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Paterno MV, Fitzgerald GK. Booster visits in the management of the acute musculoskeletal injuries: Transforming care to improve outcomes-A perspective review. J Orthop Res 2024; 42:1151-1158. [PMID: 38597734 DOI: 10.1002/jor.25852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 02/22/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
The current healthcare delivery system for patients with acute musculoskeletal injury is failing. Current rehabilitation management of acute musculoskeletal injury typically includes physical therapy, focused on management of impairments, with an eventual transition to functional activities and release to prior level of function. At that point, formal physical therapy is often discontinued, despite the knowledge that a high percentage of patients fail to maintain preinjury level of activity and often reduce participation in regular physical activity. Further, for those who attempt to return to prior levels of pivoting and cutting activities, there is a high second injury rate. The long-term human experience is compromised by the current model of care which terminates at the point of transition to activity. This model of care fails to meet the continued needs of these patients and may result in long term deficits and potential disability. Extended care models include intermittent follow up visits after discharge from an acute episode of care and have been efficacious and cost effective in some patient populations with musculoskeletal conditions. Specifically, a type of extended care model, labeled "booster sessions," represents an opportunity to provide structured, intermittent care to assist in a smooth transition back to function, following an acute episode of care and promote a healthier life outcome. This perspective review will discuss the opportunity to transform acute musculoskeletal care to booster visit care model in an attempt to develop a more efficacious and cost-effective system of care which could be generalizable to all musculoskeletal conditions.
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Affiliation(s)
- Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Dobija L, Lechauve JB, Mbony-Irankunda D, Plan-Paquet A, Dupeyron A, Coudeyre E. Smartphone applications are used for self-management, telerehabilitation, evaluation and data collection in low back pain healthcare: a scoping review. F1000Res 2024; 11:1001. [PMID: 38846061 PMCID: PMC11153999 DOI: 10.12688/f1000research.123331.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/09/2024] Open
Abstract
Background Smartphone use has grown in providing healthcare for patients with low back pain (LBP), but the literature lacks an analysis of the use of smartphone apps. This scoping review aimed to identify current areas of smartphone apps use for managing LBP. We also aimed to evaluate the current status of the effectiveness or scientific validity of such use and determine perspectives for their potential development. Methods We searched PubMed, PEDro and Embase for articles published in English up to May 3 rd, 2021 that investigated smartphone use for LBP healthcare and their purpose. All types of study design were accepted. Studies concerning telemedicine or telerehabilitation but without use of a smartphone were not included. The same search strategy was performed by two researchers independently and a third researcher validated the synthesis of the included studies. Results We included 43 articles: randomised controlled trials (RCTs) (n=12), study protocols (n=6), reliability/validity studies (n=6), systematic reviews (n=7), cohort studies (n=4), qualitative studies (n=6), and case series (n=1). The purposes of the smartphone app were for 1) evaluation, 2) telerehabilitation, 3) self-management, and 4) data collection. Self-management was the most-studied use, showing promising results derived from moderate- to good-quality RCTs for patients with chronic LBP and patients after spinal surgery. Promising results exist regarding evaluation and data collection use and contradictory results regarding measurement use. Conclusions This scoping review revealed a notable interest in the scientific literatures regarding the use of smartphone apps for LBP patients. The identified purposes point to current scientific status and perspectives for further studies including RCTs and systematic reviews targeting specific usage.
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Affiliation(s)
- Lech Dobija
- UNH, INRAE, Université Clermont-Auvergne, Clermont-Ferrand, Puy de Dôme, 63000, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Jean-Baptiste Lechauve
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Didier Mbony-Irankunda
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Anne Plan-Paquet
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Arnaud Dupeyron
- Université Montpellier, Nimes, 30900, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Nimes, Nimes, 30900, France
| | - Emmanuel Coudeyre
- UNH, INRAE, Université Clermont-Auvergne, Clermont-Ferrand, Puy de Dôme, 63000, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
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Mantelatto Andrade R, Gomes Santana B, Verttú Schmidt A, Eduardo Barsotti C, Pegoraro Baroni M, Tirotti Saragiotto B, Ribeiro AP. Effect of traditional rehabilitation programme versus telerehabilitation in adolescents with idiopathic scoliosis during the COVID-19 pandemic: a cohort study. J Rehabil Med 2024; 56:jrm5343. [PMID: 38407430 PMCID: PMC10910275 DOI: 10.2340/jrm.v56.5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/22/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Telerehabilitation has become increasingly popular since the SARS-CoV-2 (COVID-19) outbreak. However, studies are needed to understand the effects of remote delivery of spine treatment approaches. OBJECTIVES To verify and compare the effects of traditional rehabilitation programmes (in-person) and telerehabilitation (online) on the progression of scoliotic curvature in adolescents with idiopathic scoliosis during the COVID-19 pandemic, and to verify the acceptability, appropriateness, and feasibility among patients and physiotherapists regarding both treatments. METHODS This is a cohort study (prospective analysis of 2 intervention groups: telerehabilitation (online) and traditional rehabilitation (in-person). A total of 66 adolescents with idiopathic scoliosis were included. Recruitment was conducted through the Clinical Center in Scoliosis Care (January-December 2020). Participants were divided into 2 intervention groups: telerehabilitation (online) (n = 33) and traditional rehabilitation programme (in-person) (n = 33). Both groups also were supplied with a spinal orthopaedic brace. Scoliosis was confirmed by a spine X-ray examination (Cobb angle). Radiographic parameters measured were: Cobb angles (thoracic and lumbar). The method of Nash and Moe (thoracic and lumbar) was also evaluated based on the relationship between the vertebral pedicles and the centre of the vertebral body in the X-rays. Assessments were performed at baseline (T0) and after 6 months of the intervention protocol (T6). Patient and physiotherapist reports were evaluated on the acceptability, appropriateness, and feasibility of the interventions. RESULTS Adolescents with idiopathic scoliosis showed a significant decrease in the Cobb angle (main scoliotic curvature), with a 4.9° for the traditional rehabilitation programme and 2.4° for the telerehabilitation. Thoracic and lumbar Cobb angles did not show significant changes after the intervention in both groups or between groups. Thoracic and lumbar Nash and Moe scores scores also did not show significant differences after 6 months of in-person or telerehabilitation intervention, or between groups. The intervention by telerehabilitation was acceptable, appropriate, and feasible for patients and physiotherapists. CONCLUSION Use of the rehabilitation programme for adolescents with idiopathic scoliosis, delivered via telerehabilitation during the COVID-19 pandemic, was encouraging for future applications due to the improved effect on reducing the Cobb angle, preventing progression of scoliosis. In addition, telerehabilitation showed good acceptability among patients and physiotherapists. Traditional rehabilitation programmes (in-person) in adolescents with idiopathic scoliosis also showed a reduction in the Cobb angle.
