 year led to decreased serum PFAS levels, although health outcomes were not directly measured in that study. Objective: In collaboration with fire service leadership in Arizona, the Firefighter Collaborative Research Project (FCRP) was established to evaluate the effectiveness of 3 interventions in a randomized controlled trial design to reduce serum PFAS levels, reduce cancer and cardiovascular risk, and improve overall health and wellness in US firefighters. Methods: This study aimed to recruit and enroll up to 1500 active firefighters between August 2023 and October 2024. Between August 2023 and October 2024, active firefighters were recruited and randomized into a study arm based on their eligibility, including serum PFOS levels, for the specific arms. The trial arms include (1) blood and plasma donation, (2) zone 2 physical activity, and (3) intermittent fasting. FCRP outcomes include serum PFAS reduction (arm 1), epigenetic age acceleration (all arms), cardiovascular conditioning (arm 2) and cognitive outcomes (all arms), mental health (all arms), and overall disease risk (all arms). Each study arm includes an intervention and a control group. At enrollment and end of the study, participants provide blood and urine samples and complete a comprehensive questionnaire on their occupational and health history, exposures, and lifestyle behaviors. At the end of the study, participants also participated in a cognitive evaluation. Depending on the study arm, participants may additionally complete a cardiopulmonary exercise test at baseline and follow-up, a mid-study survey, and a mid-study blood and urine collection. Results: Participant activities and data collection will conclude by December 2025. Conclusions: The FCRP is a randomized controlled trial that aims to test the effectiveness of fire service–selected interventions in reducing serum PFAS levels. Study results will contribute to potential interventions that could be used to reduce serum PFAS levels in firefighters. Trial Registration: ClinicalTrials.gov NCT05869747; https://clinicaltrials.gov/study/NCT05869747 International Registered Report Identifier (IRRID): DERR1-10.2196/67120 %M 40239196 %R 10.2196/67120 %U https://www.researchprotocols.org/2025/1/e67120 %U https://doi.org/10.2196/67120 %U http://www.ncbi.nlm.nih.gov/pubmed/40239196 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e54993 %T Developing a Multisensor-Based Machine Learning Technology (Aidar Decompensation Index) for Real-Time Automated Detection of Post–COVID-19 Condition: Protocol for an Observational Study %A Mathew,Jenny %A Pagliaro,Jaclyn A %A Elumalai,Sathyanarayanan %A Wash,Lauren K %A Ly,Ka %A Leibowitz,Alison J %A Vimalananda,Varsha G %+ , Aidar Health, Inc, 8920 MD-108 STE B, Columbia, MD, 21045, United States, 1 (443) 875 6456, jmathew@aidar.com %K Aidar Decompensation Index %K AIDI %K biophysical biomarkers of worsening health %K biosensor-based physiological monitoring %K cardiorespiratory, metabolic, renal, and neurological complications after COVID-19 %K early warning signs of clinical decompensation %K long COVID %K noninvasive monitoring of physiology %K postacute sequelae of COVID-19 %K PACS %K rapid assessment tool %K risk triaging related to long COVID %D 2025 %7 27.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post–COVID-19 condition is emerging as a new epidemic, characterized by the persistence of COVID-19 symptoms beyond 3 months, and is anticipated to substantially alter the lives of millions of people globally. Patients with severe episodes of COVID-19 are significantly more likely to be hospitalized in the following months. The pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiovascular and pulmonary diseases, which are common among those at risk of severe disease. Objective: This study aims to use a single, integrated device—MouthLab, which measures 10 vital health parameters in 60 seconds—and a cloud-based proprietary analytics engine to develop and validate the Aidar Decompensation Index (AIDI), to predict decompensation in health among patients who previously had severe COVID-19. Methods: Overall, 200 participants will be enrolled. Inclusion criteria are patients in the US Department of Veterans Affairs health care system; “severe” COVID-19 infection during the acute phase, defined as requiring hospitalization, within 3-6 months before enrollment; aged ≥18 years; and having 1 of 6 prespecified chronic conditions. All participants will be instructed to use the MouthLab device to capture daily physiological data and complete monthly symptom surveys. Structured data collection tables will be developed to extract the clinical characteristics of those who experience decompensation events (DEs). The performance of the AIDI will depend on the magnitude of difference in physiological signals between those experiencing DEs and those who do not, as well as the time until a DE (ie, the closer to the event, the easier the prediction). Information about demographics, symptoms (Medical Research Council Dyspnea Scale and Post-COVID-19 Functional Status Scale), comorbidities, and other clinical characteristics will be tagged and added to the biomarker data. The resultant predicted probability of decompensation will be translated into the AIDI, where there will be a linear relationship between the risk score and the AIDI. To improve prediction accuracy, data may be stratified based on biological sex, race, ethnicity, or underlying clinical characteristics into subgroups to determine if there are differences in performance and detection lead times. Using appropriate algorithmic techniques, the study expects the model to have a sensitivity of >80% and a positive predicted value of >70%. Results: Recruitment began in January 2023, and at the time of manuscript submission, 204 patients have been enrolled. Publication of the complete results and data from the study is expected in 2025. Conclusions: The focus on identifying predictor variables using a combination of biosensor-derived physiological features should enable the capture of heterogeneous characteristics of complications related to post–COVID-19 condition across diverse populations. Trial Registration: ClinicalTrials.gov NCT05220306; https://clinicaltrials.gov/study/NCT05220306 %M 40146983 %R 10.2196/54993 %U https://www.researchprotocols.org/2025/1/e54993 %U https://doi.org/10.2196/54993 %U http://www.ncbi.nlm.nih.gov/pubmed/40146983 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60436 %T Coach-Assisted eHealth With Group or Individual Support for Employees With Obesity: Randomized Controlled Trial on Weight, Body Composition, and Health Metrics %A Männistö,Siniriikka A %A Pietiläinen,Kirsi H %A Muotka,Joona %A Suojanen,Laura-Unnukka %A Lappalainen,Raimo %A Korpela,Riitta %+ HealthyWeightHub, Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Tukholmankatu 8F, Helsinki, 00290, Finland, 358 442351020, siniriikka.mannisto@helsinki.fi %K eHealth %K weight loss %K acceptance and commitment therapy %K weight-neutral %K Healthy Weight Coaching %K occupational health %K digital health %K body composition %K obesity %K psychobehavioral %K intervention %K health care %K metabolic health %K physiological change %D 2025 %7 12.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth. Objective: This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity. Methods: This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m2 were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time. Results: There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5% during the intervention, with 18% (20/111) of the participants attaining a ≥5% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6% of the eHealth program. Conclusions: There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Trial Registration: ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586 %M 40073400 %R 10.2196/60436 %U https://www.jmir.org/2025/1/e60436 %U https://doi.org/10.2196/60436 %U http://www.ncbi.nlm.nih.gov/pubmed/40073400 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e58388 %T Comparison of Occupational Performance in Immersive Virtual and Real Environments Among Patients With Stroke: Observational Randomized Crossover Pilot Study %A Wei,Xijun %A Zhou,Ping %A Wei,Yixi %A Wu,Dashuang %A Qin,Ping %A Zhang,Yingying %A Zhu,Jing %A Ren,Zhanbing %A Li,Hai %A Zhang,Yumei %K instrumental activities of daily living %K immersive virtual reality %K occupational performance %K stroke rehabilitation %K occupational therapy %D 2024 %7 15.11.2024 %9 %J JMIR Serious Games %G English %X Background: Conventional rehabilitation approaches involve therapists simulating various occupational tasks in health care settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADLs). As an alternative, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but research comparing occupational performance between virtual and real environments is limited. Objective: This study aims to introduce a novel IVR shopping system designed for patients with stroke and to investigate the correlation of occupational performance in virtual and real environments among patients with stroke. Methods: Ten patients with stroke were recruited from the Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, who met the inclusion and exclusion criteria for this observational, randomized crossover study; the patients were predominantly male (n=7), had experienced ischemic stroke (n=9), were aged 14 to 73 years, and had a time since stroke of 1 to 42 months. All patients attempted shopping tasks in virtual and real environments. The Mini-Mental State Examination (MMSE), Timed Up and Go Test (TUGT), modified Barthel index (MBI), and Lawton index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. The Wilcoxon test and Spearman correlation coefficients were used to analyze the differences and correlations between the 2 environments. Results: The Wilcoxon test showed no significant differences between the virtual and real environments in memory capacity and duration of task completion (P>.99 and P=.99), and memory capacity in both environments correlated with the LI (ρ=0.81; P=.005). Memory duration had a relationship with the TUGT in the virtual environment (ρ=0.68; P=.03) and a borderline negative correlation with MMSE in the real environment (ρ=−0.58; P=.08). Conclusions: Considering the small sample size used in this study and the study’s limitations, despite the significant correlation between shopping performance in IVR and the real world, it is still too early to conclude that IVR is a noninferior approach, but it presents the potential to be an alternative for assessment and training in IADLs when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and impact of virtual training on real-world performance. The implications for practice might include the following: (1) occupational performance in virtual shopping might be the same as real-world shopping, and more virtual IADLs could thus be developed; (2) virtual IADL assessment and training systems could be used in remote locations or locations with limited resources; and (3) more objective parameters of IADLs could be extracted from virtual environments. