51
|
Keel S, Schmid A, Keller F, Schoeb V. Investigating the use of digital health tools in physiotherapy: facilitators and barriers. Physiother Theory Pract 2022:1-20. [PMID: 35293846 DOI: 10.1080/09593985.2022.2042439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Digital tools are becoming more and more common in healthcare. Their potential to improve treatment, monitoring, and coaching in physiotherapy has been recognized. Yet studies report that the adoption of digital health tools in ambulatory physiotherapy is rather low and that their potential is underexploited. OBJECTIVE This paper aims to investigate how digital health tools in general, and the mobile health tool physitrackTM (hereafter the app) more particularly, are used in outpatient physiotherapy clinics and also to identify what facilitates or hinders the app's use. METHODS The paper is part of a larger study and adopts an ethnographic approach. It is based on observational and interview data collected at two outpatient clinics. RESULTS We reveal how physiotherapists and patients use the app in physiotherapy and identify 16 interdependent factors, on the macro-, meso-, and micro-level, that either facilitate or hinder its use. CONCLUSIONS We argue that a single factor's facilitating or hindering impact cannot be grasped in isolation but needs to be investigated as one piece of a dynamic interplay. Further qualitative research is required, especially to shed more light on the app's compatibility with physiotherapy practice and use in therapist-patient interactions.
Collapse
Affiliation(s)
- Sara Keel
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| | - Anja Schmid
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| | - Fabienne Keller
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| | - Veronika Schoeb
- School of Health Sciences, (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| |
Collapse
|
52
|
Schäfer A, Löffler-Idel I, Adelt E, Fielder C, Reinhardt A, Wilhelm N, Lochwitz A, Paelke V. Evaluation eines mHealth unterstützten Heimübungsprogramms für Menschen mit Kniearthrose (mhexos). PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1405-5023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Hintergrund Kniearthrose ist einer der Hauptgründe für Behinderungen und Mobilitätseinschränkungen bei älteren Menschen, die mit Leid und hohen Krankheitskosten verbunden sind. Nicht operative Therapien wie Übungstherapie, Maßnahmen zur Steigerung der körperlichen Aktivität und zur Unterstützung des Selbstmanagements können Schmerzen verringern sowie die Funktion und gesundheitsbezogene Lebensqualität verbessern. Entsprechende Heimübungsprogramme sind ein wichtiger Baustein der Therapie, die Adhärenz ist jedoch oft nicht ausreichend. Digitale Gesundheitsanwendungen sind, insbesondere unter den Bedingungen der aktuellen COVID-19-Pandemie, eine vielversprechende Möglichkeit, um Barrieren zu überwinden.
Ziel Untersuchung der Implementierbarkeit eines mHealth-Heimübungsprogramms für Patient*innen mit Kniearthrose (mhexos) in Hinblick auf Bedienbarkeit, Erfahrungen von Nutzer*innen, Nutzungsverhalten und der Veränderung gesundheitsbezogener Endpunkte.
Methode Patient*innen mit Kniearthrose führten das mHealth Heimübungsprogramm mhexos 4 Wochen lang durch. Die Umsetzung erfolgte über ein Tablet mit insgesamt 39 Übungsvideos zur Kräftigung, Balance und Koordination, die in 3 Schwierigkeitsstufen konfiguriert werden können. Über eine App wurden Daten zur Schmerzintensität und der selbst wahrgenommenen Belastung erfasst. Es wurden leitfadengestützte Interviews durchgeführt und Fragebögen zur Erfassung der Bedienbarkeit und der Erfahrungen der Nutzer*innen sowie zu gesundheitsbezogenen Endpunkten an 2 Messzeitpunkten eingesetzt.
Ergebnisse Es wurden 10 Patient*innen und 7 Therapeut*innen eingeschlossen. Das mHealth-Heimübungsprogramm konnte in die Praxis und den Alltag der Teilnehmenden implementiert werden. Die App wurde überwiegend als bedienungsfreundlich und motivierend eingeschätzt, die Therapietreue war mit einer Übungsfrequenz von 2,7 × pro Woche (SD 0,6) hoch. In den gesundheitsbezogenen Endpunkten zeigten sich im Interventionszeitraum kleine, klinisch und statistisch nicht signifikante Veränderungen.
Schlussfolgerung: mhexos scheint geeignet, Heimübungsprogramme für Menschen mit Kniearthrose unter den Rahmenbedingungen der Routineversorgung zu unterstützen. Für eine weitergehende Beurteilung der klinischen Wirksamkeit sind kontrollierte Studien nötig.
Collapse
Affiliation(s)
- Axel Schäfer
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Ingrid Löffler-Idel
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Elisabeth Adelt
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Christina Fielder
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Angelika Reinhardt
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Nathalie Wilhelm
- Hochschule für angewandte Wissenschaft und Kunst (HAWK) Hildesheim, Fakultät Soziale Arbeit und Gesundheit, Studiengänge Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Andreas Lochwitz
- Hochschule Bremen, Fakultät Elektrotechnik und Informatik, Bremen, Deutschland
| | - Volker Paelke
- Hochschule Bremen, Fakultät Elektrotechnik und Informatik, Bremen, Deutschland
| |
Collapse
|
53
|
Paalimäki-Paakki K, Virtanen M, Henner A, Nieminen MT, Kääriäinen M. Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review. J Med Internet Res 2022; 24:e30077. [PMID: 34989681 PMCID: PMC8778552 DOI: 10.2196/30077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022] Open
Abstract
Background Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. Objective This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. Methods Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. Results Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. Conclusions This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling.
Collapse
Affiliation(s)
- Karoliina Paalimäki-Paakki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Mari Virtanen
- School of Rehabilitation and Examination, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
| | - Anja Henner
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Miika T Nieminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| |
Collapse
|
54
|
Implementation of telerehabilitation in Austrian outpatient physiotherapy – A qualitative study / Implementierung von Telerehabilitation in der ambulanten Physiotherapie in Österreich – Eine qualitative Studie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2022. [DOI: 10.2478/ijhp-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
New technologies, for example, telerehabilitation (TR) tools, can support physiotherapists’ work. Even though studies have demonstrated their potential, TR is not yet fully implemented in Austrian outpatient physiotherapy. As a result of the Coronavirus pandemic and the associated lockdowns, physiotherapists in Austria were confronted with the challenge of offering therapies without physical contact. This study aims to investigate opinions and experiences of physiotherapists in Austria regarding TR and its implementation in different clinical fields.
Methods
A qualitative research design with expert interviews and a focus group discussion were conducted. Data were analysed using content analysis. The categories were formed following a deductive-inductive approach.
Results
The interview partners considered opportunities for using synchronous TR in internal medicine as well as orthopaedics and traumatology, especially in later, exercise-dominated stages. In addition, using TR can be supportive for patient education. In the field of neurology, synchronous TR is viewed with some criticism, especially when used for people with severe neuropsychological disorders. Asynchronous TR is considered useful across all disciplines and could support physical therapy from the first therapy session and throughout the treatment. Important questions regarding liability, billing, or data protection still need to be clarified. Interdisciplinary approaches in TR should also be pursued to improve care.
Conclusion
The use of asynchronous TR in addition to regular physiotherapy is seen as promising in all clinical fields. In general, when implementing TR, the needs and requirements of different fields should be considered. Moreover, various framework conditions still need to be clarified for further implementation of TR.
Collapse
|
55
|
Lara-Palomo IC, Antequera-Soler E, Matarán-Peñarrocha GA, Fernández-Sánchez M, García-López H, Castro-Sánchez AM, Aguilar-Ferrándiz ME. Comparison of the effectiveness of an e-health program versus a home rehabilitation program in patients with chronic low back pain: A double blind randomized controlled trial. Digit Health 2022; 8:20552076221074482. [PMID: 35111332 PMCID: PMC8801654 DOI: 10.1177/20552076221074482] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/03/2022] [Indexed: 12/26/2022] Open
Abstract
OBJETIVE We conducted a randomized double blind clinical trial, to compare the effectiveness of McKenzie exercises and electroanalgesia via an e-Health program versus a home rehabilitation program on functionality, pain, fear of movement and quality of life in patients with non-specific chronic low back pain. METHODS Seventy-four participants with non-specific chronic low back pain were randomized to either the e- Health program group (n = 39) or the home rehabilitation program group (n = 35). The interventions consisted of the e-Health program group performing McKenzie exercises and received transcutaneous electrical nerve stimulation, while the home rehabilitation group attended an information session to explain the exercises, which they then performed at home with printed instructions. Both groups performed 3 weekly sessions for 8 weeks. The following were analyzed main measures: pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline and at 2 months. RESULTS Independent samples Student's t-tests showed that although the patients who followed the e-Health program showed significantly greater improvement than those who followed the home disability rehabilitation program in terms of intensity of pain, lumbar flexion mobility (P < 0.001), and the following dimensions of quality of life (P < 0.005), both groups improved significantly in the immediate post-treatment follow up compared with baseline scores. CONCLUSIONS Patients with chronic low back pain who followed an unsupervised home intervention supported by an individualized video exercise program showed greater post-treatment improvement than those who followed the same program with printed instructions.