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Affiliation(s)
- Rodrigo Mantelatto Andrade
- University of Sao Paulo, School of Medicine, Physical Therapy Department, Sao Paulo, Brazil; Clinical Center in Scoliosis, São Paulo, SP, Brazil.
| | | | - Ariane Verttú Schmidt
- Medicine Department, Health Science Post-Graduate, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, Sao Paulo, Brazil
| | | | - Marina Pegoraro Baroni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo/SP, Brazil
| | - Bruno Tirotti Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo/SP, Brazil
| | - Ana Paula Ribeiro
- University of Sao Paulo, School of Medicine, Physical Therapy Department, Sao Paulo, Brazil; Medicine Department, Health Science Post-Graduate, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, Sao Paulo, Brazil.
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Özden F, Güçlü B, Tümtürk İ, Doğrukök ÖN, İmerci A, Tuğay BU. The effect of visual feedback-based clinical monitoring application in patients with chronic low back pain: a randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:505-516. [PMID: 38182853 DOI: 10.1007/s00586-023-08098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE No study has addressed the effect of patient-reported outcomes as a visual feedback tool during telerehabilitation. This study aimed to investigate the effect of a visual feedback-based monitoring application PhysioAnalyst on pain, pain catastrophizing, physical functions, quality of life, usability, satisfaction, and exercise adherence in individuals with chronic low back pain (CLBP). METHODS A single-blind, randomized controlled trial was conducted with 44 CLBP patients. Participants were randomized into two groups: the tele-assessment feedback group (TAFG) (n = 22) and the control group (CG) (n = 22). Participants were assessed before the intervention, at the 4th week and after the intervention. Individuals were assessed using the Visual Analog Scale (VAS), Nottingham Health Profile (NHP), Pain Catastrophizing Scale (PCS), Oswestry Disability Index (ODI), Telehealth Usability Questionnaire (TUQ), Telemedicine Satisfaction Questionnaire (TSQ), and Exercise Adaptation Rating Scale (EARS) via PhysioAnalyst. Individuals in the TAFG group received graph-based visual feedback on assessment data in week 4. RESULTS The improvement in VAS, NHP, ODI, TUQ, TSQ, and EARS of individuals in TAFG was statistically significant (p < 0.05). Only ODI and PCS scores in CG showed significant improvement (p < 0.05). After the graphics-based visual feedback presented to the TAFG, the VAS, NHP-Emotional, NHP-Sleep, NHP-Total, PCS, TUQ, TSQ, ODI, and EARS scores gained more than CG (p < 0.05). CONCLUSION The results confirmed the additional contribution of telerehabilitation's graphics-based visual feedback in pain, pain catastrophizing, disability, quality of life, and exercise participation. Since the importance of continuity in long-term rehabilitation in patients with CLBP is comprehended, feedback to increase patient motivation can be added to telerehabilitation applications.
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Affiliation(s)
- Fatih Özden
- Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sitki Koçman University, Muğla, Turkey.
| | - Bekir Güçlü
- Department of Physiotherapy, Vocational School of Health Services, Üsküdar University, İstanbul, Turkey
| | - İsmet Tümtürk
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Süleyman Demirel University, Isparta, Turkey
| | | | - Ahmet İmerci
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Baki Umut Tuğay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sitki Koçman University, Muğla, Turkey
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Shaikh TA, Rasool T, Verma P. Machine intelligence and medical cyber-physical system architectures for smart healthcare: Taxonomy, challenges, opportunities, and possible solutions. Artif Intell Med 2023; 146:102692. [PMID: 38042609 DOI: 10.1016/j.artmed.2023.102692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 12/04/2023]
Abstract
Hospitals use medical cyber-physical systems (MCPS) more often to give patients quality continuous care. MCPS isa life-critical, context-aware, networked system of medical equipment. It has been challenging to achieve high assurance in system software, interoperability, context-aware intelligence, autonomy, security and privacy, and device certifiability due to the necessity to create complicated MCPS that are safe and efficient. The MCPS system is shown in the paper as a newly developed application case study of artificial intelligence in healthcare. Applications for various CPS-based healthcare systems are discussed, such as telehealthcare systems for managing chronic diseases (cardiovascular diseases, epilepsy, hearing loss, and respiratory diseases), supporting medication intake management, and tele-homecare systems. The goal of this study is to provide a thorough overview of the essential components of the MCPS from several angles, including design, methodology, and important enabling technologies, including sensor networks, the Internet of Things (IoT), cloud computing, and multi-agent systems. Additionally, some significant applications are investigated, such as smart cities, which are regarded as one of the key applications that will offer new services for industrial systems, transportation networks, energy distribution, monitoring of environmental changes, business and commerce applications, emergency response, and other social and recreational activities.The four levels of an MCPS's general architecture-data collecting, data aggregation, cloud processing, and action-are shown in this study. Different encryption techniques must be employed to ensure data privacy inside each layer due to the variations in hardware and communication capabilities of each layer. We compare established and new encryption techniques based on how well they support safe data exchange, secure computing, and secure storage. Our thorough experimental study of each method reveals that, although enabling innovative new features like secure sharing and safe computing, developing encryption approaches significantly increases computational and storage overhead. To increase the usability of newly developed encryption schemes in an MCPS and to provide a comprehensive list of tools and databases to assist other researchers, we provide a list of opportunities and challenges for incorporating machine intelligence-based MCPS in healthcare applications in our paper's conclusion.