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000041058; https://www.chictr.org.cn/showprojEN.html?proj=65714 %R 10.2196/58388 %U https://games.jmir.org/2024/1/e58388 %U https://doi.org/10.2196/58388 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e59915 %T Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study %A Barría,Patricio %A Andrade,Asterio %A Gomez-Vargas,Daniel %A Yelincic,Alejandro %A Roberti,Flavio %A Bahamonde,Eduardo %A Aguilar,Rolando %A Cordova,Bessie %+ Institute of Automatics, National University of San Juan, Av. Libertador Gral. San Martín 1102, San Juan, 5400, Argentina, 54 542644213303, dgomez@inaut.unsj.edu.ar %K rehabilitation %K home-based therapy %K physical therapy %K psychological therapy %K home physiotherapy %K disabilities %K occupational therapy %K personalized care %K patient care %K motor disorder %K mood disorder %K motor function %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy. Objective: This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood. Methods: A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively. Results: The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score. Conclusions: This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being. Trial Registration: ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791 %M 39412860 %R 10.2196/59915 %U https://rehab.jmir.org/2024/1/e59915 %U https://doi.org/10.2196/59915 %U http://www.ncbi.nlm.nih.gov/pubmed/39412860 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60955 %T Implementing and Evaluating a Mobile Phone–Supported and Family-Centered Rehabilitation Program for People With Stroke in Uganda (F@ce 2.0): Protocol for a Randomized Controlled Trial %A Eriksson,Gunilla %A Kamwesiga,Julius Tunga %A Fors,Uno %A Oyana,Tonny %A von Koch,Lena %A Ytterberg,Charlotte %A Guidetti,Susanne %+ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Stockholm, 171 77, Sweden, 46 702216924, gunilla.eriksson@ki.se %K information and communication technology %K ICT %K mobile health %K mHealth %K telehealth %K telemedicine %K remote rehabilitation %K activity of daily living %K ADL %K East Africa %K sub-Saharan Africa %K intervention %K occupational therapy %K physiotherapy %D 2024 %7 25.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke. Objective: This study aims to implement F@ce 2.0, a mobile phone–supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0. Methods: A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process. Results: Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025. Conclusions: This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/60955 %M 39321459 %R 10.2196/60955 %U https://www.researchprotocols.org/2024/1/e60955 %U https://doi.org/10.2196/60955 %U http://www.ncbi.nlm.nih.gov/pubmed/39321459 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50230 %T Evaluating the Feasibility, Acceptance, and Beneficial Effects of Online Occupational Therapy for Post–COVID-19 Condition: Protocol for a Randomized Controlled Trial (ErgoLoCo Study) %A Müllenmeister,Christina %A Stoelting,Andrea %A Schröder,Dominik %A Schmachtenberg,Tim %A Ritter,Simon %A El-Sayed,Iman %A Steffens,Sandra %A Klawonn,Frank %A Klawitter,Sandra %A Homann,Stefanie %A Mikuteit,Marie %A Berg,Christoph %A Behrens,Georg %A Hummers,Eva %A Cook,Aisha %A Müller,Frank %A Dopfer-Jablonka,Alexandra %A Happle,Christine %+ Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, Goettingen, 37073, Germany, 49 551396807, christina.muellenmeister@med.uni-goettingen.de %K SARS-CoV-2 %K COVID-19 %K post COVID-19 condition %K pandemic %K occupational therapy %K cognitive deficits %K online treatment %K long Covid %K RCT %K randomized controlled trial %K controlled trials %K internet based %K digital health %K digital intervention %K video %K prerecorded %K feasibility %K acceptability %K effectiveness %K online therapy %D 2024 %7 13.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post–COVID-19 syndrome (PCS; also known as “long COVID”) is a relatively novel disease comprising physical, psychological, and cognitive complaints persisting several weeks to months after acute infection with SARS-CoV-2. Approximately 10% of patients with COVID-19 are affected by long-term symptoms. However, effective treatment strategies are lacking. The ErgoLoCo (Occupational Therapy [Ergotherapie] for Long COVID) study was designed to develop and evaluate a novel occupational therapy (OT) concept of online delivery of therapy for long COVID. Objective: The primary study objective is to assess the feasibility of the online OT intervention in PCS. Secondary aims include the evaluation of online OT concerning cognitive problems, occupational performance, and social participation. Methods: This randomized controlled interventional pilot study involves parallel mixed methods process analyses and a realist evaluation approach. A total of 80 clients with PCS aged at least 16 years will be recruited into two interventional groups. The control cohort (watch and wait) comprises 80 clients with long COVID. Treatment is provided through teletherapy (n=40) or delivery of prerecorded videos (n=40) using the same standardized OT concept twice weekly over 12 weeks. Analyses of quantitative questionnaires and qualitative interviews based on the theoretical framework of acceptability will be performed to assess feasibility. Focus group meetings will be used to assess how acceptable and helpful the intervention was to the participating occupational therapists. Standardized tests will be used to assess the initial efficacy of the intervention on neurocognitive performance; limitations in mobility, self-care, and everyday activities; pain; disabilities; quality of life (QoL); social participation; and anxiety and depression in PCS, and the possible effects of online OT on these complaints. Results: The German Ministry of Education and Research provided funding for this research in March 2022. Data collection took place from October 2022 to August 31, 2023. Data analysis will be completed by the end of April 2024. We anticipate publishing the results in the fall of 2024. Conclusions: Despite the enormous clinical need, effective and scalable treatment options for OT clients who have PCS remain scarce. The ErgoLoCo study will assess whether online-delivered OT is a feasible treatment approach in PCS. Furthermore, this study will assess the effect of the intervention on cognitive symptoms, QoL, and occupational performance and participation in everyday life. Particular emphasis will be placed on the experiences of clients and occupational therapists with digitally delivered OT. This study will pave the way for novel and effective treatment strategies in PCS. Trial Registration: German Clinical Trial Registry DRKS00029990; https://drks.de/search/de/trial/DRKS00029990 International Registered Report Identifier (IRRID): PRR1-10.2196/50230 %M 38739435 %R 10.2196/50230 %U https://www.researchprotocols.org/2024/1/e50230 %U https://doi.org/10.2196/50230 %U http://www.ncbi.nlm.nih.gov/pubmed/38739435 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e52049 %T Caregivers’ Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners %A Gately,Megan Elizabeth %A Waller,Dylan E %A Metcalf,Emily E %A Moo,Lauren R %+ VA Bedford Health Care System, Geriatric Research Education and Clinical Center (GRECC), 200 Springs Road, Bedford, MA, 01730, United States, 1 7816872000, megan.gately@va.gov %K telemedicine %K caregivers %K occupational therapy %K caregiver %K care worker %K telehealth %K older adults %K older adult %K geriatric %K rural %K remote %K OT practitioner %K web-based %K national survey %K role %K home care %K clinical support %K mobile phone %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults’ health- and technology-related challenges may necessitate caregiver assistance. Objective: This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). Methods: A web-based national survey of VHA OT practitioners about caregivers’ role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. Results: Of approximately 1787 eligible VHA OT practitioners, 286 (16% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81%), White (163/225, 72.4%), and occupational therapists (275/286, 96.2%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34% rural, on average (SD 0.22). Most participants (162/232, 69.8%) had >10 years of OT experience serving a patient cohort mostly aged ≥65 years (189/232, 81.5%) in primarily outpatient rehabilitation (132/232, 56.9%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4%) and enabling and operating the microphone and setting the volume (126/248, 50.8%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8%) and assisting with patient communication (124/240, 51.7%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3%), whereas the top barrier was poor connectivity (80/235, 34%). Increased access to video telehealth (212/235, 90.2%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. Conclusions: Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers’ challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients’ access to video visits. %M 38483462 %R 10.2196/52049 %U https://rehab.jmir.org/2024/1/e52049 %U https://doi.org/10.2196/52049 %U http://www.ncbi.nlm.nih.gov/pubmed/38483462 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e51116 %T Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study %A Rettinger,Lena %A Schönthaler,Erna %A Kerschbaumer,Andrea %A Hauser,Carina %A Klupper,Carissa %A Aichinger,Lea %A Werner,Franz %+ Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Favoritenstrasse 226, Vienna, 1100, Austria, 43 606 68 77 ext 4382, lena.rettinger@fh-campuswien.ac.at %K handwriting %K handwriting pressure %K pen %K children %K occupational therapy %K assistive technology %K tablet %K app %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The acquisition of handwriting skills is essential for a child’s academic success, self-confidence, and general school performance. Nevertheless, an estimated 5% to 27% of children face handwriting challenges, where the ability to modulate pressure on the pencil and lead on the paper is a key motor component. Objective: We aimed to investigate the experience with and usability of the SensoGrip system, a pressure-measuring pen system with personalized real-time feedback about pressure modulation, in a clinical setting with children and occupational therapists (OTs). Methods: A multimethods study was conducted, incorporating qualitative interviews and questionnaires with children, user diaries, focus group discussions, and a usability questionnaire with OTs, along with a questionnaire for parents. Results: The study involved OTs (n=8), children with handwriting difficulties (n=16), and their parents (n=16), each of whom used the SensoGrip system in up to 5 therapy sessions. OTs reported that the SensoGrip system helped to focus the child’s awareness on handwriting pressure and to measure it objectively. The system received high acceptance and usability ratings from the OTs—usefulness: median score of 4 out of 7; ease of use and ease of learning: median score of 6 out of 7; and satisfaction: median score of 6 out of 7. Participants appreciated that it fosters pressure awareness and motivation to draw and write. Conclusions: The SensoGrip pressure-sensing system with real-time feedback is a promising tool for pediatric occupational therapy. It supports children with handwriting difficulties to adjust their pressure application during the task. In the future, controlled quantitative trials are warranted to further examine the system’s impact. %M 38451584 %R 10.2196/51116 %U https://rehab.jmir.org/2024/1/e51116 %U https://doi.org/10.2196/51116 %U http://www.ncbi.nlm.nih.gov/pubmed/38451584 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47458 %T Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences %A Patel,Priya %A Brown,Susan %A Guo,Boliang %A Holmes,Emily A %A Iyadurai,Lalitha %A Kingslake,Jonathan %A Highfield,Julie %A Morriss,Richard %+ NIHR ARC East Midlands, University of Nottingham, Innovation Park Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 7790988203, Priya.Patel1@nottingham.ac.uk %K intensive care %K posttraumatic stress disorder %K PTSD %K qualitative research %K intervention study %K health care professionals %K digital intervention %K staff well-being %K pandemic %K intrusive memories %K work-related trauma %K mobile phone %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. Objective: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. Methods: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. Results: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. Conclusions: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial. %M 38421698 %R 10.2196/47458 %U https://formative.jmir.org/2024/1/e47458 %U https://doi.org/10.2196/47458 %U http://www.ncbi.nlm.nih.gov/pubmed/38421698 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47986 %T Feasibility of a Career Development Intervention for Veterans in Vocational Rehabilitation: Protocol for a Pilot Randomized Controlled Trial %A Stevenson,Brian %A Teravainen,Taina %A Kathawalla,Ummul Kiram %A Singer,Margo %A Wilkins,Sarah %A Mueller,Lisa %A Kelly,Megan %A Ellison,Marsha %A Shirk,Steven D %A Bakken,Shana %A Blustein,David %+ Veterans Integrated Services Network 1 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Bedford Healthcare System, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 854 1436, brian.stevenson4@va.gov %K psychiatric disorders %K career development %K vocational rehabilitation %K randomized controlled trial %K transitional work %K veterans %K mental health %K employment %D 2023 %7 30.