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Rendell R, Pinheiro M, Wang B, McKay F, Ewen A, Carnegie C, Tikomaidelana E, Fattah Z, Hassett L. Digital Apps to Improve Mobility in Adults with Neurological Conditions: A Health App-Focused Systematic Review. Healthcare (Basel) 2024; 12:929. [PMID: 38727486 PMCID: PMC11083333 DOI: 10.3390/healthcare12090929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps are suitable for prescribing mobility exercises for adults with neurological health conditions, (2) how well these apps incorporate telehealth strategies, and (3) how well these apps rate in terms of quality and capacity for behaviour change. The Australian Apple iTunes Store was systematically searched, by using a search code and manually, for apps suitable for training mobility in neurological rehabilitation. Additional searches were conducted in known app repositories and for web-based apps. Trained reviewers extracted data from the included apps, including population-specific characteristics; quality, by using the Mobile App Rating Scale (MARS); and behaviour change potential, by using the App Behaviour Change Scale (ABACUS). The included apps (n = 18) provided <50 to >10,000 exercises, many incurred a subscription fee (n = 13), and half included telehealth features. App quality was moderate (mean MARS score of 3.2/5 and SD of 0.5), and potential for behaviour change was poor (mean ABACUS score of 5.7/21 and SD of 2.1). A limited number of high-quality apps are available for the prescription of mobility exercises in people with neurological conditions.
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Affiliation(s)
- Reem Rendell
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW 2000, Australia
- Ingham Institute for Applied Medical Research/South Western Sydney Local Health District, Sydney, NSW 2000, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
| | - Belinda Wang
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
| | - Fiona McKay
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, VIC 3000, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC 3000, Australia
| | | | - Catherine Carnegie
- Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
| | | | - Zino Fattah
- South Western Sydney Local Health District, Sydney, NSW 2000, Australia
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- Ingham Institute for Applied Medical Research/South Western Sydney Local Health District, Sydney, NSW 2000, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2000, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
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Pinheiro MB, Hassett L, Sherrington C, Hayes A, van den Berg M, Lindley RI, Crotty M, Chagpar S, Treacy D, Weber H, Fairhall N, Wong S, McCluskey A, Togher L, Scrivener K, Howard K. Economic evaluation of digitally enabled aged and neurological rehabilitation care in the Activity and MObility UsiNg Technology (AMOUNT) trial. Clin Rehabil 2023; 37:651-666. [PMID: 36408722 DOI: 10.1177/02692155221138920] [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: 11/22/2022]
Abstract
OBJECTIVE To investigate the trial-based cost-effectiveness of the addition of a tailored digitally enabled exercise intervention to usual care shown to be clinically effective in improving mobility in the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial compared to usual care alone. DESIGN Economic evaluation alongside a pragmatic randomized controlled trial. PARTICIPANTS 300 people receiving inpatient aged and neurological rehabilitation were randomized to the intervention (n = 149) or usual care control group (n = 151). MAIN MEASURES Incremental cost effectiveness ratios were calculated for the additional costs per additional person demonstrating a meaningful improvement in mobility (3-point in Short Physical Performance Battery) and quality-adjusted life years gained at 6 months (primary analysis). The joint probability distribution of costs and outcomes was examined using bootstrapping. RESULTS The mean cost saving for the intervention group at 6 months was AU$2286 (95% Bootstrapped cost CI: -$11,190 to $6410) per participant; 68% and 67% of bootstraps showed the intervention to be dominant (i.e. more effective and cost saving) for mobility and quality-adjusted life years, respectively. The probability of the intervention being cost-effective considering a willingness to pay threshold of AU$50,000 per additional person with a meaningful improvement in mobility or quality-adjusted life year gained was 93% and 77%, respectively. CONCLUSIONS The AMOUNT intervention had a high probability of being cost-effective if decision makers are willing to pay AU$50,000 per meaningful improvement in mobility or per quality-adjusted life year gained, and a moderate probability of being cost-saving and effective considering both outcomes at 6 months post randomization.