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Affiliation(s)
- Tawseef Ayoub Shaikh
- Department of Computer Science & Engineering, National Institute of Technology (NIT), Srinagar 190006, Jammu & Kashmir, India.
| | - Tabasum Rasool
- NPDF Fellow, Interdisciplinary Centre for Water Research (ICWaR), Indian Institute of Science, Bengaluru, India.
| | - Prabal Verma
- Department of Information Technology, National Institute of Technology (NIT), Srinagar 190006, Jammu & Kashmir, India.
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Gallotti M, Campagnola B, Cocchieri A, Mourad F, Heick JD, Maselli F. Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review. J Clin Med 2023; 12:5832. [PMID: 37762773 PMCID: PMC10531538 DOI: 10.3390/jcm12185832] [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: 08/03/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists' characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.
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Affiliation(s)
- Marco Gallotti
- Catholic University of the Sacred Heart, Rome Campus, 00168 Rome, Italy
| | - Benedetta Campagnola
- University Hospital Foundation Campus Bio-Medico, Rome University, 00128 Rome, Italy
| | | | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Luxembourg, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Luxembourg, Luxembourg
| | - John D. Heick
- Department of Physical Therapy, Northern Arizona University, P.O. Box 15105, Flagstaff, AZ 86011, USA
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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O'Hagan ET, Cashin AG, Rizzo RRN, Leake HB, Zahara P, Bagg MK, Wand BM, McAuley JH. Development of a booster intervention for graded sensorimotor retraining (RESOLVE) in people with persistent low back pain: A nested, randomised, feasibility trial. Musculoskeletal Care 2023; 21:444-452. [PMID: 36433897 PMCID: PMC10946532 DOI: 10.1002/msc.1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Low back pain contributes to an increasing global health burden exacerbated by unsustained improvements from current treatments. There is a need to develop, and test interventions to maintain initial improvements from low back pain treatments. One option is to implement a booster intervention. This study aimed to develop and test the feasibility of implementing a booster intervention delivered remotely to supplement the benefits from a complex intervention for chronic low back pain. METHOD This study was nested in the RESOLVE trial. The booster intervention was developed by an expert group, including a clinical psychologist, exercise physiologist and physiotherapists, and based on a motivational interviewing framework. We developed a conversational flow chart to support the clinician to guide participants towards achieving their pre-specified personal goals and future low back pain self-management. Participants with chronic low back pain who were aged over 18 years and fluent in English were recruited. The booster intervention was delivered in one session, remotely, by telephone. The intervention was considered feasible if: participants were able to be contacted or <3 contacts were necessary to arrange the booster session; there were sufficient willing participants (<15% of sample unwilling to participate); and participants and research clinicians reported a perceived benefit of >7/10. RESULTS Fifty participants with chronic non-specific low back pain were recruited to test the feasibility of implementing the booster intervention. Less than three contact attempts were necessary to arrange the booster session, only one participant declined to participate. Participants perceived the session to be beneficial; on a 0 to 10 scale of perceived benefit, the average score recorded was 8.3 (SD 2.0). Clinicians also reported a moderate perceived benefit to the participant; the average score recorded by clinicians was 6.3 (SD 1.6). CONCLUSION We developed a step by step, simple booster intervention that was perceived to be beneficial to participants with chronic low back pain. The booster can feasibly be delivered remotely following a complex intervention.
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Affiliation(s)
- Edel T. O'Hagan
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- Prince of Wales Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
| | - Aidan G. Cashin
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Health SciencesFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rodrigo R. N. Rizzo
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Health SciencesFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Hayley B. Leake
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- IIMPACT in HealthAllied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Pauline Zahara
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Matthew K. Bagg
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- Curtin Health Innovation Research InstituteFaculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Perron Institute for Neurological and Translational SciencePerthWestern AustraliaAustralia
| | - Benedict M. Wand
- Faculty of Medicine, Nursing and Midwifery and Health SciencesThe University of Notre Dame AustraliaFremantleWestern AustraliaAustralia
| | - James H. McAuley
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Health SciencesFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
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Albers R, Lemke S, Knapp S, Krischak G, Bethge M. Non-inferiority of a hybrid outpatient rehabilitation: a randomized controlled trial (HIRE, DRKS00028770). BMC DIGITAL HEALTH 2023; 1:15. [PMID: 38014366 PMCID: PMC10125254 DOI: 10.1186/s44247-023-00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/09/2023] [Indexed: 11/29/2023]
Abstract
Background Physiotherapeutic telerehabilitation in various musculoskeletal and internal diseases, including back pain, might be comparable to face-to-face rehabilitation or better than non-rehabilitation. In Germany, a standardized back school for patients with chronic back pain is provided in outpatient rehabilitation centers. The effectiveness of this standardized back school was shown in a randomized controlled trial in face-to-face rehabilitation. This study examines non-inferiority of a hybrid rehabilitation applying a digital version of the standardized back school against a rehabilitation applying the face-to-face back school. Methods/design We recruit 320 patients in eight German outpatient rehabilitation centers. Patients are randomized equally to the intervention and control groups. Patients aged 18 to 65 years with back pain are included. Patients lacking a suitable private electronic device and German language skills are excluded. Both groups receive the standardized back school as part of the 3-week rehabilitation program. The control group receives the back school conventionally in face-to-face meetings within the outpatient rehabilitation center. The intervention group receives the back school online using a private electronic device. Besides the back school, the patients participate in rehabilitation programs according to the German rehabilitation guideline for patients with chronic back pain. Hence, the term "hybrid" rehabilitation for the intervention group is used. The back school consists of seven modules. We assess data at four time points: start of rehabilitation, end of rehabilitation, 3 months after the end of rehabilitation and, 12 months after the end of rehabilitation. The primary outcome is pain self-efficacy. Secondary outcomes are, amongst others, motivational self-efficacy, cognitive and behavioral pain management, and disorder and treatment knowledge. Guided interviews with patients, physicians, physiotherapists and other health experts supplement our study with qualitative data. Discussion/aim Our randomized controlled trial aims to demonstrate non-inferiority of the online back school, compared to conventional implementation of the back school. Trial registration German Clinical Trials Register (DRKS00028770, April 05, 2022). Supplementary Information The online version contains supplementary material available at 10.1186/s44247-023-00013-4.