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Veterans with psychiatric disorders want additional career development services to support their recovery and pursuit of meaningful employment. However, no career counseling programs have been designed for this specific population. We developed the Purposeful Pathways intervention to fill this need. Objective: This study protocol aims to (1) evaluate the feasibility and acceptability of the Purposeful Pathways intervention for veterans living with psychiatric disorders and (2) explore preliminary clinical outcome data. Methods: A total of 50 veterans who are participating in transitional work vocational rehabilitation services at a Veterans Affairs hospital will be randomized to either treatment as usual or the augmented treatment condition (treatment as usual plus Purposeful Pathways). Feasibility will be assessed via recruitment rates, clinician fidelity to treatment, retention rates, and acceptability of randomization procedures. Acceptability will be assessed via client satisfaction at treatment termination using quantitative and qualitative data collection. Preliminary clinical and vocational outcomes will be assessed at baseline, 6 weeks, 12 weeks (treatment termination), and a 3-month follow-up via quantitative measures assessing vocational functioning, vocational process, and mental and physical functioning. Results: This pilot randomized controlled trial is beginning recruitment in June 2023 and is expected to continue through November 2025. Data collection is expected to be completed by February 2026, with full data analysis completed by March 2026. Conclusions: Findings from this study will provide information on the feasibility and acceptability of the Purposeful Pathways intervention, as well as secondary outcomes related to vocational functioning, vocational process, and mental and physical functioning. Trial Registration: ClinicalTrials.gov NCT04698967; https://clinicaltrials.gov/ct2/show/NCT04698967 International Registered Report Identifier (IRRID): PRR1-10.2196/47986 %M 37389915 %R 10.2196/47986 %U https://www.researchprotocols.org/2023/1/e47986 %U https://doi.org/10.2196/47986 %U http://www.ncbi.nlm.nih.gov/pubmed/37389915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38540 %T A Web-Based Gender-Sensitive Educational Simulation on Vocational Rehabilitation for Service Providers Working With Youth With Disabilities: Pilot Evaluation %A Lindsay,Sally %A Thomson,Nicole %A Moll,Sandra %A Colantonio,Angela %A Stinson,Jennifer %+ Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3654, slindsay@hollandbloorview.ca %K continuing professional development %K CME %K medical education %K professional development %K continuing education %K gender-sensitive care %K online %K gender %K education %K simulator %K simulation %K clinician %K pilot %K youth %K young %K disabled %K disability %K child %K pediatric %K disabilities %K trainee %K community %K training %K tool %K rehabilitation %K feedback %K survey %D 2023 %7 24.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although there is a need for gender-specific health care, especially within the context of vocational rehabilitation for youth with disabilities, clinicians, trainees, and community service providers commonly report lacking training in gender-sensitive approaches. Therefore, an educational tool designed for clinicians working with youth, that addresses how to approach such issues, could help clinicians to augment the care they provide. Objective: The objective of our study was to conduct a pilot evaluation of an educational simulation for health care and service providers focusing on gender-sensitive approaches within the context of supporting youth with disabilities in vocational rehabilitation. Methods: We conducted a survey from May to September 2021 to assess the relevance of the simulation content, preliminary perceived impact on gender-sensitive knowledge and confidence, and open-ended feedback of a web-based gender-sensitive educational simulation. A total of 12 health care providers from a variety of professions who had experience working with youth in the context of vocational rehabilitation participated in the survey (11 women and 1 man). Results: Most participants reported that the content of the simulation was relevant and comprehensive. The majority of participants reported that the simulation helped to increase their perceived knowledge or understanding of the topic, changed their perceived understanding of their intervention or approach, and informed their perceived confidence. Our qualitative findings from the open-ended questions highlighted three main themes: (1) relevance of the simulation content, (2) perceived impact for clinical practice (ie, gender-sensitive language and communication and building rapport with patients), and (3) perceived impact on organizational processes (ie, practices, policy, and privacy). Conclusions: Our educational simulation shows preliminary potential as an educational tool for service providers working with youth who have a disability within the context of vocational rehabilitation. Further research is needed to assess the impact of the tool with larger samples. %M 36961496 %R 10.2196/38540 %U https://formative.jmir.org/2023/1/e38540 %U https://doi.org/10.2196/38540 %U http://www.ncbi.nlm.nih.gov/pubmed/36961496 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40548 %T A Tailored Occupational Therapist–Led Vocational Intervention for People With Stroke: Protocol for a Pilot Randomized Controlled Trial %A O'Keefe,Sophie %A Radford,Kathryn %A Farrin,Amanda %A Oakman,Jodi %A Alves-Stein,Serena %A Cloud,Geoffrey %A Douglas,Jacinta %A Stanley,Mandy %A Lannin,Natasha A %+ Department of Neuroscience, Monash University, The Alfred Centre, Level 6, 99 Commercial Road, Melbourne, 3004, Australia, 61 41 7135 153, natasha.lannin@monash.edu %K return to work %K vocational rehabilitation %K acquired brain injury %K stroke %K traumatic brain injury %K neuroscience %K rehabilitation %K intervention %K feasibility %K stroke recovery %K resume work %D 2022 %7 31.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Resuming work after stroke is a common goal of working-age adults, yet there are few vocational rehabilitation programs designed to address the unique challenges faced following stroke. The Work intervention was developed to address these gaps. Objective: This paper presents a protocol that outlines the steps that will be undertaken to pilot both the intervention and trial processes for the Work trial. Methods: The Work trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. A total of 54 adults of working age who have experienced a stroke <4 months prior will be randomized 1:1 to either (1) an experimental group who will receive a 12-week early vocational intervention (Work intervention) plus usual clinical rehabilitation or (2) a control group who will receive only their usual clinical rehabilitation. Results: Outcomes include study and intervention feasibility and intervention benefit. In addition to evaluating the feasibility of delivering vocational intervention early after stroke, benefit will be assessed by measuring rates of vocational participation and quality-of-life improvements at the 3- and 6-month follow-ups. Process evaluation using data collected during the study, as well as postintervention individual interviews with participants and surveys with trial therapists, will complement quantitative data. Conclusions: The results of the trial will provide details on the feasibility of delivering the Work intervention embedded within the clinical rehabilitation context and inform future trial processes. Pilot data will enable a future definitive trial to determine the clinical effectiveness of vocational rehabilitation when delivered in the early subacute phase of stroke recovery. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001164189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378112&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/40548 %M 36315220 %R 10.2196/40548 %U https://www.researchprotocols.org/2022/10/e40548 %U https://doi.org/10.2196/40548 %U http://www.ncbi.nlm.nih.gov/pubmed/36315220 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 3 %P e39883 %T Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study %A Brehon,Katelyn %A Niemeläinen,Riikka %A Hall,Mark %A Bostick,Geoff P %A Brown,Cary A %A Wieler,Marguerite %A Gross,Douglas P %+ Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 77 University Campus, Edmonton, AB, T6G2R3, Canada, 1 403 700 0599, brehon@ualberta.ca %K compensation and redress %K postacute COVID-19 syndrome %K long COVID %K COVID-19 %K rehabilitation %K return-to-work %K health outcome %K occupational health %K patient-reported outcome %K anxiety disorder %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Emerging evidence suggests that worldwide, between 30% and 50% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed. Objective: This study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program. Methods: A cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW. Results: The sample consisted of 81 workers. Most workers were female (n=52, 64%) and from health-related occupations (n=43, 53%). Only 43 (53%) individuals returned to work at program discharge, with 40 (93%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=–3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95% CI 0.99-1.00) predicted RTW even when controlling for age and gender. Conclusions: Workers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation. %M 36094442 %R 10.2196/39883 %U https://rehab.jmir.org/2022/3/e39883 %U https://doi.org/10.2196/39883 %U http://www.ncbi.nlm.nih.gov/pubmed/36094442 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e32457 %T Goal Attainment Scaling in Outpatient Physical Therapy for Chronic Low Back Pain: Protocol for a Mixed Methods Study %A Haladay,Douglas %A Ditwiler,Rebecca Edgeworth %A Klein,Aimee B %A Miro,Rebecca %A Lazinski,Matthew %A Swisher,Laura Lee %A Beckstead,Jason %A Wolfson,Jay %A Hardwick,Dustin %+ School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd MDC 77, Tampa, FL, 33612, United States, 1 8139741971, dhaladay@usf.edu %K goal attainment scaling %K goal setting %K low back pain %K chronic pain %K physical therapy %K patient engagement %K adherence %K rehabilitation %K physical therapist %D 2022 %7 7.