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Hoenig HM, Amis K, Edmonds C, Morgan MS, Landerman L, Caves K. Testing fine motor coordination via telehealth: Effects of video characteristics on reliability and validity. J Telemed Telecare 2017; 24:365-372. [PMID: 28350283 DOI: 10.1177/1357633x17700032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background There is limited research about the effects of video quality on the accuracy of assessments of physical function. Methods A repeated measures study design was used to assess reliability and validity of the finger-nose test (FNT) and the finger-tapping test (FTT) carried out with 50 veterans who had impairment in gross and/or fine motor coordination. Videos were scored by expert raters under eight differing conditions, including in-person, high definition video with slow motion review and standard speed videos with varying bit rates and frame rates. Results FTT inter-rater reliability was excellent with slow motion video (ICC 0.98-0.99) and good (ICC 0.59) under the normal speed conditions. Inter-rater reliability for FNT 'attempts' was excellent (ICC 0.97-0.99) for all viewing conditions; for FNT 'misses' it was good to excellent (ICC 0.89) with slow motion review but substantially worse (ICC 0.44) on the normal speed videos. FTT criterion validity (i.e. compared to slow motion review) was excellent (β = 0.94) for the in-person rater and good ( β = 0.77) on normal speed videos. Criterion validity for FNT 'attempts' was excellent under all conditions ( r ≥ 0.97) and for FNT 'misses' it was good to excellent under all conditions ( β = 0.61-0.81). Conclusions In general, the inter-rater reliability and validity of the FNT and FTT assessed via video technology is similar to standard clinical practices, but is enhanced with slow motion review and/or higher bit rate.
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Affiliation(s)
- Helen M Hoenig
- 1 Physical Medicine & Rehabilitation Service, Durham VA Health Care System, Durham, NC, USA.,2 Department of Medicine/Geriatrics, Duke University Medical Center, Durham, NC, USA
| | - Kristopher Amis
- 1 Physical Medicine & Rehabilitation Service, Durham VA Health Care System, Durham, NC, USA
| | - Carol Edmonds
- 1 Physical Medicine & Rehabilitation Service, Durham VA Health Care System, Durham, NC, USA
| | - Michelle S Morgan
- 3 Center for Aging & Human Development, Duke University, Durham, NC, USA
| | - Lawrence Landerman
- 3 Center for Aging & Human Development, Duke University, Durham, NC, USA
| | - Kevin Caves
- 4 Speech and Audiology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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152
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Pastora-Bernal JM, Martín-Valero R, Barón-López FJ, García-Gómez O. Effectiveness of telerehabilitation programme following surgery in shoulder impingement syndrome (SIS): study protocol for a randomized controlled non-inferiority trial. Trials 2017; 18:82. [PMID: 28231815 PMCID: PMC5324280 DOI: 10.1186/s13063-017-1822-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background Shoulder pain is common in society, with high prevalence in the general population. Shoulder impingement syndrome (SIS) is the most frequent cause. Patients suffer pain, muscle weakness and loss of movement in the affected joint. Initial treatment is predominantly conservative. The surgical option has high success rates and is often used when conservative strategy fails. Traditional physiotherapy and post-operative exercises are needed for the recovery of joint range, muscle strength, stability and functionality. Telerehabilitation programmes have shown positive results in some orthopaedic conditions after surgery. Customized telerehabilitation intervention programmes should be developed to recover shoulder function after SIS surgery. The objective of this study is to evaluate the feasibility and effectiveness of a telerehabilitation intervention compared with usual care in patients after subacromial decompression surgery. Methods We will compare an intervention group receiving videoconferences and a telerehabilitation programme to a control group receiving traditional physiotherapy intervention in a single-blind, randomized controlled non-inferiority trial study design. Discussion Through this study, we will further develop our preliminary data set and practical experience with the telerehabilitation programmes to evaluate their effectiveness and compare this with traditional intervention. We will also explore patient satisfaction and cost-effectiveness. Patient enrolment is ongoing. Trial registration ClinicalTrials.gov, NCT02909920. 14 September 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1822-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jose-Manuel Pastora-Bernal
- Health Science, Degree of Physiotherapy, University of Málaga, Málaga, Spain. .,Department of Physiotherapy, Faculty of Health Sciences C/Arquitecto Francisco Peñalosa Ampliación del C. Teatinos, 29071, Málaga, Spain.