Collapse
Affiliation(s)
| | - Eduardo Antequera-Soler
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almería, Andalucía, Spain
| | | | - Manuel Fernández-Sánchez
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almería, Andalucía, Spain
| | - Héctor García-López
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almería, Andalucía, Spain
| | | | | |
Collapse
|
56
|
Rafiq MT, Hamid MSA, Hafiz E. Short-Term Effects of Strengthening Exercises of the Lower Limb Rehabilitation Protocol on Pain, Stiffness, Physical Function, and Body Mass Index among Knee Osteoarthritis Participants Who Were Overweight or Obese: A Clinical Trial. ScientificWorldJournal 2021; 2021:6672274. [PMID: 34975349 PMCID: PMC8716196 DOI: 10.1155/2021/6672274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) of the knee is defined as a progressive disease of the synovial joints and is characterized by wear and tear of the cartilage and underlying bone. This study aimed to determine the short-term effects of the lower limb rehabilitation protocol (LLRP) on pain, stiffness, physical function, and body mass index (BMI) among knee OA participants who were overweight or obese. Methodology. A single-blinded randomized controlled trial of one-month duration was conducted at Rehmatul-Lil-Alameen Postgraduate Institute, Lahore, Pakistan. Fifty overweight or obese participants with knee OA were randomly divided into two groups by a computer-generated number. Participants in the rehabilitation protocol group (RPG) were provided with leaflets explaining the strengthening exercises of the LLRP and instruction of daily care (IDC), while the participants in the control group (CG) were provided with leaflets explaining the IDC only for a duration of four weeks. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function. The secondary outcome measures were BMI, exercise adherence, and patients' satisfaction assessed by using the numeric rating scale ranging from 0 to 10. The paired-sample t-test was used to analyze the differences within groups from baseline to posttest evaluations. The analysis of variance 2 × 2 factor was used to analyze the differences in BMI, knee pain, stiffness, and physical function between the groups. RESULTS Participants in the RPG and CG reported a statistically significant reduction in knee pain and stiffness (p ≤ 0.05) within the group. The reduction in the scores of knee pain was higher in participants in the RPG than that in participants in the CG (p=0.001). Additionally, participants in the RPG reported greater satisfaction (p=0.001) and higher self-reported exercise adherence (p=0.010) and coordinator-reported exercise adherence (p=0.046) than the participants in the CG. CONCLUSION Short-term effects of the LLRP appear to reduce knee pain and stiffness only, but not physical function and BMI.
Collapse
Affiliation(s)
- Muhammad Tariq Rafiq
- Centre for Sport and Exercise Sciences, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Rehmatul-Lil-Alameen Postgraduate Institute of Cardiology, Punjab Employees Social Security Institution, Lahore, Pakistan
| | - Mohamad Shariff A. Hamid
- Unit of Sports Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Eliza Hafiz
- Centre for Sport and Exercise Sciences, University of Malaya, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
57
|
The Unknown Prevalence of Postrandomization Bias in 15 Physical Therapy Journals: A Methods Review. J Orthop Sports Phys Ther 2021; 51:542-550. [PMID: 34546817 DOI: 10.2519/jospt.2021.10491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the prevalence of prospective clinical trial registration and postrandomization bias in published musculoskeletal physical therapy randomized clinical trials (RCTs). DESIGN A methods review. LITERATURE SEARCH Articles indexed in MEDLINE and published between January 2016 and July 2020 were included. STUDY SELECTION CRITERIA Two independent blinded reviewers identified the RCTs using Covidence. We included RCTs related to musculoskeletal interventions that were published in International Society of Physiotherapy Journal Editors member journals. DATA SYNTHESIS Data were extracted independently for the variables of interest from the identified RCTs by 2 blinded reviewers. The data were presented descriptively or in frequency tables. RESULTS One hundred thirty-eight RCTs were identified. One third of RCTs were consistent with their prospectively registered intent (49/138); consistency with prospectively registered intent could not be determined for two thirds (89/138) of the RCTs. Four RCTs (8%)reported inconsistent results with the primary aims and 7 (14%) with the outcomes from the prospective clinical trial registry, despite high methodological quality (Physiotherapy Evidence Database [PEDro] scale score). Differences between prospectively registered and non-prospectively registered RCTs for PEDro scale scores had a medium effect size (r = 0.30). Two of 15 journals followed their clinical trial registration policy 100% of the time; in 1 journal, the published RCTs were consistent with the clinical trial registration. CONCLUSION Postrandomization bias in musculoskeletal physical therapy RCTs could not be ruled out, due to the lack of prospective clinical trial registration and detailed data analysis plans. J Orthop Sports Phys Ther 2021;51(11):542-550. Epub 21 Sep 2021. doi:10.2519/jospt.2021.10491.
Collapse
|
58
|
Baschung Pfister P, Tobler-Ammann B, Knols RH, de Bruin ED, de Bie RA. Usability and Acceptance of an Interactive Tablet-Based Exercise Application: A Mixed Methods Study. Front Digit Health 2021; 2:578281. [PMID: 34713051 PMCID: PMC8521963 DOI: 10.3389/fdgth.2020.578281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose: To investigate usability and acceptance of a newly developed interactive, tablet-based exercise application (app) and to explore personal opinions of therapists when using this app in the clinical setting. Methods: Twenty participants (10 therapists and 10 inactive healthy adults) tested usability of this app performing different test tasks, using the think aloud method, and rated overall satisfaction with the System Usability Scale and acceptance with a modified Technology Acceptance Model Questionnaire. For a secondary objective, personal opinions of therapists were evaluated with two focus groups, one for team leaders and one for team members. Results: Overall, the app was judged to be usable. Effectiveness varied between 73 and 90%, overall satisfaction between 70.5 and 85.5/100 points and acceptance between 74 and 80%. Team leader and team member focus groups considered the app as providing a great opportunity for therapy extension, especially because of its blended character. Barriers to its implementation were seen in the existing clinical working processes, personal attitudes of therapists and uncertainty of who would cover expenses for this new form of therapy. Some improvements such as using videos instead of photos, the integration of more interactive tools and the possibility to add additional exercises were suggested in both settings. Conclusion: The app showed high acceptance and usability in trainees and therapists, although some ideas for upgrading functions were formulated. Before this app can be used in clinical practice, feasibility of this blended approach should be evaluated in a clinical setting.
Collapse
Affiliation(s)
- Pierrette Baschung Pfister
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.,Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland.,Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Bernadette Tobler-Ammann
- University Clinic of Hand- and Plastic Surgery, Department of Hand and Occupational Therapy Research, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ruud H Knols
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.,Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Rob A de Bie
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
59
|
Rafiq MT, Abdul Hamid MS, Hafiz E. The effect of rehabilitation protocol using mobile health in overweight and obese patients with knee osteoarthritis: a clinical trial. Adv Rheumatol 2021; 61:63. [PMID: 34689837 DOI: 10.1186/s42358-021-00221-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this randomized controlled trial (RCT) was to investigate the effectiveness of the lower limb rehabilitation protocol (LLRP) combined with mobile health (mHealth) applications on knee pain, mobility, functional activity and activities of daily living (ADL) among knee osteoarthritis (OA) patients who were overweight and obese. METHODS This study was a single-blind, RCT conducted at Teaching Bay of Rehmatul-Lil-Alameen Post Graduate Institute of Cardiology between February and November 2020. 114 knee OA patients who were overweight and obese were randomly divided by a computer-generated number into the rehabilitation group with mHealth (RGw-mHealth) to receive LLRP + instructions of daily care (IDC) combined with mHealth intervention, rehabilitation group without mHealth (RGwo-mHealth) to receive LLRP + IDC intervention and control group (CG) to receive IDC intervention. All three groups were also provided leaflets explaining about their intervention. The primary outcome measure was knee pain measured by the Western Ontario and McMaster Universities Osteoarthritis Index score. The secondary outcome measures were mobility measured by the Timed up and go (TUG) test, functional activity measured by the patient-specific functional scale (PSFS), and ADL measured by the Katz Index of independence in ADL scores. RESULTS Among the 114 patients who were randomized (mean age, 53 years), 96 (84%) completed the trial. After 3-months of intervention, patients in all three groups had statistically significant knee pain reduction (RGw-mHealth: 2.54; RGwo-mHealth: 1.47; and CG: 0.37) within groups (P < 0.05). Furthermore, patients in the RGw-mHealth and RGwo-mHealth had statistically significant improvement in mobility, functional activity, and ADL within groups (P < 0.05), but no improvement was noted in the CG (p > 0.05). As indicated in the overall analysis of covariance, there were statistically significant differences in the mean knee pain, mobility, functional activity, and ADL changes between groups after 3-months (p < 0.001). The pairwise between-group comparisons (Bonferroni post hoc analysis) of the knee pain, mobility, functional activity, and ADL scores at 3-months revealed that patients in the RGw-mHealth had significantly higher mean change in the knee pain, TUG test, functional activity, and ADL scores compared to patients in the RGwo-mHealth or CG. CONCLUSION Reduction in knee pain, improvement in mobility, functional activity, and ADL were more among patients in the RGw-mHealth compared with the RGwo-mHealth or CG. Trial registration National Medical Research Registry: NMRR-20-1094-52911. Date of registration: 05-05-2020. URL: https://www.nmrr.gov.my .
Collapse
Affiliation(s)
- Muhammad Tariq Rafiq
- Centre for Sport and Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Eliza Hafiz
- Sports Centre, Centre for Sport and Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
60
|
Haglo H, Wang E, Berg OK, Hoff J, Helgerud J. Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e28124. [PMID: 34673536 PMCID: PMC8569541 DOI: 10.2196/28124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/27/2021] [Accepted: 06/25/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding. OBJECTIVE This study sought to investigate if self-administered 4×4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4×4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL). METHODS Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4×4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85% to 95% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period. RESULTS VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected. CONCLUSIONS High-intensity 4×4-min interval training increased VO2max and HRQoL, contributing to patients' reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population. TRIAL REGISTRATION ClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528.
Collapse
Affiliation(s)
- Håvard Haglo
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- Myworkout, Medical Rehabilitation Clinic, Trondheim, Norway
| | - Eivind Wang
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ole Kristian Berg
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| | - Jan Hoff
- Myworkout, Medical Rehabilitation Clinic, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olav's University Hospital, Trondheim, Norway
| | - Jan Helgerud
- Myworkout, Medical Rehabilitation Clinic, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
61
|
Ryan S, Ní Chasaide N, O' Hanrahan S, Corcoran D, Caulfield B, Argent R. mHealth Apps for Musculoskeletal Rehabilitation: State of the Practice Review (Preprint). JMIR Rehabil Assist Technol 2021; 9:e34355. [PMID: 35916688 PMCID: PMC9379789 DOI: 10.2196/34355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Background The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways. Objective The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities. Methods A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction. Results A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%). Conclusions The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies.