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patient engagement in decisions regarding their health care may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their health care, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in health care decisions. Physical therapy goals are often generated by health care providers based on subjective information or standardized, fixed-item, patient-reported outcome measures. However, these outcome measures may not fully reveal the activity and participation limitations of individual patients. Goal attainment scaling (GAS) is a patient-centered approach that allows patients to set meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various populations, there is limited evidence in the United States on utilizing GAS in physical therapy for patients with chronic low back pain (LBP). Objective: The purpose of this paper is to describe the protocol for a study to (1) develop a way to apply GAS procedures for physical therapists treating patients with chronic LBP in the United States and (2) test the feasibility of applying GAS procedures for chronic LBP in an outpatient physical therapy setting. Methods: This study used a mixed methods design with 2 phases: qualitative and quantitative. The qualitative phase of the study employed focus groups of patients with chronic LBP to identify an inventory of goals that were important and measurable. A series of prompts was developed from this inventory to assist physical therapists in collaboratively establishing goals with patients in a clinical setting. The quantitative phase of the study pilot-tested the inventory developed in the qualitative phase in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We also plan to compare how well GAS reveals change over time relative to traditional, fixed-item, patient-reported measures. Results: Phase 1 data collection was completed in June 2020, while data collection for phase 2 was performed between March 2021 and December 2021. We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and that it will demonstrate clinically important changes in patients with chronic LBP. Conclusions: GAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in real-world physical therapy for chronic LBP in a clinical setting. Due to unique time and productivity constraints, for GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in a clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful changes in patient outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/32457 %M 35254282 %R 10.2196/32457 %U https://www.researchprotocols.org/2022/3/e32457 %U https://doi.org/10.2196/32457 %U http://www.ncbi.nlm.nih.gov/pubmed/35254282 %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 %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31502 %T Patient Outcomes and Lessons Learned From Treating Patients With Severe COVID-19 at a Long-term Acute Care Hospital: Single-Center Retrospective Study %A Grevelding,Pete %A Hrdlicka,Henry Charles %A Holland,Steve %A Cullen,Lorraine %A Meyer,Amanda %A Connors,Catherine %A Cooper,Darielle %A Greco,Allison %+ Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, CT, 06492, United States, 1 203 741 3386, pgrevelding@gaylord.org %K COVID-19 %K SARS-CoV-2 %K post–COVID-19 %K subacute COVID-19 %K postacute care %K long-term acute care hospital %K pulmonary %K speech therapy %K speech-language pathology %K rehabilitation %K physical therapy %K occupational therapy %K respiratory therapy %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources. Objective: This study aimed to describe the characteristics, clinical management, and patient outcomes during and after the acute COVID-19 phase in an LTACH in the Northeastern United States. Methods: This was a single-center group comparative retrospective analysis of the electronic medical records of patients treated for COVID-19–related impairments from March 19, 2020, through August 14, 2020, and a reference population of medically complex patients discharged between December 1, 2019, and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the holistic treatment approach of the facility. Results: Of the 127 total COVID-19 admissions, 118 patients were discharged by the data cutoff. At admission, 29.9% (38/127) of patients tested positive for SARS-CoV-2 infection. The mean age of the COVID-19 cohort was lower than that of the reference cohort (63.3, 95% CI 61.1-65.4 vs 65.5, 95% CI 63.2-67.8 years; P=.04). There were similar proportions of males and females between cohorts (P=.38); however, the proportion of non-White/non-Caucasian patients was higher in the COVID-19 cohort than in the reference cohort (odds ratio 2.79, 95% CI 1.5-5.2; P=.001). The mean length of stay in the COVID-19 cohort was similar to that in the reference cohort (25.5, 95% CI 23.2-27.9 vs 29.9, 95% CI 24.7-35.2 days; P=.84). Interestingly, a positive correlation between patient age and length of stay was observed in the COVID-19 cohort (r2=0.05; P=.02), but not in the reference cohort. Ambulation assistance scores improved in both the reference and COVID-19 cohorts from admission to discharge (P<.001). However, the mean assistance score was greater in the COVID-19 cohort than in the reference cohort at discharge (4.9, 95% CI 4.6-5.3 vs 4.1, 95% CI 3.7-4.7; P=.001). Similarly, the mean change in gait distance was greater in the COVID-19 cohort than in the reference cohort (221.1, 95% CI 163.2-279.2 vs 146.4, 95% CI 85.6-207.3 feet; P<.001). Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet. Conclusions: The majority of patients treated at the LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate that other patients with COVID-19 would benefit from care in an LTACH. %M 35023835 %R 10.2196/31502 %U https://rehab.jmir.org/2022/1/e31502 %U https://doi.org/10.2196/31502 %U http://www.ncbi.nlm.nih.gov/pubmed/35023835 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e30794 %T Occupational and Physical Therapy Strategies for the Rehabilitation of COVID-19-Related Guillain-Barré Syndrome in the Long-term Acute Care Hospital Setting: Case Report %A Connors,Catherine %A McNeill,Stephanie %A Hrdlicka,Henry Charles %+ Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, CT, 06492, United States, 1 203 284 2864, hhrdlicka@gaylord.org %K Gullian-Barre syndrome %K COVID-19 %K SARS-CoV-2 %K occupational therapy %K physical therapy %K long-term acute care hospital %K rehabilitation %K case report %K treatment %K diagnosis %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Although several reports have described the diagnosis and treatment of patients with COVID-19-associated Guillain-Barré syndrome (GBS), there is a paucity of literature describing the occupational and physical therapy (OT and PT) strategies used in the long-term acute care hospital (LTACH) setting to rehabilitate these patients. Objective: To expand this body of literature, we present a case report highlighting the treatment strategies used to rehabilitate and discharge an individual from an independent LTACH facility, following diagnosis and treatment of COVID-19-related GBS at a regional ACH. Methods: A 61-year-old male was admitted to an LTACH for the rehabilitation of GBS following COVID-19 infection and intravenous immunoglobulin treatment. Rehabilitation in the LTACH setting uses a variety of skilled treatment interventions to meet patient-driven goals and maximize their function to the highest level possible in preparation of their discharge to a subacute or homecare setting. In this case, this was accomplished through individual OT and PT sessions, OT/PT cotreatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. Results: With the OT and PT standard of care, the patient’s improvement was demonstrated by several outcome measures, including manual muscle testing, range of motion, grip strength, and the activity measure for postacute care. The patient was successfully rehabilitated and returned to the community after presenting with COVID-19-associated GBS. Conclusions: This report highlights the complex rehabilitation needs patients require to regain independence after diagnosis of COVID-19-associated GBS. %M 35023838 %R 10.2196/30794 %U https://rehab.jmir.org/2022/1/e30794 %U https://doi.org/10.2196/30794 %U http://www.ncbi.nlm.nih.gov/pubmed/35023838 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e31634 %T Comparing Web-Based and In-Person Educational Workshops for Canadian Occupational Therapists and Understanding Their Learning Experiences: Mixed Methods Study %A Kim,Sungha %A Bayer,Ilana %A Gewurtz,Rebecca %A Larivière,Nadine %A Letts,Lori %+ School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada, 1 289 659 7787, kims130@mcmaster.ca %K online education %K occupational therapy %K occupational therapist %K continuing education %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Do-Live-Well (DLW) framework is an occupation-focused health promotion approach. Occupational therapists (OTs) have been interested in training opportunities regarding this framework. Traditionally, in-person continuing educational interventions are the main way that OTs obtain knowledge, but web-based learning has become popular among health care professionals. However, its effectiveness and learners’ experience in web-based learning have not been well-studied in occupational therapy education. Objective: This study aims to evaluate the effectiveness of the web-based and in-person educational DLW workshops for Canadian OTs and to understand their experiences in both workshop types. Methods: An explanatory sequential mixed methods study design was used, where quantitative data were collected first, then qualitative data were used to explain the quantitative findings. A quasi-experimental design and interpretative description methodology were used in the quantitative and qualitative phases, respectively. Results: Quantitative results were as follows: a total of 43 OTs completed pre-, post-, and follow-up evaluations (in-person group: 21/43, 49%; web-based group: 22/43, 51%). Practice settings of the participants varied, including geriatric, hospital, long-term, mental health, pediatric, and primary settings. The primary outcome was as follows: there were no statistically significant differences in knowledge changes at the 3 time points (P=.57 to P=.99) between the groups. In the web-based group, the knowledge scores at follow-up were lower compared with the posttest results, meaning that knowledge gain was reduced over time (P=.001). The secondary outcomes were as follows: there were statistically significant differences between the groups in factors influencing DLW adoption at posttest (P=.001) and in satisfaction with the workshop (P<.001) at posttest in favor of the in-person group. Qualitative results were as follows: a total of 18 OTs (9/18, 50% from each group) participated in an individual interview. Five themes were identified regarding learners’ workshop experiences: relevance to their practices and interests may improve learning, a familiar learning environment may facilitate learning, synchronous in-person interaction is valuable in the learning process, ease of access to learning should be considered, and flexibility in web-based learning can be both beneficial and challenging. Conclusions: The quantitative results of this study reported no difference in knowledge acquisition between the in-person and web-based groups, indicating that web-based education is as effective as in-person workshops. However, participants’ satisfaction with the workshop was statistically significantly higher for the in-person workshop. The qualitative findings described the participants’ perceived benefits and challenges of each educational format. The participants in both the web-based and in-person workshop groups valued in-person interactions in learning, but the participants in the web-based workshop group expressed web-based learning lacked in-person-like interactions. Thus, adding synchronous in-person interactions to web-based learning may improve learners’ educational experiences in web-based occupational therapy and continuing education. %M 34982719 %R 10.2196/31634 %U https://mededu.jmir.org/2022/1/e31634 %U https://doi.org/10.2196/31634 %U http://www.ncbi.nlm.nih.gov/pubmed/34982719 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e27761 %T A Telehealth System Incorporating a Serious Game Intervention to Aid Occupational Therapists in Identifying and Treating Children With Difficulty Crossing the Body’s Midline: Key Informant Interviews Among Occupational Therapists %A Jacobs,Jonathan %A Heymann,Reolyn %A Greeff,Jacob Jacobus %+ Centre for Collaborative Digital Networks, Department of Electrical and Electronic Engineering Science, University of Johannesburg, Engineering Building, Corner of Kingsway and University Road, Auckland Park, Johannesburg, South Africa, 27 741550219, jonty.jacobs@gmail.com %K serious games %K input device %K telehealth %K occupational therapy %K midline crossing %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The midline is an imaginary line that isolates the left and right parts of the body. Crossing the midline infers that a body part (eg, hand or foot) can spontaneously move over to the opposite side of the body to perform an action. A child who has difficulty crossing the midline can physically perform actions that cross the center of the body; however, they do not intuitively cross the midline when challenged with a task that requires this movement, as their perceptual components prevent them from engaging on the contralateral side. This requires treatment from an occupational