%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 %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43615 %T Technologies in Home-Based Digital Rehabilitation: Scoping Review %A Arntz,Angela %A Weber,Franziska %A Handgraaf,Marietta %A Lällä,Kaisa %A Korniloff,Katariina %A Murtonen,Kari-Pekka %A Chichaeva,Julija %A Kidritsch,Anita %A Heller,Mario %A Sakellari,Evanthia %A Athanasopoulou,Christina %A Lagiou,Areti %A Tzonichaki,Ioanna %A Salinas-Bueno,Iosune %A Martínez-Bueso,Pau %A Velasco-Roldán,Olga %A Schulz,Ralf-Joachim %A Grüneberg,Christian %+ Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Gesundheitscampus 6-8, Bochum, 44801, Germany, 49 234 77727 679, angela.arntz@hs-gesundheit.de %K digital rehabilitation %K digital technologies %K home-based rehabilitation %K digital health intervention %K scoping review %K artificial intelligence %K AI %K machine learning %K COVID-19 pandemic %K mobile app %K remote health %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients’ needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. Objective: In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. Methods: The scoping review followed the framework of Arksey and O’Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. Results: A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. Conclusions: Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients’ needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic. %M 37253381 %R 10.2196/43615 %U https://rehab.jmir.org/2023/1/e43615 %U https://doi.org/10.2196/43615 %U http://www.ncbi.nlm.nih.gov/pubmed/37253381 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43250 %T Role of Oral Intake, Mobility, and Activity Measures in Informing Discharge Recommendations for Hospitalized Inmate and Noninmate Patients With COVID-19: Retrospective Analysis %A Briggs,Matthew S %A Kolbus,Erin Shevawn %A Patterson,Kevin Michael %A Harmon-Matthews,Lindsay Elizabeth %A McGrath,Shana %A Quatman-Yates,Catherine C %A Meirelles,Cristiane %A Salsberry,Marka Jean %+ Rehabilitation Services, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, United States, 1 614 293 2385, matt.briggs@osumc.edu %K incarceration %K Functional Oral Intake %K Activity Measure for Postacute Care %K speech language pathology %K physical therapy %K occupational therapy %K COVID-19 %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Patients who were incarcerated were disproportionately affected by COVID-19 compared with the general public. Furthermore, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. Objective: We aimed to compare the functional outcomes of oral intake, mobility, and activity between inmates and noninmates diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. Methods: A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including the Functional Oral Intake Scale and Activity Measure for Postacute Care (AM-PAC) were collected and compared between inmates and noninmates. Binary logistic regression models were used to evaluate the odds of whether patients were discharged to the same place they were admitted from and whether patients were being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. Results: A total of 83 patients (inmates: n=38; noninmates: n=45) were included in the final analysis. There were no differences between inmates and noninmates in the initial (P=.39) and final Functional Oral Intake Scale scores (P=.35) or in the initial (P=.06 and P=.46), final (P=.43 and P=.79), or change scores (P=.97 and P=.45) on the AM-PAC mobility and activity subscales, respectively. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR 0.922, 95% CI 0.875-0.972 and OR 0.918, 95% CI 0.871-0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR 5.285, 95% CI 1.334-20.931 and OR 6.083, 95% CI 1.548-23.912), “Other” race (OR 7.596, 95% CI 1.203-47.968 and OR 8.515, 95% CI 1.311-55.291), and female sex (OR 4.671, 95% CI 1.086-20.092 and OR 4.977, 95% CI 1.146-21.615). Conclusions: The results of this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and noninmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic. %M 37224276 %R 10.2196/43250 %U https://rehab.jmir.org/2023/1/e43250 %U https://doi.org/10.2196/43250 %U http://www.ncbi.nlm.nih.gov/pubmed/37224276 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e39512 %T SARS-CoV-2–Related Adaptation Mechanisms of Rehabilitation Clinics Affecting Patient-Centered Care: Qualitative Study of Online Patient Reports %A Kühn,Lukas %A Lindert,Lara %A Kuper,Paulina %A Choi,Kyung-Eun Anna %+ Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Germany, 49 015783035009, Lukas.Kuehn@mhb-fontane.de %K patient-led care %K patient autonomy %K patient report %K satisfaction %K pandemic %K coronavirus %K inpatient %K health care delivery %K service delivery %K rehabilitation %K internet %K web-based %K reviews %K complaint %K rating %K COVID-19 %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The SARS-CoV-2 pandemic impacted access to inpatient rehabilitation services. At the current state of research, it is unclear to what