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Affiliation(s)
- Richard Albers
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Stella Lemke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Sebastian Knapp
- GOREHA GmbH, Neue Schönhauser Straße 20, 10178 Berlin, Germany
| | - Gert Krischak
- Zentrum Für Ambulante Rehabilitation, Spatenstraße 12, 88046 Friedrichshafen, Germany
| | - Matthias Bethge
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Lenoir dit Caron R, Rouzée M, Coquart J, Gilliaux M. Compliance with a personalised home exercise programme in chronic low back pain patients after a multidisciplinary programme: A pilot randomised controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1050157. [PMID: 36466941 PMCID: PMC9712950 DOI: 10.3389/fresc.2022.1050157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 12/21/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) is a very common problem throughout the world. One treatment possibility is the multidisciplinary programme (MP) in a rehabilitation centre, which provides intensive rehabilitation through physical exercise to quickly improve the patient conditions. Patients nevertheless do not always continue the exercises when they return home. This study thus evaluated compliance with a personalised home-based programme for CLBP patients post-MP. METHODS A randomised controlled single-blind trial was conducted. Thirty patients were randomised into two groups and participated in an MP for 4 weeks. They were then given an exercise booklet for home rehabilitation. In addition, each patient in the experimental group constructed a personalised exercise programme with a physiotherapist. The control group was only encouraged to continue the exercises at home. To assess therapeutic compliance, both groups were asked to document each completed exercise in a logbook. In addition, pain intensity, flexibility, muscle endurance, activity limitations, participation restrictions, and beliefs about physical activity were assessed at the beginning and end of the MP and again after 12 weeks at home. RESULTS Compliance was good for all activities in both groups, but there were no significant differences between groups. All participants improved on the criteria by the end of MP, and both groups maintained the improvements in most of the criteria at 3-month follow-up. CONCLUSION This study showed the effectiveness of an MP for CLBP in the short and medium term. However, future research should focus on longer-term compliance.
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Affiliation(s)
- R. Lenoir dit Caron
- Normandie University, CETAPS Laboratory, UR 3832, Mont Saint Aignan, France
- Clinical Research Department, La Musse Hospital (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France
| | - M. Rouzée
- Cabinet de Kinésithérapie, Ferrière-Haut-Clocher, France
| | - J. Coquart
- Unité de Recherche Pluridisciplinaire Sport Santé Société” is a departement, Univ. Lille, Univ. Artois, Univ. Littoral Côte D'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Liévin, France
| | - M. Gilliaux
- Normandie University, CETAPS Laboratory, UR 3832, Mont Saint Aignan, France
- Clinical Research Department, La Musse Hospital (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France
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McLeod G, Morgan E, McMillan S, McCahon S, Sanna N. Why Are Patients Not Doing Their Prescribed Home-Based Exercises? An Updated Review of the Factors Affecting Adherence to Prescribed Home-Based Exercise in Patients With Chronic Low Back Pain. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221116143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prescribed home-based exercise programs have been found to be an effective non-pharmacological treatment for the management of chronic low back pain. However, such programs rely on continued patient adherence to performing the exercises. The purpose of this integrative review is to present the key factors that influence adherence to prescribed home-based exercise for individuals with chronic low back pain. Searches of AMED, SPORTDiscus, CINAHL, MEDLINE, ScienceDirect, and Cochrane Library databases were performed for the period 2015 to 2021, using the following key search terms: exercise adherence, exercise compliance, exercise therapy, home-based exercise, chronic low back pain, and enabler, barrier or factor. Eight studies met the inclusion criteria and included Qualitative, Prospective Observation, Feasibility, Case Series and Randomised Controlled Trial studies. All participants were adults ranging from 18 to 85 years old with chronic low back pain and there was an overall female representation of 53.4%. Studies were assessed for methodological quality using the Critical Appraisal Skills Programme (CASP) checklist. The findings highlighted 2 key factors influencing adherence to home-based exercise programs for individuals with chronic low back pain: (1) the need for practitioners to develop effective communication skills that focus on the individual’s needs, including personalisation of exercise programs aimed at an individual’s symptoms, lifestyle and treatment goals; and (2) follow-up feedback and support strategies via electronic (virtual) or face to face in-clinic and home visits. Adherence to home-based exercise programs requires effective practitioner communication and targeted follow-up support and feedback.