therapist. Owing to the recent COVID-19 pandemic, access to therapeutic sessions was not possible or reduced, putting the responsibility for treatment on caretakers at home. Caretakers do not have the knowledge and skills to provide treatment, and occupational therapists do not receive adequate feedback from caretakers on the child’s progress. Objective: The first objective is to adapt a simple serious game, or applied game, into a telehealth solution. Children will play the game at home under the supervision of a caretaker, and the results will be stored on the web. Occupational therapists can monitor progress via a web-based dashboard, receive additional valuable feedback about the child’s behavior during treatment, and easily adapt the game to target specific needs. The second objective is to evaluate whether the implemented telehealth solution is feasible as a treatment option for midline crossing difficulties and thus fit for purpose. Methods: To meet the first objective, engineering and game development stakeholders formed a team with an occupational therapist, and through a collaborative design process combined with an agile programming approach, a telehealth solution was designed to assist remote monitoring of the serious gameplay. For the second objective, 6 different occupational therapists were introduced to the game, had the opportunity to play the game, and then provided feedback regarding the feasibility, benefits, and applicability of the system during structured interviews. Results: A telehealth system was designed aimed to address this problem. All results are saved on the web and accessed by occupational therapists via a dashboard. In addition, observed behavioral information is also saved. During the interviews, occupational therapists indicated that the dashboard would support their treatment plan and was indeed a feasible solution. Conclusions: The feedback from the occupational therapists for this telehealth solution suggests a feasible method to treat midline crossing problems remotely. The therapists commented on the convenience of integrating both assessment and treatment into the same application, as it assists them when grading a child. The therapists collectively agreed that the quantitative aspect the serious game creates by providing measurable and standardized data proves advantageous when compared with traditional methods of assessment and treatment. %M 34723821 %R 10.2196/27761 %U https://games.jmir.org/2021/4/e27761 %U https://doi.org/10.2196/27761 %U http://www.ncbi.nlm.nih.gov/pubmed/34723821 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e30244 %T The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review %A Snyder,Natalie %A Wilson,Ria %A Finch,Lian %A Gallant,Brooklyn %A Landa,Chris %A Frankel,Daniel %A Brooks,Dina %A Packham,Tara %A Oliveira,Ana %+ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main St West, Hamilton, ON, L8S 1C7, Canada, 1 6477651525, ana.oliveira@westpark.org %K chronic respiratory disease %K COPD %K lung diseases %K occupational therapy %K pulmonary rehabilitation program %D 2021 %7 26.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic respiratory diseases are highly prevalent and compromise an individual’s ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual’s exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful “occupations,” improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines. Objective: The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs. Methods: The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic. Results: The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022. Conclusions: The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes. Trial Registration: OSF Registries ZH63W; https://osf.io/zh63w International Registered Report Identifier (IRRID): DERR1-10.2196/30244 %M 34309572 %R 10.2196/30244 %U https://www.researchprotocols.org/2021/7/e30244 %U https://doi.org/10.2196/30244 %U http://www.ncbi.nlm.nih.gov/pubmed/34309572 %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 %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e24669 %T Adapting a Person’s Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App’s Acceptability %A Guay,Manon %A Labbé,Mathieu %A Séguin-Tremblay,Noémie %A Auger,Claudine %A Goyer,Geneviève %A Veloza,Emily %A Chevalier,Natalie %A Polgar,Jan %A Michaud,François %+ School of Rehabilitation, Faculty of Medicine and Health Sciences, Sherbrooke University, 3001 12 Ave N Immeuble X1, Sherbrooke, QC, J1H 5N4, Canada, 1 819 780 2220 ext 45484, Manon.Guay@USherbrooke.ca %K occupational therapy %K mobile phone %K aging %K disability %K telehealth %K 3D visualization %K universal design %K built environment %K camera %K remote assessment %K assistive technology %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT’s work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective: The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT’s work when conducting assessments in which home representations are essential to fit a person’s needs. Methods: A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results: A total of 24 stakeholders contributed significantly to MapIt technology’s co-design over a span of 4 years. Fueled by the objective to enhance MapIt’s acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders’ perception was favorable regarding MapIt’s acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions: MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person’s occupational engagement. %M 33973867 %R 10.2196/24669 %U https://rehab.jmir.org/2021/2/e24669 %U https://doi.org/10.2196/24669 %U http://www.ncbi.nlm.nih.gov/pubmed/33973867 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 2 %P e24299 %T Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study %A Gately,Megan E %A Tickle-Degnen,Linda %A Voydetich,Deborah J %A Ward,Nathan %A Ladin,Keren %A Moo,Lauren R %+ Department of Veterans Affairs, Geriatric Research Education and Clinical Center, 200 Springs Road, Bedford, MA, , United States, 1 781 687 2000, megan.gately@va.gov %K occupational therapy %K telemedicine %K health services %K older adults %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Occupational therapy (OT) is a vital service that supports older adults’ ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood. Objective: This study examines VHA OT practice using video telehealth with older veterans using an implementation framework. Methods: A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth. Results: Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0% response rate). Most were female (196/259, 75.7%) occupational therapists (281/305, 92.1%) with a master’s degree (147/259, 56.8%) and 10 years or fewer (165/305, 54.1%) of VHA OT practice. Less than half (125/305, 41.0%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (P<.001), instrumental activities of daily living (P=.004), home safety (P<.001), home exercise or therapeutic exercise (P<.001), veteran or caregiver education (P<.001), durable medical equipment (P<.001), assistive technology (P<.001), education and work (P=.04), and wheelchair clinic or seating and positioning (P<.001). More than half (74/125, 59.2%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being Inadequate space, physical locations and related equipment. Most (92/125, 73.6%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84%) and willingness to try innovative approaches (76/92, 83%). Conclusions: Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians’ attitudes to understand how they are driving the implementation of video telehealth. %M 33904825 %R 10.2196/24299 %U https://rehab.jmir.org/2021/2/e24299 %U https://doi.org/10.2196/24299 %U http://www.ncbi.nlm.nih.gov/pubmed/33904825 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e22670 %T A Web-Based Lifestyle Intervention Aimed at Improving Cognition in Patients With Cancer Returning to Work in an Outpatient Setting: Protocol for a Randomized Controlled Trial %A Drijver,A Josephine %A Reijneveld,Jaap C %A Wesselman,Linda M P %A Klein,Martin %+ Department of Neurology, Amsterdam UMC, ZH 2 A 63, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 20444 4219, a.drijver@amsterdamumc.nl %K cancer %K cognitive functioning %K lifestyle %K web-based intervention %K RCT %K cancer-related cognitive impairment %D 2021 %7 26.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A high percentage of patients with cancer experience cognitive impairment after cancer treatment, resulting in a decreased health-related quality of life and difficulty returning to work. Consequently, there is a need for effective treatment options to improve cognitive functioning in these patients. In a healthy aging population, multidomain web-based lifestyle interventions have been found to be effective in preventing cognitive decline and improving cognitive functioning. Objective: This study aims to investigate the feasibility and effectiveness of the web-based lifestyle intervention Mijn Fitte Brein (My Fit Brain [MFB]) on cognitive functioning in patients with cancer returning to work. Methods: The study consists of a feasibility study (N=10), followed by a randomized controlled trial (RCT; N=220). Patients will be recruited by their occupational physicians after their return to work following cancer treatment. Mijn Fitte Brein is organized into 4-week cycles in which patients set a lifestyle goal using the Goal Attainment Scale, receive weekly tips and support, and finally evaluate whether they succeeded in achieving this goal. Lifestyle goals are based on 6 domains: physical exercise, diet, sleep, stress, alcohol use, and smoking. In the feasibility study, data on user experience (structured interview) and usability, assessed with the Post-Study System Usability Scale, will be collected and used to optimize Mijn Fitte Brein. In the RCT, patients will be randomized 1:1 between an intervention group and a control group. Patients will be assessed at baseline, 3 months, and 6 months. The primary outcome measure is subjective cognitive functioning, assessed with the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog). Secondary outcome measures are lifestyle, objective cognitive functioning, and work and psychosocial factors. Results: Recruitment for the feasibility study has started in February 2020. As of July 2020, however, no patients have been enrolled (due to COVID-19 restrictions). The findings of the feasibility study will be used to optimize the Mijn Fitte Brein intervention. Enrollment for the RCT will continue when possible. The feasibility study will take 6 months (including making adjustments to the intervention), and the RCT will take 2 years. The final results are expected in 2024. The results of the feasibility study and the RCT will be published in peer-reviewed journals. Conclusions: This is the first time the feasibility and efficacy of a multidomain web-based lifestyle intervention will be studied in patients with cancer. If Mijn Fitte Brein is found to be effective in decreasing cognitive complaints in these patients returning to work, it will be a promising treatment option because of being both affordable and accessible. Trial Registration: Netherlands Trial Register NL8407; https://www.trialregister.nl/trial/8407 International Registered Report Identifier (IRRID): DERR1-10.2196/22670 %M 33900201 %R 10.2196/22670 %U https://www.researchprotocols.org/2021/4/e22670 %U https://doi.org/10.2196/22670 %U http://www.ncbi.nlm.nih.gov/pubmed/33900201 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23568 %T Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation %A Lindsay,Sally %A Kolne,Kendall %A Barker,Donna J %A Colantonio,Angela %A Stinson,Jennifer %A Moll,Sandra %A Thomson,Nicole %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3654, slindsay@hollandbloorview.ca %K continuing education %K gender-identity %K gender-sensitive care %K rehabilitation %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective: This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods: We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results: Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions: Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities. %M 33720023 %R 10.2196/23568 %U https://formative.jmir.org/2021/3/e23568 %U https://doi.org/10.2196/23568 %U http://www.ncbi.nlm.nih.gov/pubmed/33720023 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e20463 %T Online Self-Determination Toolkit for Youth With Disabilities: Protocol for a Mixed Methods Evaluation Study %A Lindsay,Sally %A Kosareva,Polina %A Sukhai,Mahadeo %A Thomson,Nicole %A Stinson,Jennifer %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital and University of Toronto, 150 Kilgour Road, Toronto, ON, Canada, 1 416 425 6220 ext 3654, slindsay@hollandbloorview.ca %K disability %K involvement %K occupational therapy %K rehabilitation %K youth %D 2021 %7 11.1.