extent the adaptation of rehabilitation services to infection-protective standards affected patient-centered care in Germany. Objective: The aim of this study was to determine the most relevant aspects of patient-centered care for patients in inpatient rehabilitation clinics under early phase pandemic conditions. Methods: A deductive-inductive framework analysis of online patient reports posted on a leading German hospital rating website, Klinikbewertungen (Clinic Reviews), was performed. This website is a third-party, patient-centered commercial platform that operates independently of governmental entities. Following a theoretical sampling approach, online reports of rehabilitation stays in two federal states of Germany (Brandenburg and Saarland) uploaded between March 2020 and September 2021 were included. Independent of medical specialty groups, all reports were included. Keywords addressing framework domains were analyzed descriptively. Results: In total, 649 online reports reflecting inpatient rehabilitation services of 31 clinics (Brandenburg, n=23; Saarland, n=8) were analyzed. Keywords addressing the care environment were most frequently reported (59.9%), followed by staff prerequisites (33.0%), patient-centered processes (4.5%), and expected outcomes (2.6%). Qualitative in-depth analysis revealed SARS-CoV-2–related reports to be associated with domains of patient-centered processes and staff prerequisites. Discontinuous communication of infection protection standards was perceived to threaten patient autonomy. This was amplified by a tangible gratification crisis of medical staff. Established and emotional supportive relationships to clinicians and peer groups offered the potential to mitigate the adverse effects of infection protection standards. Conclusions: Patients predominantly reported feedback associated with the care environment. SARS-CoV-2–related reports were strongly affected by increased staff workloads as well as patient-centered processes addressing discontinuous communication and organizationally demanding implementation of infection protection standards, which were perceived to threaten patient autonomy. Peer relationships formed during inpatient rehabilitation had the potential to mitigate these mechanisms. %M 36947585 %R 10.2196/39512 %U https://rehab.jmir.org/2023/1/e39512 %U https://doi.org/10.2196/39512 %U http://www.ncbi.nlm.nih.gov/pubmed/36947585 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43436 %T Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study %A Churchill,Laura %A Morrow,Mary %A Capin,Jacob J %A Jolley,Sarah E %A Hare,Kristine %A MaWhinney,Samantha %A Stevens-Lapsley,Jennifer E %A Erlandson,Kristine M %+ Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E 19th Ave, Mail Stop B168, Aurora, CO, 80045, United States, 1 303 724 4941, Kristine.erlandson@cuanschutz.edu %K Fitbit %K steps %K COVID-19 %K hospitalization %K rehabilitation %K digital health intervention %K physical activity %K step count %K mHealth application %K tele-rehabilitation %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Knowledge on physical activity recovery after COVID-19 survival is limited. The AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors randomized participants, following hospital discharge, to either education and unstructured physical activity or a telerehabilitation program. Step count data were collected as a secondary outcome, and we found no significant differences in total step count trajectories between groups at 6 weeks. Further step count data were not analyzed. Objective: The purpose of this analysis was to examine step count trajectories and correlates among all participants (combined into a single group) across the 12-week study period. Methods: Linear mixed models with random effects were used to model daily steps over the number of study days. Models with 0, 1, and 2 inflection points were considered, and the final model was selected based on the highest log-likelihood value. Results: Participants included 44 adults (41 with available Fitbit [Fitbit LLC] data). Initially, step counts increased by an average of 930 (95% CI 547-1312; P<.001) steps per week, culminating in an average daily step count of 7658 (95% CI 6257-9059; P<.001) at the end of week 3. During the remaining 9 weeks of the study, weekly step counts increased by an average of 67 (95% CI −30 to 163; P<.001) steps per week, resulting in a final estimate of 8258 (95% CI 6933-9584; P<.001) steps. Conclusions: Participants showed a marked improvement in daily step counts during the first 3 weeks of the study, followed by more gradual improvement in the remaining 9 weeks. Physical activity data and step count recovery trajectories may be considered surrogates for physiological recovery, although further research is needed to examine this relationship. Trial Registration: ClinicalTrials.gov NCT04663945; https://tinyurl.com/2p969ced %M 36939818 %R 10.2196/43436 %U https://rehab.jmir.org/2023/1/e43436 %U https://doi.org/10.2196/43436 %U http://www.ncbi.nlm.nih.gov/pubmed/36939818 