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Carey RL, Le H, Coffman DL, Nahum-Shani I, Thirumalai M, Hagen C, Baehr LA, Schmidt-Read M, Lamboy MSR, Kolakowsky-Hayner SA, Marino RJ, Intille SS, Hiremath SV. mHealth-Based Just-in-Time Adaptive Intervention to Improve the Physical Activity Levels of Individuals With Spinal Cord Injury: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57699. [PMID: 38941145 PMCID: PMC11245659 DOI: 10.2196/57699] [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] [Received: 02/24/2024] [Revised: 04/27/2024] [Accepted: 05/03/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The lack of regular physical activity (PA) in individuals with spinal cord injury (SCI) in the United States is an ongoing health crisis. Regular PA and exercise-based interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Providing people with an accurate estimate of their everyday PA level can promote PA. Furthermore, PA tracking can be combined with mobile health technology such as smartphones and smartwatches to provide a just-in-time adaptive intervention (JITAI) for individuals with SCI as they go about everyday life. A JITAI can prompt an individual to set a PA goal or provide feedback about their PA levels. OBJECTIVE The primary aim of this study is to investigate whether minutes of moderate-intensity PA among individuals with SCI can be increased by integrating a JITAI with a web-based PA intervention (WI) program. The WI program is a 14-week web-based PA program widely recommended for individuals with disabilities. A secondary aim is to investigate the benefit of a JITAI on proximal PA, defined as minutes of moderate-intensity PA within 120 minutes of a PA feedback prompt. METHODS Individuals with SCI (N=196) will be randomized to a WI arm or a WI+JITAI arm. Within the WI+JITAI arm, a microrandomized trial will be used to randomize participants several times a day to different tailored feedback and PA recommendations. Participants will take part in the 24-week study from their home environment in the community. The study has three phases: (1) baseline, (2) WI program with or without JITAI, and (3) PA sustainability. Participants will provide survey-based information at the initial meeting and at the end of weeks 2, 8, 16, and 24. Participants will be asked to wear a smartwatch every day for ≥12 hours for the duration of the study. RESULTS Recruitment and enrollment began in May 2023. Data analysis is expected to be completed within 6 months of finishing participant data collection. CONCLUSIONS The JITAI has the potential to achieve long-term PA performance by delivering tailored, just-in-time feedback based on the person's actual PA behavior rather than a generic PA recommendation. New insights from this study may guide intervention designers to develop engaging PA interventions for individuals with disability. TRIAL REGISTRATION ClinicalTrials.gov NCT05317832; https://clinicaltrials.gov/study/NCT05317832. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57699.
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Affiliation(s)
- Rachel L Carey
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
| | - Ha Le
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Donna L Coffman
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Mohanraj Thirumalai
- Division of Preventive Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Cole Hagen
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
| | - Laura A Baehr
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
| | - Mary Schmidt-Read
- Magee Rehabilitation Hospital, Jefferson Health, Philadelphia, PA, United States
| | - Marlyn S R Lamboy
- MossRehab Hospital, Jefferson Health, Philadelphia, PA, United States
| | | | - Ralph J Marino
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Stephen S Intille
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Shivayogi V Hiremath
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
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Nataletti S, Banerjee A, Macaluso R, Prokup S, Jayaraman A, Wong AWK. Developing a mobile exercise program for individuals with Spinal Cord Injury: Stakeholder perceptions of app features and implementation determinants. Disabil Health J 2024:101667. [PMID: 38964938 DOI: 10.1016/j.dhjo.2024.101667] [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: 02/20/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Individuals with Spinal Cord Injury (SCI) often experience physical deconditioning, leading to long-term health challenges. While regular exercise can offer substantial health benefits, adherence to exercise guidelines among individuals with SCI is hindered by barriers such as inaccessibility. Exercise programs using the mobile application (App) tailored to individual needs present a promising solution for promoting exercise adherence among individuals with SCI. OBJECTIVE This study aimed to identify factors contributing to the successful implementation of an app-based home exercise program for individuals with SCI and gather user feedback on app preferences, functionality, and features. METHODS Guided by the Consolidated Framework for Implementation Research (CFIR), twenty-six clinicians completed an expert panel survey to rank factors influencing the implementation of an app-based intervention for increasing exercise adherence for individuals with SCI. CFIR-selected factors and app quality features obtained from the Mobile Application Rating Scale (MARS) framework were discussed in seven focus groups with 23 individuals with SCI, 6 caregivers, and 6 clinicians. RESULTS The expert survey identified adaptability, complexity, evidence strength/quality, relative advantage, knowledge/beliefs about the initiative, and execution as the key CFIR factors that affected the intervention's success. Major themes emerging from focus groups with individuals with SCI and caregivers included usability, instruction and guidelines, user-friendly interface, and clinician interaction. In contrast, clinicians mentioned themes such as the representation of the SCI population, time commitment, accessibility, and equipment. CONCLUSIONS The study highlights the significance of incorporating these determinants into future designs to develop app-based home exercise interventions for individuals with SCI.