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Nursery and Physiotherapy, PhD Lecture University of Cádiz, Cádiz, Spain
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153
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Rothgangel A, Braun S, Smeets R, Beurskens A. Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach. JMIR Rehabil Assist Technol 2017; 4:e2. [PMID: 28582249 PMCID: PMC5454587 DOI: 10.2196/rehab.6761] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/27/2016] [Accepted: 01/09/2017] [Indexed: 11/17/2022] Open
Abstract
Background Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately, patients’ adherence to unsupervised exercises is generally poor and there is a need for effective strategies such as telerehabilitation to support long-term self-management of patients with phantom limb pain. Objective The main aim of this study was to describe the user-centered approach that guided the design and development of a telerehabilitation platform for patients with phantom limb pain. We addressed 3 research questions: (1) Which requirements are defined by patients and therapists for the content and functions of a telerehabilitation platform and how can these requirements be prioritized to develop a first prototype of the platform? (2) How can the user interface of the telerehabilitation platform be designed so as to match the predefined critical user requirements and how can this interface be translated into a medium-fidelity prototype of the platform? (3) How do patients with phantom limb pain and their treating therapists judge the usability of the medium-fidelity prototype of the telerehabilitation platform in routine care and how can the platform be redesigned based on their feedback to achieve a high-fidelity prototype? Methods The telerehabilitation platform was developed using an iterative user-centered design process. In the first phase, a questionnaire followed by a semistructured interview was used to identify the user requirements of both the patients and their physical and occupational therapists, which were then prioritized using a decision matrix. The second phase involved designing the interface of the telerehabilitation platform using design sketches, wireframes, and interface mock-ups to develop a low-fidelity prototype. Heuristic evaluation resulted in a medium-fidelity prototype whose usability was tested in routine care in the final phase, leading to the development of a high-fidelity prototype. Results A total of 7 categories of patient requirements were identified: monitoring, exercise programs, communication, settings, background information, log-in, and general requirements. One additional category emerged for therapists: patient management. Based on these requirements, patient and therapist interfaces for the telerehabilitation platform were developed and redesigned by the software development team in an iterative process, addressing the usability problems that were reported by the users during 4 weeks of field testing in routine care. Conclusions Our findings underline the importance of involving the users and other stakeholders early and continuously in an iterative design process, as well as the need for clear criteria to identify critical user requirements. A decision matrix is presented that incorporates the views of various stakeholders in systematically rating and prioritizing user requirements. The findings and lessons learned might help health care providers, researchers, software designers, and other stakeholders in designing and evaluating new teletreatments, and hopefully increase the likelihood of user acceptance.