Collapse
Affiliation(s)
- Shíofra Ryan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Noirín Ní Chasaide
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Shane O' Hanrahan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Darragh Corcoran
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Rob Argent
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
62
|
Sowers K, Litwin B, Lee A, Galantino ML. Effect of Moderate Intensity Exercise on Infection Rates in Individuals with Primary Immunodeficiency Disease: A Preliminary Pilot Randomized Investigation. Physiother Theory Pract 2021; 38:2677-2688. [PMID: 34587873 DOI: 10.1080/09593985.2021.1983907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Individuals with a diagnosis of primary immunodeficiency disease (PID) have poorer health-related quality of life (HRQoL) compared with healthy individuals. Regular moderate exercise enhances immune function and wellbeing. Whether exercise at recommended levels for the general population is tolerated by individuals diagnosed with PID, without adverse effects, is unknown and warrants investigation. METHODS A prospective randomized preliminary pilot investigation with individuals diagnosed with PID was undertaken; participants were assigned to either an exercise (n = 18) or control group (n = 16). The exercise group completed an eight-week, semi-customized, home-based, moderate intensity exercise program, while the control group engaged in routine activities. Participants completed recall surveys assessing infection rates and non-routine medical care over 8 weeks prior to the eight-week intervention. RESULTS Given recruitment issues, the study was underpowered. Thus, as expected, no difference between groups was observed. CONCLUSION This preliminary pilot investigation provides the foundation for a large scale, appropriately powered, randomized controlled trial to investigate the effect of moderate exercise on infection rates and non-routine medical care for individuals with PID. Recommendations are made to strengthen the methodology of future investigations on the effects of exercise on the immune function and quality of life for individuals diagnosed with PID.
Collapse
Affiliation(s)
- Kerri Sowers
- Health Science Program, Stockton University, Galloway, New Jersey, USA
| | - Bini Litwin
- Physical Therapy Department, Nova Southeastern University, Davie, Florida, USA
| | - Alan Lee
- Physical Therapy Department, Nova Southeastern University, Davie, Florida, USA.,Doctor of Physical Therapy Program, Mount Saint Mary's University, Los Angeles, CA, USA
| | - Mary Lou Galantino
- Department of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA.,Physiotherapy Department, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
63
|
Swanson VA, Chan V, Cruz-Coble B, Alcantara CM, Scott D, Jones M, Zondervan DK, Khan N, Ichimura J, Reinkensmeyer DJ. A Pilot Study of a Sensor Enhanced Activity Management System for Promoting Home Rehabilitation Exercise Performed during the COVID-19 Pandemic: Therapist Experience, Reimbursement, and Recommendations for Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10186. [PMID: 34639494 PMCID: PMC8508164 DOI: 10.3390/ijerph181910186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
Adherence to home exercise programs (HEPs) during physical rehabilitation is usually unmonitored and is thought to be low from self-reports. This article describes exploratory implementation of a Sensor Enhanced Activity Management (SEAM) system that combines HEP management software with a movement sensor for monitoring and motivating HEP adherence. The article also presents results from attempting to gain reimbursement for home use of the system with therapist oversight using Remote Physiologic Monitoring (RPM) codes. Four therapists used the system in their regular practice during the first six months of the COVID-19 pandemic. Therapists filled out surveys, kept notes, and participated in interviews. Billing and reimbursement data were obtained from the treatment facility. Exercise data from the SEAM system were used to understand HEP adherence. Patients were active for a mean of 40% (26% SD) of prescribed days and completed a mean of 25% (25% SD) of prescribed exercises. The therapists billed 23 RPM codes (USD 2353), and payers reimbursed eight of those instances (USD 649.21). The therapists reported that remote monitoring and the use of a physical movement sensor was motivating to their patients and increased adherence. Sustained technical support for therapists will likely improve implementation of new remote monitoring and treatment systems. RPM codes may enable reimbursement for review and program management activities, but, despite COVID-19 CMS waivers, organizations may have more success if these services are billed under supervision of a physician.
Collapse
Affiliation(s)
- Veronica A. Swanson
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
| | - Vicky Chan
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Betsaida Cruz-Coble
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Celeste M. Alcantara
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Douglas Scott
- Division of Rehabilitative Services, University of California, Irvine, CA 92868, USA;
| | - Mike Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA;
| | | | | | - Jan Ichimura
- Department of Physical Therapy, Acute Rehabilitation Unit, University of California, Irvine, CA 92868, USA;
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
- Department of Anatomy and Neurobiology, UC Irvine School of Medicine, University of California, Irvine, CA 92697, USA
| |
Collapse
|
64
|
Agnew JMR, Hanratty CE, McVeigh JG, Nugent C, Kerr DP. An investigation into the use of mHealth in musculoskeletal physiotherapy: Scoping Review (Preprint). JMIR Rehabil Assist Technol 2021; 9:e33609. [PMID: 35275089 PMCID: PMC8956993 DOI: 10.2196/33609] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jonathon M R Agnew
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Catherine E Hanratty
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Chris Nugent
- Discipline in Computing, School of Computing, University of Ulster, Newtownabbey, United Kingdom
| | - Daniel P Kerr
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| |
Collapse
|
65
|
Mastronardo C, Muddle LS, Grace S, Engel RM, Fazalbhoy A. Digital health technologies for osteopaths and allied healthcare service providers: A scoping review. INT J OSTEOPATH MED 2021; 41:37-44. [PMID: 36032806 PMCID: PMC9391923 DOI: 10.1016/j.ijosm.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/27/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
Background Digital health technologies are poised to revolutionise the healthcare industry by improving accessibility to services and patient outcomes. The novel coronavirus disease-19 (COVID-19) pandemic has presented unprecedented challenges for the delivery of allied healthcare and has catalysed rapid adoption of telehealth. As such, allied healthcare consumers and providers stand to benefit from the capabilities of the digital health movement, ultimately justifying a scoping review of current and emerging technologies. Objective To provide decision makers with up-to-date information on the allied health applications of new and emerging digital health technologies; their evidence of efficacy, scope of use, and limitations. Methods A scoping review of the literature was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. To synthesise original research, MEDLINE, CINAHL, and EMBASE databases were searched from 2010 to June 2020 and reference lists were examined for randomised control trials analysing the efficacy of these technologies in allied health applications. Results A total of 14 articles were included with a focus on common musculoskeletal conditions managed by allied health service providers. Studies were selected for data extraction after abstract and full-text screening by three independent reviewers. The results of this review indicate that telehealth technology effectively monitors and progresses patient care, while mobile health applications provide remote support and enable data collection. Conclusion Emerging trends suggest that digital technologies serve as promising adjuncts to allied healthcare. Further research is warranted regarding the safety and efficacy of digital health technologies in this context.
Collapse
Affiliation(s)
- C Mastronardo
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3000, Australia
| | - L S Muddle
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3000, Australia
| | - S Grace
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, 2480, Australia
| | - R M Engel
- Department of Chiropractic, Macquarie University, Sydney, NSW, 2000, Australia
| | - A Fazalbhoy
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3000, Australia
| |
Collapse
|
66
|
A model of integrated remote monitoring and behaviour change for osteoarthritis. BMC Musculoskelet Disord 2021; 22:669. [PMID: 34372822 PMCID: PMC8350550 DOI: 10.1186/s12891-021-04555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background The National Institute for Health and Care Excellence recommends the use of digital and mobile health technologies to facilitate behaviour change interventions. Due to its high prevalence and dependence upon patient self-management strategies, osteoarthritis is one musculoskeletal condition which may benefit from such approaches. This is particularly pertinent due to the increasing use of remote monitoring technologies to collect patient data and facilitate self-management in individuals outside of hospital clinics. In practice however, application of digital behaviour change interventions is difficult due to insufficient reporting of behaviour change theories in the current literature. When digital technologies are employed to alter behaviour change in osteoarthritis, they often focus on physical activity. Currently, such interventions focus of self-efficacy but do not often explicitly report the behaviour change techniques they use to facilitate these changes. Methods This paper proposes a new model of integrating specific behaviour change principles (persuasive design) in an integrated model of remote monitoring and digital behaviour change interventions for osteoarthritis. Results There is potential to combine remote monitoring systems of patient data through digital and mobile technologies with behaviour change principles to improve physical activity behaviours in individuals with osteoarthritis. The use of persuasive design principles (e.g. prompts or nudges) through mobile notifications and strategic system design can be directed to enhance behaviour change. A validated measure of behaviour change, such as the patient activation measure, will allow effective evaluation of such systems. Conclusions Digital behaviour change interventions should be directed towards the underlying principles of behaviour change they employ, although this is not commonly reported in practice. Such interventions can be integrated within remote monitoring pathways using persuasive design techniques to enhance patient activation. This approach can enhance self-management in individuals with musculoskeletal conditions, such as osteoarthritis.
Collapse
|
67
|
Solomon P, Carusone SC, Davis AM, Aubry R, O'Brien KK. Experiences of People Living With HIV in Community Based Exercise: A Qualitative Longitudinal Study. J Int Assoc Provid AIDS Care 2021; 20:2325958221995344. [PMID: 33611978 PMCID: PMC7903824 DOI: 10.1177/2325958221995344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This qualitative longitudinal study examined the experiences of people living with HIV who engaged in a structured community-based exercise (CBE) program under the supervision of a fitness coach. Twenty people living with HIV were invited to participate in 3 semi-structured interviews over time. Participants engaged in exercise 3 times per week for 6 months with one weekly session supervised by a coach. Interviews were audio-recorded, transcribed verbatim and underwent longitudinal thematic analyses. Eleven participants were included representing a total of 30 interviews. Participants valued their experiences with the CBE program, particularly the motivation provided by the coach. Concerns about the environment, stigma and episodic health challenges affected their overall experience. To foster independence and promote self-management, health providers should consider these findings when encouraging CBE with people living with HIV. It is important to understand their goals and offer a variety of exercise options to meet their needs.