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: Youth with disabilities encounter many challenges during their transition to adulthood including finding employment. Jobs are often inaccessible, and youth often face a lack of support, discriminatory attitudes, and sometimes low self-confidence. Therefore, it is critical to help youth enhance their self-determination skills to advocate for their needs in the workplace. Objective: The aim of this paper is to describe how an online toolkit aimed to improve self-determination in advocating for needs, including disability disclosure and accommodation requests to employers, was co-created with youth with disabilities. Methods: We will use a mixed method design in which qualitative data (ie, focus groups and mentored discussion forum) are collected to understand the contextual factors during the intervention that could affect outcomes or explain results through the pre-post questionnaires. Fifty youths with disabilities aged 15 to 24 years will be recruited. Results: Data collection is in progress. Planned analyses include focus groups and pre-post surveys to determine the impact of the intervention on self-determination. A qualitative content analysis of the focus groups and all open-ended survey questions will be conducted to understand the impact of the toolkit. Conclusions: Our online toolkit includes evidence-informed content that was co-created with youth who have a disability. It has potential for educational and vocational programming for youth with disabilities. International Registered Report Identifier (IRRID): PRR1-10.2196/20463 %M 33427688 %R 10.2196/20463 %U http://www.researchprotocols.org/2021/1/e20463/ %U https://doi.org/10.2196/20463 %U http://www.ncbi.nlm.nih.gov/pubmed/33427688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e15625 %T Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups %A Engdahl,Patrik %A Svedberg,Petra %A Lexén,Annika %A Bejerholm,Ulrika %+ Mental Health, Activity and Participation, Department of Health Science, Lund University, PO Box 157, Lund, SE-22100, Sweden, 46 462221958, patrik.engdahl@med.lu.se %K qualitative method %K mental health %K mHealth %K quality improvement %K vocational rehabilitation %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. Objective: The aim of this study was to examine stakeholder groups’ perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. Methods: A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. Results: The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers’ concern of legislation incompatibility with innovative technology, and RTW professionals’ concern of the possibility that digital solutions may replace them to a certain extent. Conclusions: This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context. %M 32936089 %R 10.2196/15625 %U http://formative.jmir.org/2020/9/e15625/ %U https://doi.org/10.2196/15625 %U http://www.ncbi.nlm.nih.gov/pubmed/32936089 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e16401 %T An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 2): Protocol for a Single-Arm Mixed Methods Pilot Test to Assess Feasibility and Acceptability %A Hill,Brandon J %A Motley,Darnell N %A Rosentel,Kris %A VandeVusse,Alicia %A Garofalo,Robert %A Schneider,John A %A Kuhns,Lisa M %A Kipke,Michele D %A Reisner,Sari %A Rupp,Betty M %A Sanchez,Maria %A McCumber,Micah %A Renshaw,Laura %A West Goolsby,Rachel %A Loop,Matthew Shane %+ Planned Parenthood Great Plains, 4401 W 109th St #100, Overland Park, KS, , United States, 1 913 345 4624, brandon.hill@ppgreatplains.org %K HIV/AIDS %K YMSM %K YTW %K GNC youth %K LGBTQ %K unemployment %K homelessness %K sex work %D 2020 %7 10.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth of color face substantial economic and health disparities. In particular, HIV risk and infection among these groups remains a significant public health issue. In 2017, 17% of all new HIV diagnoses were attributed to male-to-male sexual contact among adolescents and young adults aged 13 to 24 years. However, such disparities cannot be attributed to individual-level factors alone but rather are situated within larger social and structural contexts that marginalize and predispose YMSM, YTW, and GNC youth of color to increased HIV exposure. Addressing social and structural risk factors requires intervention on distal drivers of HIV risk, including employment and economic stability. The Work2Prevent (W2P) study aims to target economic stability through job readiness and employment as a structural-level intervention for preventing adolescent and young adult HIV among black and Latinx YMSM, YTW, and GNC youth. This study seeks to assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce sexual risk behaviors. Objective: The goal of the research is to pilot-test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color. This intervention was adapted from Increased Individual Income and Independence, an existing evidence-based employment program for HIV-positive adults during phase 1 of the W2P study. Methods: The employment intervention will be pilot-tested among vulnerable YMSM, YTW, and GNC youth of color in a single-arm pre-post trial to assess feasibility, acceptability, and preliminary estimates of efficacy. Results: Research activities began in March 2018 and were completed in November 2019. Overall, 5 participants were enrolled in the pretest and 51 participants were enrolled in the pilot. Conclusions: Interventions that address the social and structural drivers of HIV exposure and infection are sorely needed in order to successfully bend the curve in the adolescent and young adult HIV epidemic. Employment as prevention has the potential to be a scalable intervention that can be deployed among this group. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/16401 %M 32773376 %R 10.2196/16401 %U https://www.researchprotocols.org/2020/8/e16401 %U https://doi.org/10.2196/16401 %U http://www.ncbi.nlm.nih.gov/pubmed/32773376 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e16384 %T An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 1): Protocol for Determining Essential Intervention Components Using Qualitative Interviews and Focus Groups %A Hill,Brandon J %A Motley,Darnell N %A Rosentel,Kris %A VandeVusse,Alicia %A Garofalo,Robert %A Schneider,John A %A Kuhns,Lisa M %A Kipke,Michele D %A Reisner,Sari %A Rupp,Betty M %A Sanchez,Maria %A McCumber,Micah %A Renshaw,Laura %A Loop,Matthew Shane %+ Planned Parenthood Great Plains, 4401 W 109th St #100, Overland Park, KS, , United States, 1 913 345 4624, brandon.hill@ppgreatplains.org %K HIV/AIDS %K YMSM %K YTW %K GNC youth %K LGBTQ %K unemployment %K homelessness %K sex work %D 2020 %7 10.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV continues to have a disparate impact on young cisgender men who have sex with men (YMSM), young trans women (YTW), and gender-nonconforming (GNC) youth who are assigned male at birth. Outcomes are generally worse among youth of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence young people’s proximity to HIV risk by limiting their access to health care and potentially moving them toward sex work as a means of income as well as increased substance use. Work2Prevent (W2P) aims to achieve economic stability through employment as a structural-level intervention for preventing adolescent and young adult HIV infection. The study will pilot-test an effective, theoretically driven employment program (increased individual income and independence [iFOUR]), for HIV-positive adults, and adapt it to the needs of black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years who are vulnerable to HIV exposure. Objective: This paper aimed to describe the protocol for the exploratory phase of W2P. The purpose of this phase was to determine the essential components needed for a structural-level employment intervention aimed at increasing job-seeking self-efficacy and career readiness among black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years. Methods: The exploratory phase of the W2P study consisted of in-depth interviews and focus groups with members of the target community as well as brief interviews with lesbian, gay, bisexual, transgender, and queer (LGBTQ)–inclusive employers. The study team will conduct in-depth interviews with up to 12 YMSM and 12 YTW and GNC youth, up to 10 focus groups with a maximum of 40 YMSM and 40 YTW and GNC youth, and up to 40 brief interviews with LGBTQ-inclusive employers. Participants will be recruited through a community-based recruiter, passive recruitment in community spaces and on social media, and active recruitment by research staff in community spaces serving LGBTQ youth. Results: In-depth interviews were conducted with 21 participants, and 7 focus groups were conducted with 46 participants in total. In addition, 19 brief interviews with LGBTQ-inclusive employers were conducted. The analysis of the data is underway. Conclusions: Preliminary findings from the formative phase of the study will be used to inform the tailoring and refinement of the iFOUR adult-based intervention into the youth-focused W2P intervention curriculum. Perspectives from YMSM, YTW, GNC youth, and LGBTQ-inclusive employers offer a multidimensional view of the barriers and facilitators to adolescent and young adult LGBTQ employment. This information is critical to the development of a culturally appropriate and relevant youth-focused intervention. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/16384 %M 32773383 %R 10.2196/16384 %U https://www.researchprotocols.org/2020/8/e16384 %U https://doi.org/10.2196/16384 %U http://www.ncbi.nlm.nih.gov/pubmed/32773383 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e18313 %T Immersive Virtual Reality for the Reduction of State Anxiety in Clinical Interview Exams: Prospective Cohort Study %A Concannon,Brendan Joseph %A Esmail,Shaniff %A Roduta Roberts,Mary %+ Department of Occupational Therapy, University of Alberta, 8205 - 114 St 2-64 Corbett Hall, Edmonton, AB, T6G 2G4, Canada, 1 780 492 2499, mroberts@ualberta.ca %K virtual reality %K VR %K head-mounted display %K HMD %K immersive technology %K occupational therapy %K OSCE %K simulation %K psychology %K anxiety %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Immersive virtual reality (VR) with head-mounted display was used to determine if clinical interview simulation could reduce the anxiety levels of first-year occupational therapy (OT) students as they prepared for upcoming Objective Structured Clinical Examinations (OSCEs). Anxiety among health science students is a potential problem that may diminish their performance during OSCEs. This investigation aimed to fill the gap in the literature regarding the effectiveness of VR to reduce anxiety in OT students. Objective: This investigation aimed to uncover the effectiveness of immersive VR in reducing state anxiety in OT students who were preparing for OSCEs. Methods: A prospective, experimental, nonrandomized controlled trial compared levels of state anxiety, test anxiety, and academic self-efficacy in two groups of first-year OT students; these levels were measured at four different time points by self-reported psychometric scales, analyzed with a mixed factorial analysis of variance (ANOVA). Members of Phase 1 (NoVR) were not exposed to the VR simulation and acted as a control group for members of Phase 2 (YesVR), who were exposed to the VR simulation. VR simulation featured a virtual clinic and a standardized patient who students