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Affiliation(s)
- Gopi McLeod
- Southern Cross University, Lismore, NSW, Australia
| | - Eva Morgan
- Southern Cross University, Lismore, NSW, Australia
| | | | | | - Niribi Sanna
- Southern Cross University, Lismore, NSW, Australia
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11
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Rehabilitation Professional and Patient Satisfaction with Telerehabilitation of Musculoskeletal Disorders: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7366063. [PMID: 35958819 PMCID: PMC9363217 DOI: 10.1155/2022/7366063] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/08/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022]
Abstract
Telerehabilitation offers an alternative healthcare delivery remotely in a patient's environment at a lower cost, better accessibility, and equivalent quality to the standard approach. Several studies had examined the effectiveness of telerehabilitation inpatients with musculoskeletal disorders, and although there is evidence that it is at least equally effective as the standard care, the patient and rehabilitation professional satisfaction with the delivery method is not conclusive. A systematic review was conducted to study the patients' and rehabilitation professionals' satisfaction with telerehabilitation for musculoskeletal disorders. A search for relevant studies on 29 April 2021 was carried out in Medline/PubMed, Scopus, and Web of Science (WOS). The search terms included “telerehabilitation,” AND “satisfaction” AND “musculoskeletal disorders,” “telehealth,” “telemedicine,” “patient experience,” and “pain”. Fifteen eligible studies with 12,341 patients were included in this systematic review. A report was included if it (a) assessed the satisfaction of patients or professionals or both as one of the outcomes of a telerehabilitation intervention, (b) included adults 18 years and above with musculoskeletal disorders, and (c) is an intervention study using a quantitative approach. The quality of studies was assessed using the critical appraisal checklist tool developed by Joanna Briggs Institute (JBI). Most of the studies reported that patients were satisfied with both telerehabilitation and face-to-face intervention. However, few studies reported that patients were more satisfied with telerehabilitation compared to face-to-face of intervention. Patients in one study had preferred the incorporation of telerehabilitation and face-to-face sessions. Two of three studies had reported overall satisfaction with telerehabilitation by the professionals. Overall, there is evidence that patients and rehabilitation professional are satisfied with telerehabilitation compared to face-to-face consultation.
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12
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Itoh N, Mishima H, Yoshida Y, Yoshida M, Oka H, Matsudaira K. Evaluation of the Effect of Patient Education and Strengthening Exercise Therapy Using a Mobile Messaging App on Work Productivity in Japanese Patients With Chronic Low Back Pain: Open-Label, Randomized, Parallel-Group Trial. JMIR Mhealth Uhealth 2022; 10:e35867. [PMID: 35576560 PMCID: PMC9152720 DOI: 10.2196/35867] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Artificial intelligence–assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions. Objective This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment. Methods Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed. Results The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years; n=27, 56.3% male patients) and 46.9 years (SD 12.3 years; n=28, 54.9% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method; 0.062 vs 0.114; difference between groups −0.053, 95% CI −0.184 to 0.079; P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8; difference between groups −0.5, 95% CI −1.1 to 0.0; P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006; difference between groups 0.061, 95% CI 0.008 to 0.114; P=.03), and fear of movement at week 12 (−2.3 vs 0.5; difference between groups −2.8, 95% CI −5.5 to −0.1; P=.04). Conclusions This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions. Trial Registration University Hospital Medical Information Network Clinical Trials Registry UMIN000041037; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046866
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Affiliation(s)
- Naohiro Itoh
- Medical Affairs Department, Shionogi & Co, Ltd, Osaka, Japan
| | | | - Yuki Yoshida
- Data Science Department, Shionogi & Co, Ltd, Osaka, Japan
| | - Manami Yoshida
- Medical Affairs Department, Shionogi & Co, Ltd, Osaka, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Meddar JM, Ponnapalli A, Azhar R, Turchioe MR, Duran AT, Creber RM. A Structured Review of Commercially Available Cardiac Rehabilitation mHealth Applications Using the Mobile Application Rating Scale. J Cardiopulm Rehabil Prev 2022; 42:141-147. [PMID: 35135963 PMCID: PMC11086945 DOI: 10.1097/hcr.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study systematically evaluated the quality and functionalities of patient-facing, commercially available mobile health (mHealth) apps for cardiac rehabilitation (CR). METHODS We performed our search in two of the most widely used commercial mobile app stores: Apple iTunes Appstore and Google Play Store (Android apps). Six search terms were used to query relevant CR apps: "cardiac rehabilitation," "heart disease and remote therapy," "heart failure exercise," "heart therapy and cardiac recovery," "cardiac recovery," and "heart therapy." App quality was evaluated using the Mobile Application Rating Scale (MARS). App functionality was evaluated using the IQVIA functionality scale, and app content was evaluated against the American Heart Association guidelines for CR. Apps meeting our inclusion criteria were downloaded and evaluated by two to three reviewers, and interclass correlations between reviewers were calculated. RESULTS We reviewed 3121 apps and nine apps met our inclusion criteria. On average, the apps scored a 3.0 on the MARS (5-point Likert scale) for overall quality. The two top-ranking mHealth apps for CR for all three quality, functionality, and consistency with evidence-based guidelines were My Cardiac Coach and Love My Heart for Women, both of which scored ≥4.0 for behavior change. CONCLUSION Overall, the quality and functionality of free apps for mobile CR was high, with two apps performing the best across all three quality categories. High-quality CR apps are available that can expand access to CR for patients with cardiovascular disease.