Collapse
Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, 3710McMaster University, Hamilton, Canada
| | - Soo Chan Carusone
- 169566Casey House, Toronto, Canada.,Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada
| | - Aileen M Davis
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), 7938University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute (RSI), 7938University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Rachel Aubry
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), 7938University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute (RSI), 7938University of Toronto, Toronto, Canada
| |
Collapse
|
68
|
Scotti Requena S, Sterling M, Elphinston RA, Ritchie C, Robins S, R Armfield N. Development and use of mobile messaging for individuals with musculoskeletal pain conditions: a scoping review protocol. BMJ Open 2021; 11:e048964. [PMID: 34253673 PMCID: PMC8276305 DOI: 10.1136/bmjopen-2021-048964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Previous reviews of mobile messaging for individuals with musculoskeletal pain have shown positive effects on pain and disability. However, the configuration of digital content, method of presentation and interaction, dose and frequency needed for optimal results remain unclear. Patient preferences concerning such systems are also unclear. Addressing these knowledge gaps, incorporating evidence from both experimental and observational studies, may be useful to understand the extent of the relevant literature, and to influence the design and outcomes of future messaging systems. We aim to map information that could be influential in the design of future mobile messaging systems for individuals with musculoskeletal pain conditions, and to summarise the findings of efficacy, effectiveness, and economics derived from both experimental and observational studies. METHODS AND ANALYSIS We will include studies describing the development and/or use of mobile messaging to support adults (≥18 years) with acute or chronic musculoskeletal pain. We will exclude digital health studies that lack a mobile messaging component, or those targeted at other health conditions unrelated to the bones, muscles and connective tissues, or involving surgical or patients with cancer, or studies involving solely healthy individuals. Our sources of information will be online databases and reference lists of relevant papers. We will include papers published in English in the last 10 years. Two pairs of independent reviewers will screen, select and extract the data, with any disagreements mediated by a third reviewer. We will report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. We will synthesise the findings in a tabular format and provide a descriptive summary. ETHICS AND DISSEMINATION Formal ethical approval is not required. We will disseminate the findings through publication in a peer-reviewed journal, relevant conferences, and relevant consumer forums. TRIAL REGISTRATION Open Science Framework https://osf.io/8mzya; DOI: 10.17605/OSF.IO/8MZYA.
Collapse
Affiliation(s)
- Simone Scotti Requena
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, Herston, Queensland, Australia
| | - Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, Herston, Queensland, Australia
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carrie Ritchie
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Sarah Robins
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Nigel R Armfield
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Wooloongabba, Queensland, Australia
| |
Collapse
|
69
|
Brewer BW, Van Raalte JL, Cornelius AE. An Interactive Cognitive-Behavioural Multimedia Program Favourably Affects Pain and Kinesiophobia During Rehabilitation After Anterior Cruciate Ligament Surgery: An Effectiveness Trial. INTERNATIONAL JOURNAL OF SPORT AND EXERCISE PSYCHOLOGY 2021; 20:1133-1155. [PMID: 35968222 PMCID: PMC9365250 DOI: 10.1080/1612197x.2021.1934712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/16/2021] [Indexed: 06/15/2023]
Abstract
Psychological interventions have been found effective in helping athletes cope with the challenges associated with knee surgery. In this investigation, an interactive cognitive-behavioural multimedia program was evaluated as a means of delivering psychological interventions to individuals experiencing anterior cruciate ligament (ACL) surgery in a field trial with 69 ACL surgery patients (30 women and 39 men; 24 competitive athletes, 41 recreational athletes, and 4 nonathletes; M age = 35.01, SD = 11.98 years). Results indicated that compared to participants who received standard care, participants who received the multimedia program reported greater preoperative confidence in ability to cope, lower postoperative pain and kinesiophobia, and greater use and perceived utility of patient education materials. The findings suggest that the multimedia program has promise as an economical and effective means of educating and delivering psychological interventions to people experiencing ACL surgery and rehabilitation.
Collapse
Affiliation(s)
- Britton W Brewer
- Department of Psychology, Springfield College, 263 Alden Street, Springfield, MA 01109 USA
| | - Judy L Van Raalte
- Department of Psychology, Springfield College, and College of Health Sciences, Wuhan Sports University
| | | |
Collapse
|
70
|
Van de Winckel A, Nawshin T, Byron C. Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial. JMIR Form Res 2021; 5:e22659. [PMID: 33640865 PMCID: PMC8075043 DOI: 10.2196/22659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/25/2020] [Accepted: 02/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51%) and control (22/45, 49%) groups, with 74% (17/23) and 86% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68% (15/22) sent videos. They sent 68% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=.99), whereas it decreased from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280
Collapse
Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Tanjila Nawshin
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Casey Byron
- Hennepin County Medical Center, Minneapolis, MN, United States
| |
Collapse
|
71
|
Maxwell C, Robinson K, McCreesh K. Understanding Shoulder Pain: A Qualitative Evidence Synthesis Exploring the Patient Experience. Phys Ther 2021; 101:6054190. [PMID: 33373455 DOI: 10.1093/ptj/pzaa229] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments. METHODS A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme appraisal tool. RESULTS Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact ("It has been a big upheaval"); (2) developing an understanding ("Why is it hurting so much?"); and (3) exercise ("Am I going to go through a lot of pain in moving it…?"). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a "permanent" solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations. CONCLUSION These findings deepen our understanding of the impact of shoulder pain on peoples' lives and provide novel insight into the experience of treatment. Enhanced awareness of people's experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation. IMPACT To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms. LAY SUMMARY Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People's understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.
Collapse
Affiliation(s)
- Christina Maxwell
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Robinson
- Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Karen McCreesh
- Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| |
Collapse
|
72
|
Kowatsch T, Lohse KM, Erb V, Schittenhelm L, Galliker H, Lehner R, Huang EM. Hybrid Ubiquitous Coaching With a Novel Combination of Mobile and Holographic Conversational Agents Targeting Adherence to Home Exercises: Four Design and Evaluation Studies. J Med Internet Res 2021; 23:e23612. [PMID: 33461957 PMCID: PMC7939948 DOI: 10.2196/23612] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/28/2020] [Accepted: 01/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. OBJECTIVE To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. METHODS We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients' perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. RESULTS Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality-based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. CONCLUSIONS The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders.
Collapse
Affiliation(s)
- Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland.,Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Kim-Morgaine Lohse
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Valérie Erb
- Graduate School of Culture Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,People and Computing Lab, Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Leo Schittenhelm
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Helen Galliker
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Rea Lehner
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Elaine M Huang
- People and Computing Lab, Department of Informatics, University of Zurich, Zurich, Switzerland
| |
Collapse
|
73
|
van Leer E, Lewis B, Porcaro N. Effect of an iOS App on Voice Therapy Adherence and Motivation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:210-227. [PMID: 33476177 PMCID: PMC8740599 DOI: 10.1044/2020_ajslp-19-00213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/17/2019] [Accepted: 09/28/2020] [Indexed: 05/22/2023]
Abstract
Purpose Patients commonly report difficulties adhering to voice therapy. An iOS app was developed in our lab that assists practice via reminder notifications, instructional recordings, and cepstral peak prominence analysis results. The purpose of this study was to assess the effect of such homework support modality on adherence behavior and associated motivation in a comparison of app support and written homework instructions and to assess the usability and utility of the app. Method Thirty-four individuals exhibiting adducted hyperfunction were randomized to receive either written homework instructions or the app when practicing resonant voice exercises for 3 weeks. All patients digitally audio-recorded all home practice, provided self-reported estimates of generalization, and completed weekly motivation scales. Results App support significantly increased practice frequency but did not affect self-reported generalization or motivation. Practice was significantly predicted by System Usability Scale scores. Utility of reminders and instructions were good, but cepstral peak prominence feedback was considered useful to only a subset of participants. Conclusion Interactive mobile therapy support can significantly increase practice of resonant voice homework without influencing motivation.
Collapse
Affiliation(s)
- Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | - Brittney Lewis
- Autonomous Reanimation and Evacuation Program, The Geneva Foundation, San Antonio, TX
| | | |
Collapse
|
74
|
Perceived Barriers and Facilitators of Sports Rehabilitation Adherence in Injured Volleyball Athletes: A Qualitative Study From Greece. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2021. [DOI: 10.1123/jcsp.2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Adherence to exercise rehabilitation has been shown to be an important factor that may influence successful treatment. In professional athletes, a significant reduction in exercise adherence delays recovery. The aim of this study was to explore barriers to and facilitators of exercise rehabilitation adherence in injured volleyball athletes. Eight professional volleyball athletes were recruited, and qualitative data were collected using semistructured interviews. All athletes had completed their rehabilitation program after they had suffered a musculoskeletal injury. All data were analyzed using thematic analysis after the investigators ensured that saturation had been reached. Pain was identified as a significant barrier to exercise adherence by all athletes. The provision of social support, including mental, practical, and task related, also had a significant positive impact. The athletes’ ability to develop the necessary coping strategies and confidence on performing exercises at home was also mentioned as a factor that affected exercise adherence, although less often.