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Affiliation(s)
- Sara Nataletti
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
| | - Anushua Banerjee
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Rebecca Macaluso
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Sara Prokup
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, 60611, USA.
| | - Alex W K Wong
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Baehr LA, Kaimal G, Bruneau M, Finley M. Development and Feasibility of a Group Tele-Exercise Program for Individuals With Spinal Cord Injury. J Neurol Phys Ther 2023; 47:200-207. [PMID: 37306469 DOI: 10.1097/npt.0000000000000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE More than 50% of individuals with spinal cord injury (SCI) report no regular exercise due to numerous barriers to participation. Tele-exercise services offer viable solutions to reduce barriers. However, limited evidence for SCI-specific tele-exercise programs is available. The purpose of this study was to evaluate the feasibility of a synchronous group tele-exercise program designed for individuals with SCI. METHODS Explanatory sequential mixed-methods design assessed feasibility of a synchronous 2-month biweekly group tele-exercise program for individuals with SCI. Numeric measures of feasibility were first collected (recruitment rate, sample features, retention, attendance), followed by postprogram interviews with participants. Thematic analysis of experiential feedback elaborated on numeric findings. RESULTS Eleven volunteers (ages = 49.5 ± 16.7 years) with SCI (range: 2.7-33.0 years) enrolled within 2 weeks of recruitment initiation. Retention was 100% retention at program completion. Median number of live classes attended per participant was 10 (62.5%). Participants described that attendance and satisfaction were facilitated by program-specific features including coinstruction by instructors with SCI-specific knowledge and lived experience, as well as group structure. Participants reported increased exercise knowledge, confidence, and motivation. DISCUSSION AND CONCLUSIONS This study demonstrated feasibility of a synchronous group tele-exercise class for individuals with SCI. Key features facilitating participation include class length, frequency, coleadership by individuals familiar with SCI and exercise instruction, and group motivation. These findings begin to examine a viable tele-service strategy that could be employed as a bridge among rehabilitation specialists, community fitness instructors, and clients with SCI to increase physical activity access and behavior.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A442 ).
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Affiliation(s)
- Laura A Baehr
- Departments of Physical Therapy and Rehabilitation Science (L.A.B., M.F.), Health Sciences (M.B.), and Department of Creative Arts Therapies (G.K.), Drexel University, Philadelphia, Pennsylvania
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Wilroy J, Kim Y, Lai B, Young HJ, Giannone J, Powell D, Thirumalai M, Mehta T, Rimmer J. Increasing Physical Activity in Persons With Spinal Cord Injury With an eHealth-Based Adaptive Exercise Intervention: Protocol for a Sequential Multiple Assignment Randomized Trial. JMIR Res Protoc 2023; 12:e47665. [PMID: 37498650 PMCID: PMC10415946 DOI: 10.2196/47665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Participating in an adequate amount of physical activity to acquire health benefits is challenging for people with spinal cord injury (SCI) due to personal and logistic barriers. Barriers in the built and social environments may include lack of transportation, lack of accessible facilities or programs, and lack of training among fitness personnel. Low self-efficacy, lack of self-regulation skills, and improper outcome expectations are examples of personal barriers. Current approaches to investigating physical activity programs in people with SCI have been limited to traditional "one-size-fits-all" design, which has yielded low adherence rates, high dropout rates, and participants not maintaining physical activity levels at follow-up. OBJECTIVE The primary aim of this study is to test the feasibility of a tele-exercise program that applies an adaptive intervention design for 30 adults with SCI, targeting increases in adherence to the exercise program and physical activity participation. METHODS The Sequential Multiple Assignment Randomized Trial for Home-based Exercise and Lifestyle Tele-Health (SMART-HEALTH) is a 12-week, home-based, movement-to-music (M2M) program. The goal of a SMART-designed study is to develop an adaptive intervention that modifies support provisions based on response levels. In SMART-HEALTH, 2 groups of participants will undergo 3-week and 6-week asynchronous M2M interventions in the first phase. Participants who did not achieve the desired adherence rate (≥95% of video watch minutes) will be rerandomized into M2M Live (switch) or individualized behavioral coaching (augmented with the asynchronous M2M program). The study will primarily assess rates of recruitment or enrollment, adherence and retention, timing to identify nonresponders, and scientific outcomes (eg, physical activity and exercise self-efficacy). The study will qualitatively evaluate the acceptability of the study using semistructured interviews among participants who complete the 12-week intervention. RESULTS Recruitment procedures started in June 2022. All data are expected to be collected by September 2023. Full trial results are expected to be published by March 2024. Secondary analyses of data will be subsequently published. Results will include exercise adherence rates; changes in self-reported physical activity levels and blood pressure; and changes in secondary conditions including pain, sleep, and fatigue. Thematic analysis of semistructured interviews will include results on participant enjoyment and acceptability of SMART-HEALTH and inform modifications for future delivery of the program. CONCLUSIONS This study will strengthen our understanding of the potential benefits of the tele-exercise intervention for people with SCI and build upon adaptive intervention design and its delivery strategies that aim to increase adoption and sustainable exercise behavior. This pilot trial will inform future SMART-designed studies and provide new and innovative strategies for investigating intervention effects on physical activity behavior in the SCI population. TRIAL REGISTRATION ClinicalTrials.gov NCT04726891; https://classic.clinicaltrials.gov/ct2/show/NCT04726891. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47665.
