Neurorehabilitation and apps: A systematic review of mobile applications

Usability of a mobile phone application to enhance activities of daily living in occupational therapy services for breast cancer survivors

Background/Objective: The use of new technologies in rehabilitation to evaluate and improve occupational performance and quality of life is increasing. Technological applications in the health field could help meet the needs of patients, including those of women breast cancer survivors. The main aim of this study was to design a mobile phone application "MAIA" focused on the perceived needs of women who have had breast cancer to achieve optimal performance in their daily lives in a meaningful way. Methods: A cross-sectional usability study using an online questionnaire was designed. Sociodemographic and occupational performance data were collected. System Usability Scale, Engagement in Meaningful Activities Survey, Occupational Balance Questionnaire, General Self-Efficacy Scale, Functional Assessment of Cancer Therapy - General and Disabilities of the Arm, Shoulder and Hand were administered. Descriptive statistics were used to describe categorical (frequencies and percentages) and quantitative variables (mean and standard deviation). Results: The sample was composed of seventy-eight women diagnosed with breast cancer. Nine activities of daily living were affected in more than 20% of women with breast cancer. The most affected were sleep and rest and functional mobility. Conclusions: Women survivors of breast cancer showed difficulties in daily life performance and participation. The MAIA App could be useful as a new online resource in occupational therapy for the rehabilitation of breast cancer survivors.

mHealth Impact on Gait and Dynamic Balance Outcomes in Neurorehabilitation: Systematic Review and Meta-analysis

Gait and dynamic balance are two main goals in neurorehabilitation that mHealth systems could address. To analyze the impact of using mHealth systems on gait and dynamic balance outcomes in subjects with neurological disorders. Randomized controlled trials (RCT) published in PubMed, Web of Science, Scopus, and PEDro databases were searched up to April 2023. Studies including adults with neurological disorders, analyzing the effectiveness of mHealth systems on gait and dynamic balance compared with conventional therapy and/or not intervention, were included. The PEDro scale and the Cochrane Collaboration's 2.0 tool were used for the methodological quality and risk of bias assessment. The Review Manager 5.4 software was used to obtain meta-analyses. 13 RCT were included in the systematic review and 11 in the meta-analyses, involving 528 subjects. A total of 21 mobile applications were identified for gait and balance training, and to enhance physical activity behaviors. There were significant differences in gait parameters, speed by 0.10 s/m (95% confidence interval (CI)=0.07,0.13;p<0.001), cadence by 8.01 steps/min (95%CI=3.30,12.72;p<0.001), affected step length by 8.89 cm (95%CI=4.88,12.90;p<0.001), non-affected step length by 8.08 cm (5%CI=2.64,13.51;p=0.004), and in dynamic balance, Timed Up and Go by -7.15 s (95%CI=-9.30,-4.99;p<0.001), and mobility subscale of Posture Assessment Scale for Stroke by 1.71 points (95%CI=1.38,2.04;p<0.001). Our findings suggested the use of mHealth systems for improving gait in subjects with neurological disorders, but controversial results on dynamics balance recovery were obtained. However, the quality of evidence is insufficient to strongly recommend them, so further research is needed.

Influence of Core-Stability Exercises Guided by a Telerehabilitation App on Trunk Performance, Balance and Gait Performance in Chronic Stroke Survivors: A Preliminary Randomized Controlled Trial

Stroke is one of the main causes of disability. Telerehabilitation could face the growing demand and a good strategy for post-stroke rehabilitation. The aim of this study is to examine the possible effects of therapeutic exercises performed by an App on trunk control, balance, and gait in stroke survivors. A preliminary 12-week randomized controlled trial was developed. Thirty chronic stroke survivors were randomly allocated into two groups. Both groups performed conventional physiotherapy, in addition to, the experimental group (EG) had access to a telerehabilitation App to guide home-based core-stability exercises (CSE). Trunk performance was measured with the Spanish-Trunk Impairment Scale (S-TIS 2.0) and Spanish-Function in Sitting Test. Balance and gait were measured with Spanish-Postural Assessment Scale for Stroke patient, Berg Balance Scale and an accelerometer system. In EG was observed an improvement of 2.76 points in S-TIS 2.0 (p = 0.001). Small differences were observed in balance and gait. Adherence to the use of the App was low. CSE guided by a telerehabilitation App, combined with conventional physiotherapy, seem to improve trunk function and sitting balance in chronic post-stroke. Active participation in the rehabilitation process should be increased among stroke survivors. Further confirmatory studies are necessary with a large sample size.