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Affiliation(s)
- John M Meddar
- Department of Population Health Sciences, New York University Grossman School of Medicine, New York (Mr Meddar); Department of Population Health Sciences, Weill Cornell Medicine, New York, New York (Mr Ponnapalli, Ms Azhar, and Drs Turchioe and Creber); and Center for Behavioral Cardiovascular Health, Columbia Irving Medical Center, New York, New York (Dr Duran)
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14
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Sony M, Antony J, McDermott O. The impact of medical cyber–physical systems on healthcare service delivery. TQM JOURNAL 2022. [DOI: 10.1108/tqm-01-2022-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe pandemic has reinforced the need for revamping the healthcare service delivery systems around the world to meet the increased challenges of modern-day illnesses. The use of medical cyber–physical system (MCPS) in the healthcare is one of the means of transforming the landscape of the traditional healthcare service delivery system. The purpose of this study is to critically examine the impact of MCPS on the quality of healthcare service delivery.Design/methodology/approachThis paper uses an evidence-based approach, the authors have conducted a systematic literature review to study the impact of MCPS on healthcare service delivery. Fifty-four articles were thematically examined to study the impact of MCPS on eight characteristics of the healthcare service delivery proposed by the world health organisation.FindingsThe study proposes support that MCPS will positively impact (1) comprehensiveness, (2) accessibility, (3) coverage, (4) continuity, (5) quality, (6) person-centredness, (7) coordination, (8) accountability and (9) efficiency dimension of the healthcare service delivery. The study further draws nine propositions to support the impact of MCPS on the healthcare service delivery.Practical implicationsThis study can be used by stakeholders as a guide point while using MCPS in healthcare service delivery systems. Besides, healthcare managers can use this study to understand the performance of their healthcare system. This study can further be used for designing effective strategies for deploying MCPS to be effective and efficient in each of the dimensions of healthcare service delivery.Originality/valueThe previous studies have focussed on technology aspects of MCPS and none of them critically analysed the impact on healthcare service delivery. This is the first literature review carried out to understand the impact of MCPS on the nine dimensions of healthcare service delivery proposed by WHO. This study provides improved thematic awareness of the resulting body of knowledge, allowing the field of MCPS and healthcare service delivery to progress in a more informed and multidisciplinary manner.
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Kersey J, Hammel J, Baum C, Huebert K, Malagari E, Terhorst L, McCue M, Skidmore ER. Effect of interventions on activity and participation outcomes for adults with brain injury: a scoping review. Brain Inj 2022; 36:21-31. [DOI: 10.1080/02699052.2022.2034043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly Huebert
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Emily Malagari
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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16
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Amelot A, Jacquot A, Terrier LM, Aggad M, Planty-Bonjour A, Fouquet B, Cook AR, Zemmoura I, Velut S, Destrieux C, François P, Borius PY, Mathon B. Chronic low back pain during COVID-19 lockdown: is there a paradox effect? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:167-175. [PMID: 34729679 PMCID: PMC8562766 DOI: 10.1007/s00586-021-07049-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
Purpose The coronavirus 2019 (COVID-19) pandemic led to a compulsory lockdown of 3 months with strict restrictions. The impact of the COVID-19 pandemic has shown broad repercussions on patients with chronic pain; especially for conditions that present a significant emotional participation such as chronic low back pain (cLBP). Methods We performed a prospective study on 50 patients. Pre- and 1-month post-lockdown questionnaires such as: the Impact of Event Scale (IES), the Oswestry Disability Index (ODI), the Roland–Morris questionnaire (RMQ) and the visual analogue scale (VAS) for back and leg pain intensity were collected. Results The mean time of the evolution of cLBP was 33.04 months (range 5–120 months). Eighteen (36%) patients improved their cLBP (i-cLBP), whereas for 14 (28%) it was worse (w-cLBP). Cox multivariate proportional hazard model identified that MODIC 1 disc disease [OR 19.93, IC95% (2.81–102.13), p = 0.015] and at-home workouts [OR 18.854, IC95% (1.151–204.9), p = 0.040] were good prognosis factors of the improvement of cLBP while subclinical/mild Covid-19 anxiety (IES score < 26) was a poor prognosis factor in improving cLBP [OR 0.21, IC95% (0.001–0.384), p = 0.009]. Furthermore, pre-lockdown benzodiazepine medication [OR 2.554, IC95% (1.20–9.9), p = 0.002] was a prognosis factor of worse cLBP. In contrast, patients with severe Covid-19 anxiety (IES score > 26) significantly improved their cLBP [OR 0.58, IC95% (0.025–0.834), p = 0.01]. Conclusion Lockdown affected the somatic component of cLBP by decreasing activities and physical measures, whereas the SARS-CoV-2 pandemic spectrum paradoxically improved the psychic and emotional component of cLBP.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France.
| | - Anais Jacquot
- Physical Medicine and Rehabilitation Department, CHU de Tours, Tours, France
| | - Louis-Marie Terrier
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Mourad Aggad
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Alexia Planty-Bonjour
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Bernard Fouquet
- Physical Medicine and Rehabilitation Department, CHU de Tours, Tours, France
| | - Ann-Rose Cook
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Ilyess Zemmoura
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Stephane Velut
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Christophe Destrieux
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Patrick François
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | | | - Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière, Paris, France
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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.
