TY - JOUR AU - Pessoa, Cheila PY - 2025/4/14 TI - Enhancing Self-Management Support Apps for Spinal Cord Injury: The Missing Role of Caregivers JO - JMIR Mhealth Uhealth SP - e72037 VL - 13 KW - mobile phone KW - mHealth KW - eHealth KW - telemedicine KW - telehealth KW - spinal cord injury KW - self-management KW - internet-based intervention KW - World Wide Web KW - systematic review KW - caregiver UR - https://mhealth.jmir.org/2025/1/e72037 UR - http://dx.doi.org/10.2196/72037 ID - info:doi/10.2196/72037 ER - TY - JOUR AU - Seel, Mariella AU - Mihalic, Alexander Julian AU - Froschauer, Mathias Stefan AU - Holzner, Bernhard AU - Meier, Jens AU - Gotterbarm, Tobias AU - Holzbauer, Matthias PY - 2025/3/25 TI - Changes in Health Education Literacy After Structured Web-Based Education Versus Self-Directed Online Information Seeking in Patients Undergoing Carpal Tunnel Release Surgery: Nonrandomized, Controlled Study JO - JMIR Form Res SP - e65114 VL - 9 KW - carpal tunnel release surgery KW - patient education KW - structured web-based education KW - online information KW - health education literacy KW - web-based KW - health education KW - information seeking KW - carpal tunnel release KW - carpal tunnel surgery KW - non-randomized KW - controlled study KW - self-management KW - perioperative KW - online health information KW - health literacy KW - day surgery KW - online search KW - carpal tunnel KW - carpal N2 - Background: With advancements in anesthesiologic and surgical techniques, many surgeries are now performed as day-surgery procedures, requiring greater responsibilities for self-management from patients during the perioperative process. Online health information often lacks reliability and comprehensibility, posing risks for patients with low health literacy. Carpal tunnel release (CTR) surgery, a common day-surgery procedure, necessitates effective patient education for optimal recovery and self-management. Objective: This study introduces the CTS Academy, a web-based education program designed for patients undergoing CTR day surgery. The study aimed to evaluate the CTS Academy?s impact on patients? health education literacy (HEL) compared with self-directed online information seeking. Methods: A scoping review on education programs focusing on the perioperative process of CTR was conducted before this study. In a nonrandomized controlled study, 60 patients scheduled for CTR were assigned to 2 groups based on the patients? preferences; the test group used the CTS Academy, while the control group performed self-directed online searches. HEL was assessed using the Health Education Literacy of Patients with chronic musculoskeletal diseases (HELP) questionnaire, focusing on patients?s comprehension of medical information (COMPR), patients?s ability to apply health-related information in an everyday life (APPLY), and patient?s ability to communicate with health care professional (COMM). Secondary outcomes included content comprehensibility, patient preferences, platform usability, and clinical carpal tunnel syndrome (CTS)?related parameters. Results: In the scoping review, 17 studies could be identified and included for full-text analysis. Eighteen patients each were included in the test group (13 women and 5 men) and in the control group (11 women and 7 men). The average time spent in the study was 167 and 176 days for the test and control groups, respectively. The test group showed significant improvements in APPLY (mean 28, SD 7.99 vs mean 24, SD 5.14; P<.05) and COMM (mean 30, SD 10.52 vs mean 25, SD 6.01; P=.02) after using the CTS Academy in a longitudinal analysis. No significant changes were observed in the control group. In a comparison between groups, the test group had significantly higher APPLY scores at follow-up (mean 24, SD 5.14 vs mean 33, SD 14.78; P=.044) and fewer comprehension issues at baseline (mean 38, SD 16.60 vs mean 50, SD 19.00; P=.03). The CTS-related knowledge assessment yielded 92% (66/72) versus 90% (65/72) correct answers in the test and control groups, respectively. The test group rated the CTS Academy highly in usability (6.22 of 7.00 points) and utility (6.13 of 7.00 points). Preferences leaned toward using CTS Academy alongside doctor consultations (16/18, 89%) and over self-directed searches (15/18, 84%). No significant differences were found in CTS-related symptoms between groups. Conclusions: The CTS Academy effectively enhanced patients? HEL, especially in applying and communicating medical information. The platform?s usability and utility were rated favorably, and patients preferred it over independent online information seeking. This suggests that structured, web-based education enhances patient self-management during the day surgery process. UR - https://formative.jmir.org/2025/1/e65114 UR - http://dx.doi.org/10.2196/65114 ID - info:doi/10.2196/65114 ER - TY - JOUR AU - Rafiei, Mahdie AU - Das, Supratim AU - Bakhtiari, Mohammad AU - Roos, Maria Ewa AU - Skou, T. Sřren AU - Grřnne, T. Dorte AU - Baumbach, Jan AU - Baumbach, Linda PY - 2025/3/21 TI - Personalized Predictions for Changes in Knee Pain Among Patients With Osteoarthritis Participating in Supervised Exercise and Education: Prognostic Model Study JO - JMIR Rehabil Assist Technol SP - e60162 VL - 12 KW - osteoarthritis KW - prediction KW - pain intensity KW - exercise therapy KW - machine learning N2 - Background: Knee osteoarthritis (OA) is a common chronic condition that impairs mobility and diminishes quality of life. Despite the proven benefits of exercise therapy and patient education in managing OA pain and functional limitations, these strategies are often underused. To motivate and enhance patient engagement, personalized outcome prediction models can be used. However, the accuracy of existing models in predicting changes in knee pain outcomes remains insufficiently examined. Objective: This study aims to validate existing models and introduce a concise personalized model predicting changes in knee pain from before to after participating in a supervised patient education and exercise therapy program (GLA:D) among patients with knee OA. Methods: Our prediction models leverage self-reported patient information and functional measures. To refine the number of variables, we evaluated the variable importance and applied clinical reasoning. We trained random forest regression models and compared the rate of true predictions of our models with those using average values. In supplementary analyses, we additionally considered recently added variables to the GLA:D registry. Results: We evaluated the performance of a full, continuous, and concise model including all 34 variables, all 11 continuous variables, and the 6 most predictive variables, respectively. All three models performed similarly and were comparable to the existing model, with R2 values of 0.31?0.32 and root-mean-squared errors of 18.65?18.85?despite our increased sample size. Allowing a deviation of 15 (visual analog scale) points from the true change in pain, our concise model correctly estimated the change in pain in 58% of cases, while using average values that resulted in 51% accuracy. Our supplementary analysis led to similar outcomes. Conclusions: Our concise personalized prediction model provides more often accurate predictions for changes in knee pain after the GLA:D program than using average pain improvement values. Neither the increase in sample size nor the inclusion of additional variables improved previous models. Based on current knowledge and available data, no better predictions are possible. Guidance is needed on when a model?s performance is good enough for clinical practice use. UR - https://rehab.jmir.org/2025/1/e60162 UR - http://dx.doi.org/10.2196/60162 ID - info:doi/10.2196/60162 ER - TY - JOUR AU - Rampioni, Margherita AU - Leonzi, Sara AU - Antognoli, Luca AU - Mura, Anna AU - Stara, Vera PY - 2025/3/4 TI - Poststroke eHealth Technologies?Based Rehabilitation for Upper Limb Recovery: Systematic Review JO - J Med Internet Res SP - e57957 VL - 27 KW - stroke KW - rehabilitation KW - technology-based interventions KW - upper limb KW - technologies-based rehabilitation KW - limb KW - systematic review KW - cerebral vascular diseases KW - patient KW - effectiveness KW - database KW - therapy KW - conventional therapy KW - mobile phone N2 - Background: Stroke is one of the most common cerebral vascular diseases, usually affecting people aged 60 years and older. It leads to a variety of disabilities requiring motor and cognitive rehabilitation. Poststroke rehabilitation is critical for recovery, particularly for upper limb impairments, which affect approximately 80% of stroke survivors. Conventional rehabilitation often faces barriers such as cost, accessibility, and patient adherence. In contrast, eHealth technologies offer a promising alternative by providing accessible, cost-effective, and engaging rehabilitation solutions. Objective: While numerous systematic reviews have explored various aspects of technology-based rehabilitation for poststroke upper limb recovery, there is a notable lack of comprehensive synthesis of these findings. This gap presents challenges, primarily due to the focus on specific technologies, which complicates understanding the overall effectiveness of these interventions. Consequently, clinicians and researchers may find it difficult to assess the field holistically, potentially hindering informed decision-making in clinical practice. This review synthesizes evidence from systematic reviews evaluating the effectiveness of eHealth technology?based interventions for upper limb recovery in poststroke individuals. Two main questions are examined: (1) Are eHealth technology?based therapies more or equally effective than conventional therapies for stroke rehabilitation? (2) What are the main clinical considerations for low-cost eHealth technology?based rehabilitation? Methods: Comprehensive literature searches were conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar using predefined inclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework. Systematic reviews published in English without date restrictions were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart guided study selection. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) criteria. Results: A total of 1792 records were screened, resulting in 7 systematic reviews published between 2019 and 2023 being included. These reviews encompassed 95 studies involving 2995 participants with a mean age of 58.8 years across acute, subacute, and chronic stroke phases. Interventions included telerehabilitation, mobile health (mHealth) apps, augmented reality (AR), virtual reality (VR), wearable devices, and exergames. While AR and VR demonstrated potential benefits when combined with conventional therapies (eg, AR showing significant improvements in upper limb function with a standardized mean difference 0.657; P<.001), evidence for stand-alone effectiveness remained inconclusive due to heterogeneity in study designs, intervention protocols, and outcome measures. Most reviews were rated as critically low quality due to methodological limitations. Conclusions: eHealth technologies hold promise for enhancing upper limb rehabilitation post stroke by addressing barriers such as cost and accessibility while providing engaging interventions. However, the field remains fragmented with insufficient evidence to establish clear efficacy. Future research should focus on standardizing protocols, optimizing neurorehabilitation principles such as dosage and task specificity, and improving methodological rigor to evaluate these interventions? long-term impact better. UR - https://www.jmir.org/2025/1/e57957 UR - http://dx.doi.org/10.2196/57957 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053744 ID - info:doi/10.2196/57957 ER - TY - JOUR AU - Rujeedawa, Tanzil AU - Karimi, Zahabiya AU - Wood, Helen AU - Sangeorzan, Irina AU - Smith, Roy AU - Sadler, Iwan AU - Martin-Moore, Esther AU - Gardner, Adrian AU - K Demetriades, Andreas AU - Sinha, Rohitashwa AU - Grahovac, Gordan AU - Bateman, Antony AU - Deakin, Naomi AU - Davies, Benjamin PY - 2025/2/24 TI - Evaluation of Financial Support Workshops for Patients Under State Pension Age With Degenerative Cervical Myelopathy: Survey Study JO - JMIR Form Res SP - e59032 VL - 9 KW - myelopathy KW - degenerative KW - spine KW - spinal KW - benefits KW - aid KW - financial KW - money KW - income KW - poverty KW - disability KW - disabled KW - finance KW - workshop KW - education KW - service KW - access KW - accessibility KW - navigate KW - confidence KW - government N2 - Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels of disability and dependence, and may reduce quality of life. Myelopathy.org is the first global scientific and clinical charity for DCM, providing an accessible platform freely disseminating information relevant to the DCM diagnosis and its treatment. Significant transient and long-term change to earnings do occur and can thrust individuals into poverty. People with DCM face many challenges accessing state financial assistance. This can have a cumulative negative financial effect due to the association between DCM and low socioeconomic index. Financial support available to patients under pension age include Universal Credit (UC), a payment that helps with living costs, and Personal Independence Payment (PIP), which helps with extra living costs if someone has both a long-term health condition or disability and difficulty doing certain everyday tasks. Objective: This study aimed to assess if delivering workshops centered around access to financial support could assist people with DCM living in the United Kingdom. Methods: A series of 2 internet-based workshops was targeted at accessing financial support for English patients under the state pension age, with an anonymized survey delivered to participants after each session. The first session was on UC and the second on PIP. The survey consisted of a mixture of Likert scales, free text and yes or no answers. Survey responses were analyzed using descriptive statistics and free text answers underwent inductive thematic analysis. Results: The average rating on the use of UC was 9.00/10. Presession self-rated confidence levels were 5.11/10 rising to 8.00/10. The mean score of wanting further similar sessions was 8.67/10 with 56% (5/9) of participants wanting one-to-one sessions. For PIP, the average session use rating was 10/10. Presession self-rated confidence levels were 4.43/10 rising to 9.57/10. The mean score of wanting further similar sessions was 8.71/10, with 43% (3/7) of participants wanting one-to-one sessions . Following inductive thematic analysis, themes regarding the usefulness of such sessions and the challenges to accessing financial support emerged. One participant gave negative feedback, which included the length of the session and perceived problems around confidentiality and data protection. Conclusions: The pilot series was largely perceived as a success, with participants finding them useful and increasing their self-rated confidence in navigating the UK financial support system. Given the small sample size, it is hard to predict the success of future sessions. Finally, given that the hurdles in accessing financial support extend beyond DCM, such workshops may be relevant to other organizations. UR - https://formative.jmir.org/2025/1/e59032 UR - http://dx.doi.org/10.2196/59032 ID - info:doi/10.2196/59032 ER - TY - JOUR AU - Oh, Sejun AU - Lee, SangHeon PY - 2025/1/28 TI - Rehabilomics Strategies Enabled by Cloud-Based Rehabilitation: Scoping Review JO - J Med Internet Res SP - e54790 VL - 27 KW - cloud-based KW - health KW - rehabilitation KW - rehabilomics KW - strategies N2 - Background: Rehabilomics, or the integration of rehabilitation with genomics, proteomics, metabolomics, and other ?-omics? fields, aims to promote personalized approaches to rehabilitation care. Cloud-based rehabilitation offers streamlined patient data management and sharing and could potentially play a significant role in advancing rehabilomics research. This study explored the current status and potential benefits of implementing rehabilomics strategies through cloud-based rehabilitation. Objective: This scoping review aimed to investigate the implementation of rehabilomics strategies through cloud-based rehabilitation and summarize the current state of knowledge within the research domain. This analysis aims to understand the impact of cloud platforms on the field of rehabilomics and provide insights into future research directions. Methods: In this scoping review, we systematically searched major academic databases, including CINAHL, Embase, Google Scholar, PubMed, MEDLINE, ScienceDirect, Scopus, and Web of Science to identify relevant studies and apply predefined inclusion criteria to select appropriate studies. Subsequently, we analyzed 28 selected papers to identify trends and insights regarding cloud-based rehabilitation and rehabilomics within this study?s landscape. Results: This study reports the various applications and outcomes of implementing rehabilomics strategies through cloud-based rehabilitation. In particular, a comprehensive analysis was conducted on 28 studies, including 16 (57%) focused on personalized rehabilitation and 12 (43%) on data security and privacy. The distribution of articles among the 28 studies based on specific keywords included 3 (11%) on the cloud, 4 (14%) on platforms, 4 (14%) on hospitals and rehabilitation centers, 5 (18%) on telehealth, 5 (18%) on home and community, and 7 (25%) on disease and disability. Cloud platforms offer new possibilities for data sharing and collaboration in rehabilomics research, underpinning a patient-centered approach and enhancing the development of personalized therapeutic strategies. Conclusions: This scoping review highlights the potential significance of cloud-based rehabilomics strategies in the field of rehabilitation. The use of cloud platforms is expected to strengthen patient-centered data management and collaboration, contributing to the advancement of innovative strategies and therapeutic developments in rehabilomics. UR - https://www.jmir.org/2025/1/e54790 UR - http://dx.doi.org/10.2196/54790 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54790 ER - TY - JOUR AU - Turcott, Alyssa AU - Kang, Ruthine AU - Yao, Christopher AU - O'Melinn, Colleen AU - Mahoney, Patricia AU - Barlow, Susan AU - Schmidt, Julia PY - 2025/1/7 TI - The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study JO - JMIR Rehabil Assist Technol SP - e59181 VL - 12 KW - concussion KW - self-management KW - health information technology KW - perceptions KW - concussion recovery KW - concussion management KW - concussion rehabilitation KW - rehabilitation KW - self-management tool KW - perception KW - digital health KW - e-health KW - mobile app KW - mhealth KW - web-based tool N2 - Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. Objective: This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool. Methods: Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed. Results: Participants reported two key benefits of using the web-based self-management tool: (1) the tool?s emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients? independence in managing their own recovery. Conclusions: Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use. UR - https://rehab.jmir.org/2025/1/e59181 UR - http://dx.doi.org/10.2196/59181 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59181 ER - TY - JOUR AU - Bernard, M. Renaldo AU - Seijas, Vanessa AU - Davis, Micheal AU - Volkova, Anel AU - Diviani, Nicola AU - Lüscher, Janina AU - Sabariego, Carla PY - 2024/12/19 TI - Self-Management Support Apps for Spinal Cord Injury: Results of a Systematic Search in App Stores and Mobile App Rating Scale Evaluation JO - JMIR Mhealth Uhealth SP - e53677 VL - 12 KW - mobile phone KW - mobile health KW - mHealth KW - eHealth KW - telemedicine KW - telehealth KW - spinal cord injury KW - self-management KW - internet-based intervention KW - world wide web KW - systematic review KW - review N2 - Background: The use of mobile technology to meet health needs, widely referred to as mobile health (mHealth), has played a critical role in providing self-management support for chronic health conditions. However, despite its potential benefits, mHealth technologies such as self-management support apps for spinal cord injury (SCI) have received little research attention, and an understanding of their public availability is lacking. Therefore, an overview of these apps is needed to complement findings from the literature for a complete understanding of mHealth self-management support tools for SCI to support the selection and improvement of existing apps and the development of new ones. Objective: This study aimed to identify and describe quantity, quality, focus, strengths, and weaknesses of self-management support apps for SCI available on major mobile app digital distribution platforms. Methods: A systematic search of the Google Play Store and Apple App Store was conducted to identify and summarize apps for SCI that have been updated since 2017. A supplementary systematic literature review was conducted across 11 bibliographic databases to identify publications that provided more detailed descriptions of the identified apps than what is typically available in app stores. The data synthesis was guided by self-management tasks and skills taxonomies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines informed the reporting. Results: The 13 apps included in the final synthesis were launched between 2013 and 2021, mostly originating in the United States, with availability in 72 countries and support for 14 languages. Most apps used the Android operating system (10/13, 77%), while 31% (4/13) used iOS. The identified apps mainly focused on activities of daily living, physical activity promotion, health literacy, and therapeutic exercise. All 3 self-management tasks (medical, role, and emotional management) and most self-management skills and support activities were supported by the apps. The mean Mobile App Rating Scale score was 3.86 (SD 0.54), indicating good overall quality. No publications were found describing these apps. Conclusions: Despite their good overall quality, as measured by the Mobile App Rating Scale assessment, the 13 identified apps, alone or combined, do not appear to offer a comprehensive self-management approach that incorporates theory-based strategies. Besides working to improve comprehensiveness, future research and practice should consider adopting new technologies, such as artificial intelligence, to enhance future self-management support apps for SCI. Furthermore, adopting new app development methods, such as low-code development platforms, could help reduce barriers to development, such as time, cost, and securing scarce expertise. UR - https://mhealth.jmir.org/2024/1/e53677 UR - http://dx.doi.org/10.2196/53677 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53677 ER - TY - JOUR AU - C Areias, Anabela AU - G Moulder, Robert AU - Molinos, Maria AU - Janela, Dora AU - Bento, Virgílio AU - Moreira, Carolina AU - Yanamadala, Vijay AU - P Cohen, Steven AU - Dias Correia, Fernando AU - Costa, Fabíola PY - 2024/11/19 TI - Predicting Pain Response to a Remote Musculoskeletal Care Program for Low Back Pain Management: Development of a Prediction Tool JO - JMIR Med Inform SP - e64806 VL - 12 KW - telerehabilitation KW - predictive modeling KW - personalized medicine KW - rehabilitation KW - clinical decision support KW - machine learning KW - artificial intelligence N2 - Background: Low back pain (LBP) presents with diverse manifestations, necessitating personalized treatment approaches that recognize various phenotypes within the same diagnosis, which could be achieved through precision medicine. Although prediction strategies have been explored, including those employing artificial intelligence (AI), they still lack scalability and real-time capabilities. Digital care programs (DCPs) facilitate seamless data collection through the Internet of Things and cloud storage, creating an ideal environment for developing and implementing an AI predictive tool to assist clinicians in dynamically optimizing treatment. Objective: This study aims to develop an AI tool that continuously assists physical therapists in predicting an individual?s potential for achieving clinically significant pain relief by the end of the program. A secondary aim was to identify predictors of pain nonresponse to guide treatment adjustments. Methods: Data collected actively (eg, demographic and clinical information) and passively in real-time (eg, range of motion, exercise performance, and socioeconomic data from public data sources) from 6125 patients enrolled in a remote digital musculoskeletal intervention program were stored in the cloud. Two machine learning techniques, recurrent neural networks (RNNs) and light gradient boosting machine (LightGBM), continuously analyzed session updates up to session 7 to predict the likelihood of achieving significant pain relief at the program end. Model performance was assessed using the area under the receiver operating characteristic curve (ROC-AUC), precision-recall curves, specificity, and sensitivity. Model explainability was assessed using SHapley Additive exPlanations values. Results: At each session, the model provided a prediction about the potential of being a pain responder, with performance improving over time (P<.001). By session 7, the RNN achieved an ROC-AUC of 0.70 (95% CI 0.65-0.71), and the LightGBM achieved an ROC-AUC of 0.71 (95% CI 0.67-0.72). Both models demonstrated high specificity in scenarios prioritizing high precision. The key predictive features were pain-associated domains, exercise performance, motivation, and compliance, informing continuous treatment adjustments to maximize response rates. Conclusions: This study underscores the potential of an AI predictive tool within a DCP to enhance the management of LBP, supporting physical therapists in redirecting care pathways early and throughout the treatment course. This approach is particularly important for addressing the heterogeneous phenotypes observed in LBP. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 and NCT05417685; https://clinicaltrials.gov/ct2/show/NCT05417685 UR - https://medinform.jmir.org/2024/1/e64806 UR - http://dx.doi.org/10.2196/64806 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64806 ER - TY - JOUR AU - Chen, Xing-Ling AU - Li, Jin AU - Sun, Shu-Ning AU - Zhao, Qiang-Qiang AU - Lin, Sheng-Rong AU - Wang, Ling-Jun AU - Yang, Zhong-Qi AU - Ni, Shi-Hao AU - Lu, Lu PY - 2024/11/12 TI - Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study JO - J Med Internet Res SP - e54200 VL - 26 KW - daily internet use KW - intrinsic capacity KW - IC KW - middle-aged and older adult KW - healthy aging KW - social participation N2 - Background: Intrinsic capacity (IC), as a comprehensive measure of an individual?s functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population. Objective: This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC. Methods: Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ?45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status. Results: Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9%) did not use the internet, while 521 (4.1%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78% (95% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001). Conclusions: The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics. UR - https://www.jmir.org/2024/1/e54200 UR - http://dx.doi.org/10.2196/54200 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54200 ER - TY - JOUR AU - Lange-Drenth, Lukas AU - Schulz, Holger AU - Suck, Isabell AU - Bleich, Christiane PY - 2024/11/8 TI - Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders JO - JMIR Form Res SP - e51865 VL - 8 KW - telerehabilitation KW - rehabilitation KW - eHealth development KW - value specification KW - stakeholder participation KW - occupational injuries KW - vocational rehabilitation KW - aftercare KW - mobile phone N2 - Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients? lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. UR - https://formative.jmir.org/2024/1/e51865 UR - http://dx.doi.org/10.2196/51865 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51865 ER - TY - JOUR AU - Areias, C. Anabela AU - Janela, Dora AU - Molinos, Maria AU - Bento, Virgílio AU - Moreira, Carolina AU - Yanamadala, Vijay AU - Cohen, P. Steven AU - Correia, Dias Fernando AU - Costa, Fabíola PY - 2024/10/29 TI - Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study JO - J Med Internet Res SP - e65354 VL - 26 KW - musculoskeletal pain KW - physical therapy KW - telerehabilitation KW - eHealth KW - racial/ethnic concordance KW - patient?provider concordance KW - digital rehabilitation KW - musculoskeletal conditions N2 - Background: Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. Objective: This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. Methods: This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). Results: Of 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted ? coefficient 5.32, 95% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01). Conclusions: Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. Trial Registration: ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946 UR - https://www.jmir.org/2024/1/e65354 UR - http://dx.doi.org/10.2196/65354 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470695 ID - info:doi/10.2196/65354 ER - TY - JOUR AU - Zeidan, S. Rola AU - Ohama, K. Margaret AU - Evripidou, Natalia AU - Anton, D. Stephen AU - Hamed, L. Laith AU - Lin, Yi AU - Leeuwenburgh, Christiaan AU - Guirguis, W. Faheem AU - Efron, A. Philip AU - Flynn, Sheryl AU - Smith, Barbara AU - Bacher, Rhonda AU - Bakarasan, Naveen AU - Sarmiento Delgado, Juan AU - Mankowski, T. Robert PY - 2024/10/17 TI - Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial JO - JMIR Res Protoc SP - e60270 VL - 13 KW - sepsis KW - physical function KW - exercise KW - rehabilitation KW - remotely delivered KW - aging N2 - Background: While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. Objective: This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. Methods: The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. Results: This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. Conclusions: This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. Trial Registration: ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511 International Registered Report Identifier (IRRID): DERR1-10.2196/60270 UR - https://www.researchprotocols.org/2024/1/e60270 UR - http://dx.doi.org/10.2196/60270 UR - http://www.ncbi.nlm.nih.gov/pubmed/39418096 ID - info:doi/10.2196/60270 ER - TY - JOUR AU - Van Oirschot, Garett AU - Pomphrey, Amanda AU - Dunne, Caoimhe AU - Murphy, Kate AU - Blood, Karina AU - Doherty, Cailbhe PY - 2024/10/15 TI - An Evaluation of the Design of Multimedia Patient Education Materials in Musculoskeletal Health Care: Systematic Review JO - JMIR Rehabil Assist Technol SP - e48154 VL - 11 KW - health education KW - patient education KW - patient education materials KW - multimedia KW - musculoskeletal diseases KW - musculoskeletal pain KW - eHealth KW - self-management N2 - Background: Educational multimedia is a cost-effective and straightforward way to administer large-scale information interventions to patient populations in musculoskeletal health care. While an abundance of health research informs the content of these interventions, less guidance exists about optimizing their design. Objective: This study aims to identify randomized controlled trials of patient populations with musculoskeletal conditions that used multimedia-based patient educational materials (PEMs) and examine how design was reported and impacted patients? knowledge and rehabilitation outcomes. Design was evaluated using principles from the cognitive theory of multimedia learning (CTML). Methods: PubMed, CINAHL, PsycINFO, and Embase were searched from inception to September 2023 for studies examining adult patients with musculoskeletal conditions receiving multimedia PEMs compared to any other interventions. The primary outcome was knowledge retention measured via test scores. Secondary outcomes were any patient-reported measures. Retrievability was noted, and PEMs were sourced through search, purchase, and author communication. Results: A total of 160 randomized controlled trials were eligible for inclusion: 13 (8.1%) included their educational materials and 31 (19.4%) required a web search, purchase, or direct requests for educational materials. Of these 44 (27.5%) studies, none fully optimized the design of their educational materials, particularly lacking in the CTML principles of coherence, redundancy, modality, and generative activities for the learner. Of the 160 studies, the remaining 116 (72.5%) contained interventions that could not be retrieved or appraised. Learning was evaluated in 5 (3.1%) studies. Conclusions: Musculoskeletal studies should use open science principles and provide their PEMs wherever possible. The link between providing multimedia PEMs and patient learning is largely unexamined, but engagement potential may be maximized when considering design principles such as the CTML. UR - https://rehab.jmir.org/2024/1/e48154 UR - http://dx.doi.org/10.2196/48154 UR - http://www.ncbi.nlm.nih.gov/pubmed/39162239 ID - info:doi/10.2196/48154 ER - TY - JOUR AU - Butler, Sonia AU - Sculley, Dean AU - Santos, Derek AU - Girončs, Xavier AU - Singh-Grewal, Davinder AU - Coda, Andrea PY - 2024/9/17 TI - Development and Delivery of an Integrated Digital Health Care Approach for Children With Juvenile Idiopathic Arthritis: Usability Study JO - JMIR Pediatr Parent SP - e56816 VL - 7 KW - phone app KW - smart watch KW - juvenile idiopathic arthritis KW - pain KW - medication adherence KW - physical activity KW - integrated care KW - medication KW - development KW - usability study KW - chronic inflammatory disorder KW - children KW - child KW - usability KW - survey KW - thematic analysis KW - gamification KW - modules KW - web-based platform KW - support N2 - Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics among children with JIA. Methods: As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Results: Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7%) and 1 parent for each child (n=12; female: n=8, 66.7%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. Conclusions: The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Trial Registration: ANZCTR ACTRN12616000665437; https://tinyurl.com/mwwfje8r UR - https://pediatrics.jmir.org/2024/1/e56816 UR - http://dx.doi.org/10.2196/56816 ID - info:doi/10.2196/56816 ER - TY - JOUR AU - Widhalm, Klaus AU - Maul, Lukas AU - Durstberger, Sebastian AU - Putz, Peter AU - Leder-Berg, Sebastian AU - Kainz, Hans AU - Augat, Peter PY - 2024/8/20 TI - Efficacy of Real-Time Feedback Exercise Therapy in Patients Following Total Hip Arthroplasty: Protocol for a Pilot Cluster-Randomized Controlled Trial JO - JMIR Res Protoc SP - e59755 VL - 13 KW - hip replacement KW - exercise therapy KW - real-time feedback KW - movement analysis N2 - Background: Osteoarthritis of the hip joint is an increasing functional and health-related problem. The most common surgical treatment is hip replacement to reduce pain and improve function. Rehabilitation after total hip arthroplasty (THA) is not regulated in Austria and mostly depends on the patient?s own initiative and possibilities. Functional deficits, such as valgus thrust of the leg, functional Trendelenburg gait, or Duchenne limp, are characteristic symptoms before and, due to the performance learning effect prior to surgery, also after the operation. Addressing these deficits is possible through neuromuscular-focused exercise therapy. The efficacy of such therapy relies significantly on the quality of performance, the frequency of exercise, and the duration of engagement. Enhancing sustainability is achievable through increased motivation and real-time feedback (RTF) on exercise execution facilitated by digital feedback systems. Objective: This study will be performed to quantify the medium-term effectiveness of digital home exercise feedback systems on functional performance following THA. Methods: A clinical trial with a cluster-randomized, 2-arm, parallel-group design with an 8-week intervention phase and subsequent follow-ups at 3 and 6 months postsurgery will be conducted. Feedback during exercising will be provided through a blended-care program, combining a supervised group exercise program with a self-developed digital feedback system for home exercise. In total, 70 patients will be recruited for baseline. The primary outcome parameters will be the frontal knee range of motion, pelvic obliquity, and lateral trunk lean. Secondary outcomes will be the sum scores of patient-reported outcomes and relevant kinematic, kinetic, and spatiotemporal parameters. Results: The trial started in January 2024, and the first results are anticipated to be published by June 2025. RTF-supported home exercise is expected to improve exercise execution quality and therapeutic adherence compared to using paper instructions for excise guidance. Conclusions: The anticipated findings of this study aim to offer new insights into the effect of a blended-care program incorporating digital RTF on exercise therapy after unilateral THA, in addition to knowledge on the functional status 3 and 6 months postsurgery, for further improvement in the development of rehabilitation guidelines following THA. Trial Registration: ClinicalTrials.gov: NCT06161194; https://clinicaltrials.gov/study/NCT06161194 International Registered Report Identifier (IRRID): PRR1-10.2196/59755 UR - https://www.researchprotocols.org/2024/1/e59755 UR - http://dx.doi.org/10.2196/59755 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59755 ER - TY - JOUR AU - Barcheus, Ida-Maria AU - Ranner, Maria AU - Mĺnsson Lexell, Eva AU - Jacobsson, Lars AU - Larsson-Lund, Maria PY - 2024/8/15 TI - The Internet-Based Intervention Strategies for Empowering Activities in Everyday Life: Qualitative Study of Experiences of Clients With Stroke JO - JMIR Form Res SP - e56189 VL - 8 KW - internet-based rehabilitation KW - occupational therapy intervention KW - rehabilitation KW - self-management KW - stroke KW - active everyday life KW - activity-based intervention N2 - Background: There is a need to enhance access to and support for self-management of activities in everyday life after a stroke. Internet-based solutions have the potential to contribute to this development. Consequently, an internet-based intervention called Strategies for Empowering Activities in Everyday Life (SEE) was developed. The intervention aims to assist clients in developing management strategies that promote a healthy distribution and balanced engagement in various activities performed in different places and with other people. To further support the development and feasibility of this intervention, more knowledge is needed about clients? experiences during the intervention process. Objective: This study aims to explore and describe how clients with stroke experienced the SEE intervention process and whether participation in SEE influenced their experience of everyday life. Methods: Overall, 9 clients with stroke who received SEE participated in the study?4 (44%) women and 5 (56%) men aged 37 to 73 years. Qualitative interviews about experiences with SEE were conducted twice during the intervention process with each participant. The data were analyzed using the constant comparative method of grounded theory. Results: The participants? experiences with the intervention process of SEE formed the core category, conceptualized as The relevance of and readiness for entering a change process in activities of everyday life differ among clients, constituting of two main categories: (1) an eye-opener providing agency for a change process and (2) never beginning a change process in activities in everyday life. The results showed that the relevance of and readiness for SEE differed between the participants. The experiences of 78% (7/9) of the participants reflected that the intervention process provided them with an agency to drive their own change process for activities in everyday life to promote health. Overall, 22% (2/9) of the participants refrained from entering a change process during SEE as they did not recognize any need for changes in their activities. When SEE was relevant and adopted as expected, the participants described it as an eye-opener for how they can alter their health based on how they distribute and spend their time on various activities. Conclusions: SEE has the potential to support clients? development of self-management and to take an active role in influencing their engagement in activities in everyday life and health. This study identified necessary improvements in the educational program for professionals to enhance delivery and strengthen the therapeutic mechanisms of SEE for future research. To effectively implement internet-based interventions such as SEE, it is crucial to identify clients who express a need for self-management in activities and are ready to invest the effort required to adopt a change process. Furthermore, it is indicated that participants? self-analysis of their everyday activities empowers them to adopt new self-management strategies, which can also benefit other interventions. UR - https://formative.jmir.org/2024/1/e56189 UR - http://dx.doi.org/10.2196/56189 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56189 ER - TY - JOUR AU - Munce, EP Sarah PY - 2024/4/22 TI - Introducing JMIR Rehabilitation and Assistive Technologies: A Venue for Publishing Interdisciplinary Research on the Development, Implementation, and Evaluation of Health Innovations and Emerging Technologies in the Field of Rehabilitation JO - JMIR Rehabil Assist Technol SP - e56348 VL - 11 KW - rehabilitation KW - assistive technologies KW - JMIR Rehabilitation and Assistive Technologies KW - digital KW - online UR - https://rehab.jmir.org/2024/1/e56348 UR - http://dx.doi.org/10.2196/56348 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648632 ID - info:doi/10.2196/56348 ER - TY - JOUR AU - Li, Zhaoying AU - Lei, Yating AU - Bui, Quoc AU - DePaul, Olivia AU - Nicol, E. Ginger AU - Mohr, C. David AU - Lee, I. Sunghoon AU - Fong, M. Mandy W. AU - Metts, L. Christopher AU - Tomazin, E. Stephanie AU - Wong, K. Alex W. PY - 2024/2/19 TI - A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial JO - JMIR Rehabil Assist Technol SP - e50863 VL - 11 KW - digital intervention KW - feasibility KW - mobile health KW - participation KW - rehabilitation KW - self-efficacy KW - self-management KW - stroke KW - technology KW - telehealth KW - telemedicine KW - text messaging N2 - Background: Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. Objective: This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. Methods: A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System?s Self-Efficacy for Managing Chronic Conditions. Results: The retention rate was 82% (9/11), and the engagement (SMS text message response) rate was 78% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). Conclusions: Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. Trial Registration: ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137&rank=1 UR - https://rehab.jmir.org/2024/1/e50863 UR - http://dx.doi.org/10.2196/50863 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373029 ID - info:doi/10.2196/50863 ER - TY - JOUR AU - van der Horst, Annemieke AU - Meijer, Laura AU - van Os - Medendorp, Harmieke AU - Jukema, S. Jan AU - Bohlmeijer, Ernst AU - Schreurs, MG Karlein AU - Kelders, Saskia PY - 2024/2/7 TI - Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study JO - JMIR Form Res SP - e54600 VL - 8 KW - pilot feasibility study KW - spinal surgery KW - digital health intervention KW - positive psychology KW - acceptance and commitment therapy KW - mobile phone N2 - Background: Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. Objective: The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). Methods: We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum?Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. Results: A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum?Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients. Conclusions: This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted. UR - https://formative.jmir.org/2024/1/e54600 UR - http://dx.doi.org/10.2196/54600 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324374 ID - info:doi/10.2196/54600 ER - TY - JOUR AU - Zhou, Siyu AU - Gromala, Diane AU - Wang, Leyu PY - 2023/12/4 TI - Ethical Challenges of Virtual Reality Technology Interventions for the Vulnerabilities of Patients With Chronic Pain: Exploration of Technician Responsibility JO - J Med Internet Res SP - e49237 VL - 25 KW - patients with chronic pain KW - vulnerability KW - virtual reality interventions KW - ethics KW - responsibility KW - technical developers UR - https://www.jmir.org/2023/1/e49237 UR - http://dx.doi.org/10.2196/49237 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048153 ID - info:doi/10.2196/49237 ER - TY - JOUR AU - Vaezipour, Atiyeh AU - Aldridge, Danielle AU - Koenig, Sebastian AU - Burns, Clare AU - Baghaei, Nilufar AU - Theodoros, Deborah AU - Russell, Trevor PY - 2023/10/31 TI - Rehabilitation Supported by Immersive Virtual Reality for Adults With Communication Disorders: Semistructured Interviews and Usability Survey Study JO - JMIR Rehabil Assist Technol SP - e46959 VL - 10 KW - communication disorders KW - speech and language therapy KW - rehabilitation KW - virtual reality KW - human-computer interaction KW - technology acceptance KW - acceptance KW - communication KW - therapy KW - usefulness KW - usability KW - survey KW - barrier KW - mobile phone N2 - Background: Individuals who have acquired communication disorders often struggle to transfer the skills they learn during therapy sessions to real-life situations. Immersive virtual reality (VR) technology has the potential to create realistic communication environments that can be used both in clinical settings and for practice at home by individuals with communication disorders. Objective: This research aims to enhance our understanding of the acceptance, usefulness, and usability of a VR application (SIM:Kitchen), designed for communication rehabilitation. Additionally, this research aims to identify the perceived barriers and benefits of using VR technology from the perspective of individuals with acquired communication disorders. Methods: Semistructured interviews and usability surveys were conducted with 10 individuals with acquired neurogenic communication disorders aged 46-81 (mean 58, SD 9.57) years after trialing an immersive VR application. The audio-recorded interviews were transcribed and analyzed to identify themes. Results: The quantitative data regarding the usability of the system associated with participants? immersion experience in the VR application were promising. Findings from semistructured interviews are discussed across five key thematic areas including (1) participant?s attitude toward VR, (2) perceived usefulness of the VR system, (3) perceived ease of use of the VR system, (4) their willingness to continue using VR, and (5) the factors they perceived as challenges or facilitators to adopting this VR technology. Conclusions: Overall, participants in this study found the VR experience to be enjoyable and were impressed by the realism of the VR application designed for communication rehabilitation. This study highlighted personally relevant, immersive VR interventions with different levels of task difficulty that could enhance technology uptake in the context of communication rehabilitation. However, it is essential that VR hand controller technology is refined to be more naturalistic in movement and able to accommodate user capabilities. UR - https://rehab.jmir.org/2023/1/e46959 UR - http://dx.doi.org/10.2196/46959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37906228 ID - info:doi/10.2196/46959 ER - TY - JOUR AU - Krag, Thea AU - Jřrgensen, Hřjgaard Emma AU - Phanareth, Klaus AU - Kayser, Lars PY - 2023/8/14 TI - Experiences With In-Person and Virtual Health Care Services for People With Chronic Obstructive Pulmonary Disease: Qualitative Study JO - JMIR Rehabil Assist Technol SP - e43237 VL - 10 KW - chronic obstructive pulmonary disease KW - telemedicine KW - telehealth KW - virtual RCC service KW - rehabilitation KW - self-management KW - eHealth literacy KW - social support KW - well-being N2 - Background: The World Health Organization and the European Commission predict increased use of health technologies in the future care for patients in Europe. Studies have shown that services based on telehealth, which includes components of education, as well as rehabilitation initiatives can support the self-management of individuals living with COPD. This raises an interest in how virtual and in-person interactions and roles can best be organized in a way that suits people living with COPD in relation to their treatment and rehabilitation. Objective: This study aims to investigate how individuals living with COPD experience different combinations of virtual and in-person care, to help us better understand what aspects are valued and how to best combine elements of these services in future care. Methods: Two rounds of semistructured interviews were conducted with 13 and 4 informants, respectively. The individuals were all recruited in relation to a research project led by the telehealth initiative Epital Health. The first round of interviews included 11 informants, as 2 dropped out. Of these, 7 received the telemedicine service provided by Epital Health, 3 participated in a 12-week COPD program provided by their respective municipality, and 1 did not receive any supplementary service besides the usual care. In the second round, which included 4 informants, all had at one point received the telemedicine service and participated in a municipality-based rehabilitation program. A content analysis of the interviews was performed based on deductive coding with 4 categories, namely, (1) Self-management, (2) Health-related support, (3) Digital context, and (4) Well-being. Results: Medical and emotional support from health care professionals is a key aspect of care for individuals with COPD. Acute treatment with at-home medicine, monitoring one?s own condition through technology, and having easy access and close contact with health care professionals familiar to them can promote self-management and well-being, as well as provide a feeling of security. Having regular meetings with a network of peers and health care professionals provides education, support, and tools to cope with the condition and improve own health. Furthermore, group-based activity motivates and increases the activity level of the individuals. Continued offers of services are desired as many experience a decrease in achieved benefits after the service ends. More emphasis is placed on the importance of the therapeutic and medical elements of care compared with factors such as technology. The identified barriers related to optimal utilization of the virtual service were related to differentiation in levels of contact depending on disease severity and skills related to the practical use of equipment. Conclusions: A combination of virtual and in-person services providing lasting medical and social support is suggested for the future. This should build upon the preferences and needs of individuals living with COPD and support relationships to caregivers and peers. UR - https://rehab.jmir.org/2023/1/e43237 UR - http://dx.doi.org/10.2196/43237 UR - http://www.ncbi.nlm.nih.gov/pubmed/37578832 ID - info:doi/10.2196/43237 ER - TY - JOUR AU - Gĺsvćr, Inge Jo AU - Jepsen, Randi AU - Heldal, Ilona AU - Sudmann, Tobba PY - 2023/7/11 TI - Supporting Collaboration in Rehabilitation Trajectories With Information and Communication Technologies: Scoping Review JO - JMIR Rehabil Assist Technol SP - e46408 VL - 10 KW - rehabilitation KW - shared decision-making KW - ICT system KW - decision support systems KW - remote dialogue KW - patient participation N2 - Background: Despite a surge in health information and communication technology (ICT), there is little evidence of lowered cost or increased quality of care. ICT may support patients, health care providers, and other stakeholders through complex rehabilitation trajectories by offering digital platforms for collaboration, shared decision-making, and safe storage of data. Yet, the questions on how ICT can become a useful tool and how the complex intersection between producers and users of ICT should be solved are challenging. Objective: This study aims to review the literature on how ICTs are used to foster collaboration among the patient, the provider, and other stakeholders. Methods: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies were identified by searching MEDLINE (OVID), Embase (OVID), CINAHL (EBSCOhost), AMED (EBSCOhost), and Scopus. Unpublished studies were extracted from OAIster, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, NARIC, and Google Scholar. Eligible papers addressed or described a remote dialogue between stakeholders using ICT to address goals and means, provide decision support, or evaluate certain treatment modalities within a rehabilitation context. Due to the rapid development of ICTs, searches included studies published in the period of 2018-2022. Results: In total, 3206 papers (excluding duplicates) were screened. Three papers met all inclusion criteria. The papers varied in design, key findings, and key challenges. These 3 studies reported outcomes such as improvements in activity performance, participation, frequency of leaving the house, improved self-efficacy, change in patients? perspective on possibilities, and change in professionals? understanding of patients? priorities. However, a misfit between the participants? needs and the technology offered, complexity and lack of availability of the technology, difficulties with implementation and uptake, and lack of flexibility in setup and maintenance reduced the value of ICT for those involved in the studies. The low number of included papers is probably due to the complexity of remote collaboration with ICT. Conclusions: ICT has the potential to facilitate communication among stakeholders in the complex and collaborative context of rehabilitation trajectories. This scoping review indicates that there is a paucity of research considering remote ICT-supported collaboration in health care and rehabilitation trajectories. Furthermore, current ICT builds on eHealth literacy, which may differ among stakeholders, and the lack of sufficient eHealth literacy and ICT knowledge creates barriers for access to health care and rehabilitation. Lastly, the aim and results of this review are probably most relevant in high-income countries. UR - https://rehab.jmir.org/2023/1/e46408 UR - http://dx.doi.org/10.2196/46408 UR - http://www.ncbi.nlm.nih.gov/pubmed/37432715 ID - info:doi/10.2196/46408 ER - TY - JOUR AU - Weber, Franziska AU - Kloek, Corelien AU - Arntz, Angela AU - Grüneberg, Christian AU - Veenhof, Cindy PY - 2023/7/7 TI - Blended Care in Patients With Knee and Hip Osteoarthritis in Physical Therapy: Delphi Study on Needs and Preconditions JO - JMIR Rehabil Assist Technol SP - e43813 VL - 10 KW - telerehabilitation KW - osteoarthritis KW - physical therapy KW - knee KW - hip KW - blended KW - preconditions KW - Delphi KW - focus group KW - user need N2 - Background: Osteoarthritis is a major public health concern. Despite existing evidence-based treatment options, the health care situation remains unsatisfactory. Digital care options, especially when combined with in-person sessions, seem to be promising. Objective: The aim of this study was to investigate the needs, preconditions, barriers, and facilitators of blended physical therapy for osteoarthritis. Methods: This Delphi study consisted of interviews, an online questionnaire, and focus groups. Participants were physical therapists, patients with hip and/or knee osteoarthritis with or without experience in digital care, and stakeholders of the health care system. In the first phase, interviews were conducted with patients and physical therapists. The interview guide was based on the Consolidated Framework For Implementation Research. The interviews focused on experiences with digital and blended care. Furthermore, needs, facilitators, and barriers were discussed. In the second phase, an online questionnaire and focus groups served the process to confirm the needs and collect preconditions. The online questionnaire contained statements drawn by the results of the interviews. Patients and physical therapists were invited to complete the questionnaire and participate in one of the three focus groups including (1) patients; (2) physical therapists; and (3) a patient, a physical therapist, and stakeholders from the health care system. The focus groups were used to determine concordance with the results of the interviews and the online questionnaire. Results: Nine physical therapists, seven patients, and six stakeholders confirmed that an increase of acceptance of the digital care part by physical therapists and patients is crucial. One of the most frequently mentioned facilitators was conducting regular in-person sessions. Physical therapists and patients concluded that blended physical therapy must be tailored to the patients? needs. Participants of the last focus group stated that the reimbursement of blended physical therapy needs to be clarified. Conclusions: Most importantly, it is necessary to strengthen the acceptance of patients and physical therapists toward digital care. Overall, for development and usage purposes, it is crucial to take the needs and preconditions into account. Trial Registration: German Clinical Trials Register DRKS00023386; https://drks.de/search/en/trial/DRKS00023386 UR - https://rehab.jmir.org/2023/1/e43813 UR - http://dx.doi.org/10.2196/43813 UR - http://www.ncbi.nlm.nih.gov/pubmed/37418301 ID - info:doi/10.2196/43813 ER - TY - JOUR AU - Brehon, Katelyn AU - MacIsaac, Rob AU - Bhatia, Zahra AU - Buck, Taryn AU - Charbonneau, Rebecca AU - Crochetiere, Steven AU - Donia, Scott AU - Daoust, Jason AU - Ho, Chester AU - Kainth, Hardeep AU - Loewen, Janee AU - Lorch, Brandice AU - Mastrodimos, Kiesha AU - Neunzig, Brittney AU - Papathanassoglou, Elizabeth AU - Parmar, Rajvir AU - Pohar Manhas, Kiran AU - Tenove, Terry AU - Velji, Elysha AU - Loyola-Sanchez, Adalberto PY - 2023/6/23 TI - Outcomes of Implementing a Webinar-Based Strategy to Improve Spinal Cord Injury Knowledge and Community Building: Convergent Mixed Methods Study JO - JMIR Rehabil Assist Technol SP - e46575 VL - 10 KW - spinal cord injury KW - telehealth KW - webinars KW - mixed methods KW - implementation N2 - Background: COVID-19 disrupted services received by persons with spinal cord injury (SCI) worldwide. The International Disability Alliance declared the need for a disability-inclusive response to the COVID-19 crisis, as decreased access to health care services for individuals living with varying levels of function was unacceptable. As a result, an SCI community in Canada created a novel webinar-based strategy aimed at improving access to self-management information for people living with SCI and other stakeholders. However, although telehealth practices have previously been used effectively in SCI management and rehabilitation, little to no scholarship has investigated the outcomes of implementing a webinar-based telehealth strategy in this population. Objective: This study aims to understand the outcomes of implementing the webinar series. Specifically, the authors aimed to determine the reach of the series; understand its impact on social connectedness, perceptions of disability, and overall quality of interactions among persons with SCI, their families, service providers, and the public at large; and explore the long-term sustainability of the initiative. Methods: The authors implemented a community-based participatory strategy to define a convergent mixed methods design to triangulate qualitative and quantitative data collected simultaneously. Quantitative methods included pop-up questions administered during the live webinars, surveys administered following webinars, and an analysis of YouTube analytics. Qualitative methods included semistructured interviews with persons with SCI and health care providers who attended at least one webinar. The results were integrated, following methods adapted from Creswell and Clark. Results: A total of 234 individuals attended at least 1 of the 6 webinars that took place during the 6-month study period. In total, 13.2% (31/234) of the participants completed the postwebinar survey, and 23% (7/31) participated in the semistructured interviews. The reach of the webinar series was mainly to persons with SCI, followed by health professionals, with most of them living in urban areas. The topics sexuality and research were the most viewed on YouTube. The knowledge disseminated during the webinars was mainly perceived as valid and useful, related to the fact that the presentation format involved people with lived experience and clinical experts. The webinars did not necessarily help build a new extended community of people involved in SCI but helped strengthen the existing community of people with SCI in Alberta. The webinar positively influenced the perceptions of normality and disability regarding people with SCI. The webinar format was perceived as highly usable and accessible. Conclusions: The webinar series was associated with improved participant knowledge of what is possible to achieve after an SCI and their perceptions of disability. The long-term implementation of this initiative is feasible, but further considerations to increase its reach to rural areas and ensure the integration of diverse individuals should be taken. UR - https://rehab.jmir.org/2023/1/e46575 UR - http://dx.doi.org/10.2196/46575 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351945 ID - info:doi/10.2196/46575 ER - TY - JOUR AU - Peterson, Gunnel AU - Peolsson, Anneli PY - 2023/6/20 TI - Efficacy of Neck-Specific Exercise With Internet Support Versus Neck-Specific Exercise at a Physiotherapy Clinic in Chronic Whiplash-Associated Disorders: Multicenter Randomized Controlled Noninferiority Trial JO - J Med Internet Res SP - e43888 VL - 25 KW - internet-based intervention KW - telerehabilitation KW - whiplash associated disorders KW - neck KW - whiplash KW - physiotherapy KW - physiotherapist KW - physical therapy KW - neck pain KW - exercise KW - chronic pain KW - digital health intervention KW - telehealth KW - rehabilitation KW - pain management KW - internet-based KW - telemedicine KW - digital health N2 - Background: Neck-specific exercises (NSE) supervised by a physiotherapist twice a week for 12 weeks have shown good results in chronic whiplash-associated disorders (WADs), but the effect of exercise delivered via the internet is unknown. Objective: This study examined whether NSE with internet support (NSEIT) and 4 physiotherapy sessions for 12 weeks were noninferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE). Methods: In this multicenter randomized controlled noninferiority trial with masked assessors, we recruited adults aged 18-63 years with chronic WAD grade II (ie, neck pain and clinical musculoskeletal signs) or III (ie, grade II plus neurological signs). Outcomes were measured at baseline and at 3- and 15-month follow-ups. The primary outcome was change in neck-related disability, measured with the Neck Disability Index (NDI; 0%-100%), with higher percentages indicating greater disability. Secondary outcomes were neck and arm pain intensity (Visual Analog Scale [VAS]), physical function (Whiplash Disability Questionnaire [WDQ] and Patient-Specific Functional Scale [PSFS]), health-related quality of life (EQ-5D-3L and EQ VAS), and self-rated recovery (Global Rating Scale [GRS]). The analyses were conducted on an intention-to-treat basis and with the per-protocol approach as sensitivity analyses. Results: Between April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90%) and 64 (91%), respectively, were followed up at 3 months, and 56 (80%) and 58 (83%), respectively, at 15 months. NSEIT demonstrated noninferiority to NSE in the primary outcome NDI, as the 1-sided 95% CI of the mean difference in change did not cross the specified noninferiority margin (7 percentage units). There were no significant between-group differences in change in NDI at the 3- or 15-month follow-up, with a mean difference of 1.4 (95% CI ?2.5 to 5.3) and 0.9 (95% CI ?3.6 to 5.3), respectively. In both groups, the NDI significantly decreased over time (NSEIT: mean change ?10.1, 95% CI ?13.7 to ?6.5, effect size=1.33; NSE: mean change ?9.3, 95% CI ?12.8 to ?5.7, effect size=1.19 at 15 months; P<.001). NSEIT was noninferior to NSE for most of the secondary outcomes except for neck pain intensity and EQ VAS, but post hoc analyses showed no differences between the groups. Similar results were seen in the per-protocol population. No serious adverse events were reported. Conclusions: NSEIT was noninferior to NSE in chronic WAD and required less physiotherapist time. NSEIT could be used as a treatment for patients with chronic WAD grades II and III. Trial Registration: ClinicalTrials.gov NCT03022812; https://clinicaltrials.gov/ct2/show/NCT03022812 UR - https://www.jmir.org/2023/1/e43888 UR - http://dx.doi.org/10.2196/43888 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338972 ID - info:doi/10.2196/43888 ER - TY - JOUR AU - Ashikaga, Kohei AU - Doi, Shunichi AU - Yoneyama, Kihei AU - Suzuki, Norio AU - Kuwata, Shingo AU - Koga, Masashi AU - Takeichi, Naoya AU - Watanabe, Satoshi AU - Izumo, Masaki AU - Kida, Keisuke AU - Akashi, J. Yoshihiro PY - 2023/5/17 TI - Efficacy and Safety of Home-Based Cardiac Telemonitoring Rehabilitation in Patients After Transcatheter Aortic Valve Implantation: Single-Center Usability and Feasibility Study JO - JMIR Rehabil Assist Technol SP - e45247 VL - 10 KW - transcatheter aortic valve implantation KW - telerehabilitation KW - cardiac rehabilitation KW - remote KW - telemonitoring N2 - Background: No consensus exists on the efficacy of home-based cardiac rehabilitation (CR) in patients who have undergone transcatheter aortic valve implantation (TAVI). Additionally, there are no reports on home-based cardiac telemonitoring rehabilitation (HBTR) in patients after TAVI. Objective: We aimed to investigate the efficacy of HBTR in patients who have undergone TAVI. Methods: This single-center preliminary study introduced HBTR to patients after TAVI, and the efficacy outcomes of the rehabilitation method were compared to that of a historical control cohort. The historical control cohort (control group) consisted of 6 consecutive patients who underwent ordinary outpatient CR after TAVI from February 2016 to March 2020. Patients who participated in the HBTR program were only recruited after the TAVI procedure and before discharge between April 2021 and May 2022. In the first 2 weeks after TAVI, patients underwent outpatient CR and were trained using telemonitoring rehabilitation systems. Thereafter, patients underwent HBTR twice a week for 12 weeks. The control group performed standard outpatient CR at least once a week for 12 to 16 weeks. Efficacy was assessed using peak oxygen uptake (VO2) prior to and after CR. Results: Eleven patients were included in the HBTR group. All patients underwent 24 HBTR sessions during the 12-week training period, and no adverse events were observed. The control group participants performed 19 (SD 7) sessions during the training period, and no adverse events were observed. Participants in the HBTR and control groups had a mean age of 80.4 (SD 6.0) years and 79.0 (SD 3.9) years, respectively. In the HBTR group, preintervention and postintervention peak VO2 values were 12.0 (SD 1.7) mL/min/kg and 14.3 (SD 2.7) mL/min/kg (P=.03), respectively. The peak VO2 changes in the HBTR and control groups were 2.4 (SD 1.4) mL/min/kg and 1.3 (SD 5.0) mL/min/kg (P=.64), respectively. Conclusions: Home-based CR using a telemonitoring system is a safe outpatient rehabilitation method. Its efficacy is not inferior to that of standard CR in patients who have undergone TAVI. Trial Registration: Japan Registry of Clinical Trials jRCTs032200122; https://jrct.niph.go.jp/latest-detail/jRCTs032200122 UR - https://rehab.jmir.org/2023/1/e45247 UR - http://dx.doi.org/10.2196/45247 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195764 ID - info:doi/10.2196/45247 ER - TY - JOUR AU - Rochette, Annie AU - Thomas, Aliki AU - Salbach, M. Nancy AU - Vachon, Brigitte AU - Menon, Anita AU - Poissant, Lise AU - Boutin, Maurane AU - Grad, Roland AU - Pluye, Pierre PY - 2023/5/8 TI - Expected Health Benefits as the Ultimate Outcome of Information Available on Stroke Engine, a Knowledge Translation Stroke Rehabilitation Website: Web-Based Survey JO - JMIR Rehabil Assist Technol SP - e44715 VL - 10 KW - crowdsourcing KW - health-related information KW - internet KW - knowledge translation KW - rehabilitation KW - stroke N2 - Background: Electronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week. Objective: With the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users? perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted. Methods: A web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments. Results: The sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22%) and students (2784/6634, 41.97%) represented 97.18% (6447/6634) of the total responses. The remaining 2.82% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31%) and their relatives (100/6634, 1.51%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64%) and students (1228/2437, 50.39%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59%) and their relatives (57/91, 63%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4%) and a feeling of being reassured for individuals with stroke (26/75, 35%) and their relatives (28/97, 29%). Conclusions: Valuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development. UR - https://rehab.jmir.org/2023/1/e44715 UR - http://dx.doi.org/10.2196/44715 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155228 ID - info:doi/10.2196/44715 ER - TY - JOUR AU - Scheer, Justin AU - Areias, C. Anabela AU - Molinos, Maria AU - Janela, Dora AU - Moulder, Robert AU - Lains, Jorge AU - Bento, Virgílio AU - Yanamadala, Vijay AU - Dias Correia, Fernando AU - Costa, Fabíola PY - 2023/3/16 TI - Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study JO - JMIR Mhealth Uhealth SP - e44316 VL - 11 KW - physical therapy KW - physiotherapy KW - remote care KW - telerehabilitation KW - digital therapy KW - eHealth KW - telehealth KW - telemedicine KW - musculoskeletal KW - musculoskeletal conditions KW - urban KW - rural KW - pain KW - health inequity KW - digital care KW - pain management KW - clinical outcome KW - health equity KW - engagement N2 - Background: Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. Objective: The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. Methods: This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain. Results: Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1%, rural: 68.3%; P=.30). Conclusions: This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 UR - https://mhealth.jmir.org/2023/1/e44316 UR - http://dx.doi.org/10.2196/44316 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735933 ID - info:doi/10.2196/44316 ER - TY - JOUR AU - Pagaki-Skaliora, Marina AU - Morrow, Eileen AU - Theologis, Tim PY - 2022/10/17 TI - Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review JO - JMIR Rehabil Assist Technol SP - e36842 VL - 9 IS - 4 KW - cerebral palsy KW - CP KW - assistive technology KW - scoping review KW - software KW - application KW - telehealth KW - telerehabilitation KW - rehabilitation KW - COVID-19 KW - children KW - health intervention KW - health care KW - digital intervention N2 - 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. UR - https://rehab.jmir.org/2022/4/e36842 UR - http://dx.doi.org/10.2196/36842 UR - http://www.ncbi.nlm.nih.gov/pubmed/36041012 ID - info:doi/10.2196/36842 ER - TY - JOUR AU - Murakami, Tatsunori AU - Higuchi, Yumi AU - Ueda, Tetsuya AU - Kozuki, Wataru AU - Gen, Aki PY - 2022/9/20 TI - Internet-Based Information Sharing With Families of Patients With Stroke in a Rehabilitation Hospital During the COVID-19 Pandemic: Case-Control Study JO - JMIR Rehabil Assist Technol SP - e38489 VL - 9 IS - 3 KW - COVID-19 KW - internet-based KW - health information KW - stroke KW - family KW - rehabilitation KW - case-control KW - activities of daily living KW - information communication technology KW - physical function KW - recovery N2 - 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. UR - https://rehab.jmir.org/2022/3/e38489 UR - http://dx.doi.org/10.2196/38489 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960841 ID - info:doi/10.2196/38489 ER - TY - JOUR AU - Brunner, Melissa AU - Rietdijk, Rachael AU - Togher, Leanne PY - 2022/4/28 TI - Training Resources Targeting Social Media Skills to Inform Rehabilitation for People Who Have an Acquired Brain Injury: Scoping Review JO - J Med Internet Res SP - e35595 VL - 24 IS - 4 KW - brain injury KW - social media KW - training KW - social communication KW - scoping review N2 - Background: In 2020 and 2021, people increasingly used the internet to connect socially and professionally. However, people with an acquired brain injury (ABI) experience challenges in using social media, and rehabilitation professionals have reported feeling underprepared to support them in its use. To date, no review of social media skills training to inform ABI rehabilitation has been conducted. Objective: This scoping review aimed to examine research on interventions addressing social media skills and safety, with a focus on people living with health conditions; free web-based resources for the general public on social media skills training; and currently available online support groups for people with ABI. Methods: An integrative scoping review was conducted, with a systematic search strategy applied in March and November 2020 across OvidSP (MEDLINE, AMED, PsycINFO, and Embase), Scopus, Web of Science, CINAHL, Google Scholar, Google, and Facebook. The data collected were critically appraised and synthesized to describe the key content and features of social media training resources. Results: This review identified 47 peer-reviewed academic articles, 48 social media training websites, and 120 online support groups for people with ABI. A key recommendation was interactive training with practical components addressing cybersafety, how to use platforms, and how to connect with others. However, no social media training resources that were relevant and accessible for people with ABI were identified. Conclusions: Training resources to support people with ABI in safely using social media are limited. The key content to be addressed and the features to be incorporated into web-based social media training were determined, including the need for interactive training that is co-designed and safe and incorporates practical components that support people with ABI. These findings can be used to inform the development of web-based evidence-based support for people with ABI who may be vulnerable when participating in social media. UR - https://www.jmir.org/2022/4/e35595 UR - http://dx.doi.org/10.2196/35595 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482369 ID - info:doi/10.2196/35595 ER - TY - JOUR AU - Shore, Josh AU - Nalder, Emily AU - Hutchison, Michael AU - Reed, Nick AU - Hunt, Anne PY - 2022/4/4 TI - Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development JO - JMIR Pediatr Parent SP - e34822 VL - 5 IS - 2 KW - concussion KW - pediatrics KW - active rehabilitation KW - telehealth KW - exercise KW - mobile phone N2 - Background: Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective: This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods: The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results: Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions: The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach. UR - https://pediatrics.jmir.org/2022/2/e34822 UR - http://dx.doi.org/10.2196/34822 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377326 ID - info:doi/10.2196/34822 ER - TY - JOUR AU - Lunde, Pernille AU - Bye, Asta AU - Bruusgaard, Anette Kari AU - Hellem, Elisabet AU - Nilsson, Blakstad Birgitta PY - 2022/3/23 TI - Patients? Experiences of Using a Smartphone App After Cardiac Rehabilitation: Qualitative Study JO - JMIR Hum Factors SP - e34294 VL - 9 IS - 1 KW - mHealth KW - mobile health KW - cardiac rehabilitation KW - mobile phone app KW - smartphone KW - lifestyle N2 - Background: Exercise-based cardiac rehabilitation (CR) is a crucial part of the treatment of patients with cardiac diseases, and adherence to healthy behavior is a prerequisite to improve long-term prognosis. Unfortunately, adherence to healthy behavior adapted in CR is challenging for many cardiac patients in the long term. Recently, we demonstrated that follow-up conducted via an app for 1 year significantly improved adherence to healthy behavior after CR. To increase the knowledge and understanding of mobile Health (mHealth) interventions that can promote acceptance and adherence, qualitative research investigating patients? experiences with these interventions is warranted. Objective: The aim was to investigate patient experiences with individualized long-term follow-up conducted via an app for 1 year and their thoughts about what features promoted adherence to healthy behavior after CR. The purpose was to increase the understanding of significant findings previously reported and to guide future development of similar interventions in the field of adherence. Methods: A qualitative study with individual interviews was conducted from November 2018 to May 2019. A thematic interview guide was used when conducting the semistructured in-depth interviews. The interviews were audio recorded and transcribed successively during the period in which the interviews were conducted. Texts were managed and systematized by NVivo. Interviews were analyzed by qualitative content analysis. Codes and themes were inductively developed. Results: Ten patients who had participated in a randomized controlled trial evaluating the effect of follow-up conducted via an app on adherence to healthy behavior after CR were included. The median patient age was 65 years (range 46-72 years), and both genders were represented. The analysis resulted in the following 4 themes describing the patients? experiences: (1) The person behind the app is crucial for motivation and adherence; (2) The app as a commitment; (3) The app as a path to independence; and (4) Suggestions for improvements. Features experienced as beneficial to promote adherence were individualized feedback and the use of goal setting. The significance of the person behind the app (the supervisor) who provided individualized feedback was a consistent finding. This person seemed to promote motivation in general and to enable other known behavioral change techniques. Conclusions: The person behind the app (the supervisor) seems to be one of the most significant success factors in promoting adherence to healthy behavior after CR. This indicates that a health care provider must actively participate in a patient?s process of adherence to healthy behavior, even when using interventions, including an app. Future development of interventions in the field of adherence should strive to create tools that enable an ongoing collaborative relationship between the patient and the health care provider. The follow-up should be based on the patient?s own goals, and individualized feedback should be provided. UR - https://humanfactors.jmir.org/2022/1/e34294 UR - http://dx.doi.org/10.2196/34294 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319476 ID - info:doi/10.2196/34294 ER - TY - JOUR AU - Rozenberg, Dmitry AU - Santa Mina, Daniel AU - Nourouzpour, Sahar AU - Camacho Perez, Encarna AU - Stewart, Lyn Brooke AU - Wickerson, Lisa AU - Tsien, Cynthia AU - Selzner, Nazia AU - Shore, Josh AU - Aversa, Meghan AU - Woo, Minna AU - Holdsworth, Sandra AU - Prevost, Karina AU - Park, Jeff AU - Azhie, Amirhossein AU - Huszti, Ella AU - McLeod, Elizabeth AU - Dales, Sarah AU - Bhat, Mamatha PY - 2022/3/23 TI - Feasibility of a Home-Based Exercise Program for Managing Posttransplant Metabolic Syndrome in Lung and Liver Transplant Recipients: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e35700 VL - 11 IS - 3 KW - lung transplant KW - liver transplant KW - posttransplant metabolic syndrome KW - exercise training KW - randomized controlled trial KW - pilot study N2 - Background: Posttransplant metabolic syndrome (PTMS) is a common contributor to morbidity and mortality among solid organ transplant recipients in the late posttransplant period (?1 year). Patients diagnosed with PTMS are at a higher risk of cardiovascular disease and frequently experience decreased physical function and health-related quality of life (HRQL). Studies in the early posttransplant period (<1 year) have shown the benefits of facility-based exercise training on physical function and HRQL, but have not evaluated the effects on metabolic risk factors. It remains unclear whether home-based exercise programs are feasible and can be delivered at a sufficient exercise dose to have effects on PTMS. This protocol outlines the methodology of a randomized controlled trial of a partly supervised home-based exercise program in lung transplant (LTx) and orthotopic liver transplant (OLT) recipients. Objective: This study aims to evaluate the feasibility (ie, recruitment rate, program adherence, attrition, safety, and participant satisfaction) of a 12-week individualized, home-based aerobic and resistance training program in LTx and OLT recipients initiated 12 to 18 months after transplantation, and to assess estimates of intervention efficacy on metabolic risk factors, exercise self-efficacy, and HRQL. Methods: In total, 20 LTx and 20 OLT recipients with ?2 cardiometabolic risk factors at 12 to 18 months after transplantation will be randomized to an intervention (home-based exercise training) or control group. The intervention group will receive an individualized exercise prescription comprising aerobic and resistance training, 3 to 5 times a week for 12 weeks. Participants will meet on a weekly basis (via videoconference) with a qualified exercise professional who will supervise exercise progression, provide support, and support exercise self-efficacy. Participants in both study groups will receive a counseling session on healthy eating with a dietitian at the beginning of the intervention. For the primary aim, feasibility will be assessed through recruitment rate, program adherence, satisfaction, attrition, and safety parameters. Secondary outcomes will be measured at baseline and 12 weeks, including assessments of metabolic risk factors (ie, insulin resistance, abdominal obesity, blood pressure, and cholesterol), HRQL, and exercise self-efficacy. Descriptive statistics will be used to summarize program feasibility and effect estimates (means and 95% CIs) for sample size calculations in future trials. Results: Enrollment started in July 2021. It is estimated that the study period will be 18 months, with data collection to be completed by December 2022. Conclusions: A partly supervised home-based, individually tailored exercise program that promotes aerobic and resistance training and exercise self-efficacy may be an important intervention for improving the metabolic profile of LTx and OLT recipients with cardiometabolic risk factors. Thus, characterizing the feasibility and effect estimates of home-based exercise constitutes the first step in developing future clinical trials designed to reduce the high morbidity associated with PTMS. Trial Registration: ClinicalTrials.gov NCT04965142; https://clinicaltrials.gov/ct2/show/NCT04965142 International Registered Report Identifier (IRRID): DERR1-10.2196/35700 UR - https://www.researchprotocols.org/2022/3/e35700 UR - http://dx.doi.org/10.2196/35700 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319467 ID - info:doi/10.2196/35700 ER - TY - JOUR AU - Agnew, R. Jonathon M. AU - Hanratty, E. Catherine AU - McVeigh, G. Joseph AU - Nugent, Chris AU - Kerr, P. Daniel PY - 2022/3/11 TI - An Investigation Into the Use of mHealth in Musculoskeletal Physiotherapy: Scoping Review JO - JMIR Rehabil Assist Technol SP - e33609 VL - 9 IS - 1 KW - physiotherapy KW - musculoskeletal KW - mHealth KW - rehabilitation KW - scoping review KW - mobile phone N2 - Background: Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. Objective: The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. Methods: A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. Results: Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. Conclusions: mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available. UR - https://rehab.jmir.org/2022/1/e33609 UR - http://dx.doi.org/10.2196/33609 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275089 ID - info:doi/10.2196/33609 ER - TY - JOUR AU - Chaplin, Emma AU - Barnes, Amy AU - Newby, Chris AU - Houchen-Wolloff, Linzy AU - Singh, J. Sally PY - 2022/3/10 TI - Comparison of the Impact of Conventional and Web-Based Pulmonary Rehabilitation on Physical Activity in Patients With Chronic Obstructive Pulmonary Disease: Exploratory Feasibility Study JO - JMIR Rehabil Assist Technol SP - e28875 VL - 9 IS - 1 KW - SPACE for COPD KW - internet KW - web-based KW - chronic obstructive pulmonary disease KW - pulmonary rehabilitation KW - physical activity KW - exercise KW - chronic disease KW - COPD KW - rehabilitation N2 - Background: Pulmonary Rehabilitation (PR) increases exercise capacity, with less clear evidence regarding physical activity (PA). The World Health Organization recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA per week to reduce the risks of chronic disease. Objective: The objective of this study was to assess the effectiveness of conventional PR versus web-based PR with respect to changes in PA. Methods: Patients with COPD were randomized to either conventional PR classes (n=51) or a web-based PR program (n=52) for 7 weeks in a feasibility study. Accelerometers (Sensewear) were worn before and after the intervention, and PA was measured as steps per day and mean bouts of moderate activity for ?2, ?5, ?10, and ?20 minutes. Measures were derived for patients with ?8 hours of data per day for ?4 days, using the R package for statistical analysis. Variables were explored to examine their relationships with bouts of activity. Results: Baseline characteristics did not differ significantly between groups. Complete PA data were available for the groups receiving web-based (n=20) and conventional (n=34) PR interventions. The web-based PR group demonstrated a nonsignificant increase in the number of steps per day, which mainly comprised short bouts of moderate to vigorous intensity PA when compared to the conventional PR group (P=.20). The conventional PR group demonstrated increased 20-minute bouts of PA by 49.1%, although this was not significant (P=.07). At baseline, age (r=?0.21, P=.04), BMI (r=?0.311, P=.004), and FEV1 (forced expiratory volume in 1 second; % predicted; r=?0.248, P=.048) were significantly correlated with 10-minute bouts of PA; however, this was not observed post intervention. Conclusions: The analysis revealed a nonsignificant difference in the pattern of PA between groups receiving conventional vs web-based PR?the former being associated with an increase in 20-minute bouts, while the latter having demonstrated an increase in the number of steps per day. There appears to be a differing response emerging between the two interventions. Trial Registration: International Clinical Trials Registry ISRCTN03142263; https://tinyurl.com/y4dmfyrb UR - https://rehab.jmir.org/2022/1/e28875 UR - http://dx.doi.org/10.2196/28875 UR - http://www.ncbi.nlm.nih.gov/pubmed/35266871 ID - info:doi/10.2196/28875 ER - TY - JOUR AU - Gopal, Arpita AU - Hsu, Wan-Yu AU - Allen, D. Diane AU - Bove, Riley PY - 2022/3/9 TI - Remote Assessments of Hand Function in Neurological Disorders: Systematic Review JO - JMIR Rehabil Assist Technol SP - e33157 VL - 9 IS - 1 KW - neurological disease KW - hand function KW - remote assessment KW - assessment KW - telemedicine KW - rehabilitation KW - telerehabilitation KW - review KW - neurological KW - hand KW - function KW - diagnosis KW - intervention KW - dysfunction KW - feasibility KW - mobile phone N2 - Background: Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be regularly assessed to monitor loss of fine motor skills in people with central nervous system disorders; however, there are challenges to in-clinic assessments. Remotely assessing hand function could facilitate monitoring and supporting of early diagnosis and intervention when warranted. Objective: Remote assessments can facilitate the tracking of limitations, aiding in early diagnosis and intervention. This study aims to systematically review existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction. Methods: PubMed and MEDLINE, CINAHL, Web of Science, and Embase were searched for studies that reported remote assessment of hand function (ie, outside of traditional in-person clinical settings) in adults with chronic central nervous system disorders. We excluded studies that included participants with orthopedic upper limb dysfunction or used tools for intervention and treatment. We extracted data on the evaluated hand function domains, validity and reliability, feasibility, and stage of development. Results: In total, 74 studies met the inclusion criteria for Parkinson disease (n=57, 77% studies), stroke (n=9, 12%), multiple sclerosis (n=6, 8%), spinal cord injury (n=1, 1%), and amyotrophic lateral sclerosis (n=1, 1%). Three assessment modalities were identified: external device (eg, wrist-worn accelerometer), smartphone or tablet, and telerehabilitation. The feasibility and overall participant acceptability were high. The most common hand function domains assessed included finger tapping speed (fine motor control and rigidity), hand tremor (pharmacological and rehabilitation efficacy), and finger dexterity (manipulation of small objects required for daily tasks) and handwriting (coordination). Although validity and reliability data were heterogeneous across studies, statistically significant correlations with traditional in-clinic metrics were most commonly reported for telerehabilitation and smartphone or tablet apps. The most readily implementable assessments were smartphone or tablet-based. Conclusions: The findings show that remote assessment of hand function is feasible in neurological disorders. Although varied, the assessments allow clinicians to objectively record performance in multiple hand function domains, improving the reliability of traditional in-clinic assessments. Remote assessments, particularly via telerehabilitation and smartphone- or tablet-based apps that align with in-clinic metrics, facilitate clinic to home transitions, have few barriers to implementation, and prompt remote identification and treatment of hand function impairments. UR - https://rehab.jmir.org/2022/1/e33157 UR - http://dx.doi.org/10.2196/33157 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262502 ID - info:doi/10.2196/33157 ER - TY - JOUR AU - Morimoto, Yuh AU - Takahashi, Tetsuya AU - Sawa, Ryuichi AU - Saitoh, Masakazu AU - Morisawa, Tomoyuki AU - Kagiyama, Nobuyuki AU - Kasai, Takatoshi AU - Dinesen, Birthe AU - Hollingdal, Malene AU - Refsgaard, Jens AU - Daida, Hiroyuki PY - 2022/1/27 TI - Web Portals for Patients With Chronic Diseases: Scoping Review of the Functional Features and Theoretical Frameworks of Telerehabilitation Platforms JO - J Med Internet Res SP - e27759 VL - 24 IS - 1 KW - telerehabilitation KW - web portal KW - chronic disease KW - monitoring/data tracking function KW - patient-centered care N2 - Background: The COVID-19 pandemic has required an increased need for rehabilitation activities applicable to patients with chronic diseases. Telerehabilitation has several advantages, including reducing clinic visits by patients vulnerable to infectious diseases. Digital platforms are often used to assist rehabilitation services for patients in remote settings. Although web portals for medical use have existed for years, the technology in telerehabilitation remains a novel method. Objective: This scoping review investigated the functional features and theoretical approaches of web portals developed for telerehabilitation in patients with chronic diseases. Methods: PubMed and Web of Science were reviewed to identify articles associated with telerehabilitation. Of the 477 nonduplicate articles reviewed, 35 involving 14 portals were retrieved for the scoping review. The functional features, targeted diseases, and theoretical approaches of these portals were studied. Results: The 14 portals targeted patients with chronic obstructive pulmonary disease, cardiovascular, osteoarthritis, multiple sclerosis, cystic fibrosis diseases, and stroke and breast cancer survivors. Monitoring/data tracking and communication functions were the most common, followed by exercise instructions and diary/self-report features. Several theoretical approaches, behavior change techniques, and motivational techniques were found to be utilized. Conclusions: The web portals could unify and display multiple types of data and effectively provide various types of information. Asynchronous correspondence was more favorable than synchronous, real-time interactions. Data acquisition often required assistance from other digital tools. Various functions with patient-centered principles, behavior change strategies, and motivational techniques were observed for better support shifting to a healthier lifestyle. These findings suggested that web portals for telerehabilitation not only provided entrance into rehabilitation programs but also reinforced participant-centered treatment, adherence to rehabilitation, and lifestyle changes over time. UR - https://www.jmir.org/2022/1/e27759 UR - http://dx.doi.org/10.2196/27759 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084355 ID - info:doi/10.2196/27759 ER - TY - JOUR AU - Jorge, Serafim Ana Elisa AU - Bennell, Louise Kim AU - Kimp, Jared Alexander AU - Campbell, Kate Penny AU - Hinman, Shane Rana PY - 2021/12/1 TI - An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data JO - JMIR Med Educ SP - e30378 VL - 7 IS - 4 KW - osteoarthritis KW - knee KW - physiotherapy KW - exercise KW - e-learning KW - telehealth KW - pain KW - education KW - implementation KW - evaluation KW - professional development KW - rehabilitation N2 - Background: The COVID-19 pandemic necessitated clinicians to transition to telehealth, often with little preparation or training. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules were developed to upskill physiotherapists in management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the e-learning modules are perceived by physiotherapists as effective when they are part of a comprehensive training program for a clinical trial. However, the effectiveness of the modules on their own in a real-world setting is unknown. Objective: This study aims to evaluate the reach, effectiveness, adoption, and implementation of PEAK e-learning modules. Methods: This longitudinal study was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators, and health care students who registered for access to the modules between April 1 and November 30, 2020. Reach was evaluated by outcomes (countries, referral sources, and attrition) extracted from registration data and embedded within precourse surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with videoconferencing; likelihood of using education, strengthening exercise, and physical activity in a treatment plan for knee OA; usefulness of modules) measured using a 10-point numeric rating scale (NRS; score range from 1=not confident or likely or useful at all to 10=extremely confident or likely or useful) in pre- and postcourse (on completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to the use of learning and usefulness of program elements (measured via a 4-point Likert scale, from not at all useful to extremely useful) in a survey administered 4 months after module completion. Results: Broad reach was achieved, with 6720 people from 97 countries registering for access. Among registrants, there were high levels of attrition, with 36.65% (2463/6720) commencing the program and precourse survey and 19.61% (1318/6720) completing all modules and the postcourse survey. The program was effective. Learners who completed the modules demonstrated increased confidence with videoconferencing (mean change 3.1, 95% CI 3.0-3.3 NRS units) and increased likelihood of using education, strengthening and physical activity in a knee OA treatment plan, compared to precourse. Adoption and implementation of learning (n=149 respondents) occurred at 4 months. More than half of the respondents used their learning to structure in-person consultations with patients (80/142, 56.3%) and patient information booklets in their clinical practice (75/142, 52.8%). Conclusions: Findings provide evidence of the reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting among physiotherapists. The e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via videoconferencing. Attrition across the e-learning program highlights the challenges of keeping learners engaged in self-directed web-based learning. UR - https://mededu.jmir.org/2021/4/e30378 UR - http://dx.doi.org/10.2196/30378 UR - http://www.ncbi.nlm.nih.gov/pubmed/34587585 ID - info:doi/10.2196/30378 ER - TY - JOUR AU - Gaboury, Isabelle AU - Tousignant, Michel AU - Corriveau, Hélčne AU - Menear, Matthew AU - Le Dorze, Guylaine AU - Rochefort, Christian AU - Vachon, Brigitte AU - Rochette, Annie AU - Gosselin, Sylvie AU - Michaud, François AU - Bollen, Jessica AU - Dean, Sarah PY - 2021/10/28 TI - Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial JO - JMIR Res Protoc SP - e32134 VL - 10 IS - 10 KW - adherence KW - interprofessional shared decision making KW - rehabilitation KW - stroke KW - telerehabilitation N2 - Background: Strong evidence supports beginning stroke rehabilitation as soon as the patient?s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients? adherence to a rehabilitation plan and on their level of reintegration into normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration into normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured with clinicians. Methods: In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will be comprised of 220 patients who will take part in stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation group) versus face-to-face standard of care (control group: n=110 patients). Results: Our Research Ethics Board approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. Conclusions: This study will contribute to the minimization of both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practice guidelines regarding telecare services and the provision of telerehabilitation, including recommendations for effective interdisciplinary collaboration regarding stroke rehabilitation. Trial Registration: ClinicalTrials.gov NCT04440215; https://clinicaltrials.gov/ct2/show/NCT04440215 International Registered Report Identifier (IRRID): DERR1-10.2196/32134 UR - https://www.researchprotocols.org/2021/10/e32134 UR - http://dx.doi.org/10.2196/32134 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709196 ID - info:doi/10.2196/32134 ER - TY - JOUR AU - Keller, Maria Franziska AU - Dahmen, Alina AU - Derksen, Christina AU - Kötting, Lukas AU - Lippke, Sonia PY - 2021/8/26 TI - Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects JO - JMIR Ment Health SP - e30610 VL - 8 IS - 8 KW - mental health KW - COVID-19 KW - medical rehabilitation KW - psychosomatic rehabilitation KW - internet-delivered digital trainings N2 - Background: The COVID-19 pandemic has largely affected people?s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. Objective: Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19?related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients? rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. Methods: A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points?before (N=1719) and after (n=738) rehabilitation?between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19?related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. Results: Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, ?2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, ?2p=0.04), had lower financial worries (F1,837=38.96, P<.001, ?2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, ?2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, ?2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, ?2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (?=?.14, P<.001), anxiety (?=?.12, P<.001), loneliness (?=?.18, P<.001), and stress postrehabilitation (?=?.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, ?2p=0.01) and anxiety (F1,725=6.22, P=.01, ?2p=0.01) from pre- to postrehabilitation. Conclusions: This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. Trial Registration: ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 UR - https://mental.jmir.org/2021/8/e30610 UR - http://dx.doi.org/10.2196/30610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34270444 ID - info:doi/10.2196/30610 ER - TY - JOUR AU - Kraaijkamp, M. Jules J. AU - van Dam van Isselt, F. Eléonore AU - Persoon, Anke AU - Versluis, Anke AU - Chavannes, H. Niels AU - Achterberg, P. Wilco PY - 2021/8/19 TI - eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability JO - J Med Internet Res SP - e24015 VL - 23 IS - 8 KW - geriatric rehabilitation KW - eHealth KW - mHealth KW - digital health KW - effectiveness KW - feasibility KW - usability KW - systematic review N2 - Background: eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. Objective: The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. Methods: We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ?70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. Results: In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. Conclusions: eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation. UR - https://www.jmir.org/2021/8/e24015 UR - http://dx.doi.org/10.2196/24015 UR - http://www.ncbi.nlm.nih.gov/pubmed/34420918 ID - info:doi/10.2196/24015 ER - TY - JOUR AU - Ding, Y. Eric AU - Erskine, Nathaniel AU - Stut, Wim AU - McManus, D. David AU - Peterson, Amy AU - Wang, Ziyue AU - Escobar Valle, Jorge AU - Albuquerque, Daniella AU - Alonso, Alvaro AU - Botkin, F. Naomi AU - Pack, R. Quinn PY - 2021/7/8 TI - MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study JO - JMIR Hum Factors SP - e18130 VL - 8 IS - 3 KW - cardiac rehabilitation KW - telerehabilitation KW - health watch KW - mHealth KW - exercise N2 - Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch?informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch?based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. UR - https://humanfactors.jmir.org/2021/3/e18130 UR - http://dx.doi.org/10.2196/18130 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255660 ID - info:doi/10.2196/18130 ER - TY - JOUR AU - Miller, C. William AU - Mohammadi, Somayyeh AU - Watson, Wendy AU - Crocker, Morag AU - Westby, Marie PY - 2021/7/6 TI - The Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER) as an eHealth Approach to Presurgical Hip Replacement Education: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e29322 VL - 10 IS - 7 KW - total hip replacement KW - osteoarthritis KW - eHealth KW - prehabiliatation KW - preoperative education KW - randomized controlled trial KW - evaluation KW - feasibility KW - rehabilitation KW - recovery KW - hip KW - bone KW - surgery KW - education N2 - Background: Osteoarthritis (OA), leading to hip replacement (THR), is a primary contributor to global mobility impairment. In 2018, more than 59,000 THR surgeries were performed in Canada. Health promotion education, such as prehabilitation, is vital to optimizing surgical outcomes. Objective: This study aims to evaluate the feasibility of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER), an eHealth approach to prehabilitation education. Methods: A single-blind (assessor-blind), 2-arm, feasibility randomized controlled trial will be conducted. We will recruit 40 (HIPPER group, n=20; control group, n=20) older adults with hip OA and on a waitlist for a THR. The HIPPER intervention consists of 12 online, interactive modules. The control group will receive the current standard practice consisting of 2 online educational sessions lasting 2 hours each (webinars). Feasibility outcomes (eg, recruitment and retention rates) will be evaluated. Results: Recruitment started in March 2021. As of April 20, 2021, 18 participants were recruited. All 18 completed T1 measures. Only 1 participant has been scheduled to have a surgery and therefore has been scheduled to complete T2 measures. The remainder of the participants are waiting to be notified of their surgery date. This project was funded by a Canadian Institutes of Health Research Project Grant. Our institute?s research ethics board approved this study in November 2016. Conclusions: Results will lead to refinement of the HIPPER protocol in order to evaluate a standardized and geographically accessible prehabilitation program. Trial Registration: ClinicalTrials.gov NCT02969512; https://clinicaltrials.gov/ct2/show/NCT02969512 International Registered Report Identifier (IRRID): DERR1-10.2196/29322 UR - https://www.researchprotocols.org/2021/7/e29322 UR - http://dx.doi.org/10.2196/29322 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255722 ID - info:doi/10.2196/29322 ER - TY - JOUR AU - Richardson, Julie AU - Letts, Lori AU - Sinclair, Susanne AU - Chan, David AU - Miller, Jordan AU - Donnelly, Catherine AU - Smith-Turchyn, Jenna AU - Wojkowski, Sarah AU - Gravesande, Janelle AU - Loyola Sánchez, Adalberto PY - 2021/3/18 TI - Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study JO - JMIR Rehabil Assist Technol SP - e19519 VL - 8 IS - 1 KW - rehabilitation KW - physiotherapy KW - occupational therapy KW - self-management KW - function KW - web-based application KW - usability KW - user-centered design N2 - Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ?45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. UR - https://rehab.jmir.org/2021/1/e19519 UR - http://dx.doi.org/10.2196/19519 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734090 ID - info:doi/10.2196/19519 ER - TY - JOUR AU - Lindsay, Sally AU - Kolne, Kendall AU - Barker, J. Donna AU - Colantonio, Angela AU - Stinson, Jennifer AU - Moll, Sandra AU - Thomson, Nicole PY - 2021/3/15 TI - Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation JO - JMIR Form Res SP - e23568 VL - 5 IS - 3 KW - continuing education KW - gender-identity KW - gender-sensitive care KW - rehabilitation N2 - 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. UR - https://formative.jmir.org/2021/3/e23568 UR - http://dx.doi.org/10.2196/23568 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720023 ID - info:doi/10.2196/23568 ER - TY - JOUR AU - Naqvi, Ali Imama AU - Montiel, Casameni Tahani AU - Bittar, Yazan AU - Hunter, Norma AU - Okpala, Munachi AU - Johnson, Constance AU - Weiner, G. Mark AU - Savitz, Sean AU - Sharrief, Anjail AU - Beauchamp, Sanner Jennifer Elizabeth PY - 2021/3/8 TI - Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study JO - JMIR Form Res SP - e25123 VL - 5 IS - 3 KW - internet access KW - stroke KW - caregivers KW - surveys KW - questionnaires KW - mobile phone N2 - Background: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods: A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results: Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, ?21=18.5, P<.001) and used text messaging (n=321, ?21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke. UR - https://formative.jmir.org/2021/3/e25123 UR - http://dx.doi.org/10.2196/25123 UR - http://www.ncbi.nlm.nih.gov/pubmed/33683206 ID - info:doi/10.2196/25123 ER - TY - JOUR AU - Saunders, Rosemary AU - Seaman, Karla AU - Emery, Laura AU - Bulsara, Max AU - Ashford, Catherine AU - McDowall, Judith AU - Gullick, Karen AU - Ewens, Beverley AU - Sullivan, Trudy AU - Foskett, Charlotte AU - Whitehead, Lisa PY - 2021/3/3 TI - Comparing an eHealth Program (My Hip Journey) With Standard Care for Total Hip Arthroplasty: Randomized Controlled Trial JO - JMIR Rehabil Assist Technol SP - e22944 VL - 8 IS - 1 KW - hip arthroplasty KW - education KW - eHealth program KW - rehabilitation KW - economic evaluation N2 - Background: The role of eHealth programs to support patients through surgical pathways, including total hip arthroplasty (THA), is rapidly growing and offers the potential to improve patient engagement, self-care, and outcomes. Objective: The aim of this study is to compare the effects of an eHealth program (intervention) versus standard care for pre- and postoperative education on patient outcomes for primary THA. Methods: A prospective parallel randomized controlled trial with two arms (standard care and standard care plus access to the eHealth education program) was conducted. Participants included those who underwent THA. Outcome measures were collected preadmission, at 6 weeks, and at 3 and 6 months after surgery. The primary outcome was the Hip Dysfunction and Osteoarthritis Outcome Score. Secondary outcomes were a 5-level 5-dimension quality of life measure and the self-efficacy for managing chronic disease scale. Demographic and clinical characteristics were also collected. A satisfaction survey was completed by all participants 6 weeks after surgery, and those in the intervention arm completed an additional survey specific to the eHealth program. Results: A total of 99 patients were recruited: 50 in the eHealth program (intervention) and 49 in standard care (control). Clinical improvements were demonstrated in both groups across all time points. Per-protocol analysis demonstrated no differences between the groups for all outcome measures across all time points. Participants in the eHealth program reported that the program was accessible, that they felt comfortable using it, and that the information was helpful. Conclusions: This study demonstrated that the eHealth program, in addition to standard care, had no additional benefit to THA recovery compared with standard care alone. The study found that the eHealth program was highly valued by participants, and it supported the preoperative preparation, recovery, and postoperative rehabilitation of participants. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12617001433392; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657 UR - https://rehab.jmir.org/2021/1/e22944 UR - http://dx.doi.org/10.2196/22944 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656449 ID - info:doi/10.2196/22944 ER - TY - JOUR AU - Xie, Su-Hang AU - Wang, Qian AU - Wang, Li-Qiong AU - Wang, Lin AU - Song, Kang-Ping AU - He, Cheng-Qi PY - 2021/1/5 TI - Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e21542 VL - 23 IS - 1 KW - internet-based rehabilitation KW - knee KW - osteoarthritis KW - pain KW - physical function KW - meta-analysis KW - review KW - telerehabilitation KW - eHealth KW - telemedicine N2 - Background: Osteoarthritis (OA) is a chronic, debilitating, and degenerative joint disease. However, it is difficult for patients with knee OA to access conventional rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies to provide a means combining monitoring, guidance, and treatment for patients with knee OA. Objective: The aim of this study was to conduct a systematic review and meta-analysis for assessing the effect of internet-based rehabilitation programs on pain and physical function in patients with knee OA. Methods: Keywords related to knee OA and internet-based rehabilitation were systematically searched in the Web of Science, MEDLINE, EMBASE, CENTRAL, Scopus, PEDro (Physiotherapy Evidence Database), CNKI, SinoMed, and WANFANG databases from January 2000 to April 2020. Only randomized controlled trials were included. The authors independently screened the literature. The main outcome measures were focused on pain and physical function. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses. Results: The systematic review identified 6 randomized controlled trials, 4 of which were included in the meta-analysis, comprising a total of 791 patients with knee OA. The meta-analysis with the fixed-effects model showed that the internet-based rehabilitation programs could significantly alleviate the osteoarthritic pain for patients compared with conventional rehabilitation (standardized mean difference [SMD]??0.21, 95% CI???0.4 to ?0.01, P=.04). No significant difference was found in the improvement of physical function in patients with knee OA compared with conventional rehabilitation within 2 to 12 months (SMD??0.08, 95% CI??0.27 to 0.12, P=.43). Conclusions: This systematic review shows that internet-based rehabilitation programs could improve the pain but not physical function for patients with knee OA. However, there was a very small number of studies that could be included in the review and meta-analysis. Thus, further studies with large sample sizes are warranted to promote the effectiveness of internet-based rehabilitation and to develop its personalized design. UR - https://www.jmir.org/2021/1/e21542 UR - http://dx.doi.org/10.2196/21542 UR - http://www.ncbi.nlm.nih.gov/pubmed/33399542 ID - info:doi/10.2196/21542 ER - TY - JOUR AU - Garcia-Rudolph, Alejandro AU - Garcia-Molina, Alberto AU - Opisso, Eloy AU - Tormos Muńoz, Jose PY - 2020/10/6 TI - Personalized Web-Based Cognitive Rehabilitation Treatments for Patients with Traumatic Brain Injury: Cluster Analysis JO - JMIR Med Inform SP - e16077 VL - 8 IS - 10 KW - cluster analysis KW - traumatic brain injury KW - web-based rehabilitation N2 - Background: Traumatic brain injury (TBI) is a leading cause of disability worldwide. TBI is a highly heterogeneous disease, which makes it complex for effective therapeutic interventions. Cluster analysis has been extensively applied in previous research studies to identify homogeneous subgroups based on performance in neuropsychological baseline tests. Nevertheless, most analyzed samples are rarely larger than a size of 100, and different cluster analysis approaches and cluster validity indices have been scarcely compared or applied in web-based rehabilitation treatments. Objective: The aims of our study were as follows: (1) to apply state-of-the-art cluster validity indices to different cluster strategies: hierarchical, partitional, and model-based, (2) to apply combined strategies of dimensionality reduction by using principal component analysis and random forests and perform stability assessment of the final profiles, (3) to characterize the identified profiles by using demographic and clinically relevant variables, and (4) to study the external validity of the obtained clusters by considering 3 relevant aspects of TBI rehabilitation: Glasgow Coma Scale, functional independence measure, and execution of web-based cognitive tasks. Methods: This study was performed from August 2008 to July 2019. Different cluster strategies were executed with Mclust, factoextra, and cluster R packages. For combined strategies, we used the FactoMineR and random forest R packages. Stability analysis was performed with the fpc R package. Between-group comparisons for external validation were performed using 2-tailed t test, chi-square test, or Mann-Whitney U test, as appropriate. Results: We analyzed 574 adult patients with TBI (mostly severe) who were undergoing web-based rehabilitation. We identified and characterized 3 clusters with strong internal validation: (1) moderate attentional impairment and moderate dysexecutive syndrome with mild memory impairment and normal spatiotemporal perception, with almost 66% (111/170) of the patients being highly educated (P<.05); (2) severe dysexecutive syndrome with severe attentional and memory impairments and normal spatiotemporal perception, with 49.2% (153/311) of the patients being highly educated (P<.05); (3) very severe cognitive impairment, with 45.2% (42/93) of the patients being highly educated (P<.05). We externally validated them with severity of injury (P=.006) and functional independence assessments: cognitive (P<.001), motor (P<.001), and total (P<.001). We mapped 151,763 web-based cognitive rehabilitation tasks during the whole period to the 3 obtained clusters (P<.001) and confirmed the identified patterns. Stability analysis indicated that clusters 1 and 2 were respectively rated as 0.60 and 0.75; therefore, they were measuring a pattern and cluster 3 was rated as highly stable. Conclusions: Cluster analysis in web-based cognitive rehabilitation treatments enables the identification and characterization of strong response patterns to neuropsychological tests, external validation of the obtained clusters, tailoring of cognitive web-based tasks executed in the web platform to the identified profiles, thereby providing clinicians a tool for treatment personalization, and the extension of a similar approach to other medical conditions. UR - https://medinform.jmir.org/2020/10/e16077 UR - http://dx.doi.org/10.2196/16077 UR - http://www.ncbi.nlm.nih.gov/pubmed/33021482 ID - info:doi/10.2196/16077 ER - TY - JOUR AU - Backman, Chantal AU - Harley, Anne AU - Kuziemsky, Craig AU - Mercer, Jay AU - Peyton, Liam PY - 2020/9/14 TI - MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruyčre Continuing Care: User-Centered Design and Feasibility Testing Study JO - JMIR Form Res SP - e18169 VL - 4 IS - 9 KW - geriatric rehabilitation KW - care transition KW - technology KW - hip fracture N2 - Background: When older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers. Objective: The overall objective was to develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home. Methods: This study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of MyPath to Home. Baseline and follow-up surveys, as well as select semistructured interviews were conducted. Results: In phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team. Conclusions: We were successful at designing the MyPath to Home prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11031 UR - http://formative.jmir.org/2020/9/e18169/ UR - http://dx.doi.org/10.2196/18169 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924953 ID - info:doi/10.2196/18169 ER - TY - JOUR AU - Babatunde, Omoniyi Folarin AU - MacDermid, Joy AU - Grewal, Ruby AU - Macedo, Luciana AU - Szekeres, Mike PY - 2020/5/6 TI - Development and Usability Testing of a Web-Based and Therapist-Assisted Coping Skills Program for Managing Psychosocial Problems in Individuals With Hand and Upper Limb Injuries: Mixed Methods Study JO - JMIR Hum Factors SP - e17088 VL - 7 IS - 2 KW - usability testing KW - upper extremities KW - psychosocial KW - internet KW - coping skills N2 - Background: Ineffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. Objective: This study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. Methods: The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. Results: In total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. Conclusions: We describe the development and usability testing of HOCOS; a new web-based psychosocial intervention for individuals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants. UR - http://humanfactors.jmir.org/2020/2/e17088/ UR - http://dx.doi.org/10.2196/17088 UR - http://www.ncbi.nlm.nih.gov/pubmed/32374265 ID - info:doi/10.2196/17088 ER - TY - JOUR AU - Cole, Maria AU - Froehlich-Grobe, Katherine AU - Driver, Simon AU - Shegog, Ross AU - McLaughlin, Jeffery PY - 2019/12/17 TI - Website Redesign of a 16-Week Exercise Intervention for People With Spinal Cord Injury by Using Participatory Action Research JO - JMIR Rehabil Assist Technol SP - e13441 VL - 6 IS - 2 KW - internet KW - exercise KW - intervention KW - spinal cord injury KW - community-based research N2 - Background: People with spinal cord injury (SCI) are at higher risk for numerous preventable chronic conditions. Physical activity is a protective factor that can reduce this risk, yet those with SCI encounter barriers to activity and are significantly less likely to be active. Limited evidence supports approaches to promote increased physical activity for those with SCI. Objective: Building upon our previous theory- and evidence-based approach to increase participation in regular physical activity for those with SCI, this study aimed to use a participatory action research approach to translate a theory-based intervention to be delivered via the Web to individuals with SCI. Methods: A total of 10 individuals with SCI were invited to participate in consumer input meetings to provide the research team with iterative feedback on an initial website designed as a platform for delivering a theory-based exercise intervention. Results: A total of 7 individuals with SCI whose average age was 43.6 years (SD 13.4) and lived an average age of 12.5 years (SD 14.9) with SCI met on 2 occasions to provide their feedback of the website platform, both on the initial design and subsequently on the revamped site. Their iterative feedback resulted in redesigning the website content, format, and functionality as well as delivery of the intervention program. Conclusions: The substantially redesigned website offers an easier-to-navigate platform for people with SCI with greater functionality that delivers information using a module format with less text, short video segments, and presents more resources. Preliminary testing of the site is the next step. UR - http://rehab.jmir.org/2019/2/e13441/ UR - http://dx.doi.org/10.2196/13441 UR - http://www.ncbi.nlm.nih.gov/pubmed/31845902 ID - info:doi/10.2196/13441 ER - TY - JOUR AU - Tropea, Peppino AU - Schlieter, Hannes AU - Sterpi, Irma AU - Judica, Elda AU - Gand, Kai AU - Caprino, Massimo AU - Gabilondo, Inigo AU - Gomez-Esteban, Carlos Juan AU - Busnatu, Stefan AU - Sinescu, Crina AU - Kyriazakos, Sofoklis AU - Anwar, Sadia AU - Corbo, Massimo PY - 2019/10/1 TI - Rehabilitation, the Great Absentee of Virtual Coaching in Medical Care: Scoping Review JO - J Med Internet Res SP - e12805 VL - 21 IS - 10 KW - virtual coaching KW - rehabilitation KW - clinical medicine KW - review KW - embodied conversational agent KW - physical activity KW - health behavior N2 - Background: In the last few years, several studies have focused on describing and understanding how virtual coaches (ie, coaching program or smart device aiming to provide coaching support through a variety of application contexts) could be key drivers for health promotion in home care settings. As there has been enormous technological progress in the field of artificial intelligence and data processing in the past decade, the use of virtual coaches gains an augmented attention in the considerations of medical innovations. Objective: This scoping review aimed at providing an overview of the applications of a virtual coach in the clinical field. In particular, the review focused on the papers that provide tangible information for coaching activities with an active implication for engaging and guiding patients who have an ongoing plan of care. Methods: We aimed to investigate the use of the term virtual coach in the clinical field performing a methodical review of the relevant literature indexed on PubMed, Scopus, and Embase databases to find virtual coach papers focused on specific activities dealing with clinical or medical contexts, excluding those aimed at surgical settings or electronic learning purposes. Results: After a careful revision of the inclusion and exclusion criteria, 46 records were selected for the full-text review. Most of the identified articles directly or indirectly addressed the topic of physical activity. Some papers were focused on the use of virtual coaching (VC) to manage overweight or nutritional issues. Other papers dealt with technological interfaces to facilitate interactions with patients suffering from different chronic clinical conditions such as heart failure, chronic obstructive pulmonary disease, depression, and chronic pain. Conclusions: Although physical activity is a healthy practice that is most encouraged by a virtual coach system, in the current scenario, rehabilitation is the great absentee. This paper gives an overview of the tangible applications of this tool in the medical field and may inspire new ideas for future research on VC. UR - https://www.jmir.org/2019/10/e12805 UR - http://dx.doi.org/10.2196/12805 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573902 ID - info:doi/10.2196/12805 ER - TY - JOUR AU - Terrill, L. Alexandra AU - MacKenzie, J. Justin AU - Reblin, Maija AU - Einerson, Jackie AU - Ferraro, Jesse AU - Altizer, Roger PY - 2019/9/6 TI - A Collaboration Between Game Developers and Rehabilitation Researchers to Develop a Web-Based App for Persons With Physical Disabilities: Case Study JO - JMIR Rehabil Assist Technol SP - e13511 VL - 6 IS - 2 KW - spinal cord injury KW - software design KW - interdisciplinary health team KW - rehabilitation KW - internet N2 - Background: Individuals with a disability and their partners, who often provide care, are both at risk for depression and lower quality of life. Mobile health (mHealth) interventions are promising to address barriers to mental health care. Rehabilitation researchers and software development researchers must collaborate effectively with each other and with clinical and patient stakeholders to ensure successful mHealth development. Objective: This study aimed to aid researchers interested in mHealth software development by describing the collaborative process between a team of rehabilitation researchers, software development researchers, and stakeholders. Thus, we provide a framework (conceptual model) for other teams to replicate to build a Web-based mHealth app for individuals with physical disability. Methods: Rehabilitation researchers, software development researchers, and stakeholders (people with physical disabilities and clinicians) are involved in an iterative software development process. The overall process of developing an mHealth intervention includes initial development meetings and a co-design method called design box, in which the needs and key elements of the app are discussed. On the basis of the objectives outlined, a prototype is developed and goes through scoping iterations with feedback from stakeholders and end users. The prototype is then tested by users to identify technical errors and gather feedback on usability and accessibility. Results: Illustrating the overall development process, we present a case study based on our experience developing an app (SupportGroove) for couples coping with spinal cord injury. Examples of how we addressed specific challenges are also included. For example, feedback from stakeholders resulted in development of app features for individuals with limited functional ability. Initial designs lacked accessibility design principles made visible by end users. Solutions included large text, single click, and minimal scrolling to facilitate menu navigation for individuals using eye gaze technology. Prototype testing allowed further refinement and demonstrated high usability and engagement with activities in the app. Qualitative feedback indicated high levels of satisfaction, accessibility, and confidence in potential utility. We also present key lessons learned about working in a collaborative interdisciplinary team. Conclusions: mHealth promises to help overcome barriers to mental health intervention access. However, the development of these interventions can be challenging because of the disparate and often siloed expertise required. By describing the mHealth software development process and illustrating it with a successful case study of rehabilitation researchers, software development researchers, and stakeholders collaborating effectively, our goal is to help other teams avoid challenges we faced and benefit from our lessons learned. Ultimately, good interdisciplinary collaboration will benefit individuals with disabilities and their families. UR - http://rehab.jmir.org/2019/2/e13511/ UR - http://dx.doi.org/10.2196/13511 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573927 ID - info:doi/10.2196/13511 ER - TY - JOUR AU - Nathan, P. Edward AU - Winkler, L. Sandra PY - 2019/08/29 TI - Amputees? Attitudes Toward Participation in Amputee Support Groups and the Role of Virtual Technology in Supporting Amputees: Survey Study JO - JMIR Rehabil Assist Technol SP - 14887 VL - 6 IS - 2 KW - amputation KW - amputee KW - survey KW - support KW - support group KW - technology KW - virtual KW - virtual reality N2 - Background: Acquiring information about and living with an amputation (or limb differential) is a lifelong endeavor. Although medical institutions address the immediate medical needs of amputees, information regarding how to live life as an amputee is provided from numerous sources, one of which is amputee support groups. Objective: This study aimed at understanding why amputees join support groups, leave support groups, and possibly return to support groups as well as how technology, specifically virtual reality, might play a role in supporting patients? needs. The results are intended to provide data for support groups, to increase their impact on amputee participants. Methods: A 38-item online survey was developed based on the findings of a previous randomized trial. The survey was administered between April and September 2018 and divided into four sections: Demographics, Limb Loss History, Amputee Support Group Participation, and Technology Usage. Items used multiple-choice, drop-down menu, check-box formats with explanation boxes for open-ended responses. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. Results: Of the 59 amputees enrolled, 54 completed the survey. All the respondents were aged 20-39 years, and nearly half of the older respondents thought audio and video teleconferencing or avatar-based technology would increase participation in support groups. The results suggest that an early goal for amputees who join support groups is to focus on regaining mobility and functionality in order to return to their normal life. Once achieved, the goal transitions to one of social connection with other amputees, although there is a caveat: Simply being an amputee may not provide sufficient connections for developing long-term social relationships. The strongest reason for joining a support group was to learn about living with an amputation, followed by networking and learning new skills. Conclusions: The results suggest four key takeaways regarding amputee participation in support groups: (1) the needs of participants in amputee support groups change over time; (2) meeting content needs to be relevant to agendas primarily driven by participants; (3) support group participation is also driven by the desire to increase functionality by developing skills, become familiar with prosthetic technology, have more than amputation in common with other participants, and participate at the designated meeting time and location; and (4) the use of technology should support patients? needs. UR - http://rehab.jmir.org/2019/2/e14887/ UR - http://dx.doi.org/10.2196/14887 UR - http://www.ncbi.nlm.nih.gov/pubmed/31469085 ID - info:doi/10.2196/14887 ER - TY - JOUR AU - Dias Correia, Fernando AU - Nogueira, André AU - Magalhăes, Ivo AU - Guimarăes, Joana AU - Moreira, Maria AU - Barradas, Isabel AU - Molinos, Maria AU - Teixeira, Laetitia AU - Pires, Joaquim AU - Seabra, Rosmaninho AU - Lains, Jorge AU - Bento, Virgílio PY - 2019/06/21 TI - Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study JO - JMIR Rehabil Assist Technol SP - e14523 VL - 6 IS - 1 KW - THA KW - THR KW - digital physiotherapy KW - telerehabilitation KW - biofeedback KW - motion trackers KW - AI-powered rehabilitation N2 - Background: The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care. Objective: The aim of this study was to assess the feasibility of a novel artificial intelligence?powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation. Methods: This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM). Results: A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of ?4.79 seconds (95% CI ?7.24 to ?1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion. Conclusions: This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. Trial Registration: ClinicalTrials.gov NCT03045549; https://clinicaltrials.gov/ct2/show/NCT03045549 UR - http://rehab.jmir.org/2019/1/e14523/ UR - http://dx.doi.org/10.2196/14523 UR - http://www.ncbi.nlm.nih.gov/pubmed/31228176 ID - info:doi/10.2196/14523 ER - TY - JOUR AU - van der Maas, Mark AU - Shi, Jing AU - Elton-Marshall, Tara AU - Hodgins, C. David AU - Sanchez, Sherald AU - Lobo, SS Daniela AU - Hagopian, Sylvia AU - Turner, E. Nigel PY - 2019/01/07 TI - Internet-Based Interventions for Problem Gambling: Scoping Review JO - JMIR Ment Health SP - e65 VL - 6 IS - 1 KW - problem gambling KW - treatment KW - intervention N2 - Background: This study seeks to give an overview of academic research on internet-based interventions that are used to address problem gambling. The rate of treatment seeking has been demonstrated to be low across several research environments. This is in part because of the systemic barriers that treatment seekers face to accessing traditional face-to-face treatment. Making treatment resources for problem gambling available through the internet is one way to reduce the impact of those systemic barriers. The use of internet-based resources to address problem gambling has been growing, and a field of research evaluating it has developed as well. However, little has been done to summarize this collection of research. Objective: This study aimed to provide a scoping review of the use of internet-based interventions for problem gambling treatment and prevention to provide an understanding of the current state of the field. Methods: A scoping review was performed for 6 peer-reviewed research databases (Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Social Science Abstracts, and Scopus) and 3 gray literature databases (MedEdPortal, Proquest: Dissertations, and OpenGrey). Article inclusion criteria were as follows: published over the 10-year period of 2007 to 2017, including an intervention for problem gambling, and involving the use of internet to deliver that intervention. Results: A total of 27 articles were found that met the review criteria. Studies were found from several different areas, with particularly strong representation for Australia, New Zealand, and Scandinavia. Cognitive behavioral therapy was the most common form of internet-based intervention. Internet-based interventions were generally shown to be effective in reducing problem gambling scores and gambling behaviors. A wide range of interventions that made use of internet resources included text-based interactions with counselors and peers, automated personalized and normative feedback on gambling behaviors, and interactive cognitive behavioral therapies. A lack of diversity in samples, little comparison with face-to-face interventions, and issues of changes in the treatment dynamic are identified as areas that require further investigation. Conclusions: Internet-based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barriers to accessing professional help. The state of the current literature is sparse, and more research is needed for directly comparing internet-based interventions and their traditional counterparts. UR - https://mental.jmir.org/2019/1/e65/ UR - http://dx.doi.org/10.2196/mental.9419 UR - http://www.ncbi.nlm.nih.gov/pubmed/30617046 ID - info:doi/10.2196/mental.9419 ER - TY - JOUR AU - Cross, Andrea AU - Rosenbaum, Peter AU - Grahovac, Danijela AU - Brocklehurst, Julie AU - Kay, Diane AU - Baptiste, Sue AU - Gorter, Willem Jan PY - 2018/12/21 TI - A Web-Based Knowledge Translation Resource for Families and Service Providers (The ?F-Words? in Childhood Disability Knowledge Hub): Developmental and Pilot Evaluation Study JO - JMIR Rehabil Assist Technol SP - e10439 VL - 5 IS - 2 KW - childhood disability KW - F-words KW - ICF KW - Knowledge Hub KW - knowledge-to-action framework KW - knowledge translation KW - Web-based resource N2 - Background: The ?F-words in Childhood Disability? (Function, Family, Fitness, Fun, Friends, and Future) are an adaptation and an attempt to operationalize the World Health Organization?s (2001) International Classification of Functioning, Disability and Health (ICF) framework. Since the paper was published (November 2011), the ?F-words? have attracted global attention (>12,000 downloads, January 2018). Internationally, people have adopted the ?F-words? ideas, and many families and service providers have expressed a need for more information, tools, and resources on the ?F-words?. Objective: This paper reports on the development and pilot evaluation of a Web-based knowledge translation (KT) resource, the ?F-words? Knowledge Hub that was created to inform people about the ?F-words? and to provide action-oriented tools to support the use of the ?F-words? in practice. Methods: An integrated research team of families and researchers at CanChild Centre for Childhood Disability Research collaborated to develop, implement, and evaluate the Knowledge Hub. A pilot study design was chosen to assess the usability and utility of the Web-based hub before implementing a larger evaluation study. Data were collected using a brief anonymous Web-based survey that included both closed-ended and open-ended questions, with the closed-ended responses being based on a five-point Likert-type scale. We used descriptive statistics and a summary of key themes to report findings. Results: From August to November 2017, the Knowledge Hub received >6,800 unique visitors. In 1 month (November 2017), 87 people completed the survey, of whom 63 completed the full survey and 24 completed 1 or 2 sections. The respondents included 42 clinicians and 30 family members or individuals with a disability. The majority of people visited the Knowledge Hub 1-5 times (n=63) and spent up to 45 minutes exploring (n=61) before providing feedback. Overall, 66 people provided information on the perceived usefulness of the Knowledge Hub, of which 92% (61/66) found the Knowledge Hub user-friendly and stated that they enjoyed exploring the hub, and a majority (n=52) reported that the Knowledge Hub would influence what they did when working with others. From the open-ended responses (n=48), the ?F-words? videos (n=21) and the ?F-words? tools (n=15) were rated as the best features on the Knowledge Hub. Conclusions: The ?F-words? Knowledge Hub is an evidence-informed Web-based KT resource that was useful for respondents, most of whom were seen as ?early adopters? of the ?F-words? concepts. Based on the findings, minor changes are to be made to improve the Knowledge Hub before completing a larger evaluation study on the impact at the family, clinician, and organizational levels with a wider group of users. Our hope is that the ?F-words? Knowledge Hub will become a go-to resource for knowledge sharing and exchange for families and service providers. UR - http://rehab.jmir.org/2018/2/e10439/ UR - http://dx.doi.org/10.2196/10439 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578233 ID - info:doi/10.2196/10439 ER - TY - JOUR AU - Duan, Ping Yan AU - Liang, Wei AU - Guo, Lan AU - Wienert, Julian AU - Si, Yan Gang AU - Lippke, Sonia PY - 2018/11/19 TI - Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e12052 VL - 20 IS - 11 KW - eHealth KW - physical activity KW - diet KW - cardiac rehabilitation KW - health resources N2 - Background: Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention. Objective: The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression). Methods: In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016. Results: The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F1,79=16.36, P<.001, ?2=.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R2adj=.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely. Conclusions: Patients? psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge. Trial Registration: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1) UR - http://www.jmir.org/2018/11/e12052/ UR - http://dx.doi.org/10.2196/12052 UR - http://www.ncbi.nlm.nih.gov/pubmed/30455167 ID - info:doi/10.2196/12052 ER - TY - JOUR AU - Lawford, J. Belinda AU - Hinman, S. Rana AU - Kasza, Jessica AU - Nelligan, Rachel AU - Keefe, Francis AU - Rini, Christine AU - Bennell, L. Kim PY - 2018/05/09 TI - Moderators of Effects of Internet-Delivered Exercise and Pain Coping Skills Training for People With Knee Osteoarthritis: Exploratory Analysis of the IMPACT Randomized Controlled Trial JO - J Med Internet Res SP - e10021 VL - 20 IS - 5 KW - telerehabilitation KW - moderators KW - osteoarthritis KW - exercise N2 - Background: Internet-delivered exercise, education, and pain coping skills training is effective for people with knee osteoarthritis, yet it is not clear whether this treatment is better suited to particular subgroups of patients. Objective: The aim was to explore demographic and clinical moderators of the effect of an internet-delivered intervention on changes in pain and physical function in people with knee osteoarthritis. Methods: Exploratory analysis of data from 148 people with knee osteoarthritis who participated in a randomized controlled trial comparing internet-delivered exercise, education, and pain coping skills training to internet-delivered education alone. Primary outcomes were changes in knee pain while walking (11-point Numerical Rating Scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index function subscale) at 3 and 9 months. Separate regression models were fit with moderator variables (age, gender, expectations of outcomes, self-efficacy [pain], education, employment status, pain catastrophizing, body mass index) and study group as covariates, including an interaction between the two. Results: Participants in the intervention group who were currently employed had significantly greater reductions in pain at 3 months than similar participants in the control group (between-group difference: mean 2.38, 95% CI 1.52-3.23 Numerical Rating Scale units; interaction P=.02). Additionally, within the intervention group, pain at 3 months reduced by mean 0.53 (95% CI 0.28-0.78) Numerical Rating Scale units per unit increase in baseline self-efficacy for managing pain compared to mean 0.11 Numerical Rating Scale units (95% CI ?0.13 to 0.35; interaction P=.02) for the control group. Conclusions: People who were employed and had higher self-efficacy at baseline were more likely to experience greater improvements in pain at 3 months after an internet-delivered exercise, education, and pain coping skills training program. There was no evidence of a difference in the effect across gender, educational level, expectation of treatment outcome, or across age, body mass index, or tendency to catastrophize pain. Findings support the effectiveness of internet-delivered care for a wide range of people with knee osteoarthritis, but future confirmatory research is needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000243617; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365812&isReview=true (Archived by WebCite at http://www.webcitation.org/6z466oTPs) UR - http://www.jmir.org/2018/5/e10021/ UR - http://dx.doi.org/10.2196/10021 UR - http://www.ncbi.nlm.nih.gov/pubmed/29743149 ID - info:doi/10.2196/10021 ER - TY - JOUR AU - Bright, Philip AU - Hambly, Karen PY - 2018/04/26 TI - Patients Using an Online Forum for Reporting Progress When Engaging With a Six-Week Exercise Program for Knee Conditioning: Feasibility Study JO - JMIR Rehabil Assist Technol SP - e9 VL - 5 IS - 1 KW - eHealth? social media? exercise therapy? rehabilitation N2 - Background: The use of electronic health (eHealth) and Web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual ?sticky notes.? Objective: The primary aim of this study was to determine feasibility of patients in a 6-week knee exercise program using Padlet as an online forum for self-reporting on outcome progression. Methods: Undergraduate manual therapy students were recruited as part of a 6-week study into knee conditioning. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analyzed for association between engagement, entry frequency, and participant characteristics. Individual data facilitated single-subject, multiple-baseline analysis using statistical process control. Experiential narrative was analyzed thematically. Results: Nineteen participants were recruited (47%, 9/19 female); ages ranged from 19 to 53 years. Twelve individuals (63%) opted to engage with the forum (range 4-40 entries), with five (42%) reporting across all 6 weeks. Gender did not influence reporting (odds ratio [OR] 0.76, 95% CI 0.06-6.93). No significant difference manifested between body mass index and engagement P=.46); age and entry frequency did not correlate (R2=.054, 95% CI ?0.42 to 0.51, P=.83). Statistically significant conditioning profiles arose in single participants. Themes of pain, mitigation, and response were inducted from the experiences posted. Conclusions: Patients will engage with an online forum for reporting progress when undertaking exercise programs. In contrast to related literature, no significant association was found with reporting and gender, age, or body mass index. Individual posted data allowed multiple-baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualized visual data to patients and the role of forums in monitoring patients? progress in symptomatic knee pain populations need further consideration. UR - http://rehab.jmir.org/2018/1/e9/ UR - http://dx.doi.org/10.2196/rehab.8567 UR - http://www.ncbi.nlm.nih.gov/pubmed/29699967 ID - info:doi/10.2196/rehab.8567 ER - TY - JOUR AU - Riis, Allan AU - Hjelmager, Meulengracht Ditte AU - Vinther, Dausel Line AU - Rathleff, Skovdal Michael AU - Hartvigsen, Jan AU - Jensen, Bach Martin PY - 2018/04/02 TI - Preferences for Web-Based Information Material for Low Back Pain: Qualitative Interview Study on People Consulting a General Practitioner JO - JMIR Rehabil Assist Technol SP - e7 VL - 5 IS - 1 KW - patient education as topic KW - medical informatics app KW - patient participation KW - general practice KW - low back pain N2 - Background: Information on self-management, including addressing people?s fears and concerns, are core aspects of managing patients with low back pain (LBP). Web apps with patient information may be used to extend patient-physician consultations and encourage self-management outside of the consultation room. It is, however, important to identify the end users? needs and preferences in order to maximize acceptance. Objective: The aim of this study was to identify preferences for the content, design, and functionality of a Web app with evidence-based information and advice for people with LBP in Denmark. Methods: This is a phenomenological qualitative study. Adults who had consulted their general practitioner because of LBP within the past 14 days were included. Each participated in a semistructured interview, which was audiotaped and transcribed for text condensation. Interviews were conducted at the participant?s home by 2 interviewers. Participants also completed a questionnaire that requested information on age, gender, internet usage, interest in searching new knowledge, LBP-related function, and pain. Results: Fifteen 45-min interviews were conducted. Participants had a median age of 40 years (range 22-68 years) and reported a median disability of 7 points (range 0-18) using the 23-item Roland Morris Disability Questionnaire. Participants reported that Web-based information should be easy to find and read, easily overviewed, and not be overloaded with information. Subjects found existing Web-based information confusing, often difficult to comprehend, and not relevant for them, and they questioned the motives driving most hosting companies or organizations. The Patient Handbook, a Danish government-funded website that provides information to Danes about health, was mentioned as a trustworthy and preferred site when searching for information and advice regarding LBP. Conclusions: This study identified important issues to consider when developing and supplementing existing general practice treatment with Web-based information and advice for patients with LBP. Development of a Web app should consider patient input, and developers should carefully address the following domains: readability, customization, design, credibility, and usability. UR - http://rehab.jmir.org/2018/1/e7/ UR - http://dx.doi.org/10.2196/rehab.8841 UR - http://www.ncbi.nlm.nih.gov/pubmed/29610108 ID - info:doi/10.2196/rehab.8841 ER - TY - JOUR AU - Wallin, Emma AU - Norlund, Fredrika AU - Olsson, Gustaf Erik Martin AU - Burell, Gunilla AU - Held, Claes AU - Carlsson, Tommy PY - 2018/03/16 TI - Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study JO - J Med Internet Res SP - e87 VL - 20 IS - 3 KW - mental health KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - myocardial infarction KW - attrition KW - adherence N2 - Background: Knowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care. Objective: The aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction. Methods: This was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis. Results: Treatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6%), and about half (63/117, 53.9%) of all participants completed the introductory module, but only 18 (15.4%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties. Conclusions: Patients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based interventions in this population. UR - http://www.jmir.org/2018/3/e87/ UR - http://dx.doi.org/10.2196/jmir.9690 UR - http://www.ncbi.nlm.nih.gov/pubmed/29549067 ID - info:doi/10.2196/jmir.9690 ER - TY - JOUR AU - Buimer, P. Hendrik AU - Tabak, Monique AU - van Velsen, Lex AU - van der Geest, Thea AU - Hermens, Hermie PY - 2017/12/14 TI - Exploring Determinants of Patient Adherence to a Portal-Supported Oncology Rehabilitation Program: Interview and Data Log Analyses JO - JMIR Rehabil Assist Technol SP - e12 VL - 4 IS - 2 KW - telemedicine KW - rehabilitation KW - patient portals KW - treatment adherence KW - compliance N2 - Background: Telemedicine applications often do not live up to their expectations and often fail once they have reached the operational phase. Objective: The objective of this study was to explore the determinants of patient adherence to a blended care rehabilitation program, which includes a Web portal, from a patient?s perspective. Methods: Patients were enrolled in a 12-week oncology rehabilitation treatment supported by a Web portal that was developed in cooperation with patients and care professionals. Semistructured interviews were used to analyze thought processes and behavior concerning patient adherence and portal use. Interviews were conducted with patients close to the start and the end of the treatment. Besides, usage data from the portal were analyzed to gain insights into actual usage of the portal. Results: A total of 12 patients participated in the first interview, whereas 10 participated in the second round of interviews. Furthermore, portal usage of 31 patients was monitored. On average, 11 persons used the portal each week, with a maximum of 20 in the seventh week and a drop toward just one person in the weeks in the follow-up period of the treatment. From the interviews, it was derived that patients? behavior in the treatment and use of the portal was primarily determined by extrinsic motivation cues (eg, stimulation by care professionals and patient group), perceived severity of the disease (eg, physical and mental condition), perceived ease of use (eg, accessibility of the portal and the ease with which information is found), and perceived usefulness (eg, fit with the treatment). Conclusions: The results emphasized the impact that care professionals and fellow patients have on patient adherence and portal usage. For this reason, the success of blended care telemedicine interventions seems highly dependent on the willingness of care professionals to include the technology in their treatment and stimulate usage among patients. UR - http://rehab.jmir.org/2017/2/e12/ UR - http://dx.doi.org/10.2196/rehab.6294 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242173 ID - info:doi/10.2196/rehab.6294 ER - TY - JOUR AU - Srikesavan, Swarnalatha Cynthia AU - Williamson, Esther AU - Eldridge, Lucy AU - Heine, Peter AU - Adams, Jo AU - Cranston, Tim AU - Lamb, E. Sarah PY - 2017/12/13 TI - A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing JO - J Med Internet Res SP - e411 VL - 19 IS - 12 KW - hand function KW - hand exercises KW - rheumatoid arthritis KW - online training KW - implementation N2 - Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. Objective: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. Methods: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. Results: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. Conclusions: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice. UR - http://www.jmir.org/2017/12/e411/ UR - http://dx.doi.org/10.2196/jmir.8424 UR - http://www.ncbi.nlm.nih.gov/pubmed/29237581 ID - info:doi/10.2196/jmir.8424 ER - TY - JOUR AU - Amann, Julia AU - Rubinelli, Sara PY - 2017/10/10 TI - Views of Community Managers on Knowledge Co-creation in Online Communities for People With Disabilities: Qualitative Study JO - J Med Internet Res SP - e320 VL - 19 IS - 10 KW - community networks KW - internet KW - patient-centered care KW - telemedicine KW - community participation KW - co-creation N2 - Background: The use of online communities to promote end user involvement and co-creation in the product and service innovation process is well documented in the marketing and management literature. Whereas online communities are widely used for health care service provision and peer-to-peer support, only little is known about how they could be integrated into the health care innovation process. Objective: The overall objective of this qualitative study was to explore community managers? views on and experiences with knowledge co-creation in online communities for people with disabilities. Methods: A descriptive qualitative research design was used. Data were collected through semi-structured interviews with nine community managers. To complement the interview data, additional information was retrieved from the communities in the form of structural information (number of registered users, number and names of topic areas covered by the forum) and administrative information (terms and conditions and privacy statements, forum rules). Data were analyzed using thematic analysis. Results: Our results highlight two main aspects: peer-to-peer knowledge co-creation and types of collaboration with external actors. Although community managers strongly encouraged peer-to-peer knowledge co-creation, our findings indicated that these activities were not common practice in the communities under investigation. In fact, much of what related to co-creation, prototyping, and product development was still perceived to be directed by professionals and experts. Community managers described the role of their respective communities as informing this process rather than a driving force. The role of community members as advisors to researchers, health care professionals, and businesses was discussed in the context of types of collaboration with external actors. According to the community managers, most of the external inquiries related to research projects of students or health care professionals in training, who often joined a community for the sole purpose of recruiting participants for their research. Despite this unilateral form of knowledge co-creation, community managers acknowledged the mere interest of these user groups as beneficial, as long as their interest was not purely financially motivated. Being able to contribute to advancing research, improving products, and informing the planning and design of health care services were described as some of the key motivations to engage with external stakeholders. Conclusions: This paper draws attention to the currently under-investigated role of online communities as platforms for collaboration and co-creation between patients, health care professionals, researchers, and businesses. It describes community managers? views on and experiences with knowledge co-creation and provides recommendations on how these activities can be leveraged to foster knowledge co-creation in health care. Engaging in knowledge co-creation with online health communities may ultimately help to inform the planning and design of products, services, and research activities that better meet the actual needs of those living with a disability. UR - https://www.jmir.org/2017/10/e320/ UR - http://dx.doi.org/10.2196/jmir.7406 UR - http://www.ncbi.nlm.nih.gov/pubmed/29017993 ID - info:doi/10.2196/jmir.7406 ER - TY - JOUR AU - Pastora-Bernal, Manuel Jose AU - Martín-Valero, Rocio AU - Barón-López, Javier Francisco AU - Estebanez-Pérez, José María PY - 2017/04/28 TI - Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review JO - J Med Internet Res SP - e142 VL - 19 IS - 4 KW - telerehabilitation KW - orthopedic surgery KW - musculoskeletal disorders KW - systematic review KW - telemedicine KW - mobile health KW - mHealth KW - telehealth KW - physiotherapy N2 - Background: In addition to traditional physiotherapy, studies based on telerehabilitation programs have published the results of effectiveness, validity, noninferiority, and important advantages in some neurological, cognitive, and musculoskeletal disorders, providing an opportunity to define new social policies and interventions. Objectives: The aim of this systematic review is to investigate the effects of telerehabilitation after surgical procedures on orthopedic conditions as well as to describe how interventions are designed and to determine whether telerehabilitation is comparable with conventional methods of delivery. This systematic review summarizes the levels of evidence and grades of recommendation regarding telerehabilitation intervention (synchronous or asynchronous provided via the telerehabilitation medium, either in conjunction with, or in isolation of, other treatment interventions) after surgical procedures on orthopedic conditions. Methods: Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scores and grade of recommendation following the recommendation of the Oxford Centre for Evidence-Based Medicine. Results: We found 3 studies with PEDro scores between 6 and 8, which is considered as level 1 evidence (good; 20% [3/15]), 4 studies with a score of 5, which is considered as level 2 evidence (acceptable; 27% [4/15]), and the remaining 8 studies had scores of 4 or less, which is considered (poor; 53% [8/15]). A total of 1316 participants received telerehabilitation intervention in the selected studies, where knee and hip replacement were 75% of all the studies. Strong and moderate grades of evidence (grade of recommendation A?B) were found in knee and hip replacement interventions. Studies on the upper limb were 25% of the studies, but only 1 study presented a moderate grade of evidence (grade of recommendation B) and the rest were of poor methodological quality with weak evidence (grade of recommendation C). Conclusions: Conclusive evidence on the efficacy of telerehabilitation for treatment after an orthopedic surgery, regardless of pathology, was not obtained. We found strong evidence in favor of telerehabilitation in patients following total knee and hip arthroplasty and limited evidence in the upper limb interventions (moderate and weak evidence). Future research needs to be more extensive and conclusive. To the best of the authors? knowledge, this is the first attempt at evaluating the quality of telerehabilitation intervention research after surgical procedures on orthopedic conditions in a systematic review. Clinical messages and future research recommendations are included in the review. UR - http://www.jmir.org/2017/4/e142/ UR - http://dx.doi.org/10.2196/jmir.6836 UR - http://www.ncbi.nlm.nih.gov/pubmed/28455277 ID - info:doi/10.2196/jmir.6836 ER - TY - JOUR AU - King, Gillian AU - Maxwell, Joanne AU - Karmali, Amir AU - Hagens, Simon AU - Pinto, Madhu AU - Williams, Laura AU - Adamson, Keith PY - 2017/04/06 TI - Connecting Families to Their Health Record and Care Team: The Use, Utility, and Impact of a Client/Family Health Portal at a Children?s Rehabilitation Hospital JO - J Med Internet Res SP - e97 VL - 19 IS - 4 KW - disability KW - engagement KW - health information KW - caregivers KW - children with disabilities KW - patient portals KW - electronic health records N2 - Background: Health care portals have the potential to provide consumers with timely, transparent access to health care information and engage them in the care process. Objective: The objective was to examine the use, utility, and impact on engagement in care and caregiver-provider communication of a client/family portal providing access to electronic health records (EHRs) and secure, 2-way e-messaging with care providers. Methods: We conducted a prospective, mixed-methods study involving collection of caregivers? portal usage information over a 14-month period (from portal introduction in January 2015 to the end of the study period in March 2016), a Web-based survey for caregivers administered after a minimum of 2 months? exposure to the portal and repeated 2 months later, and focus groups or individual interviews held with caregivers and service providers at the same points in time. The survey assessed caregivers? perceptions of the utility of and satisfaction with the EHR and e-messaging, and the portal?s impact on client engagement and perceptions of caregiver-provider communication. A total of 18 caregivers (parents) completed surveys and 6 also took part in focus groups or interviews. In addition, 5 service providers from different disciplines took part in focus groups or interviews. Results: Although usage patterns varied, the typical pattern was a steady level of use (2.5 times a month over an average of 9 months), which is higher than typically reported use. The portal pages most frequently accessed were the home page, health record main page, appointment main page, and reports main page. The Web-based survey captured caregivers? perceptions of usefulness of and satisfaction with the EHR and portal messaging, as well as the portal?s impact on their engagement in care and perceptions of caregiver-provider communication. The surveys indicated a moderate degree of utility of and satisfaction with the portal features, and a low but emerging impact on engagement in care and caregiver-provider communication (survey scales measuring these outcomes displayed excellent internal consistency, with Cronbach alpha ranging from .89 to .95). Qualitative themes from focus groups and interviews supported and extended the survey findings. Caregivers and service providers saw appreciable information benefits and provided recommendations to increase portal use and utility. Caregivers focused on the scope of organizational adoption of the portal system and indicated their hopes for the future of the portal, whereas service providers were concerned about how to best manage their investment of time and effort in preparing client-friendly reports and messaging clients via the portal. Conclusions: Overall, the findings show the promise of the portal and the need for ongoing evaluation to show the portal?s ultimate potential in enhancing engagement in care and communication with care providers. UR - http://www.jmir.org/2017/4/e97/ UR - http://dx.doi.org/10.2196/jmir.6811 UR - http://www.ncbi.nlm.nih.gov/pubmed/28385680 ID - info:doi/10.2196/jmir.6811 ER - TY - JOUR AU - Smittenaar, Peter AU - Erhart-Hledik, C. Jennifer AU - Kinsella, Rose AU - Hunter, Simon AU - Mecklenburg, Gabriel AU - Perez, Daniel PY - 2017/04/05 TI - Translating Comprehensive Conservative Care for Chronic Knee Pain Into a Digital Care Pathway: 12-Week and 6-Month Outcomes for the Hinge Health Program JO - JMIR Rehabil Assist Technol SP - e4 VL - 4 IS - 1 KW - chronic pain KW - osteoarthritis, knee KW - digital health KW - conservative management N2 - Background: Chronic knee pain (CKP) affects a large number of adults, many of whom do not receive best-practice care and are at high risk for unnecessary surgery. Objective: The aim of this study was to investigate the effect of the Hinge Health 12-week digital care program (DCP) for CKP on knee pain and function, with secondary outcomes of surgery interest and satisfaction, at 12 weeks and 6 months after starting the program. Methods: Individuals with CKP were recruited onto the 12-week program, comprising sensor-guided physical exercises, weekly education, activity tracking, and psychosocial support such as personal coaching and cognitive behavioral therapy (CBT). We used a single-arm design with assessment of outcomes at baseline, 12 weeks, and 6 months after starting the program. We used a linear mixed effects model with Tukey contrasts to compare timepoints and report intention-to-treat statistics with last observation carried forward. Results: The cohort consisted of 41 individuals (32 female, mean age 52 years, SD 9 years). Between baseline and week 12, participants reported clinically significant improvements in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) function scales of 16 points (95% CI 12-21, P<.001) and 10 points (95% CI 6-14, P<.001), respectively. Significant reductions of 57% (mean difference 30, 95% CI 21-38, P<.001) and 51% (mean difference 25, 95% CI 16-33, P<.001) in visual analog scale (VAS) knee pain and stiffness, respectively, were observed at 12 weeks, as well as a 67% reduction in surgery interest (mean reduction 2.3 out of 10, 95% CI 1.5-3.1, P<.001). Average satisfaction at week 12 was 9.2 out of 10. Critically, all improvements were maintained at 6 months at similar or greater magnitude. Conclusions: Participants on the Hinge Health DCP for CKP showed substantial clinical improvements that were maintained 6 months after enrolling in the program. This shows that DCPs carry strong potential to deliver evidence-based, cost-effective care to those suffering from CKP. UR - http://rehab.jmir.org/2017/1/e4/ UR - http://dx.doi.org/10.2196/rehab.7258 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582253 ID - info:doi/10.2196/rehab.7258 ER - TY - JOUR AU - Ab Malik, Normaliza AU - Mohamad Yatim, Sa'ari AU - Lam, Tao Otto Lok AU - Jin, Lijian AU - McGrath, Joseph Colman Patrick PY - 2017/03/31 TI - Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial JO - J Med Internet Res SP - e87 VL - 19 IS - 3 KW - oral hygiene KW - computer-aided learning KW - cerebrovascular accident KW - theory of planned behavior KW - health care providers, Internet N2 - Background: Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia. Objective: The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on ?general intention? of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB). Methods: A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: ?attitude,? ?subjective norm? (SN), ?perceived behavior control? (PBC), ?general intention? (GI), and ?knowledge? related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention. Results: The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (P<.001) and knowledge (P=.001) between the test and control groups. Regression analyses identified that the key factors associated with a change in GI at 6 months were changes in SN (beta=.36, P<.001) and changes in PBC (beta=.23, P<.001). Conclusions: The Web-based CPD program based on TPB increased general intention, attitudes, subjective norms, and knowledge to provide oral hygiene care among stroke carers for their patients. Changing subjective norms and perceived behavioral control are key factors associated with changes in general intention to provide oral hygiene care. Trial Registration: National Medical Research Register, Malaysia NMRR-13-1540-18833 (IIR); https://www.nmrr.gov.my/ fwbLoginPage.jsp UR - http://www.jmir.org/2017/3/e87/ UR - http://dx.doi.org/10.2196/jmir.7024 UR - http://www.ncbi.nlm.nih.gov/pubmed/28363880 ID - info:doi/10.2196/jmir.7024 ER - TY - JOUR AU - Cranen, Karlijn AU - Groothuis-Oudshoorn, GM Catharina AU - Vollenbroek-Hutten, MR Miriam AU - IJzerman, J. Maarten PY - 2017/01/20 TI - Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients? Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment JO - J Med Internet Res SP - e26 VL - 19 IS - 1 KW - patient preference KW - patient acceptance of health care KW - telerehabilitation KW - choice behavior KW - decision making KW - decision support techniques KW - patient compliance KW - chronic disease KW - exercise therapy KW - chronic pain N2 - Background: Patient-centered design that addresses patients? preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients? preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients? perspective. In addition, limited evidence is available about the best way to explore patients? preferences. Therefore, the assessment of patients? preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective: To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods: A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results: Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients? treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions: ?Intermediate? telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment. UR - http://www.jmir.org/2017/1/e26/ UR - http://dx.doi.org/10.2196/jmir.5951 UR - http://www.ncbi.nlm.nih.gov/pubmed/28108429 ID - info:doi/10.2196/jmir.5951 ER - TY - JOUR AU - Nordin, Catharina AU - Michaelson, Peter AU - Eriksson, K. Margareta AU - Gard, Gunvor PY - 2017/01/18 TI - It?s About Me: Patients? Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation JO - J Med Internet Res SP - e22 VL - 19 IS - 1 KW - interview KW - pain KW - patient participation KW - qualitative research KW - Web-based intervention N2 - Background: Patients? participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient?s active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients? experiences of patient participation in Web-based interventions in clinical practice. Objective: The objective of our study was to explore patients? experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care. Methods: Qualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis. Results: One theme, ?It?s about me,? and 4 categories, ?Take part in a flexible framework of own priority,? ?Acquire knowledge and insights,? ?Ways toward change,? and ?Personal and environmental conditions influencing participation,? were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one?s own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual?s emotional and cognitive resources and restrictions, as well as health care professionals and significant others? attitudes and behavior influenced patient participation in the rehabilitation. To some extent there were experiences of restrained patient participation through the great content of the Web-BCPA. Conclusions: Patient participation was satisfactory in the Web-BCPA in combination with MMR. The combined treatment was experienced to increase patient participation in the rehabilitation. Being confirmed through self-identification and finding the content of the Web-BCPA trustworthy was emphasized. Patient participation was experienced as a learning process leading to new knowledge and insights. Higher user control regarding the timing of the Web-BCPA and therapist guidance of the content may further increase patient participation in the combined treatment. UR - http://www.jmir.org/2017/1/e22/ UR - http://dx.doi.org/10.2196/jmir.5970 UR - http://www.ncbi.nlm.nih.gov/pubmed/28100440 ID - info:doi/10.2196/jmir.5970 ER - TY - JOUR AU - Hennemann, Severin AU - Beutel, E. Manfred AU - Zwerenz, Rüdiger PY - 2016/12/23 TI - Drivers and Barriers to Acceptance of Web-Based Aftercare of Patients in Inpatient Routine Care: A Cross-Sectional Survey JO - J Med Internet Res SP - e337 VL - 18 IS - 12 KW - eHealth KW - attitude to health KW - aftercare KW - rehabilitation KW - survey N2 - Background: Web-based aftercare can help to stabilize treatment effects and support transition after inpatient treatment, yet uptake by patients seems limited in routine care and little is known about the mechanisms of adoption and implementation. Objective: The aim of this study was to (1) determine acceptance of Web-based aftercare and (2) explore its drivers and barriers in different subgroups of a mixed inpatient sample. Method: In a cross-sectional design, 38.3% (374/977) of the inpatients from a broad spectrum of diagnostic groups (psychosomatic, cardiologic, orthopedic, pediatric, and substance-related disorders) filled out a self-administered questionnaire prior to discharge. Drivers and barriers to patients? acceptance of Web-based aftercare were examined based on an extension to the ?unified theory of acceptance and use of technology? (UTAUT). In total, 16.7% (59/353) of the participants indicated prior use of eHealth interventions. Results: Acceptance (min 1, max 5) was low (mean 2.56, SD 1.22) and differed between diagnostic groups (Welch F4,133.10 =7.77, P<.001), with highest acceptance in adolescent patients (mean 3.46, SD 1.42). Acceptance was significantly predicted by 3 UTAUT predictors: social influence (beta=.39, P<.001), performance expectancy (beta=.31, P<.001), and effort expectancy (beta=.22, P<.001). Furthermore, stress due to permanent availability (beta=?.09, P=.01) was negatively associated with acceptance. Conclusion: This study demonstrated a limited acceptance of Web-based aftercare in inpatients. Expectations, social environment?s attitude, and negative experience with permanent availability influence eHealth acceptance. Improving implementation, therefore, means increasing eHealth experience and literacy and facilitating positive attitudes in patients and health professionals through education and reduction of misconceptions about effectiveness or usability. UR - http://www.jmir.org/2016/12/e337/ UR - http://dx.doi.org/10.2196/jmir.6003 UR - http://www.ncbi.nlm.nih.gov/pubmed/28011445 ID - info:doi/10.2196/jmir.6003 ER - TY - JOUR AU - Kim, Benjamin Tae Won AU - Gay, Nic AU - Khemka, Arpit AU - Garino, Jonathan PY - 2016/12/14 TI - Internet-Based Exercise Therapy Using Algorithms for Conservative Treatment of Anterior Knee Pain: A Pragmatic Randomized Controlled Trial JO - JMIR Rehabil Assist Technol SP - e12 VL - 3 IS - 2 KW - knee pain KW - conservative measures KW - exercise therapy KW - nonoperative KW - algorithm KW - home-based KW - physical therapy N2 - Background: Conservative treatment remains the first-line option, and there is significant medical evidence showing that home-based exercise therapy for the treatment of common causes of knee pain is effective. SimpleTherapy created an online platform that delivers Internet-based exercise therapy for common causes of knee pain. The system is driven by an algorithm that can process the user?s feedback to provide an adaptive exercise regimen. This triple-armed, pragmatic randomized pilot was designed to evaluate if this telerehabilitation platform is safe and effective. Objective: We hypothesized that a home-based, algorithm-driven exercise therapy program can be safe for use and even improve compliance over the standard of care, the paper handout. Methods: After an independent internal review board review and approval, the website trial.simpletherapy.com was opened. Once the trial was open for enrollment, no changes to the functionality or user interaction features were performed until the trial had closed. User accrual to the website was done using website optimization and social media postings tied to existence of knee pain. Consent was obtained online through checkboxes with third-party signature confirmation. No fees were charged to any patient. Patients were recruited online from an open access website. Outcomes were self-assessed through questionnaires with no face-to-face clinician interaction. A triple-arm randomized controlled trial was used with arm 1 being a static handout of exercises, arm 2 being a video version of arm 1, and arm 3 being a video-based, algorithm-driven system that took patient feedback and changed the exercises based on the feedback. Patients used household items and were not supervised by a physical therapist or clinician. Patients were reminded at 48-hour intervals to complete an exercise session. Results: A total of 860 users found the trial and initiated the registration process. These 860 were randomized, and the demographic distribution shows the randomization was successful. In all, 70 users completed the 6-week regimen (8.1%): 20 users were in arm 1, 33 users in arm 2, and 17 users in arm 3. There were no adverse events reported in any of the 3 arms. All outcomes were self-assessed. No adverse events were reported during or after the trial. Conclusions: Because only 8.1% of those who enrolled completed the trial, an intent-to-treat analysis did not reach statistical significance in this pilot trial. However, the completion rates are comparable to those of previous online-only trials. Given an early phase trial, no adverse events were reported. Ongoing data collection continues and will form the basis for further data on the efficacy of this intervention. Trial Registration: Clinicaltrials.gov NCT01696162; https://clinicaltrials.gov/ct2/show/NCT01696162 (Archived by WebCite at http://www.webcitation.org/6lM8jC7Gu) UR - http://rehab.jmir.org/2016/2/e12/ UR - http://dx.doi.org/10.2196/rehab.5148 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582256 ID - info:doi/10.2196/rehab.5148 ER - TY - JOUR AU - Nordin, A. Catharina AU - Michaelson, Peter AU - Gard, Gunvor AU - Eriksson, K. Margareta PY - 2016/10/05 TI - Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial JO - J Med Internet Res SP - e265 VL - 18 IS - 10 KW - coping behavior KW - pain KW - patient compliance KW - patient satisfaction KW - rehabilitation KW - self-efficacy KW - Web-based intervention N2 - Background: Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR). Objective: The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated. Methods: A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items. Results: Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003). Conclusions: Adding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuable. ClinicalTrial: Clinicaltrials.gov NCT01475591; https://clinicaltrials.gov/ct2/show/NCT01475591 (Archived by WebCite at http://www.webcitation.org/6kUnt7VQh) UR - http://www.jmir.org/2016/10/e265/ UR - http://dx.doi.org/10.2196/jmir.5634 UR - http://www.ncbi.nlm.nih.gov/pubmed/27707686 ID - info:doi/10.2196/jmir.5634 ER - TY - JOUR AU - Dedov, N. Vadim AU - Dedova, V. Irina PY - 2016/08/22 TI - Application of a Web-Enabled Leg Training System for the Objective Monitoring and Quantitative Analysis of Exercise-Induced Fatigue JO - JMIR Res Protoc SP - e171 VL - 5 IS - 3 KW - exercise intervention KW - cardiac rehabilitation KW - training equipment KW - online monitoring KW - exercise dose KW - muscle fatigue KW - heart rate KW - leg work output KW - fatigability N2 - Background: Sustained cardiac rehabilitation is the key intervention in the prevention and treatment of many human diseases. However, implementation of exercise programs can be challenging because of early fatigability in patients with chronic diseases, overweight individuals, and aged people. Current methods of fatigability assessment are based on subjective self-reporting such as rating of perceived exertion or require specialized laboratory conditions and sophisticated equipment. A practical approach allowing objective measurement of exercise-induced fatigue would be useful for the optimization of sustained delivery of cardiac rehabilitation to improve patient outcomes. Objectives: The objective of this study is to develop and validate an innovative approach, allowing for the objective assessment of exercise-induced fatigue using the Web-enabled leg rehabilitation system. Methods: MedExercise training devices were equipped with wireless temperature sensors in order to monitor their usage by temperature rise in the resistance unit (?t°). Since ?t° correlated with the intensity and duration of exercise, this parameter was used to characterize participants? leg work output (LWO). Personal smart devices such as laptop computers with wireless gateways and relevant software were used for monitoring of self-control training. Connection of smart devices to the Internet and cloud-based software allowed remote monitoring of LWO in participants training at home. Heart rates (HRs) were measured by fingertip pulse oximeters simultaneously with ?t° in 7 healthy volunteers. Results: Exercise-induced fatigue manifested as the decline of LWO and/or rising HR, which could be observed in real-time. Conversely, training at the steady-state LWO and HR for the entire duration of exercise bout was considered as fatigue-free. The amounts of recommended daily physical activity were expressed as the individual ?t° values reached during 30-minute fatigue-free exercise of moderate intensity resulting in a mean of 8.1°C (SD 1.5°C, N=7). These ?t° values were applied as the thresholds for sending automatic notifications upon taking the personalized LWO doses by self-control training at home. While the mean time of taking LWO doses was 30.3 (SD 4.1) minutes (n=25), analysis of times required to reach the same ?t° by the same participant revealed that longer durations were due to fatigability, manifesting as reduced LWO at the later stages of training bouts. Typically, exercising in the afternoons associated with no fatigue, although longer durations of evening sessions suggested a diurnal fatigability pattern. Conclusions: This pilot study demonstrated the feasibility of objective monitoring of fatigue development in real-time and online as well as retrospective fatigability quantification by the duration of training bouts to reach the same exercise dose. This simple method of leg training at home accompanied by routine fatigue monitoring might be useful for the optimization of exercise interventions in primary care and special populations. UR - http://www.researchprotocols.org/2016/3/e171/ UR - http://dx.doi.org/10.2196/resprot.4985 UR - http://www.ncbi.nlm.nih.gov/pubmed/27549345 ID - info:doi/10.2196/resprot.4985 ER - TY - JOUR AU - Lai, Byron AU - Rimmer, James AU - Barstow, Beth AU - Jovanov, Emil AU - Bickel, Scott C. PY - 2016/07/14 TI - Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series JO - JMIR Rehabil Assist Technol SP - e8 VL - 3 IS - 2 KW - exercise KW - physical activity KW - telehealth KW - spinal cord injury KW - persons with disabilities N2 - Background: Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home. Objective: To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report. Methods: Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO2 peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase. Results: Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts. Conclusion: A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample. UR - http://rehab.jmir.org/2016/2/e8/ UR - http://dx.doi.org/10.2196/rehab.5524 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582252 ID - info:doi/10.2196/rehab.5524 ER - TY - JOUR AU - Pearson, Jennifer AU - Walsh, Nicola AU - Carter, Desmond AU - Koskela, Sian AU - Hurley, Michael PY - 2016/05/19 TI - Developing a Web-Based Version of An Exercise-Based Rehabilitation Program for People With Chronic Knee and Hip Pain: A Mixed Methods Study JO - JMIR Res Protoc SP - e67 VL - 5 IS - 2 KW - osteoarthritis KW - exercise KW - self-care KW - web-based program KW - behavioral change KW - qualitative research KW - quantitative research N2 - Background: Osteoarthritis is highly prevalent and has enormous personal and socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain through Exercise (ESCAPE-pain) is an integrated rehabilitation program that helps people understand how exercise can improve physical and psychosocial well-being. Unfortunately, its availability is limited. A Web-based version of the program could increase access for more people. Many Web-based resources are developed without end-user input and result in over-complex, unwanted, ineffective products with limited uptake. Objective: The objective of this study was to codesign a Web-based version of ESCAPE-pain that people with chronic joint pain find engaging, informative, and useful. Methods: To establish older persons' Internet use we conducted a postal survey of 200 people. To establish their opinions, likes or dislikes, and requirements for a Web-based version of the ESCAPE-pain program, we conducted two focus groups with 11 people who had participated in a program based on ESCAPE-pain and two with 13 people who had not. Information from the postal survey and focus groups was used to develop an online prototype website. People's opinions of the prototype website were gauged from thematic analysis of eight semistructured ?think aloud? interviews. Results: The survey response rate was 42% (83/200), of whom 67% (56/83) were female and mean age was 67 years. Eighty-three percent of the people had used the Internet, 69% described themselves as either very confident or confident Internet users, and 77% had looked online for health information. With regard to participating online, 34% had read a commentary or watched a video of someone else?s experience of a health problem and 23% had tracked a health issue. Key qualitative themes emerged that included engagement, acceptability and usability, and structure and content of the program. Conclusions: Older people use the Internet as a source of health information but have concerns about safe use and quality of information. Users require a credible website that provides personalized information, support, monitoring, and feedback. UR - http://www.researchprotocols.org/2016/2/e67/ UR - http://dx.doi.org/10.2196/resprot.5446 UR - http://www.ncbi.nlm.nih.gov/pubmed/27197702 ID - info:doi/10.2196/resprot.5446 ER - TY - JOUR AU - Spasi?, Irena AU - Button, Kate AU - Divoli, Anna AU - Gupta, Satyam AU - Pataky, Tamas AU - Pizzocaro, Diego AU - Preece, Alun AU - van Deursen, Robert AU - Wilson, Chris PY - 2015/10/16 TI - TRAK App Suite: A Web-Based Intervention for Delivering Standard Care for the Rehabilitation of Knee Conditions JO - JMIR Res Protoc SP - e122 VL - 4 IS - 4 KW - internet KW - social media KW - web applications KW - mobile applications KW - usability testing KW - knee KW - rehabilitation KW - exercise KW - self-management N2 - Background: Standard care for the rehabilitation of knee conditions involves exercise programs and information provision. Current methods of rehabilitation delivery struggle to keep up with large volumes of patients and the length of treatment required to maximize the recovery. Therefore, the development of novel interventions to support self-management is strongly recommended. Such interventions need to include information provision, goal setting, monitoring, feedback, and support groups, but the most effective methods of their delivery are poorly understood. The Internet provides a medium for intervention delivery with considerable potential for meeting these needs. Objective: The objective of this study was to demonstrate the feasibility of a Web-based app and to conduct a preliminary review of its practicability as part of a complex medical intervention in the rehabilitation of knee disorders. This paper describes the development, implementation, and usability of such an app. Methods: An interdisciplinary team of health care professionals and researchers, computer scientists, and app developers developed the TRAK app suite. The key functionality of the app includes information provision, a three-step exercise program based on a standard care for the rehabilitation of knee conditions, self-monitoring with visual feedback, and a virtual support group. There were two types of stakeholders (patients and physiotherapists) that were recruited for the usability study. The usability questionnaire was used to collect both qualitative and quantitative information on computer and Internet usage, task completion, and subjective user preferences. Results: A total of 16 patients and 15 physiotherapists participated in the usability study. Based on the System Usability Scale, the TRAK app has higher perceived usability than 70% of systems. Both patients and physiotherapists agreed that the given Web-based approach would facilitate communication, provide information, help recall information, improve understanding, enable exercise progression, and support self-management in general. The Web app was found to be easy to use and user satisfaction was very high. The TRAK app suite can be accessed at http://apps.facebook.com/kneetrak/. Conclusions: The usability study suggests that a Web-based intervention is feasible and acceptable in supporting self-management of knee conditions. UR - http://www.researchprotocols.org/2015/4/e122/ UR - http://dx.doi.org/10.2196/resprot.4091 UR - http://www.ncbi.nlm.nih.gov/pubmed/26474643 ID - info:doi/10.2196/resprot.4091 ER - TY - JOUR AU - Rasku, Jyrki AU - Pyykkö, Ilmari AU - Levo, Hilla AU - Kentala, Erna AU - Manchaiah, Vinaya PY - 2015/09/03 TI - Disease Profiling for Computerized Peer Support of Méničre's Disease JO - JMIR Rehabil Assist Technol SP - e9 VL - 2 IS - 2 KW - Méničre?s disease KW - diagnosis KW - disease profiling KW - peer-support KW - participation restriction KW - activity limitation KW - enablement KW - machine learning N2 - Background: Peer support is an emerging form of person-driven active health care. Chronic conditions such as Méničre?s disease (a disorder of the inner ear) need continuing rehabilitation and support that is beyond the scope of routine clinical medical practice. Hence, peer-support programs can be helpful in supplementing some of the rehabilitation aspects. Objective: The aim of this study was to design a computerized data collection system for the peer support of Meničre?s disease that is capable in profiling the subject for diagnosis and in assisting with problem solving. Methods: The expert program comprises several data entries focusing on symptoms, activity limitations, participation restrictions, quality of life, attitude and personality trait, and an evaluation of disease-specific impact. Data was collected from 740 members of the Finnish Méničre?s Federation and utilized in the construction and evaluation of the program. Results: The program verifies the diagnosis of a person by using an expert system, and the inference engine selects 50 cases with matched symptom severity by using a nearest neighbor algorithm. These cases are then used as a reference group to compare with the person?s attitude, sense of coherence, and anxiety. The program provides feedback for the person and uses this information to guide the person through the problem-solving process. Conclusions: This computer-based peer-support program is the first example of an advanced computer-oriented approach using artificial intelligence, both in the profiling of the disease and in profiling the person?s complaints for hearing loss, tinnitus, and vertigo. UR - http://rehab.jmir.org/2015/2/e9/ UR - http://dx.doi.org/10.2196/rehab.4109 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582248 ID - info:doi/10.2196/rehab.4109 ER -