Interaction with touchscreen smartphones in patients with essential tremor and healthy individuals

INTRODUCTION

Smartphone use in biomedical research is becoming more prevalent in different clinical settings. We performed a pilot study to obtain information on smartphone use by patients with essential tremor (ET) and healthy controls, with a view to determining whether performance of touchscreen tasks is different between these groups and describing touchscreen interaction factors.

METHOD

A total of 31 patients with ET and 40 sex- and age-matched healthy controls completed a descriptive questionnaire about the use of smartphones. Participants subsequently interacted with an under-development Android application, and performed 4 tests evaluating typical touchscreen interaction gestures; each test was performed 5 times.

RESULT

The type of smartphone use and touchscreen interaction were not significantly different between patients and controls. Age and frequency of smartphone use are key factors in touchscreen interaction.

CONCLUSION

Our results support the use of smartphone touchscreens for research into ET, although further studies are required.

The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990-2019

BACKGROUND

A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India.

METHODS

Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates.

FINDINGS

The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2-5·0) in 1990 to 8·2% (6·6-10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2-0·3) to 0·6% (0·5-0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5-4·8) to 1·1% (0·9-1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9-46·1]), headache disorders (17·5% [3·6-32·5]), epilepsy (11·3% [9·0-14·3]), cerebral palsy (5·7% [4·2-7·7]), and encephalitis (5·3% [3·7-8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution.

INTERPRETATION

The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation.

FUNDING

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Telemedicine and Virtual Reality at Time of COVID-19 Pandemic: An Overview for Future Perspectives in Neurorehabilitation

In catastrophic situations such as pandemics, patients' healthcare including admissions to hospitals and emergency services are challenged by the risk of infection and by limitations of healthcare resources. In such a setting, the use of telemedicine interventions has become extremely important. New technologies have proved helpful in pandemics as a solution to improve the quality of life in vulnerable patients such as persons with neurological diseases. Moreover, telemedicine interventions provide at-home solutions allowing clinicians to telemonitor and assess patients remotely, thus minimizing risk of infection. After a review of different studies using telemedicine in neurological patients, we propose a telemedicine process flow for healthcare of subjects with chronic neurological disease to respond to the new challenges for delivering quality healthcare during the transformation of public and private healthcare organizations around the world forced by COVID-19 pandemic contingency. This telemedicine process flow represents a replacement for in-person treatment and thereby the provision equitable access to the care of vulnerable people. It is conceptualized as comprehensive service including (1) teleassistance with patient counseling and medical treatment, (2) telemonitoring of patients' health conditions and any changes over time, as well as (3) telerehabilitation, i.e., interventions to assess and promote body functions, activities, and consecutively participation. The hereby proposed telemedicine process flow could be adopted on a large scale to improve the public health response during healthcare crises like the COVID-19 pandemic but could equally promote equitable health care independent of people's mobility or location with respect to the specialized health care center.

Outcome measures used in the smartphone applications for the management of low back pain: a systematic scoping review

PURPOSE

Smartphone applications (SPApps) have become a key tool for the self-management of low back pain (LBP). However, the scientific evidence behind the outcome measures used in SPApps for LBP is never investigated before. Therefore, this systematic review firstly assess the quality of the free SPApps for LBP, secondly examines the outcome measures used and thirdly evaluates the outcome measures against the International Classification of Functioning, Disability and Health (ICF) core set classifications for LBP.

METHODS

A systematic scoping review was conducted in the iTunes and Google Play™ on-line stores for LBP SPApps which are free to download. These searches were conducted using keywords suggested by the Cochrane Back and Neck Group. SPApps were screened and downloaded to assess the quality using the Mobile App Rating Scale (MARS). SPApps using outcome measures were reviewed separately to evaluate whether their outcome measures represented any of the ICF components for LBP.

RESULTS

The overall quality of the apps has a mean MARS score of 2.5/5. Out of 74 apps reviewed, only four apps had outcome measures that could be linked to ICF components for LBP. Two of the four categories comprising the LBP core set were well represented.