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Affiliation(s)
- Andreas Rothgangel
- Research Centre for Autonomy and Participation of People with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences Heerlen, Heerlen, Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Kaasa health, Duesseldorf, Germany
| | - Susy Braun
- Research Centre for Autonomy and Participation of People with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences Heerlen, Heerlen, Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Rob Smeets
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Libra Rehabilitation and Audiology, Eindhoven/Weert, Netherlands
| | - Anna Beurskens
- Research Centre for Autonomy and Participation of People with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences Heerlen, Heerlen, Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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154
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Martinez RN, Hogan TP, Balbale S, Lones K, Goldstein B, Woo C, Smith BM. Sociotechnical Perspective on Implementing Clinical Video Telehealth for Veterans with Spinal Cord Injuries and Disorders. Telemed J E Health 2017; 23:567-576. [PMID: 28067586 DOI: 10.1089/tmj.2016.0200] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Real-time videoconferencing technology such as clinical video telehealth (CVT) offers a means to reach patient populations who face limited access to healthcare. The Veterans Health Administration has invested in CVT to improve care access for U.S. military veterans with spinal cord injuries and disorders (SCI/D); however, no studies have assessed the factors that influence implementation of this technology in clinical practice for individuals with SCI/D. INTRODUCTION Guided by a sociotechnical perspective, the purpose of this study was to identify factors that influence implementation of CVT for veterans with SCI/D. MATERIALS AND METHODS We conducted semistructured telephone interviews with 40 healthcare providers who use CVT to deliver services to veterans with SCI/D. RESULTS Factors related to workflow and communication were widely reported as implementation barriers. Coordinating logistics for CVT appointments was challenging, and effective communication between CVT team members across facilities was considered crucial. Providers also cited factors related to technical infrastructure, people, and organizational features, including the need for appropriate equipment, space, personnel, and support for using CVT equipment. DISCUSSION The implementation of CVT in the care of veterans with SCI/D was influenced by an interrelated set of social and technical factors. Key among them were social factors related to people, workflow, and communication, given that CVT supports healthcare teams interacting remotely in real time. CONCLUSIONS CVT implementation requires teams working together to negotiate a complex, distributed process across multiple sites. Such complexity places a premium on teamwork and communication among healthcare teams before, during, and after a CVT encounter.
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Affiliation(s)
- Rachael N Martinez
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois
| | - Timothy P Hogan
- 2 Center for Healthcare Organization and Implementation Research , Edith Nourse Rogers Memorial Veterans Hospital, U.S. Department of Veterans Affairs, Bedford, Massachusetts.,3 Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Salva Balbale
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.,4 Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Keshonna Lones
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois
| | - Barry Goldstein
- 5 Spinal Cord Injuries and Disorders System of Care Program Office , U.S. Department of Veterans Affairs, Seattle, Washington.,6 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
| | - Christine Woo
- 7 Louis Stokes Cleveland DVAMC , U.S. Department of Veterans Affairs, Cleveland, Ohio
| | - Bridget M Smith
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.,8 Feinberg School of Medicine, Northwestern University , Chicago, Illinois
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155
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Kizony R, Weiss PL, Harel S, Feldman Y, Obuhov A, Zeilig G, Shani M. Tele-rehabilitation service delivery journey from prototype to robust in-home use. Disabil Rehabil 2016; 39:1532-1540. [PMID: 28004980 DOI: 10.1080/09638288.2016.1250827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to present a retrospective study on clients with Acquired Brain Injury (ABI) enrolled in a tele-motion-rehabilitation service program for two or more months. METHODS Data from 82 clients (46 males; 74 with ABI), aged 22-85 years, are reported. The Kinect-based CogniMotion System (ReAbility Online, Gertner Institute, Tel Hashomer, Israel) provided services that included 30-min biweekly sessions. Participants were evaluated prior to and 2 months following the commencement of service with clinical assessments that measured movements and function of the weaker upper extremity and cognitive abilities. RESULTS Clients enrolled in the service had intact or mild cognitive impairment, mild-moderate motor impairment but little use of their weak upper extremity for daily activities. They were satisfied with the service and reported high levels of system usability. Post-intervention clinical assessments were performed on about half of the participants after 2 months; significant improvements in active movements of the weak upper extremity, shoulder flexion range of motion and in the Trail Making Test were found (p < 0.05). CONCLUSIONS The service appears to be feasible for people with ABI and effective in important clinical outcomes related to improvements in upper extremity function. Implications for Rehabilitation Tele-rehabilitation provided with Microsoft Kinect 3D sensor virtual reality tracking system is feasible for people with Acquired Brain Injury. People with Acquired Brain Injury in the chronic stage were satisfied with the tele-rehabilitation service and perceived it as beneficial to improve their motor and cognitive abilities The CogniMotion System service appears to be effective in important clinical outcomes related to improvements in upper extremity function.