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Affiliation(s)
- Jereme Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yumi Kim
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Byron Lai
- Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- Research Collaborative, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John Giannone
- Research Collaborative, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Danielle Powell
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Rimmer
- Research Collaborative, University of Alabama at Birmingham, Birmingham, AL, United States
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Wnuk B, Ziaja D, Buczek M, Ziaja K, Banyś M. Assessing the Effectiveness of Lower Limb Home Exercises with the Use of a Prototype Exercise Robot for Continuous Passive Movement in People with Tetraparesis in the Long-Term Follow-Up: a Preliminary Report. REHABILITACJA MEDYCZNA 2022. [DOI: 10.5604/01.3001.0016.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Chronic venous insufficiency is the most commonly occurring vascular disease. One of the major risk factors for its development is long-term sitting or standing in prolonged unchanged position and the nature performed work.
Study aim: The aim of this study was to assess the effectiveness of lower limb home exercises limb with the use of the Bella Vena robot following disease onset causing tetraparesis in long-term observation.
Materials and methods: A group of 15 patients (43.80 ± 14.97 years) was enrolled in the study. These patients had experienced whiplash injury causing total or partial inertia, with preserved mobility in the ankle joints. The total duration of the observation lasted 8 months (8 visits), during which the following parameters were assessed at the beginning and end of this period: pain intensity – according to the Visual Analogue Scale (VAS), level of saturation on the toe, pulse rate of the lower limb via Doppler ultrasound evaluation of reflux parameters.
Result: Statistically significant improvement was achieved after home exercises within the following ranges - quality of pain intensity on VAS (p≤0.01), saturation at the level of the big toe (p≤0.05), Doppler ultrasound: reflux in the right femoral vein (p≤0.05), Doppler ultrasound: reflux in the left femoral vein (p≤0.05)
Conclusion: Home exercises with using a prototype of the Bella Vena device showed a moderate effect on improving calf pump in the group of patients with quadriplegia in long-term observation.
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Affiliation(s)
- Bartosz Wnuk
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Damian Ziaja
- Department of General and Vascular Surgery, Angiology and Phlebology, Medical University of Silesia in Katowice, Poland / Department of Physiotherapy, School of Health Science, Medical University of Silesia, Katowice, Poland
| | - Michał Buczek
- Department of General and Vascular Surgery, Angiology and Phlebology, Upper Silesian Medical Centre in Katowice, Ochojec, Poland
| | | | - Marcin Banyś
- MIDMED Limited Liability Company, Katowice, Poland
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Dissemination and implementation strategies for physical activity guidelines among adults with disability, chronic conditions, and pregnancy: a systematic scoping review. BMC Public Health 2022; 22:1034. [PMID: 35606712 PMCID: PMC9126633 DOI: 10.1186/s12889-022-13317-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity guidelines for adults with disability, chronic conditions, and pregnancy (i.e., specific populations) have been developed to provide guidance for engaging in physical activity. However, specific populations remain considerably less physically active compared to the general population, presenting a knowledge-practice gap. PURPOSE The purpose of this systematic scoping review was to identify and evaluate strategies for disseminating and implementing physical activity guidelines among specific populations and/or stakeholders (e.g., healthcare professionals) in Canada. METHODS Five search approaches (peer-reviewed literature databases, grey literature database, custom Google search engines, targeted web-based searches, and content expert consultation) identified records documenting and/or evaluating strategies that had been used to disseminate or implement guidelines from a predetermined list. Systematic and scoping review protocols were followed. Risk of bias assessments were conducted for all studies that evaluated strategies. RESULTS Eighty-one records reported dissemination strategies (n = 42), implementation strategies (n = 28), or both (n = 11). Twenty-two studies reporting on 29 evaluated strategies were deemed "serious" or "high" risk of bias. Common guideline dissemination and implementation strategies are deliberated and recommendations for future practice are made. CONCLUSIONS Findings may inform future dissemination and implementation efforts for physical activity guidelines in Canada or similar countries.