could interview in natural language. Measures of student study strategies and previous experience with VR were also recorded. Results: A total of 49 participants—29 in the NoVR group and 20 in the YesVR group—showed that state anxiety had a rise-then-fall trend, peaking at the time point just before the OSCE. At that point, the YesVR students showed significantly less state anxiety than did the NoVR students (t46.19=2.34, P=.02, Cohen d=0.65, ηp2=0.105). The mean difference was 6.78 units (95% CI 0.96-12.61). In similar trends for both groups, student test anxiety remained relatively static across the time points, while academic self-efficacy continually increased. A moderate positive correlation was found for total time spent studying and peak state anxiety (NoVR r=.46, n=28, P=.01; YesVR r=.52, n=19, P=.02). Conclusions: This investigation shows evidence of immersive VR’s capability to reduce state anxiety in OT students preparing for clinical practical exams. Immersive VR simulation, used for the reduction of anxiety in health science students, can potentially lead to a future of positive mental health change from the virtual to the real world. %M 32673223 %R 10.2196/18313 %U http://games.jmir.org/2020/3/e18313/ %U https://doi.org/10.2196/18313 %U http://www.ncbi.nlm.nih.gov/pubmed/32673223 %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 e14465 %T A Mobile App Directory of Occupational Therapists Who Provide Home Modifications: Development and Preliminary Usability Evaluation %A Nguyen,An Thi %A Somerville,Emily Kling %A Espín-Tello,Sandra Martina %A Keglovits,Marian %A Stark,Susan Lynn %+ Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, CB 8505, St. Louis, MO, 63110, United States, 1 2062443126, an.nguyen@wustl.edu %K mHealth %K mobile app %K occupational therapist %K occupational therapy %K older adult %K user-computer interface %D 2020 %7 30.3.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Home modifications provided by occupational therapists (OTs) are effective in improving daily activity performance and reducing fall risk among community-dwelling older adults. However, the prevalence of home modification is low. One reason is the lack of a centralized database of OTs who provide home modifications. Objective: This study aimed to develop and test the usability of a mobile app directory of OTs who provide home modifications in the United States. Methods: In phase 1, a prototype was developed by identifying OTs who provide home modifications through keyword Web searches. Referral information was confirmed by phone or email. In phase 2, community-dwelling older adults aged older than 65 years and OTs currently working in the United States were purposefully recruited to participate in a single usability test of the mobile app, Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semistructured interview questions. Interview data were coded, and themes were derived using a grounded theory approach. Results: In phase 1, referral information for 101 OTs across 49 states was confirmed. In phase 2, 6 OTs (mean clinical experience 4.3 years, SD 1.6 years) and 6 older adults (mean age 72.8 years, SD 5.0 years) participated. The mean SUS score for OTs was 91.7 (SD 8.0; out of 100), indicating good usability. The mean SUS score for older adults was 71.7 (SD 27.1), indicating considerable variability in usability. In addition, the SUS scores indicated that the app is acceptable to OTs and may be acceptable to some older adults. For OTs, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information. Conclusions: Home Maddirs demonstrates good preliminary acceptability and usability to OTs. Older adults’ perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make improvements to this promising new tool for increasing older adults’ access to home modifications. %M 32224486 %R 10.2196/14465 %U http://rehab.jmir.org/2020/1/e14465/ %U https://doi.org/10.2196/14465 %U http://www.ncbi.nlm.nih.gov/pubmed/32224486 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13019 %T Assessing the Quality of Mobile Apps Used by Occupational Therapists: Evaluation Using the User Version of the Mobile Application Rating Scale %A LeBeau,Kelsea %A Huey,Lauren G %A Hart,Mark %+ College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Health Professions, Nusring & Pharmacy Room 4176, PO Box 100175
, Gainesville, FL, 32610, United States, 1 850 499 1952, klebeau@ufl.edu %K occupational therapy %K occupational therapists %K mobile apps %K mobile applications %K technology %K computers, handheld %K mHealth %K mobile health %D 2019 %7 1.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The continuous development of mobile apps has led to many health care professionals using them in clinical settings; however, little research is available to guide occupational therapists (OTs) in choosing quality apps for use in their respective clinical settings. Objective: The purpose of this study was to use the user version of the Mobile Application Rating Scale (uMARS) to evaluate the quality of the most frequently noted mobile health (mHealth) apps used by OTs and to demonstrate the utility of the uMARS to assess the quality of mHealth apps. Methods: A previous study surveying OTs’ use of apps in therapy compiled a list of apps frequently noted. A total of 25 of these apps were evaluated individually by 2 trained researchers using the uMARS, a simple, multidimensional analysis tool that can be reliably used to evaluate the quality of mHealth apps. Results: The top 10 apps had a total quality score of 4.3, or higher, out of 5 based on the mean scores of engagement, functionality, and aesthetics. Apps scored highest in functionality and lowest in engagement. Apps noted most frequently were not always high-quality apps; apps noted least frequently were not always low-quality apps. Conclusions: Determining the effectiveness of using apps in clinical settings must be built upon a foundation of the implementation of high-quality apps. Mobile apps should not be incorporated into clinical settings solely based on frequency of use. The uMARS should be considered as a useful tool for OTs, and other professionals, to determine app quality. %M 31066712 %R 10.2196/13019 %U https://mhealth.jmir.org/2019/5/e13019/ %U https://doi.org/10.2196/13019 %U http://www.ncbi.nlm.nih.gov/pubmed/31066712 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12653 %T A 4-Week Electronic-Mentoring Employment Intervention for Youth With Physical Disabilities: Pilot Randomized Controlled Trial %A Lindsay,Sally %A Cagliostro,Elaine %A Stinson,Jennifer %A Leck,Joanne %+ Department of Occupational Science and Occupational Therapy, University of Toronto and Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3654, slindsay@hollandbloorview.ca %K social support %K mentor %K youth %K rehabilitation %K occupational therapy %D 2019 %7 24.04.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Youth with disabilities are more likely to live in poverty and be unemployed compared with youth without disabilities. Such trends are often a result of a lack of support, inaccessible jobs, environmental barriers, and discriminatory attitudes toward people with disabilities. Youth with disabilities also face barriers in accessing vocational preparation programs. One encouraging way that could help address challenges that youth encounter is by providing support through electronic mentoring (e-mentoring). Objective: The objective of this study was to assess the feasibility of a 4-week Web-based peer e-mentoring employment intervention for youth with physical disabilities. Methods: We conducted a pilot randomized controlled trial (RCT) to evaluate our intervention, Empowering youth towards employment. Participants included youth aged 15 to 25 years who were randomly assigned to an experimental (mentored) or control (nonmentored) group. Our intervention involved having trained youth mentors (ie, near peers who also had a disability) lead Web-based discussion forums while offering peer support and resources, which involved 12 modules (3 topics a week for 4 weeks). Primary outcomes focused on implementation (ie, feasibility and acceptability), whereas secondary outcomes focused on effectiveness (ie, measures of self-determination, career maturity, and social support). Results: A total of 28 youth (mean age 19.62, SD 3.53; 14/28, 50% female) completed the RCT in 3 intervention groups and 2 control groups (intervention n=18, control n=10). Participants reported satisfaction with the program and that it was feasible and acceptable. Youth’s mean engagement level with the program was 6.44 (SD 2.33) for the experimental group and 5.56 (SD 3.53) for controls. Participants in the intervention group did not demonstrate any significant improvements in social support, career maturity, or self-determination compared with those in the control group. No adverse events were reported. Conclusions: The Empowering youth towards employment e-mentoring intervention needs further testing with a larger sample and different length of formats to understand how it may have an impact on employment outcomes for youth with disabilities. Trial Registration: ClinicalTrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/77a3T4qrE) %M 31518302 %R 10.2196/12653 %U http://pediatrics.jmir.org/2019/1/e12653/ %U https://doi.org/10.2196/12653 %U http://www.ncbi.nlm.nih.gov/pubmed/31518302 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12088 %T A 12-Week Electronic Mentoring Employment Preparation Intervention for Youth With Physical Disabilities: Pilot Feasibility Randomized Controlled Trial %A Lindsay,Sally %A Cagliostro,Elaine %A Leck,Joanne %A Stinson,Jennifer %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Department of Occupational Science & Occupational Therapy, University of Toronto, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220, slindsay@hollandbloorview.ca %K social support %K mentor %K employment %K youth %K disabled persons %K rehabilitation %K occupational therapy %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Youth with disabilities are at high risk of unemployment compared with youth without disabilities. They often encounter challenges in accessing vocational programs that meet their needs. One promising approach that could help to address barriers that youth encounter while also enhancing social support is through electronic mentoring (e-mentoring). Although there is an increase in e-mentoring for youth with disabilities, little is known about its impact for youth with physical disabilities. Objective: This study aimed to assess the acceptability and initial impact of a Web-based peer electronic mentor employment intervention for youth with physical disabilities. Methods: The Empowering Youth Towards Employment intervention was evaluated using a pilot randomized controlled trial (RCT). Youth, aged 15-21 years, with physical disabilities were randomly assigned to an intervention (ie, mentored) or control (ie, not mentored) group. Trained mentors (ie, near peers) with a physical disability led the online discussion forums and provided peer support and resources for 12 modules (1 topic per week over 12 weeks). Primary outcomes focused on self-determination, career maturity, and social support. We also explored program adherence and dosage, participant satisfaction, and areas for improvement. Results: A total of 13 youth (mean age 17.3 years, SD 1.88; 54%, 7/13 female) completed the RCT. In the intervention group (n=9), 56% (5/9) of the youth were females, and in the control group (n=4), 50% (2/4) of the youth were female. Participants reported satisfaction with the program and that it was feasible and acceptable. Participants’ mean engagement level with the program was 5.22 (SD 2.48) for the intervention group and 5.40 (SD 4.56) for controls. Participants in the intervention group demonstrated significant improvements in self-determination (t12=2.49; P<.04) compared with the control group. No adverse events were reported. Conclusions: The Empowering Youth Towards Employment is a promising intervention that enhances self-determination among youth with physical disabilities. Trial Registration: ClinicalTrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/6uD58Pvjc) International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8034 %M 31518315 %R 10.2196/12088 %U http://pediatrics.jmir.org/2019/1/e12088/ %U https://doi.org/10.2196/12088 %U http://www.ncbi.nlm.nih.gov/pubmed/31518315 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e9711 %T Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project %A Weichelt,Bryan %A Bendixsen,Casper %A Keifer,Matthew %+ Marshfield Clinic Research Institute, National Farm Medicine Center, 701 W Kalsched Ave, Marshfield, WI, 54449, United States, 1 715 221 7276, weichelt.bryan@mcrf.mfldclin.edu %K agriculture %K farmworkers %K injuries %K occupational medicine %K return to work %K software application %D 2019 %7 29.