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Affiliation(s)
- Rachel Kizony
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel.,b Center of Advanced Technologies in Rehabilitation , Sheba Medical Center , Tel Hashomer , Israel.,c Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel
| | - Patrice L Weiss
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel.,c Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel
| | - Sharon Harel
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
| | - Yoram Feldman
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
| | - Alexei Obuhov
- d Neurological Rehabilitation Department, Sheba Medical Center , Tel Hashomer , Israel
| | - Gabi Zeilig
- d Neurological Rehabilitation Department, Sheba Medical Center , Tel Hashomer , Israel.,e Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Mordechai Shani
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
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156
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Richardson BR, Truter P, Blumke R, Russell TG. Physiotherapy assessment and diagnosis of musculoskeletal disorders of the knee via telerehabilitation. J Telemed Telecare 2016; 23:88-95. [DOI: 10.1177/1357633x15627237] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Lower limb musculoskeletal disorders place a heavy burden on healthcare systems. Appropriate management of these conditions is critical, however access to appropriate physiotherapy services is difficult for those in geographically remote areas or those with mobility or transport difficulties. The aim of this study was to evaluate the accuracy and reliability of an online musculoskeletal physiotherapy assessment of the knee complex using telerehabilitation compared to traditional face-to-face assessment. Methods In a repeated-measures design, 18 subjects who sought treatment for knee pain underwent a traditional face-to-face assessment and a remote telerehabilitation assessment. Telerehabilitation assessments were conducted with participants performing facilitated self-palpation, self-applied modified orthopaedic tests, active movements and functional tasks. Results Primary pathoanatomical diagnoses were in exact agreement in 67% of cases and were similar in 89% of cases. The system of pathology was found to be in agreement in 17 out of 18 cases (94%). Comparisons of objective findings from the two physical assessments demonstrated substantial agreement (kappa = 0.635) for categorical data and binary data (chi-squared = 400.36; p < 0.001). A high level of intra-rater (89%) and moderate level of inter-rater (67%) reliability was evident for telerehabilitation assessments. Discussion Telerehabilitation assessment of the knee complex appears to be feasible and reliable. This study has implications for clinical practice and the development of physiotherapy services to address the burden of lower limb musculoskeletal pain and disability.
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Affiliation(s)
- Bradley R Richardson
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Piers Truter
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Robert Blumke
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Trevor G Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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157
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Fusco F, Turchetti G. Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care. BMJ Open 2016; 6:e009964. [PMID: 27188803 PMCID: PMC4874124 DOI: 10.1136/bmjopen-2015-009964] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess cost-effectiveness and cost utility of telerehabilitation (TR) versus standard rehabilitation (SR) after total knee replacement (TKR). DESIGN Markov decision modelling of cost-effectiveness and cost-utility analysis based on patient-level and secondary data sources employing Italian National Health Service (NHS; Ita-NHS) and Society perspectives. SETTING Primary care units (PCUs) in Italy. PARTICIPANTS Patients discharged after TKR. INTERVENTIONS Mixed SR-TR service (10 face-to-face sessions and 10 telesessions) versus SR (20 face-to-face sessions) PRIMARY AND SECONDARY OUTCOME MEASURES The incremental cost per additional knee flexion range of motion (ROM) and per QALY gained by SR-TR compared with SR. Second, we considered the probability of being cost-effective and the probability of being more effective and less expensive. RESULTS TR appears to be the cost-effective in the base case and in all of the considered scenarios, but is no longer more effective and less expensive if transportation costs are excluded. Comparing SR-TR with SR, the incremental cost-effectiveness ratio (ICER) adopting the Ita-NHS perspective for the base case was -€117/ROM gained. The cost-effectiveness probability for SR-TR was 0.98 (ceiling ratio: €50/ROM), while the joint probability of being more effective and less expensive was 0.87. Assuming that TR would increase health-related quality of life (HRQOL) utilities by 2.5%, the ICER adopting Ita-NHS perspective is -€960/QALY (cost-effectiveness probability: 1; ceiling ratio: €30 000/QALY). All the performed sensitivity analyses did not change the conclusions, but if transportation costs were excluded, the probability for SR-TR of being more clinically effective and less expensive reduced to 0.56. CONCLUSIONS The analysis suggested SR-TR to be cost-effective, even less expensive and more effective if the PCUs provide ambulance transportations. However, the uncertainty related to TR costs, HRQOL and long-term clinical outcomes raises important topics for future research, which should be addressed to confirm our estimates. TRIAL REGISTRATION NUMBER ISRCTN45837371.