Collapse
|
75
|
Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2021; 12:664499. [PMID: 34163383 PMCID: PMC8215288 DOI: 10.3389/fpsyt.2021.664499] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Study Objectives: We conducted a meta-analysis to assess the effects of different regular exercise (lasting at least 2 months on a regular basis) on self-reported and physiological sleep quality in adults. Varied exercise interventions contained traditional physical exercise (e.g., walking, cycling) and mind-body exercise characterized by gentle exercise with coordination of the body (e.g., yoga). Methods: Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematical searches were conducted in three electronic databases (PubMed, Embase, and Web of Science) for relevant research that involved adult participants without pathological diseases receiving exercise intervention. The search strategy was based on the population, intervention, comparison, and outcome study design (PICOS) framework. The self-reported outcomes included varied rating scales of Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). Subgroup meta-analyses of PSQI scores were conducted based on type of exercise, duration of intervention, and participants' age and gender. The physiological outcomes were measured by Actigraph. All meta-analyses were performed in a fixed or random statistic model using Revman software. Results: Twenty-two randomized controlled trials were included in the analysis. The overall analysis on subjective outcomes suggests that exercise interventions significantly improved sleep quality in adults compared with control interventions with lower PSQI (MD -2.19; 95% CI -2.96 to -1.41), ISI (MD -1.52; 95% CI -2.63 to -0.41), and ESS (MD -2.55; 95% CI -3.32 to -1.78) scores. Subgroup analyses of PSQI scores showed both physical and mind-body exercise interventions resulted in improvements of subjective sleep to the same extent. Interestingly, short-term interventions (≤3 months) had a significantly greater reduction in sleep disturbance vs. long-term interventions (>3 months). Regarding physiological sleep, few significant effects were found in various sleep parameters except the increased sleep efficiency in the exercise group vs. control group. Conclusions: Results of this systematic review suggest that regular physical as well as mind-body exercise primarily improved subjective sleep quality rather than physiological sleep quality in adults. Specifically, self-reported sleep quality, insomnia severity, and daytime sleepiness could be improved or ameliorated with treatment of exercise, respectively, evaluated by PSQI, ISI, and ESS sleep rating scales.
Collapse
Affiliation(s)
- Yi Xie
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Liu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue-Jiao Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Han Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
76
|
Thacker J, Bosello F, Ridehalgh C. Do behaviour change techniques increase adherence to home exercises in those with upper extremity musculoskeletal disorders? A systematic review. Musculoskeletal Care 2020; 19:340-362. [PMID: 33331093 DOI: 10.1002/msc.1532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate whether behaviour change techniques (BCTs) can influence adherence to home exercise in people with upper extremity musculoskeletal disorders (UEMD). DESIGN A systematic review of randomised control trials, non-randomised control trials, case-control studies and cohort studies. Results were presented narratively. Participants were those with UEMD. The intervention was any home exercise programme, alongside a BCT designed to increase exercise adherence. Any duration of intervention was accepted. The main outcome sought was adherence to home exercise. A systematic search was performed on four online databases. Grey literature was searched. RESULTS The search resulted in 28,755 titles. 77 full-text articles were assessed for eligibility. Six studies were included in the qualitative synthesis. Four studies had Some Concern of Bias, whilst two studies had High Risk of Bias. Three studies found statistically significant differences in exercise adherence (p < 0.05) between the Intervention group and Control group. The BCT 'Social Support (unspecified)' was used within all studies that found significant differences in adherence levels at outcome. However, multiple BCTs were received by the Intervention groups within all studies, making it impossible to identify the effects of any single BCT upon adherence levels. CONCLUSION Social support may be relevant in patients' adherence levels to HEPs. However, confidence in the results is uncertain given the small number of studies found, and their High RoB. Future studies should validate their measurement and definition of adherence, as well as the number of BCTs they use, to provide reproducible evidence.
Collapse
Affiliation(s)
| | - Francesca Bosello
- European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | | |
Collapse
|
77
|
Remote management of musculoskeletal pain: a pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice. Pain Rep 2020; 5:e878. [PMID: 33344873 PMCID: PMC7743834 DOI: 10.1097/pr9.0000000000000878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/24/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022] Open
Abstract
Video and phone consultations for musculoskeletal pain are effective, safe, and appreciated by patients. Implementation and execution require special consideration and such guidance is provided. Introduction: Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations. Objectives: This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain. Methods: Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience. Results: The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication. Conclusion: This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.
Collapse
|
78
|
Papi E, Chiou SY, McGregor AH. Feasibility and acceptability study on the use of a smartphone application to facilitate balance training in the ageing population. BMJ Open 2020; 10:e039054. [PMID: 33268409 PMCID: PMC7713209 DOI: 10.1136/bmjopen-2020-039054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This study aims to investigate the feasibility and acceptability of using an app-based technology to train balance in the older population. DESIGN Prospective feasibility study. SETTING The study was conducted in a university setting and participants' homes. PARTICIPANTS Thirty-five volunteers ≥55 years old were recruited. INTERVENTION Participants were asked to follow a balance exercise programme 7 days a week for 3 weeks using a phone application. Seventeen participants trained for a further 3 weeks. OUTCOME MEASURES Postural sway measures during quiet standing with feet at shoulder width apart and feet together, one leg standing and tandem stance were measured at baseline, and at the end of the 3 and 6 training weeks; the International Physical Activity Questionnaire (IPAQ) assessed participants' physical activity level before training; and app acceptability was recorded using a user experience questionnaire. RESULTS Participants on the 3 and 6-week programme on average completed 20 (±5) and 38 (±11) days of training, respectively, and all scored moderate to high on the IPAQ. Between baseline and the 3-week assessments, statistically significant improvements were observed for anteroposterior sway, mediolateral sway, sway area during tandem stance, for anteroposterior sway during one leg standing and for sway area during feet together stance. Improvements were observed at 6 week compared with baseline but those between 3 and 6 weeks were not significant. Based on the questionnaire, participants reported that the app is an appropriate tool for balance training (77%), they reported benefits from the training (50%) and found it easy to fit it into daily routine (88%). CONCLUSION The high level of adherence and improvements observed in the analysed measures demonstrate the feasibility of using an app to train balance in moderately to highly physically active older participants. This demonstrates that given appropriate tools the older population is positive towards and receptive of digital interventions aimed to improve balance.
Collapse
Affiliation(s)
- Enrica Papi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Bioengineering Department, Imperial College London, London, UK
| | - Shin-Yi Chiou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
79
|
Malliaras P, Cridland K, Hopmans R, Ashton S, Littlewood C, Page R, Harris I, Skouteris H, Haines T. Internet and Telerehabilitation-Delivered Management of Rotator Cuff-Related Shoulder Pain (INTEL Trial): Randomized Controlled Pilot and Feasibility Trial. JMIR Mhealth Uhealth 2020; 8:e24311. [PMID: 33206059 PMCID: PMC7710452 DOI: 10.2196/24311] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rotator cuff-related shoulder pain (RCRSP) is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes. OBJECTIVE The primary aim of this pilot randomized controlled trial was to assess the feasibility of a 12-week internet-delivered intervention for RCRSP comparing advice only, recommended care, and recommended care with group-based telerehabilitation. METHODS Reporting was in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist for pilot and feasibility trials. People with a primary complaint of RCRSP for 3 months or longer were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated (via a Zelen design) to receive (1) advice only, (2) recommended care (internet-delivered evidence-based exercise and education), or (3) recommended care and telerehabilitation (including a weekly group teleconference session). Progression criteria for a full-scale trial included (1) recruitment of 20% or greater of eligible participants, (2) acceptable adherence (two or more of the three prescribed weekly sessions) among 70% or greater of participants, (3) 80% or greater retention of participants, (4) absence of intervention-related serious adverse events, and (5) 80% or greater response rates to questionnaires. Secondary clinical and patient knowledge outcomes were collected (via email or text) at baseline, six weeks, and 12 weeks (for clinical and patient knowledge), and within-group change was reported descriptively. RESULTS We enrolled 36 of 38 (95%) eligible participants and all participants were recruited within a 3-week period. Of the 36 participants, 12 participants were allocated to each of the three trial arms. The mean age of participants was between 51 and 56 years, and 83% (10/12) to 92% (11/12) were female. Retention at the 12-week endpoint was 94% (34/36) and response to email questionnaires at other time points was 83% or greater. We found acceptable adherence (defined as greater than 70% of participants performing exercise 2 or 3 times/week) in the recommended care group with telerehabilitation but not in the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms), with the exception of one instance of elective surgery (unrelated to the person's shoulder condition). CONCLUSIONS Our prespecified success criteria were met or exceeded, but there was a gender imbalance toward women. It is feasible to progress to a fully powered trial, but strategies to address the gender imbalance need to be implemented. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12620000248965); https://tinyurl.com/yy6eztf5.
Collapse
Affiliation(s)
- Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Kate Cridland
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ruben Hopmans
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Simon Ashton
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Chris Littlewood
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard Page
- Barwon Orthopaedic Research and Education, Barwon Health and School of Medicine, Deakin University, Geelong, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| |
Collapse
|
80
|
Alasfour M, Almarwani M. The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: a randomized controlled trial. Disabil Rehabil 2020; 44:2420-2427. [PMID: 33103499 DOI: 10.1080/09638288.2020.1836268] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To examine the effects of an Arabic smartphone application on adherence to home exercise programs (HEPs) and the effectiveness of mobile-based HEPs on pain, physical function, and lower-limb muscle strength among older women with knee osteoarthritis (OA). MATERIALS AND METHODS This randomised control trial (ClinicalTrials.gov: (NCT04159883) enrolled 40 women aged ≥50 years with knee OA who were randomised into the app group (experimental; n = 20) receiving HEPs using an Arabic smartphone application called "My Dear Knee", whereas the paper group (control; n = 20) receiving HEPs as hand-outs. Both groups had the same exercise program. Outcome measures were self-reported adherence, changes in the Arabic Numeric Pain Rating Scale, the Arabic version of the reduced Western Ontario, McMaster Universities Osteoarthritis Index-Physical Function subscale, and Five-Times Sit-To-Stand Test scores. All participants were assessed at baseline, at week 3 and week 6. Using completer-only analyses, the repeated measures ANOVA was used to compare the means of the outcome measures between the two groups. RESULTS At the end of week 6, the app group reported greater adherence to HEPs (p = .002) and significant reduction in pain (p = .015). CONCLUSIONS A smartphone application with motivational and attractive features could enhance adherence to HEPs in this patient cohort.IMPLICATIONS FOR REHABILITATIONOlder adults with knee OA may face many obstacles that prevent or limit their adherence to the prescribed HEP.Smart device apps supported with attractive and motivational features could be an effective strategy to enhance adherence to HEPs among older adults with knee OA.Using such remote technology appears to overcome the barriers that may limit the ability of older women to receive supervised physical therapy in a clinical setting.