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e45448 %T Telerehabilitation Delivery in Canada and the Netherlands: Results of a Survey Study %A Giesbrecht,Edward %A Major,Mel E %A Fricke,Moni %A Wener,Pamela %A van Egmond,Maarten %A Aarden,Jesse J %A Brown,Cara L %A Pol,Margriet %A van der Schaaf,Marike %+ Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada, 1 204 977 5630, ed.giesbrecht@umanitoba.ca %K telerehabilitation %K digital health %K telehealth %K eHealth %K competencies %K capabilities %K mobile phone %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Following the onset of the COVID-19 pandemic, telerehabilitation (TR) has been expanding to address the challenges and risks of in-person delivery. It is likely that a level of TR delivery will continue after the pandemic because of its advantages, such as reducing geographical barriers to service. Many pandemic-related TR initiatives were put in place quickly. Therefore, we have little understanding of current TR delivery, barriers and facilitators, and how therapists anticipate integrating TR into current practice. Knowing this information will allow the incorporation of competencies specifically related to the use and provision of TR into professional profiles and entry-to-practice education, thereby promoting high-quality TR care. Objective: This study aimed to obtain a descriptive overview of current TR practice among rehabilitation therapists in Canada and the Netherlands and identify perceived barriers to and facilitators of practice. Methods: A web-based cross-sectional survey was conducted with occupational, physical, and respiratory therapists and dietitians in Canada (in French and English) and the Netherlands (in Dutch and English) between November 2021 and March 2022. Recruitment was conducted through advertisements on social media platforms and email invitations facilitated by regulatory and professional bodies. The survey included demographic and practice setting information; whether respondents delivered TR, and if so, components of delivery; confidence and satisfaction ratings with delivery; and barriers to and facilitators of use. TR satisfaction and uptake were measured using the Telehealth Usability Questionnaire and modified Technology Acceptance Model. Data were first summarized descriptively, and then, comparisons were conducted between professions. Results: Overall, 723 survey responses were received, mostly from Canada (n=666, 92.1%) and occupational therapists (n=434, 60%). Only 28.1% (203/723) reported receiving specific training in TR, with 1.2% (9/723) indicating that it was part of their professional education. Approximately 19.5% (139/712) reported not using TR at all, whereas most participants (366/712, 51.4%) had been using this approach for 1 to 2 years. Services delivered were primarily teleconsultation and teletreatment with individuals. Respondents offering TR were moderately satisfied with their service delivery and found it to be effective; 90.1% (498/553) indicated that they were likely to continue offering TR after the pandemic. Technology access, confidence, and setup were rated the highest as facilitators, whereas technology issues and the clinical need for physical contact were the most common barriers. Conclusions: Professional practice and experience with TR were similar in both countries, suggesting the potential for common strategic approaches. The high prevalence of current practice and strong indicators of TR uptake suggest that therapists are likely to continue TR delivery after the pandemic; however, most therapists (461/712, 64.7%) felt ill prepared for practice, and the need to target TR competencies during professional and postprofessional education is critical. Future studies should explore best practice for preparatory and continuing education. %M 36806194 %R 10.2196/45448 %U https://rehab.jmir.org/2023/1/e45448 %U https://doi.org/10.2196/45448 %U http://www.ncbi.nlm.nih.gov/pubmed/36806194 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e40094 %T A Telerehabilitation Program for Maintaining Functional Capacity in Patients With Chronic Lung Diseases During a Period of COVID-19 Social Isolation: Quasi-Experimental Retrospective Study %A Miozzo,Aline Paula %A Camponogara Righi,Natiele %A Yumi Shizukuishi,Maria Luiza %A Marques Ferreira Aguilar,Hérica %A Florian,Juliessa %A da Costa Machado,Scheila %A Schardong,Jociane %A Della Méa Plentz,Rodrigo %+ Physiotherapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil, 55 51991131651, rodrigop@ufcspa.edu.br %K telerehabilitation %K lung diseases %K social isolation %K COVID-19 %K pulmonary rehabilitation %K pulmonary %K rehabilitation %K quality of life %K chronic disease %K mental health %K social functioning %K patient outcome %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Pulmonary diseases represent a great cause of disability and mortality in the world, and given the progression of these pathologies, pulmonary rehabilitation programs have proven to be effective for people with chronic respiratory diseases. During the COVID-19 