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers’ compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners’ and managers’ attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company’s human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software’s impact on patients and employers. %M 30694202 %R 10.2196/jmir.9711 %U https://www.jmir.org/2019/1/e9711/ %U https://doi.org/10.2196/jmir.9711 %U http://www.ncbi.nlm.nih.gov/pubmed/30694202 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e11674 %T Using an Electronic Tablet to Assess Patients’ Home Environment by Videoconferencing Prior to Hospital Discharge: Protocol for a Mixed-Methods Feasibility and Comparative Study %A Latulippe,Karine %A Provencher,Véronique %A Boivin,Katia %A Vincent,Claude %A Guay,Manon %A Kairy,Dahlia %A Morales,Ernesto %A Pellerin,Marc-André %A Giroux,Dominique %+ Center of Excellence on Aging Quebec, 1050 chemin Sainte-Foy, Quebec, QC, G1S 4L8, Canada, 1 418 435 8541, karine.latulippe.3@ulaval.ca %K caregivers %K feasibility %K mixed-methods %K mobile videoconferencing %K mobile phone %K occupational therapists %D 2019 %7 14.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Occupational therapists working in hospitals are usually involved in discharge planning to assess patients’ safety and autonomy upon returning home. However, their assessment is usually done at the hospital due to organizational and financial constraints. The lack of visual data about the patients’ home may thus reduce the appropriateness and applicability of the support recommended upon discharge. Although various technological tools such as mobile devices (mobile health) are promising methods for home-based distance assessment, their application in hospital settings may raise several feasibility issues. To our knowledge, their usefulness and added value compared to standard procedure have not been addressed yet in previous studies. Moreover, several feasibility issues need to be explored. Objective: This paper aims to (1) document the clinical feasibility of using an electronic tablet to assess the patient's home environment by mobile videoconferencing and (2) explore the added value of using mobile videoconferencing, compared to the standard procedure. Methods: A feasibility and comparative study using a mixed-methods (convergent) design is currently undergoing. Six occupational therapists will assess the home environment of their patients in the hospital setting: they will first perform a semistructured interview (a) and then use mobile videoconferencing (b) to compare “a versus a+b.” Interviews with occupational therapists and patients and their caregivers will further explore the advantages and disadvantages of mobile videoconferencing. Two valid tools are used (the Canadian Measure of Occupational Performance and the telehealth responsivity questionnaire). Direct and indirect time is also collected. Results: The project was funded in the spring of 2016 and authorized by the ethics committee in February 2017. Enrollment started in April 2017. Five triads (n=4 occupational therapists, n=5 clients, n=5 caregivers) have been recruited until now. The experiment is expected to be completed by April 2019 and analysis of the results by June 2019. Conclusions: Mobile videoconferencing may be a familiar and easy solution for visualizing environmental barriers in the home by caregivers and clinicians, thus providing a promising and inexpensive option to promote a safe return home upon hospital discharge, but clinical feasibility and obstacles to the use of mobile videoconferencing must be understood. International Registered Report Identifier (IRRID): DERR1-10.2196/11674 %M 31344677 %R 10.2196/11674 %U http://www.researchprotocols.org/2019/1/e11674/ %U https://doi.org/10.2196/11674 %U http://www.ncbi.nlm.nih.gov/pubmed/31344677 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e215 %T Improving Transition to Employment for Youth With Physical Disabilities: Protocol for a Peer Electronic Mentoring Intervention %A Lindsay,Sally %A Stinson,Jennifer %A Stergiou-Kita,Mary %A Leck,Joanne %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 4164256220 ext 3654, slindsay@hollandbloorview.ca %K social support %K mentor %K social inclusion %K youth %K disability %K rehabilitation %K occupational therapy %D 2017 %7 16.11.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although youth with disabilities have much to gain from employment readiness programs, they are often excluded from or have limited access to vocational programs. One encouraging approach to address gaps in vocational programming is through peer electronic mentoring (e-mentoring), which may facilitate a smoother transition to adulthood by offering support to enhance coping skills. Despite the increase in online communities, little is known about their impact on vocational mentoring for youth with physical disabilities and their parents. Objective: The aim of this paper is to develop, implement, and assess the feasibility of an online peer mentor employment readiness intervention for youth with physical disabilities and their parents to improve their self-determination, career maturity, and social support compared to controls. Methods: A mixed-methods feasibility randomized controlled trial (RCT) design will be conducted to develop and assess the feasibility, acceptability, and initial efficacy of the “Empowering Youth Towards Employment” intervention. Youth (aged 15 to 25) with physical disabilities and their parents will be randomly assigned to a control or experimental group (4-week, interactive intervention, moderated by peer mentors). Results: Data collection is in progress. Planned analyses include pre-post measures to determine the impact of the intervention on self-determination, career maturity, and social support. A qualitative thematic analysis of the discussion forums will complement the surveys to better understand why certain outcomes may have occurred. Conclusions: Our intervention includes evidence-informed content and was co-created by a multi-disciplinary group of researchers and knowledge users. It has the potential for widespread implications as a cost-effective resource to supplement educational and vocational programming for youth with disabilities. Trial Registration: Clinicaltrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/6uD58Pvjc) %M 29146566 %R 10.2196/resprot.8034 %U http://www.researchprotocols.org/2017/11/e215/ %U https://doi.org/10.2196/resprot.8034 %U http://www.ncbi.nlm.nih.gov/pubmed/29146566 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e118 %T Enhancing the Return to Work of Cancer Survivors: Development and Feasibility of the Nurse-Led eHealth Intervention Cancer@Work %A Tamminga,Sietske J %A van Hezel,Sanne %A de Boer,Angela GEM %A Frings-Dresen,Monique HW %+ Coronel Institute of Occupational Health, Academic Medical Center, Meibergdreef 9 / K0-110, Amsterdam, 1105 AZ, Netherlands, 31 205663279, s.j.tamminga@amc.nl %K cancer %K return to work %K eHealth %K survivorship %K feasibility studies %K self-management %D 2016 %7 10.06.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: It is important to enhance the return to work of cancer survivors with an appropriate intervention, as cancer survivors experience problems upon their return to work but consider it an essential part of their recovery. Objective: The objective of our study was to develop an eHealth intervention to enhance the return to work of cancer survivors and to test the feasibility of the eHealth intervention with end users. Methods: To develop the intervention we 1) searched the literature, 2) interviewed 7 eHealth experts, 3) interviewed 7 cancer survivors, 2 employers, and 7 occupational physicians, and 4) consulted experts. To test feasibility, we enrolled 39 cancer survivors, 9 supervisors, 7 occupational physicians, 9 general physicians and 2 social workers and gave them access to the eHealth intervention. We also interviewed participants, asked them to fill in a questionnaire, or both, to test which functionalities of the eHealth intervention were appropriate and which aspects needed improvement. Results: Cancer survivors particularly want information and support regarding the possibility of returning to work, and on financial and legal aspects of their situation. Furthermore, the use of blended care and the personalization of the eHealth intervention were preferred features for increasing compliance. The first version of the eHealth intervention consisted of access to a personal and secure website containing various functionalities for cancer survivors blended with support from their specialized nurse, and a public website for employers, occupational physicians, and general physicians. The eHealth intervention appeared feasible. We adapted it slightly by adding more information on different cancer types and their possible effects on return to work. Conclusions: A multistakeholder and mixed-method design appeared useful in the development of the eHealth intervention. It was challenging to meet all end user requirements due to legal and privacy constraints. The eHealth intervention appeared feasible, although implementation in daily practice needs to be subject of further research. ClinicalTrial: Dutch Trial Register number (NTR): 5190; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5190 (Archived by WebCite at http://www.webcitation.org/6hm4WQJqC) %M 27286819 %R 10.2196/resprot.5565 %U http://www.researchprotocols.org/2016/2/e118/ %U https://doi.org/10.2196/resprot.5565 %U http://www.ncbi.nlm.nih.gov/pubmed/27286819 %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 %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e283 %T Occupational Therapists’ Views on Using a Virtual Reality Interior Design Application Within the Pre-Discharge Home Visit Process %A Atwal,Anita %A Money,Arthur %A Harvey,Michele %+ Brunel University, Department of Computer Science, Brunel University, St Johns, London, UB8 3PH, United Kingdom, 44 1895266758, arthur.money@brunel.ac.uk %K occupational therapy %K pre-discharge home visits %K virtual reality %K 3D %K patient collaboration %K patient engagement %K empowerment %K technology assisted care %K patient perceptions %D 2014 %7 18.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment in order to enable patients to function independently after hospital discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement, and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualize changes prior to implementing them. Customized VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration, if developed effectively and integrated into the PHV process. Objective: The intent of the study was to explore the perceptions of OTs with regard to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilizing the think-aloud protocol and subsequent semi-structured interviews were carried out with seven OTs who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centering around the parameters that impact upon the acceptance, adoption, and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communication and patient involvement, and improve patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully; however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customizations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context. %M 25526615 %R 10.2196/jmir.3723 %U http://www.jmir.org/2014/12/e283/ %U https://doi.org/10.2196/jmir.3723 %U http://www.ncbi.nlm.nih.gov/pubmed/25526615