Collapse
Affiliation(s)
- Maryam Alasfour
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Medical Rehabilitation, Physical Therapy Department, Ministry of health, Riyadh, Saudi Arabia
| | - Maha Almarwani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
81
|
Davis-Cheshire R, Cogar C, Collier D, Deriveau W, Kunkel E, Mouser H, Newhouse J. Occupational therapy utilisation of apps in practice in the United States. Disabil Rehabil Assist Technol 2020; 17:948-956. [PMID: 33086022 DOI: 10.1080/17483107.2020.1834629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The purpose of this cross-sectional research study was to explore the use of apps by occupational therapy practitioners in the United States to gain a more complete overview of utilisation and perceived effectiveness, and assess trends by population served, practice setting, occupation addressed, and client deficit. METHODS For this cross-sectional study, 160 self-identified occupational therapy practitioners, 126 occupational therapists and 34 occupational therapy assistants, recruited through snowball sampling on social media participated in this 26-question survey available for two weeks online. Data analysis was conducted through SurveyMonkey and SPSS version 26. RESULTS The majority of respondents (71.9%) reported that they have used apps in practice, most frequently as treatment modalities (84.3%) and as recommendations (71.9%) for clients. Likewise, most respondents who reported using apps considered apps to be as effective (70.5%) or better than (27.3%) traditional practice methods. Use of apps was significantly associated with practice setting X2(9, N = 160) = 46.437, p < .001. CONCLUSIONS Occupational therapists are using apps with clients of all age groups, and these apps are being used in all phases of the occupational therapy process. Apps are available that address all eight areas of occupation, and apps are perceived to be as effective or better than traditional occupational therapy interventions.IMPLICATIONS FOR REHABILIATIONThe majority of occupational therapy practitioners surveyed are using apps in practice.Most therapists are being provided devices by employers that support app use in practice.Neuromusculoskeletal and movement related functions and mental functions related to cognition are the primary client impairments therapists are addressing when using apps.Lack of app knowledge and familiarity with apps were the leading barriers to app use in practice.
Collapse
Affiliation(s)
| | - Carly Cogar
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | - Dayna Collier
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | - Whooby Deriveau
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | | | - Hunter Mouser
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| | - Julia Newhouse
- Occupational Therapy, Kettering College, Beavercreek, OH, USA
| |
Collapse
|
82
|
Svingen J, Rosengren J, Turesson C, Arner M. A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial. Clin Rehabil 2020; 35:266-275. [PMID: 33040590 PMCID: PMC7874382 DOI: 10.1177/0269215520962287] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon. DESIGN Prospective multi-centre randomised controlled trial. SETTING Four hand surgery departments in Sweden. SUBJECTS A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control (n = 49) or intervention group (n = 52). INTERVENTION A smartphone application to facilitate rehabilitation. MAIN OUTCOME MEASURES Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks. RESULTS Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8-13.3), 11.8 (CI 11.0-12.8) for the intervention group, and 13.3 (CI 12.6-14.0), 12.8 (CI 12.0-13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9-99.5) compared to the controls 82.9 (CI 76.9-88.8) (P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction. CONCLUSION The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed. LEVEL OF EVIDENCE I. Randomised controlled trial.
Collapse
Affiliation(s)
- Jonas Svingen
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Jenny Rosengren
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Experimental, Linköping University, Linkoping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marianne Arner
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
83
|
Virtual Clinical Services for Rehabilitation in Hand Surgery. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:368. [PMID: 32954231 PMCID: PMC7486043 DOI: 10.1016/j.jhsg.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
84
|
Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract 2020; 48:102193. [PMID: 32560876 PMCID: PMC7261082 DOI: 10.1016/j.msksp.2020.102193] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Musculoskeletal conditions are a leading cause of global morbidity. Access to traditional in-person healthcare can be difficult for some under usual conditions and has become a ubiquitous barrier throughout the COVID-19 pandemic. Telehealth, defined as the 'delivery of healthcare at a distance using information and communication technology' is a solution to many access barriers and has been rapidly adopted by many healthcare professions throughout the crisis. While significant advancements in technology has made the widespread adoption of telehealth feasible, there are many factors to be considered when implementing a telehealth service. PURPOSE The aims of this masterclass are to (i) introduce telehealth and outline the current research within the context of musculoskeletal physiotherapy; (ii) provide insights into some of the broader challenges in the wide-scale adoption of telehealth; and (iii) to describe a systematic approach to implementing telehealth into existing healthcare settings, along with some practical considerations. IMPLICATIONS Telehealth is a broad concept and should be implemented to meet the specific needs of a healthcare service. This masterclass offers a structured approach to the implementation of a musculoskeletal physiotherapy telehealth service, and highlights practical considerations required by both clinicians and healthcare organisations throughout all stages of the implementation process.
Collapse
Affiliation(s)
- Michelle A. Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, 4029, Australia,Corresponding author. Physiotherapy Department, Royal Brisbane and Women's Hospital, Physiotherapy Department, Level 2 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
| | - Trevor G. Russell
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, 4072, Australia,School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, 4072, Australia
| |
Collapse
|
85
|
Brennan L, Kessie T, Caulfield B. Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e19721. [PMID: 32687476 PMCID: PMC7424492 DOI: 10.2196/19721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective The aims of this study were to explore patients’ rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of “Rehabilitation” and “Technology” and performed a thematic analysis on the interview data. Results Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer–specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance.
Collapse
Affiliation(s)
- Louise Brennan
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Threase Kessie
- Maynooth University Innovation Lab, Maynooth University, Kildare, Ireland
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
86
|
Tack C, Grodon J, Shorthouse F, Spahr N. "Physio anywhere": digitally-enhanced outpatient care as a legacy of coronavirus 2020. Physiotherapy 2020; 110:A26-A28. [PMID: 33308826 PMCID: PMC7368424 DOI: 10.1016/j.physio.2020.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Christopher Tack
- Integrated Musculoskeletal Outpatient Physiotherapy Service, Guys and St Thomas's NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, United Kingdom.
| | - Jack Grodon
- Integrated Musculoskeletal Outpatient Physiotherapy Service, Guys and St Thomas's NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, United Kingdom. https://twitter.com/physio_grodes
| | - Faye Shorthouse
- Integrated Musculoskeletal Outpatient Physiotherapy Service, Guys and St Thomas's NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - Nicolas Spahr
- Integrated Musculoskeletal Outpatient Physiotherapy Service, Guys and St Thomas's NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, United Kingdom
| |
Collapse
|
87
|
Health Promotion for Childhood Obesity: An Approach Based on Self-Tracking of Data. SENSORS 2020; 20:s20133778. [PMID: 32640540 PMCID: PMC7374452 DOI: 10.3390/s20133778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
At present, obesity and overweight are a global health epidemic. Traditional interventions for promoting healthy habits do not appear to be effective. However, emerging technological solutions based on wearables and mobile devices can be useful in promoting healthy habits. These applications generate a considerable amount of tracked activity data. Consequently, our approach is based on the quantified-self model for recommending healthy activities. Gamification can also be used as a mechanism to enhance personalization, increasing user motivation. This paper describes the quantified-self model and its data sources, the activity recommender system, and the PROVITAO App user experience model. Furthermore, it presents the results of a gamified program applied for three years in children with obesity and the process of evaluating the quantified-self model with experts. Positive outcomes were obtained in children’s medical parameters and health habits.
Collapse
|
88
|
A Discussion on Different Approaches for Prescribing Physical Interventions - Four Roads Lead to Rome, but Which One Should We Choose? J Pers Med 2020; 10:jpm10030055. [PMID: 32605044 PMCID: PMC7565695 DOI: 10.3390/jpm10030055] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023] Open
Abstract
It is well recognized that regular physical exercise has positive effects on physical and mental health. To use the beneficial health effects of physical exercise, there are worldwide movements encouraging health care providers to include physical exercise in their care and treatments strategies. However, a crucial point in administering the "exercise polypill" is the dosing and, in turn, the prescription of the physical intervention (PI). In this perspective article, we discuss the advantages and disadvantages of different approaches to prescribe PI. In this context, we also highlight outstanding questions and potential areas of opportunity for further investigations.
Collapse
|
89
|
Effects of using text message interventions for the management of musculoskeletal pain: a systematic review. Pain 2020; 161:2462-2475. [DOI: 10.1097/j.pain.0000000000001958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
90
|
Hua A, Johnson N, Quinton J, Chaudhary P, Buchner D, Hernandez ME. Design of a Low-Cost, Wearable Device for Kinematic Analysis in Physical Therapy Settings. Methods Inf Med 2020; 59:41-47. [PMID: 32535880 DOI: 10.1055/s-0040-1710380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Unsupervised home exercise is a major component of physical therapy (PT). This study proposes an inexpensive, inertial measurement unit-based wearable device to capture kinematic data to facilitate exercise. However, conveying and interpreting kinematic data to non-experts poses a challenge due to the complexity and background knowledge required that most patients lack. OBJECTIVES The objectives of this study were to identify key user interface and user experience features that would likely improve device adoption and assess participant receptiveness toward the device. METHODS Fifty participants were recruited to perform nine upper extremity exercises while wearing the device. Prior to exercise, participants completed an orientation of the device, which included examples of software graphics with exercise data. Surveys that measured receptiveness toward the device, software graphics, and ergonomics were given before and after exercise. RESULTS Participants were highly receptive to the device with 90% of the participants likely to use the device during PT. Participants understood how the simple kinematic data could be used to aid exercise, but the data could be difficult to comprehend with more complex movements. Devices should incorporate wireless sensors and emphasize ease of wear. CONCLUSION Device-guided home physical rehabilitation can allow for individualized treatment protocols and improve exercise self-efficacy through kinematic analysis. Future studies should implement clinical testing to evaluate the impact a wearable device can have on rehabilitation outcomes.