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Froehlich-Grobe K, Lee J, Ochoa C, Lopez A, Sarker E, Driver S, Shegog R, Lin SJ. Effectiveness and feasibility of the workout on wheels internet intervention (WOWii) for individuals with spinal cord injury: a randomized controlled trial. Spinal Cord 2022; 60:862-874. [PMID: 35474116 PMCID: PMC9041282 DOI: 10.1038/s41393-022-00787-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/09/2022]
Abstract
Study design Randomized-controlled trial (RCT) with immediate intervention (IMM) and wait-list control (WLC) groups; WLC participants received the intervention during delivery to subsequent cohorts. Objectives Investigate the effectiveness and feasibility of a virtually-delivered exercise intervention. Setting Home and community. Methods A total of 168 middle-aged (49.6 [12.3] years old) men (57%) and women (43%) who lived an average 15.5 (12.3) years with spinal cord injury (SCI) participated. The 16-week program provides users (a) website access with exercise information, resources, and 16 skill-building modules; (b) virtual 60-minute, group-based weekly meetings; and (c) a starter package of exercise equipment. Primary outcomes included subjective physical activity (IPAQ) and objective exercise (Polar A300 wrist-based activity monitor and H7 heart rate strap). Secondary outcomes included fitness indices during a maximal arm crank test, plus self-reported exercise barriers, exercise self-efficacy, and goal-directed thinking. Results RCT results indicate significant between group differences in participants’ self-reported weekly time spent in vigorous-intensity PA and goal directed thinking but not for fitness changes. Data combined for IMM and WLC participants from Polar monitoring show participants performed 150 min per week of aerobic exercise plus reported significantly greater time spent in moderate-PA, vigorous-PA, self-efficacy for exercise and nutrition, goal directed thinking, and exercise barriers. Oxygen uptake (V̇O2 peak) and power output (watts max) were the only physiologic measures to demonstrate significant change, with a moderate effect size. Conclusion This virtually-delivered program offers a promising approach to increase exercise among those with SCI and may help participants perceive fewer motivational barriers and greater self-efficacy.
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Affiliation(s)
- Katherine Froehlich-Grobe
- Craig Hospital, Englewood, CO, 80113, USA. .,Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA. .,Health Promotion and Behavioral Sciences Department, UTHealth School of Public Health, Houston, TX, 77030, USA.
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, College of Education, Texas Tech University, Lubbock, TX, 79409, USA
| | - Christa Ochoa
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Baylor Scott & White Research Institute, Dallas, TX, 75246, USA
| | - Amber Lopez
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Shepherd Center, Atlanta, GA, 30309, USA
| | - Erina Sarker
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Baylor Scott & White Research Institute, Dallas, TX, 75246, USA
| | - Simon Driver
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75246, USA.,Baylor Scott & White Research Institute, Dallas, TX, 75246, USA
| | - Ross Shegog
- Health Promotion and Behavioral Sciences Department, UTHealth School of Public Health, Houston, TX, 77030, USA
| | - Suh-Jen Lin
- School of Physical Therapy, Institute of Health Sciences of Dallas, Texas Woman's University, Dallas, TX, 75235, USA
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Current Approaches in Telehealth and Telerehabilitation for Spinal Cord Injury (TeleSCI). CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:77-88. [PMID: 35493027 PMCID: PMC9039273 DOI: 10.1007/s40141-022-00348-5] [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] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Telehealth and telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and improve health outcomes in the spinal cord injury population. This review provides an overview of the recent literature on the topic of teleSCI and provides insights on current evidence, future directions, and considerations when using teleSCI for clinical care. Recent Findings TeleSCI is used most often for preventive health; management of chronic pain, anxiety, and depression; and rehabilitation-related interventions. As video telehealth becomes mainstream, growth in wearable monitors, bio and neurofeedback mechanisms, and app-based care is expected. Summary TeleSCI is growing in prevalence, demonstrates positive impact on health outcomes, and requires ongoing study to identify, refine, and implement best practices.
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