CONCLUSION

The overall quality of the SPApps for LBP is low. Only very few SPApps offer outcome measures to monitor their effectiveness in the management of LBP. There is very limited evidence to show that the outcome measures used in the apps represents all the four core sets of LBP criteria set by ICF.

Cognitive Training for the Treatment of Addictions Mediated by Information and Communication Technologies (ICT)

This work constitutes a narrative review of the state of knowledge and advances in the intervention and treatment of addictions through the use of information and communication technologies, considering the growing demand for virtuality-mediated strategies that facilitate the approach of problems of public health such as addictions, which increase considerably year after year. To this end, the reader will be provided with a current overview of the drug use trend; subsequently, a conceptualization of the concept of addiction and its understanding from a neurobiological perspective and, finally, the progress in terms of intervention processes and therapeutic approach will be presented; which will imply an approach to the concept of e-health and rehabilitation mediated by information and communication technologies (ICT).

[Mobile applications in alzheimer's disease. A systematic review of the literature]

INTRODUCTION

New treatment options are emerging to treat Alzheimer's disease (AE) within the field of smartphone technologies.

OBJECTIVE

To carry out a systematic review of the literature on the use of mobile applications in AE and to review the app markets in order to extract the main apps, with a view to classifying the describing them in the context of AE.

MATERIAL AND METHODS

A systematic review was carried out from 2000 until 2018 on apps for AE. At the same time, a search for mobile applications was conducted in the main mobile application markets.

RESULTS

A total of 294 mobile applications were found, which were classified as follows: 178 with potential utility for AE and 116 with a specific design for AE (73 information apps, 8 assessment apps, 31 treatment apps, 3 information and assessment and one assessment and treatment app).

CONCLUSIONS

There are multiple apps with potential utility or a specific design for AE. However, the limited number of scientific articles and their poor quality make it impossible to generalise their use. Consequently, future research is needed by health agencies in the context of AE.

Applying M-Health to Palliative Care: A Systematic Review on the Use of M-Health in Monitoring Patients With Chronic Diseases and its Transposition in Palliative Care

BACKGROUND

The major growth of mobile technologies in the recent years has led to the development of medical-monitoring applications, particularly on smartphones.

AIM

The aim of this study was to review the use of m-health in the monitoring of patients with chronic pathologies in order to consider what could be adapted for palliative care patients at home.

DESIGN

A systematic review of the English and French literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.

DATE SOURCES

The review screened the following databases: PUBMED, SCOPUS, COCHRANE, SCIENCE DIRECT, SUDOC, and EM-Premium, screening studies published between 2008 and 2018. The selection of articles was done by the main investigator. All studies concerning the use of m-Health apps for patients with chronic diseases were included.

RESULTS

From the 337 selected publications, 8 systematic reviews and 14 original studies were included. The main uses of m-Health apps were biological and clinical monitoring (particularly concerning the symptoms) in 75% of the applications, disease self-management in 64% of the applications, and therapeutic patient education in 50% of the applications, with remote monitoring.

CONCLUSIONS

The development of an m-Health application could become a complementary monitoring tool during palliative care. However, it seems important to question the impact of technique in the professional-patient relationship and avoid the pitfalls of standardizing palliative care and reducing the patient to a "sick" health technician. A future step would then be to define which health-care professional would be in charge of this "m-monitoring."

Interaction with touchscreen smartphones in patients with essential tremor and healthy individuals

INTRODUCTION

Smartphones use in biomedical research is becoming more prevalent in different clinical settings. We performed a pilot study to obtain information on smartphone use by patients with essential tremor (ET) and healthy controls, with a view to determining whether performance of touchscreen tasks is different between these groups and describing touchscreen interaction factors.

METHOD

A total of 31 patients with ET and 40 sex- and age-matched healthy controls completed a descriptive questionnaire about the use of smartphones. Participants subsequently interacted with an under-development Android application, and performed 4 tests evaluating typical touchscreen interaction gestures; each test was performed 5 times.

RESULT

The type of smartphone use and touchscreen interaction were not significantly different between patients and controls. Age and frequency of smartphone use are key factors in touchscreen interaction.

CONCLUSION

Our results support the use of smartphone touchscreens for research into ET, although further studies are required.