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Affiliation(s)
- Francesco Fusco
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
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158
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Cottrell MA, Galea OA, O'Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil 2016; 31:625-638. [PMID: 27141087 DOI: 10.1177/0269215516645148] [Citation(s) in RCA: 325] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of treatment delivered via real-time telerehabilitation for the management of musculoskeletal conditions, and to determine if real-time telerehabilitation is comparable to conventional methods of delivery within this population. DATA SOURCES Six databases (Medline, Embase, Cochrane CENTRAL, PEDro, psycINFO, CINAHL) were searched from inception to November 2015 for literature which reported on the outcomes of real-time telerehabilitation for musculoskeletal conditions. REVIEW METHODS Two reviewers screened 5913 abstracts where 13 studies ( n = 1520) met the eligibility criteria. Methodological quality was assessed using the Downs & Black 'Checklist for Measuring Quality' tool. Results were pooled for meta-analysis based upon primary outcome measures and reported as standardised mean differences and 95% confidence intervals (CI). RESULTS Aggregate results suggest that telerehabilitation is effective in the improvement of physical function (SMD 1.63, 95%CI 0.92-2.33, I2=93%), whilst being slightly more favourable (SMD 0.44, 95%CI 0.19-0.69, I2=58%) than the control cohort following intervention. Sub-group analyses reveals that telerehabilitation in addition to usual care is more favourable (SMD 0.64, 95%CI 0.43-0.85, I2=10%) than usual care alone, whilst treatment delivered solely via telerehabilitation is equivalent to face-to-face intervention (SMD MD 0.14, 95% CI -0.10-0.37, I2 = 0%) for the improvement of physical function. The improvement of pain was also seen to be comparable between cohorts (SMD 0.66, 95%CI -0.27-1.60, I2=96%) following intervention. CONCLUSIONS Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.
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Affiliation(s)
- Michelle A Cottrell
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
| | - Olivia A Galea
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia
| | - Shaun P O'Leary
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,3 Physiotherapy Department, Royal Brisbane and Women's Hospital, Australia
| | - Anne J Hill
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
| | - Trevor G Russell
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
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159
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Gerber CN, Kunz B, van Hedel HJA. Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study. J Neuroeng Rehabil 2016; 13:33. [PMID: 27008504 PMCID: PMC4806437 DOI: 10.1186/s12984-016-0141-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/17/2016] [Indexed: 12/11/2022] Open
Abstract
Background Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting. Methods Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31–69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged. Results The usability of the system was considered average to satisfying (mean 60.1–93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems. Conclusions Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system. Trial registration ClinicalTrials.gov NCT02368223 Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0141-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Corinna N Gerber
- Pediatric Rehab Research Group, Rehabilitation Center for Children and Adolescents, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland. .,Department of Health Sciences and Technology, ETH Zurich, Rämistrasse 101, CH-8092, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland.
| | - Bettina Kunz
- Pediatric Rehab Research Group, Rehabilitation Center for Children and Adolescents, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Rämistrasse 101, CH-8092, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
| | - Hubertus J A van Hedel
- Pediatric Rehab Research Group, Rehabilitation Center for Children and Adolescents, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
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