Collapse
Affiliation(s)
- Andrew Hua
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
| | - Nicole Johnson
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States
| | - Joshua Quinton
- Department of Physics, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States
| | - Pratik Chaudhary
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States
| | - David Buchner
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
| | - Manuel E Hernandez
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
| |
Collapse
|
91
|
Greiwe J, Nyenhuis SM. Wearable Technology and How This Can Be Implemented into Clinical Practice. Curr Allergy Asthma Rep 2020; 20:36. [PMID: 32506184 PMCID: PMC7275133 DOI: 10.1007/s11882-020-00927-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Our day-to-day life is saturated with health data that was previously out of reach. Over the last decade, new devices and fitness technology companies are attempting to tap into this data, uncovering a treasure trove of useful information that, when applied correctly, has the potential to revolutionize the way we approach healthcare and chronic conditions like asthma, especially in the wake of the COVID-19 pandemic. RECENT FINDINGS By harnessing exciting developments in personalization, digitization, wellness, and patient engagement, care providers can improve health outcomes for our patients in a way we have never been able to do in the past. While new technologies to capture individual health metrics are everywhere, how can we use this information to make a real difference in our patients' lives? Navigating the complicated landscape of personal wearable devices, asthma inhaler sensors, and exercise apps can be daunting to even the most tech savvy physician. This manuscript will give you the tools necessary to make lasting changes in your patients' lives by exposing them to a world of usable, affordable, and relatable health technology that resonates with their personal fitness and wellness goals. These tools will be even more important post-COVID-19, as the landscape of clinical outpatient care changes from mainly in-person visits to a greater reliance on telemedicine and remote monitoring.
Collapse
Affiliation(s)
- Justin Greiwe
- Bernstein Allergy Group, Inc, 8444 Winton Road, Cincinnati, OH, 45231, USA. .,Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
92
|
Chung BPH, Chiang WKH, Lau H, Lau TFO, Lai CWK, Sit CSY, Chan KY, Yeung CY, Lo TM, Hui E, Lee JSW. Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: A single-blind randomized controlled trial. Hong Kong Physiother J 2020; 40:63-73. [PMID: 32489241 PMCID: PMC7136530 DOI: 10.1142/s1013702520500079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/20/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program. METHODS Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals. RESULTS A total of 56 participants were allocated to the experimental group ( n = 27 ) and control group ( n = 29 ) . There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain. CONCLUSION The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.
Collapse
Affiliation(s)
- Bryan Ping Ho Chung
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Wendy Kam Ha Chiang
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Herman Lau
- Hospital Chief Executive, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Titanic Fuk On Lau
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Charles Wai Kin Lai
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Claudia Sin Yi Sit
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Ka Yan Chan
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Chau Yee Yeung
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Tak Man Lo
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Jenny Shun Wah Lee
- Department of Medicine and Geriatrics, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| |
Collapse
|
93
|
Koppenaal T, Arensman RM, van Dongen JM, Ostelo RWJG, Veenhof C, Kloek CJJ, Pisters MF. Effectiveness and cost-effectiveness of stratified blended physiotherapy in patients with non-specific low back pain: study protocol of a cluster randomized controlled trial. BMC Musculoskelet Disord 2020; 21:265. [PMID: 32321492 PMCID: PMC7175532 DOI: 10.1186/s12891-020-3174-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient education, advice on returning to normal activities and (home-based) exercise therapy are established treatment options for patients with non-specific low back pain (LBP). However, the effectiveness of physiotherapy interventions on physical functioning and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercises and recommended physical activity behaviour. Therefore we have developed e-Exercise LBP, a blended intervention in which a smartphone application is integrated within face-to-face care. E-Exercise LBP aims to improve patient self-management skills and adherence to exercise and physical activity recommendations and consequently improve the effectiveness of physiotherapy on patients' physical functioning. The aim of this study is to investigate the short- (3 months) and long-term (12 and 24 months) effectiveness on physical functioning and cost-effectiveness of e-Exercise LBP in comparison to usual primary care physiotherapy in patients with LBP. METHODS This paper presents the protocol of a prospective, multicentre cluster randomized controlled trial. In total 208 patients with LBP pain were treated with either e-Exercise LBP or usual care physiotherapy. E-Exercise LBP is stratified based on the risk for developing persistent LBP. Physiotherapists are able to monitor and evaluate treatment progress between face-to-face sessions using patient input from the smartphone application in order to optimize physiotherapy care. The smartphone application contains video-supported self-management information, video-supported exercises and a goal-oriented physical activity module. The primary outcome is physical functioning at 12-months follow-up. Secondary outcomes include pain intensity, physical activity, adherence to prescribed (home-based) exercises and recommended physical activity behaviour, self-efficacy, patient activation and health-related quality of life. All measurements will be performed at baseline, 3, 12 and 24 months after inclusion. An economic evaluation will be performed from the societal and the healthcare perspective and will assess cost-effectiveness of e-Exercise LBP compared to usual physiotherapy at 12 and 24 months. DISCUSSION A multi-phase development and implementation process using the Center for eHealth Research Roadmap for the participatory development of eHealth was used for development and evaluation. The findings will provide evidence on the effectiveness of blended care for patients with LBP and help to enhance future implementation of blended physiotherapy. TRIAL REGISTRATION ISRCTN, ISRCTN94074203. Registered 20 July 2018 - Retrospectively registered.
Collapse
Affiliation(s)
- Tjarco Koppenaal
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Remco M Arensman
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences research institute Amsterdam, Amsterdam, the Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences research institute Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Corelien J J Kloek
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Martijn F Pisters
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
94
|
Does a Web-Based Exercise Programming System Improve Home Exercise Adherence for People With Musculoskeletal Conditions?: A Randomized Controlled Trial. Am J Phys Med Rehabil 2020; 98:850-858. [PMID: 31021823 DOI: 10.1097/phm.0000000000001204] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate whether a web-based exercise programming system improves adherence to a home exercise program for people with musculoskeletal conditions. DESIGN Eligible patients with a musculoskeletal condition presenting to a physical therapist in private practice were randomized to the following: (a) control (home exercise prescribed by therapist's usual methods) or (b) intervention (home exercise prescribed using a web-based exercise programming system). The primary outcome was self-rated exercise adherence measured at week 3 via 11-point Numeric Rating Scales. Secondary outcomes were satisfaction with exercise delivery and confidence in ability to undertake prescribed exercise. Process measures were also included. RESULTS We enrolled 305 participants, with loss to follow-up of 14.5% (22/152) and 13.7% (21/153) in intervention and control groups, respectively. Compared with controls, the intervention group reported higher exercise adherence (mean difference Numeric Rating Scale units (95% confidence intervals): adherence overall -1.0 [-1.6 to -0.3] and regarding number of exercises in session -0.7 [-1.3 to -0.1], number of repetitions -0.8 [-1.4 to -0.2], and number of sessions -1.0 [-1.6 to -0.3]). The intervention group showed greater confidence to exercise than control, with no difference in satisfaction. CONCLUSIONS A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established.
Collapse
|
95
|
Timko C, Taylor E, Nash A, Blonigen D, Smelson D, Tsai J, Finlay AK. National Survey of Legal Clinics Housed by the Department of Veterans Affairs to Inform Partnerships with Health and Community Services. J Health Care Poor Underserved 2020; 31:1440-1456. [PMID: 33416704 PMCID: PMC8215811 DOI: 10.1353/hpu.2020.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Legal clinics housed by the Department of Veterans Affairs (VA) help veterans eliminate service access barriers. In this survey of 95 VA-housed legal clinics (70% of clinics), clients' legal problems were mainly estate planning, family, obtaining VA benefits, and housing (14-17% of clients). Most clinics rarely interacted with VA health care providers, did not have access to clients' VA health care records, and did not track clients' VA health care access (58-81% of clinics); 32% did not have dedicated and adequate space. Most clinic staff members were unpaid. Survey findings-that most VA-housed legal clinics do not interact with VA health care or directly address clients' mental health and substance use needs, and lack funds to serve fully all veterans seeking services-suggest that VA and community agencies should enact policies that expand and fund veterans' legal services and health system interactions to address health inequities and improve health outcomes.
Collapse
Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Amia Nash
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Daniel Blonigen
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Palo Alto University, Palo Alto, CA, 94304, USA
- National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, CA, 94305 USA
| | - David Smelson
- National Center on Homelessness among Veterans, Department of Veterans Affairs, Bedford, MA 01730 USA
- VA Center for Healthcare Organization and Implementation Research, Bedford, MA 01730 USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 N. Lake Avenue, Worcester, MA 01655 USA
| | - Jack Tsai
- National Center on Homelessness Among Veterans, Department of Veterans Affairs, 950 Campbell Ave., 151D, West Haven, CT 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, CA, 94305 USA
| |
Collapse
|
96
|
Olsen SH, Saperstein SL, Gold RS. Content and Feature Preferences for a Physical Activity App for Adults With Physical Disabilities: Focus Group Study. JMIR Mhealth Uhealth 2019; 7:e15019. [PMID: 31605518 PMCID: PMC6913716 DOI: 10.2196/15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 11/21/2022] Open
Abstract
Background Hundreds of thousands of mobile phone apps intended to improve health and fitness are available for download across platforms and operating systems; however, few have been designed with people with physical disabilities in mind, ignoring a large population that may benefit from an effective tool to increase physical activity. Objective This study represents the first phase in the development process of a fitness tracking app for people with physical disabilities interested in nontraditional sport. The aim of this research was to explore user preferences for content, appearance, and operational features of a proposed physical activity app for people with physical disabilities to inform the design of a mobile phone app for increasing physical activity. Methods Four focus groups were conducted with 15 adults with physical disabilities who currently participate in nontraditional, non-Paralympic sport. Data collected from the focus group sessions centered on content, functionality, and appearance of apps currently used by participants as well as preferences for a future app. Results Participants (mean age 35.7, SD 9.2 years) were mostly white (13/15, 87%), and all were currently participating in CrossFit and at least one other sport. Five main themes were identified. Themes included preferences for (1) workout-specific features that were tailored or searchable by disability, (2) user experience that was intuitive and accessible, (3) profile personalization options, (4) gamification features that allowed for competition with self and other users, and (5) social features that allowed increased interaction among users. Participants expressed a primary interest in having a fitness app that was designed for people with physical disabilities such that the features present in other fitness tracking apps were relevant to them and their community of adaptive athletes. Conclusions The results showed that features related to user experience, social engagement, and gamification are considered important to people with physical disabilities. Features highlighted by participants as most desired, from a consumer perspective, were in line with research identifying attributes of quality apps that use behavior change techniques to influence positive physical activity behavior change. Such insights should inform the development of any fitness app designed to integrate users with disabilities as a primary user base.