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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
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18
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Bordeleau M, Stamenkovic A, Tardif PA, Thomas J. The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 23:175-195. [PMID: 34425250 DOI: 10.1016/j.jpain.2021.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/08/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
This systematic review aimed to synthesize the existing evidence of extended reality (XR) on pain and motor function outcomes in patients with back pain. Following the Cochrane guidelines, relevant articles of any language were selected by 2 independent reviewers from CINAHL, Cochrane, Embase, Medline and Web of Knowledge databases. Of 2,050 unique citations, 24 articles were included in our review. These studies included a total of 900 back pain patients. Despite broader XR search, all interventions were virtual reality (VR) based and involved physical exercises (n = 17, 71%), hippotherapy (n = 4, 17%), motor imagery (n = 1, 4%), distraction (n = 1, 4%), and cognitive-behavior therapy (n = 1, 4%). Sixteen controlled studies were included in a meta-analysis which suggested that VR provides a significant improvement in terms of back pain intensity over control interventions (Mean Difference: -0.67; 95% CI: -1.12 to -0.23; I2 = 85%). Almost all included studies presented high risk of bias, highlighting the need to improve methodology in the examination of VR interventions. While the specific set of studies showed high heterogeneity across several methodological factors, a tentative conclusion could be drawn that VR was effective improving back pain intensity and tends to have a positive effect on improving other pain outcomes and motion function. PERSPECTIVE: Extended reality technologies have appeared as interesting nonpharmacological options for the treatment of back pain, with the potential to minimise the need for opioid medications. Our systematic review summarised existing applications of extended reality for back pain and proposed a few recommendations to direct further studies in the field.
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Affiliation(s)
- Martine Bordeleau
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada.
| | - Alexander Stamenkovic
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval Research Center, Université Laval, Quebec City, Quebec, Canada
| | - James Thomas
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia
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Lawson DW, Stolwyk RJ, Ponsford JL, Wong D. Evaluating telehealth delivery of a compensatory memory rehabilitation programme following stroke: A single-case experimental design. Neuropsychol Rehabil 2021; 32:897-921. [PMID: 33678132 DOI: 10.1080/09602011.2020.1843500] [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: 10/22/2022]
Abstract
Rehabilitation of memory remains an unmet need for many stroke survivors. Telehealth methods may provide a solution, however evidence supporting the efficacy of remotely-delivered therapy is needed. A non-concurrent multiple baseline design was used with randomized onset of intervention across five individuals with chronic stroke-related memory complaints. A six-week compensatory memory skills programme was delivered individually via internet videoconferencing. Target behaviours of frequencies of self-reported lapses of everyday and prospective memory were measured weekly across baseline, intervention, and follow-up phases. A secondary outcome of functional goal attainment was measured once per phase, with participants setting two personal rehabilitation goals. Data were analysed visually and statistically. Improvements in memory functioning were statistically significant on at least one measure of target behaviour for four out of five participants at intervention or follow-up. Visual evidence of level change indicated at least modest improvements for all participants by follow-up. All participants attained at least one functional goal by follow-up. High rates of treatment adherence and participant satisfaction were observed. Technological issues were minimal and did not impact content delivery or engagement. These results provide preliminary support for the efficacy of a telehealth-delivered rehabilitation programme in improving memory function and achieving memory-related goals for stroke survivors.
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Affiliation(s)
- David W Lawson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Dana Wong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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20
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Dadarkhah A, Rezaimoghadam F, Najafi S, Mohebi B, Azarakhsh A, Rezasoltani Z. Remote Versus in-Person Exercise Instruction for Chronic Nonspecific Low Back Pain Lasting 12 Weeks or Longer: A Randomized Clinical Trial. J Natl Med Assoc 2020; 113:278-284. [PMID: 33349469 DOI: 10.1016/j.jnma.2020.11.016] [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] [Received: 09/14/2020] [Revised: 11/22/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low back pain is a common health problem. We compared the effects of a remote exercise instruction with in-person exercise instruction on the pain and disability of people with nonspecific low back pain for more than 12 weeks. MATERIAL AND METHODS We carried out a randomized clinical trial with two study arms in an outpatient clinic at a University Hospital. A total of 56 patients were included and randomly allocated to each study arm. The primary outcome was the intensity of the low back pain. The secondary outcome was the Oswestry Disability Questionnaire score. We measured the outcomes before the intervention and in one and three months after completion of the program. The program consisted of core stability exercises and included flexibility and strengthening for all patients. Participants in the remote exercise group carried out the exercises at home two times a day for four weeks. They were followed by telephone calls. Patients in the in-person exercise group received the same exercises at the clinic, three times a week for four weeks. RESULTS Between-group comparisons indicated that there were no significant differences between the two approaches in changing pain (p = 0.93) and disability scores (p = 0.74) from the baseline to three months postintervention values. CONCLUSIONS There was no measurable difference between an exercise program delivered remotely compared to in-person.
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Affiliation(s)
- Afsaneh Dadarkhah
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Farid Rezaimoghadam
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Sharif Najafi
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Bahare Mohebi
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Arezoo Azarakhsh
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Rezasoltani
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran.