pandemic, telerehabilitation has become an alternative for patients with such diseases. Objective: The aim of this study was to compare the outcomes (ie, functional capacity and quality of life) of telerehabilitation to those of usual care among patients who previously participated in face-to-face pulmonary rehabilitation programs. Methods: We conducted a quasi-experimental retrospective study from April 2020 to August 2021. A total of 32 patients with chronic lung diseases were included and divided into the control and intervention groups. The intervention group performed telerehabilitation synchronously twice per week and was supervised by a physical therapist during breathing, strengthening, and aerobic exercises. Changes in the degree of dyspnea and leg discomfort were assessed based on changes in Borg scale scores. The control group did not perform any activities during the period of social isolation. Functional capacity was assessed with the 6-minute walk test, and quality of life was assessed with the Medical Outcomes Study 36-item Short Form Health Survey. Results: The telerehabilitation group’s mean 6-minute walk distance decreased by 39 m, while that of the control group decreased by 120 m. There was a difference of 81 m between the groups’ mean 6-minute walk distances (P=.02). In relation to the quality of life, telerehabilitation was shown to improve the following two domains: social functioning and mental health. Conclusions: Telerehabilitation programs for patients with chronic lung diseases can ease the deleterious effects of disease progression, be used to maintain functional capacity, and improve aspects of quality of life. %M 36473024 %R 10.2196/40094 %U https://rehab.jmir.org/2022/4/e40094 %U https://doi.org/10.2196/40094 %U http://www.ncbi.nlm.nih.gov/pubmed/36473024 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e42157 %T The Impact of COVID-19 Lockdown Restrictions on Exercise Behavior Among People With Multiple Sclerosis Enrolled in an Exercise Trial: Qualitative Interview Study %A Palmer,Louise C %A Neal,Whitney N %A Motl,Robert W %A Backus,Deborah %+ Crawford Research Institute, Shepherd Center, 2020 Peachtree Rd NW, Atlanta, GA, 30309, United States, 1 404 350 7513, louise.palmer@shepherd.org %K multiple sclerosis %K exercise %K physical activity %K COVID-19 %K COVID-19 lockdown restrictions %K telerehabilitation %K interview study %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: During spring and summer 2020, US states implemented COVID-19 pandemic restrictions, resulting in the closure of rehabilitation facilities and, with them, some of the clinical trials that were taking place. One such trial was the Supervised Versus Telerehabilitation Exercise Program for Multiple Sclerosis (“STEP for MS”) comparative effectiveness multiple sclerosis (MS) exercise trial. Although 1 study arm was implemented via telerehabilitation, the comparative arm took place in rehabilitation facilities nationwide and was subsequently closed during this time frame. The experience of the STEP for MS participants provides insights into the impact of lockdown restrictions on exercise behavior by mode of exercise delivery (telerehabilitation vs conventional facility based). Objective: This study sought to understand the impact of COVID-19 lockdown restrictions on exercise behavior among people with MS enrolled in an exercise trial at the time of the restrictions. Methods: Semistructured phone and video interviews were conducted with a convenience sample of 8 participants representing both arms of the exercise trial. We applied reflexive thematic analysis to identify, analyze, and interpret common themes in the data. Results: We identified 7 main themes and 2 different narratives describing the exercise experiences during lockdown restrictions. Although the telerehabilitation participants continued exercising without interruption, facility-based participants experienced a range of barriers that impeded their ability to exercise. In particular, the loss of perceived social support gained from exercising in a facility with exercise coaches and other people with MS eroded both the accountability and motivation to exercise. Aerobic exercises via walking were the most impacted, with participants pointing to the need for at-home treadmills. Conclusions: The unprecedented disruption of COVID-19 lockdown restrictions in spring and summer 2020 impacted the ability of facility-based STEP for MS exercise trial participants to exercise in adherence to the intervention protocol. By contrast, the participants in the telerehabilitation-delivered exercise arm continued exercising without interruption and reported positive impacts of the intervention during this time. Telerehabilitation exercise programs may hold promise for overcoming barriers to exercise for people with MS during COVID-19 lockdown restrictions, and potentially other lockdown scenarios, if the participation in telerehabilitation has already been established. %M 36269870 %R 10.2196/42157 %U https://rehab.jmir.org/2022/4/e42157 %U https://doi.org/10.2196/42157 %U http://www.ncbi.nlm.nih.gov/pubmed/36269870 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e36842 %T Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review %A Pagaki-Skaliora,Marina %A Morrow,Eileen %A Theologis,Tim %+ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Centre, Windmill Road, Oxford, OX3 7LE, United Kingdom, 44 1865227607, eileen.morrow@ouh.nhs.uk %K cerebral palsy %K CP %K assistive technology %K scoping review %K software %K application %K telehealth %K telerehabilitation %K rehabilitation %K COVID-19 %K children %K health intervention %K health care %K digital intervention %D 2022 %7 17.10.2022 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP. Objective: This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research. Methods: A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children’s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate. Results: In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions: The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth. %M 36041012 %R 10.2196/36842 %U https://rehab.jmir.org/2022/4/e36842 %U https://doi.org/10.2196/36842 %U http://www.ncbi.nlm.nih.gov/pubmed/36041012 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 3 %P e38489 %T Internet-Based Information Sharing With Families of Patients With Stroke in a Rehabilitation Hospital During the COVID-19 Pandemic: Case-Control Study %A Murakami,Tatsunori %A Higuchi,Yumi %A Ueda,Tetsuya %A Kozuki,Wataru %A Gen,Aki %+ Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30, Habikino, 583-8555, Japan, 81 72 950 2111, tatsunori.m.1011@gmail.com %K COVID-19 %K internet-based %K health information %K stroke %K family %K rehabilitation %K case-control %K activities of daily living %K information communication technology %K physical function %K recovery %D 2022 %7 20.9.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The spread of COVID-19 has affected stroke rehabilitation. Given that inpatient visits are restricted in most institutions, alternative ways of providing information to family members are imperative. Informing families about patients’ rehabilitation progress via the web may help involve families in the rehabilitation process, enhance patients’ motivation to continue rehabilitation, and contribute overall to patients’ improvement in activities of daily living (ADL). Objective: We aimed to investigate the feasibility of the Internet-Based Rehabilitation Information Sharing (IRIS) intervention for families of patients with stroke at a rehabilitation hospital and examine the effect of IRIS on patients’ ADL improvement. Methods: In this case-control study, participants were inpatients at a rehabilitation hospital between March 2020 and April 2021. The intervention group (information and communication technology [ICT] group) included patients and families who requested IRIS, which consisted of a progress report on patients’ rehabilitation using text, photos, and videos. Those who did not receive internet-based information were included in the non-ICT group. The control group, matched with the ICT group based on a 1:1 propensity score, was selected from the non-ICT group. The covariates for calculating the propensity score were patients’ age, sex, and motor and cognitive scores on the Functional Independence Measure at admission. The main outcome was the degree of ADL improvement during hospitalization. Multiple regression analysis (forced entry method) was performed to confirm the impact of ICT use on ADL improvement. The independent variables were the presence of intervention, length of hospital stay, and number of days from onset to hospitalization. Results: In total, 16 groups of patients and families participated in the IRIS. The mean age of patients was 78.6 (SD 7.2) and 78.6 (SD 8.2) years in the ICT and control groups, respectively. The median total Functional Independence Measure difference was 28.5 (IQR 20.3-53.0) and 11.0 (IQR 2.8-30.0) in the ICT and control groups, respectively, and the ICT group showed significant improvement in ADL function (P=.02). In the multiple regression analysis of the ICT and control groups, the unstandardized regression coefficient was 11.97 (95% CI 0.09-23.84) for ICT use. These results indicate that ICT use was independently and significantly associated with improvement in ADL. Conclusions: This study examined the effect of IRIS on family members to improve ADL in patients with stroke who are hospitalized. The results showed that IRIS promotes the improvement of patients’ ADL regardless of age, sex, motor and cognitive functions at admission, and the length of hospital stay. %M 35960841 %R 10.2196/38489 %U https://rehab.jmir.org/2022/3/e38489 %U https://doi.org/10.2196/38489 %U http://www.ncbi.nlm.nih.gov/pubmed/35960841 %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 %@ 2369-2529 %I JMIR Publications %V 9 %N 3 %P e36836 %T Feasibility of Virtual Reality Exercises at Home for Post–COVID-19 Condition: Cohort Study %A Groenveld,Tjitske %A Achttien,Retze %A Smits,Merlijn %A de Vries,Marjan %A van Heerde,Ron %A Staal,Bart %A van Goor,Harry %A , %+ Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, Netherlands, 31 243667331, tjitske.groenveld@radboudumc.nl %K virtual reality %K rehabilitation %K COVID-19 %K long COVID %K feasibility %K physical function %K quality of life %K pandemic %K multimodal virtual reality %K outpatient care %K physiotherapy %K digital health %K patient care %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Between 30% to 76% of COVID-19 patients have persistent physical and mental symptoms, sometimes up to 9 months after acute COVID-19. Current rehabilitation is mostly focused on the physical symptoms, whereas experts have agreed on the need for a biopsychosocial approach. A novel approach such as virtual reality (VR) rehabilitation at home might benefit patients and therapists, especially considering the expected rush of patients with post–COVID-19 condition needing rehabilitation. Objective: The aim of this study was to investigate the feasibility of self-administered VR exercises at home for post–COVID-19 condition. Methods: This was a single-arm feasibility study in an outpatient care setting. Patients who needed physiotherapy because of post–COVID-19 condition were included as determined by the treating physiotherapist. Participants performed VR physical exercises at home for a period of 6 weeks and were allowed to perform VR mental exercise through applications available on the VR platform to reduce stress and anxiety and promote cognitive functioning. The main outcomes were related to feasibility (ie, duration and frequency of VR use), safety (ie, adverse events), patient satisfaction, and reasons to withdraw. Physical performance, daily activities, cognitive functioning, anxiety and depression, and the quality of life were measured before and after. Results: In total, 48 patients were included; 1 (2%) patient did not start VR, and 7 (15%) patients withdrew, mostly due to dizziness. Almost 70% (33/47) of participants reported experiencing any adverse event during VR exercising. However, only 25% (9/36) recalled these events at the end of the intervention period. The majority (27/36, 75%) of the patients described VR as having a positive influence on their recovery, and the global satisfaction score was 67%. The average VR use was 30 minutes per session, 3-4 times a week for 3-6 weeks. The overall use of VR applications was almost equally distributed over the 3 sets of VR exercises (physical, relaxing, and cognitive). However, the use frequency of physical exercises seemed to decrease over time, whereas the use of cognitive and relaxation exercises remained stable. Physical performance and quality of life outcomes were significantly improved after 6 weeks. Conclusions: VR physical exercises at home is feasible and safe with good acceptance in a significant percentage of patient with post–COVID-19 condition. Trial Registration: ClinicalTrials.gov NCT04505761; https://clinicaltrials.gov/ct2/show/NCT04505761 %M 35858254 %R 10.2196/36836 %U https://rehab.jmir.org/2022/3/e36836 %U https://doi.org/10.2196/36836 %U http://www.ncbi.nlm.nih.gov/pubmed/35858254 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e35569 %T The Current State of Remote Physiotherapy in Finland: Cross-sectional Web-Based Questionnaire Study %A Hellstén,Thomas %A Arokoski,Jari %A Sjögren,Tuulikki %A Jäppinen,Anna-Maija %A Kettunen,Jyrki %+ Faculty of Medicine, University of Helsinki, P O Box 63, Haartmaninkatu 8, Helsinki, 00014, Finland, 358 407733154, thomas.hellsten@helsinki.fi %K COVID-19 %K remote physiotherapy %K COVID-19 pandemic %K current state %K suitability in disease groups %K competence of physiotherapist %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The ongoing COVID-19 pandemic has required social, health, and rehabilitation organizations to implement remote physiotherapy (RP) as a part of physiotherapists’ daily practice. RP may improve access to physiotherapy as it delivers physiotherapy services to rehabilitees through information and communications technology. Even if RP has already been introduced in this century, physiotherapists’ opinion, amount of use, and form in daily practice have not been studied extensively. Objective: This study aims to investigate physiotherapists’ opinions of the current state of RP in Finland. Methods: A quantitative, cross-sectional, web-based questionnaire was sent to working-aged members of the Finnish Association of Physiotherapists (n=5905) in March 2021 and to physiotherapists in a private physiotherapy organization (n=620) in May 2021. The questionnaire included questions on the suitability of RP in different diseases and the current state and implementation of RP in work among physiotherapists. Results: Of the 6525 physiotherapists, a total of 9.9% (n=662; n=504, 76.1% female; mean age 46.1, SD 12 years) answered the questionnaire. The mean suitability “score” (0=not suitable at all to 10=fully suitable) of RP in different disease groups varied from 3.3 (neurological diseases) to 6.1 (lung diseases). Between early 2020 (ie, just before the COVID-19 