Collapse
Affiliation(s)
- Sara H Olsen
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Sandra L Saperstein
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Robert S Gold
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| |
Collapse
|
97
|
Butchart J, Harrison R, Ritchie J, Martí F, McCarthy C, Knight S, Scheinberg A. Child and parent perceptions of acceptability and therapeutic value of a socially assistive robot used during pediatric rehabilitation. Disabil Rehabil 2019; 43:163-170. [PMID: 31120794 DOI: 10.1080/09638288.2019.1617357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Socially assistive robots are emerging as a method of supporting the rehabilitation of children with physical disabilities. To date there has been no in-depth analysis of parent and child perspectives regarding the use of socially assistive robots for pediatric rehabilitation. The purpose of this study was to capture the experiences of parents and children who participated in a rehabilitation session with a socially assistive rehabilitation robot.Methods: An interpretivist qualitative design was used. Semi-structured interviews of five parent-child pairs were undertaken to examine their experiences during a rehabilitation session with the NAO robot. Interviews were analyzed using inductive thematic analysis.Results: Five themes were identified: 1) affective influence, 2) independence, 3) preference for human interaction, 4) accessibility of therapy and 5) familiarity with technology.Conclusion: Based on parent and child perspectives, the NAO robot is an acceptable complement to rehabilitation therapies. Children and parents perceived the NAO robot to have therapeutic value through its potential to enhance engagement, promote child independence during rehabilitation exercises and its potential support a rehabilitation program when a human therapist is not accessible.Implications for rehabilitationSocially assistive robots are an acceptable tool to support the delivery of exercise programs in pediatric rehabilitation.Therapists need to consider how to provide a positive affective experience during rehabilitation sessions, the use of socially assistive robots may be one method of doing this.When using socially assistive robots to support rehabilitation the individual needs and preferences of the child and family should be considered.Socially assistive robots may have a role in supporting home exercises programs; future work is needed to determine the feasibility of this.
Collapse
Affiliation(s)
- Joanna Butchart
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Jan Ritchie
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Felip Martí
- Department of Computer Science and Software Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Chris McCarthy
- Department of Computer Science and Software Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sarah Knight
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Adam Scheinberg
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
98
|
Hou J, Yang R, Yang Y, Tang Y, Deng H, Chen Z, Wu Y, Shen H. The Effectiveness and Safety of Utilizing Mobile Phone-Based Programs for Rehabilitation After Lumbar Spinal Surgery: Multicenter, Prospective Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e10201. [PMID: 30785406 PMCID: PMC6404639 DOI: 10.2196/10201] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/01/2018] [Accepted: 12/08/2018] [Indexed: 01/12/2023] Open
Abstract
Background Rehabilitation is crucial for postoperative patients with low back pain (LBP). However, the implementation of traditional clinic-based programs is limited in developing countries, such as China, because of the maldistribution of medical resources. Mobile phone–based programs may be a potential substitute for those who have no access to traditional rehabilitation. Objective The aim of this study was to examine the efficacy of mobile phone–based rehabilitation systems in patients who underwent lumbar spinal surgery. Methods Patients who accepted spinal surgeries were recruited and randomized into 2 groups of rehabilitation treatments: (1) a mobile phone–based eHealth (electronic health) program (EH) or (2) usual care treatment (UC). The primary outcomes were (1) function and pain status assessed by the Oswestry Disability Index (ODI) and (2) the visual analog scale (VAS). Secondary outcomes were (1) general mental health and (2) quality of life (Likert scales, EuroQol-5 Dimension health questionnaire, and 36-item Short-Form Health Survey). All the patients were assessed preoperatively and then at 3, 6, 12, and 24 months postoperatively. Results A total of 168 of the 863 eligible patients were included and randomized in this study. Our analysis showed that the improvement of primary outcomes in the EH group was superior to the UC group at 24 months postoperatively (ODI mean 7.02, SD 3.10, P<.05; VAS mean 7.59, SD 3.42, P<.05). No significant difference of primary outcomes was found at other time points. A subgroup analysis showed that the improvements of the primary outcomes were more significant in those who completed 6 or more training sessions each week throughout the trial (the highest compliance group) compared with the UC group at 6 months (ODI mean 17.94, SD 5.24, P<.05; VAS mean 19.56, SD 5.27, P<.05), 12 months (ODI mean 13.39, SD 5.32, P<.05; VAS mean 14.35, SD 5.23, P<.05), and 24 months (ODI mean 18.80, SD 5.22, P<.05; VAS mean 21.56, SD 5.28, P<.05). Conclusions This research demonstrated that a mobile phone–based telerehabilitation system is effective in self-managed rehabilitation for postoperative patients with LBP. The effectiveness of eHealth was more evident in participants with higher compliance. Future research should focus on improving patients’ compliance. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-13003314; http://www.chictr.org.cn/showproj.aspx?proj=6245 (Archived by WebCite at http://www.webcitation.org/766RAIDNc)
Collapse
Affiliation(s)
- Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiyong Tang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiquan Deng
- Department of Orthopedics, Guangxi Region People's Hospital, Nanning, China
| | - Zhong Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanfeng Wu
- Department of Biotherapy Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huiyong Shen
- Department of Orthopedics, 8th Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, China
| |
Collapse
|
99
|
Paul L, Renfrew L, Freeman J, Murray H, Weller B, Mattison P, McConnachie A, Heggie R, Wu O, Coulter EH. Web-based physiotherapy for people affected by multiple sclerosis: a single blind, randomized controlled feasibility study. Clin Rehabil 2018; 33:473-484. [DOI: 10.1177/0269215518817080] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with multiple sclerosis. Design: Multi-centre, randomized controlled, feasibility study. Setting: Three multiple sclerosis out-patient centres. Participants: A total of 90 people with multiple sclerosis (Expanded Disability Status Scale 4–6.5). Interventions: Participants were randomized to a six-month individualized, home exercise programme delivered via web-based physiotherapy ( n = 45; intervention) or a sheet of exercises ( n = 45; active comparator). Outcome measures: Outcome measures (0, three, six and nine months) included adherence, two-minute walk test, 25 foot walk, Berg Balance Scale, physical activity and healthcare resource use. Interviews were undertaken with 24 participants and 3 physiotherapists. Results: Almost 25% of people approached agreed to take part. No intervention-related adverse events were recorded. Adherence was 40%–63% and 53%–71% in the intervention and comparator groups. There was no difference in the two-minute walk test between groups at baseline (Intervention-80.4(33.91)m, Comparator-70.6(31.20)m) and no change over time (at six-month Intervention-81.6(32.75)m, Comparator-74.8(36.16)m. There were no significant changes over time in other outcome measures except the EuroQol-5 Dimension at six months which decreased in the active comparator group. For a difference of 8(17.4)m in two-minute walk test between groups, 76 participants/group would be required (80% power, P > 0.05) for a future randomized controlled trial. Conclusion: No changes were found in the majority of outcome measures over time. This study was acceptable and feasible by participants and physiotherapists. An adequately powered study needs 160 participants.
Collapse
Affiliation(s)
- Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Linda Renfrew
- Multiple Sclerosis Service, NHS Ayrshire & Arran, Irvine, UK
| | - Jennifer Freeman
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Heather Murray
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Belinda Weller
- Anne Rowling Regenerative Neurology Clinic, NHS Lothian, Edinburgh, UK
| | - Paul Mattison
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Robert Heggie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elaine H Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
100
|
Parreiras de Menezes KK, Nascimento LR, Ada L, Avelino PR, Polese JC, Mota Alvarenga MT, Barbosa MH, Teixeira-Salmela LF. High-Intensity Respiratory Muscle Training Improves Strength and Dyspnea Poststroke: A Double-Blind Randomized Trial. Arch Phys Med Rehabil 2018; 100:205-212. [PMID: 30316960 DOI: 10.1016/j.apmr.2018.09.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether high-intensity home-based respiratory muscle training, that is, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity post-stroke. DESIGN Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis. SETTING Community-dwelling patients. PARTICIPANTS Patients with stroke, who had respiratory muscle weakness (N=38). INTERVENTIONS The experimental group received 40-minute high-intensity home-based respiratory muscle training, 7 days per week, for 8 weeks, progressed weekly. The control group received a sham intervention of similar dose. MAIN OUTCOME MEASURES Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), whereas secondary outcomes were expiratory muscle strength (maximal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (6-minute walk test). Outcomes were measured at baseline, after intervention, and 1 month beyond intervention. RESULTS Compared to the control, the experimental group increased inspiratory (27cmH2O; 95% confidence interval [95% CI], 15 to 40) and expiratory (42cmH2O; 95% CI, 25 to 59) strength, inspiratory endurance (33 breaths; 95% CI, 20 to 47), and reduced dyspnea (-1.3 out of 5.0; 95% CI, -2.1 to -0.6), and the benefits were maintained at 1 month beyond training. There was no significant between-group difference for walking capacity or respiratory complications. CONCLUSION High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness post-stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.
Collapse
Affiliation(s)
| | - Lucas Rodrigues Nascimento
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Patrick Roberto Avelino
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Janaine Cunha Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Mariana Hoffman Barbosa
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | |
Collapse
|