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22
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Fiani B, Siddiqi I, Lee SC, Dhillon L. Telerehabilitation: Development, Application, and Need for Increased Usage in the COVID-19 Era for Patients with Spinal Pathology. Cureus 2020; 12:e10563. [PMID: 33101809 PMCID: PMC7577310 DOI: 10.7759/cureus.10563] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has triggered governments worldwide to implement severe restrictions on physical therapy protocols in order to better control the spread of the virus. One of the mechanisms of providing physical therapy patient care during this era is via telemedicine. Telerehabilitation or telerehab is a technological visual-audio system that serves patients, including those with a spine injury, ailment, or postoperatively, with neurological deficits. In this scoping review, we discuss the development of telerehab, the technological advances in the field, and the usage of telerehab specifically pertaining to spine patients, and comment on the advancement of telerehab in the time of COVID-19. There is preliminary evidence that suggests that the adoption of telerehab in lieu of face-to-face interventions is beneficial for reducing pain and improving physical function in patients afflicted with chronic nonmalignant musculoskeletal pain from low back pain, lumbar stenosis, neck pain, and osteoarthritis. Availability is important, as the necessary technology should be accessible to all participants. Safety and security should be addressed, as the passage of patient data over the Internet requires secure confidentiality. Ease-of-use is crucial to promote practicality, user-friendly operation, and adherence to therapy. The combination of evidence-based methodologies with cost-effective services will serve as a basis for the further expansion of vital telerehab services and increases reimbursement by health insurance providers.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Imran Siddiqi
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
| | - Sharon C Lee
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
| | - Lovepreet Dhillon
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
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Vaish H. Letter to the Editor: Tele-rehabilitation of Back Pain Patients in Coronavirus Disease 2019 Pandemic. Asian Spine J 2020; 14:590-591. [PMID: 32791770 PMCID: PMC7435308 DOI: 10.31616/asj.2020.0358.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hina Vaish
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, India
- Corresponding author: Hina Vaish Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, 133207, India Tel: +91-9450124758, E-mail: ;
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Developing a smartphone application, triaxial accelerometer-based, to quantify static and dynamic balance deficits in patients with cerebellar ataxias. J Neurol 2019; 267:625-639. [PMID: 31713101 DOI: 10.1007/s00415-019-09570-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cerebellar ataxia is characterized by difficulty in the planning of movement and lack of anticipatory postural adjustments, which can result in deficits of balance. Being able to have quantitative measurements in clinical practice, to detect any improvements on balance resulting from new rehabilitation treatments or experimental drugs is very important. AIM The purpose of this study was to develop an application (APP) able to assess static and dynamic balance in patients with cerebellar ataxias (CA). The APP that works by a wearable device (smartphone) placed at the breastbone level and immobilized by an elastic band, measures the body sway by means of a triaxial accelerometer. METHODS We investigated 40 CA patients and 80 healthy subjects. All patients were clinically evaluated using the "Berg Balance Scale" (BBS) and the "Scale for the Assessment and Rating of Ataxia" (SARA). Balance impairment was quantitatively assessed using a validated static balance evaluating systems, i.e., Techno-body Pro-Kin footboard. All participants underwent static and dynamic balance assessments using the new APP. RESULTS We observed a strong correlation between the APP measurements and the score obtained with the BBS, SARA, and Pro-Kin footboard. The intra-rater reliability and the test-retest reliability of the APP measurements, estimated by intraclass correlation coefficient, were excellent. The standard error of measurement and the minimal detectable change were small. No learning effect was observed. CONCLUSIONS We can state that the APP is an easy, reliable, and valid evaluating system to quantify the trunk sway in a static position and during the gait.
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Gialanella B, Comini L, Olivares A, Gelmini E, Ubertini E, Grioni G. Pain, disability and adherence to home exercises in patients with chronic neck pain: long term effects of phone surveillance. A randomized controlled study. Eur J Phys Rehabil Med 2019; 56:104-111. [PMID: 31165606 DOI: 10.23736/s1973-9087.19.05686-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Effectiveness of phone surveillance and other communication technologies in the management of neck pain patients have been evaluated previously only at the suspension of the service. AIM To verify whether a phone surveillance program can improve pain, disability, and adherence to home exercises in neck pain patients, and whether the improvement achieved continues to be maintained also after suspension of the support. DESIGN This is a randomized controlled study. SETTING Outpatients of Rehabilitation Unit. POPULATION 84 out of 100 outpatients consecutively randomized (by blocks of four) to Phone group (N.=42, performing a 6-month home-based phone surveillance program) or to Control group (N.=42, with the only recommendation to continue exercising at home without phone surveillance) were considered. The home-based phone surveillance program consisted of 12 scheduled phone calls, each performed every fortnight by a nurse-tutor with expertise in rehabilitation for the first six months of the study. At the end of phone surveillance period, Phone patients were encouraged to continue home exercises for a further 6 months period. METHODS Pain severity (assessed with Pain VAS), disability (Neck Disability Index), and adherence to exercises performed at home (classified as: ≥5 sessions/week, 2-4 sessions/week, occasional or no sessions) were outcome measures. Pain severity and disability were assessed at entry, at 6 and 12 months, while adherence to exercises was self-reported and recorded at 6 and 12 months. Differences between groups were analyzed with χ2 test, Student's t-test or ANOVA. RESULTS At 6 months, Pain VAS (P=0.013) and Neck Disability Index scores (P=0.012) were lower in Phone patients than Controls. At 12 months, Neck Disability Index scores (P=0.026) continued to be lower in Phone patients than Controls. At 6 months, 97.6% of Phone patients and 80.9% of Controls performed rehabilitation at home with a range of 2 to 7 sessions/week; while at 12 months, the respective percentages of Phone and Control patients were 92.9% and 73.8%. Adherence to home exercises was higher in Phone patients than in Controls at 6 (P=0.013) and 12 months (P=0.019). CONCLUSIONS In patients with chronic neck pain, the positive effects of phone surveillance on the neck disability and adherence to home exercises still persist 6 months after the suspension of the support. CLINICAL REHABILITATION IMPACT This knowledge can be useful for physicians to plan home rehabilitation of neck pain patients.
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Affiliation(s)
- Bernardo Gialanella
- Operative Unit for Recovery and Functional Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy -
| | - Laura Comini
- Scientific Direction of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Adriana Olivares
- Scientific Direction of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Elena Gelmini
- Operative Unit for Recovery and Functional Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Elena Ubertini
- Operative Unit for Recovery and Functional Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Giuseppe Grioni
- Operative Unit for Recovery and Functional Rehabilitation of the Institute of Castel Goffredo of Mantua, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
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Abstract
Telerehabilitation refers to the virtual delivery of rehabilitation services into the patient's home. This methodology has shown to be advantageous when used to enhance or replace conventional therapy to overcome geographic, physical, and cognitive barriers. The exponential growth of technology has led to the development of new applications that enable health care providers to monitor, educate, treat, and support patients in their own environment. Best practices and well-designed Telerehabilitation studies are needed to build and sustain a strong Telerehabilitation system that is integrated in the current health care structure and is cost-effective.
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