pandemic) and spring 2021, the proportion of physiotherapists who used RP increased from 33.8% (21/62) to 75.4% (46/61; P<.001) in the public sector and from 19.7% (42/213) to 76.6% (163/213; P<.001) in the private sector. However, only 11.7% (32/274) of physiotherapists reported that they spent >20% of their practice time for RP in 2021. The real-time method was the most common RP method in both groups (public sector 46/66, 69.7% vs private sector 157/219, 71.7%; P=.47). The three most commonly used technical equipments were computers/tablets (229/290, 79%), smartphones (149/290, 51.4%), and phones (voice call 51/290, 17.6%). The proportion of physiotherapists who used computers/tablets in RP was higher in the private sector than in the public sector (183/221, 82.8% vs 46/68, 67.6%; P=.01). In contrast, a higher proportion of physiotherapists in the public sector than in the private sector used phones (18/68, 26.5% vs 33/221, 14.9%; P=.04). Conclusions: During the COVID-19 pandemic, physiotherapists increased their use of RP in their everyday practice, although practice time in RP was still low. When planning RP for rehabilitees, it should be considered that the suitability of RP in different diseases seems to vary in the opinion of physiotherapists. Furthermore, our results brought up important new information for developing social, health, and rehabilitation education for information and communications technologies. %M 3560 %R 10.2196/35569 %U https://rehab.jmir.org/2022/2/e35569 %U https://doi.org/10.2196/35569 %U http://www.ncbi.nlm.nih.gov/pubmed/3560 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 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 %@ 2369-2529 %I JMIR Publications %V 7 %N 2 %P e23827 %T Leveraging Digital Technology to Overcome Barriers in the Prosthetic and Orthotic Industry: Evaluation of its Applicability and Use During the COVID-19 Pandemic %A Binedell,Trevor %A Subburaj,Karupppasamy %A Wong,Yoko %A Blessing,Lucienne T M %+ SUTD-MIT International Design Centre, Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Rd, Singapore, 65 6303 6600, trevor_binedell@ttsh.com.sg %K rehabilitation %K telehealth %K telemedicine %K 3D printing %K additive manufacturing %K prosthetics %K orthotics %K assistive technologies %K amputee %K stroke %K virtual %K COVID-19 %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The prosthetic and orthotic industry typically provides an artisan “hands-on” approach to the assessment and fitting of orthopedic devices. Despite growing interest in digital technology for prosthetic and orthotic service provision, little is known of the quantum of use and the extent to which the current pandemic has accelerated the adoption. Objective: This study’s aim is to assess the use of digital technology in prosthetics and orthotics, and whether its use can help overcome challenges posed by the current COVID-19 pandemic. Methods: A web-based survey of working prosthetists, orthotists, and lower limb patients was conducted between June and July 2020 and divided into three sections: lower limb amputees, prosthetist and orthotist (P&O) currently using digital technologies in their practice, and P&O not using any digital technology. Input was sought from industry and academia experts for the development of the survey. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. Results: In total, 113 individuals responded to the web-based survey. There were 83 surveys included in the analysis (patients: n=13, 15%; prosthetists and orthotists: n=70, 85%). There were 30 surveys excluded because less than 10% of the questions were answered. Out of 70 P&Os, 31 (44%) used digital technologies. Three dimensional scanning and digital imaging were the leading technologies being used (27/31, 88%), primarily for footwear (18/31, 58%), ankle-foot orthoses, and transtibial and transfemoral sockets (14/31, 45%). Digital technology enables safer care during COVID-19 with 24 out of 31 (77%) respondents stating it improves patient outcomes. Singapore was significantly less certain that the industry's future is digital (P=.04). The use of virtual care was reported by the P&O to be beneficial for consultations, education, patient monitoring, or triaging purposes. However, the technology could not overcome inherent barriers such as the lack of details normally obtained during a physical assessment. Conclusions: Digital technology is transforming health care. The current pandemic highlights its usefulness in providing safer care, but digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption. Technology advancements using virtual platforms, digitalization methods, and improved connectivity will continue to change the future of health care delivery. The prosthetic and orthotic industry should keep an open mind and move toward creating the required infrastructure to support this digital transformation, even if the world returns to pre–COVID-19 days. %M 33006946 %R 10.2196/23827 %U http://rehab.jmir.org/2020/2/e23827/ %U https://doi.org/10.2196/23827 %U http://www.ncbi.nlm.nih.gov/pubmed/33006946