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Affiliation(s)
- Marina B Pinheiro
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Maayken van den Berg
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Richard I Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Daniel Treacy
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Physiotherapy Department, Prince of Wales Hospital, 2989South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Heather Weber
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Nicola Fairhall
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- StrokeEd Collaboration, Sydney, New South Wales, Australia
| | - Leanne Togher
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Katharine Scrivener
- StrokeEd Collaboration, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, 7788Macquarie University, Sydney, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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O’Neil J, Egan M, Marshall S, Bilodeau M, Pelletier L, Sveistrup H. The Impact of Two Telerehabilitation Supervision Schedules on Physical Activity, Mobility, and Balance Among People with Moderate to Severe Traumatic Brain Injury: A Mixed-Method Single-Subject Design. Physiother Can 2023; 75:118-131. [PMID: 37736373 PMCID: PMC10510551 DOI: 10.3138/ptc-2021-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/26/2021] [Accepted: 10/08/2021] [Indexed: 09/23/2023]
Abstract
Background Many individuals who experience a moderate or severe traumatic brain injury (TBI) have long-term deficits in physical activity, balance, and mobility requiring specialized care. New delivery models are being investigated for interventions to address challenges caused by living in remote communities, difficulties with transportation, and/or physical distancing requirements. Determining the effectiveness of telerehabilitation is critical given the current movement toward remote health care delivery. Objective We investigated the effectiveness of two teletherapy supervision schedules used to deliver a home-based, intensive exercise programme on 1) physical activity, mobility, balance, participation, and 2) concerns with falling, and satisfaction with life. Methods A mixed methods approach with alternating single subject design (SSD) and interviews was used. Five individuals who experienced a moderate or severe TBI completed two intensive home-based telerehabilitation programmes. Programmes differed only by supervision schedule - daily or weekly. Impacts on objective and patient-reported outcomes were measured. Results Four individuals demonstrated clinically significant improvements in physical activity level, balance, and mobility. One individual experienced less concerns with falling after both schedules, while two other individuals showed a trend in that direction after the weekly remote supervision. Important functional gains (i.e., improved balance and decreased fatigue) were also perceived and reported by family partners regardless of supervision schedule. Conclusion Although the study has limitations, the findings indicate that exercise programmes delivered via telerehabilitation can improve balance and mobility as well as positively affect concerns with falling and physical activity levels for this population. No clear differences were seen between the two telerehabilitation supervision schedules.
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Affiliation(s)
- Jennifer O’Neil
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Egan
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Shawn Marshall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Martin Bilodeau
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Luc Pelletier
- Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- From the:
Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Vegter RJK, van Keeken HG, de Groot S, Houdijk HJP, Joëls M, van der Woude LHV. RehabMove2018: active lifestyle for people with physical disabilities; mobility, exercise & sports. Disabil Rehabil 2021; 43:3425-3426. [PMID: 34184586 DOI: 10.1080/09638288.2021.1940319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Riemer J K Vegter
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Helco G van Keeken
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sonja de Groot
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Han J P Houdijk
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marian Joëls
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bientzle M, Restle A, Kimmerle J. Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e25717. [PMID: 33881402 PMCID: PMC8100886 DOI: 10.2196/25717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any purpose. This also applies to patients and therapists in treatment situations. Objective The aim of this study was to investigate how purposeful smartphone use compared with recreational smartphone use (by a physiotherapist or by a patient) influenced the perception of a physiotherapeutic treatment situation. We examined the impact of smartphone use during a physiotherapy session on the perception of the physiotherapist, evaluation of attentiveness, and evaluation of smartphone use in physiotherapy in general. Methods Members of various music and sports clubs were invited to participate in an online randomized controlled trial. Participants were randomly assigned to one of four conditions. They watched a video in which a physiotherapeutic treatment was shown and in which a smartphone was used or not used in the following four different ways: (1) therapeutically purposeful use, (2) recreational use by the physiotherapist (looking at the phone from time to time with no therapeutic purpose), (3) recreational use by the patient, and (4) no smartphone use (control condition). After watching the video, the participants indicated their perception of the physiotherapist’s professional competence, social competence, and empathetic behavior. They also rated the physiotherapist’s and patient’s attentiveness and evaluated the usage of smartphones generally in physiotherapy. Results The analysis included 118 participants (63 women and 55 men). When the physiotherapist used the smartphone in a purposeful way, the physiotherapist was perceived as more professionally competent (P=.007), socially competent (P=.03), and empathetic (P=.04) than if the physiotherapist used it with no therapeutic purpose. These effects occurred because recreational smartphone use by the physiotherapist was evaluated more negatively than the behavior in the control condition (professional competence: P=.001; social competence: P=.03; empathy: P=.04). Moreover, when the physiotherapist used the smartphone in a recreational way, the physiotherapist was perceived as being less attentive (P<.001). Likewise, when the patient used the smartphone in a recreational way, the patient was perceived as being less attentive (P<.001). Finally, smartphone use in physiotherapy was rated as more positive in general when the smartphone was used in a purposeful way compared with the conditions in which the physiotherapist or patient looked at the smartphone with no therapeutic purpose (P<.001). This positive evaluation occurred because purposeful use led to a more positive rating than no smartphone use (P<.001, R=0.42). Conclusions Smartphones are only appropriate for therapists and patients if they are used directly for a therapeutic purpose. Otherwise, it is better not to use smartphones during treatment. Trial Registration AsPredicted (aspredicted.org) #24740; https://aspredicted.org/blind.php?x=vv532i
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Hamilton C, Lovarini M, van den Berg M, McCluskey A, Hassett L. Usability of affordable feedback-based technologies to improve mobility and physical activity in rehabilitation: a mixed methods study. Disabil Rehabil 2021; 44:4029-4038. [PMID: 33645384 DOI: 10.1080/09638288.2021.1884904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore physiotherapists' views on the usability of feedback-based technologies used in physical rehabilitation. MATERIALS AND METHODS A mixed methods study which was nested within a randomised controlled trial to investigate the effectiveness of affordable feedback-based technologies to improve mobility and physical activity within aged care and neurological rehabilitation. Technologies included virtual reality systems, handheld device apps and wearable devices. Physiotherapists (n = 11) who were involved in prescribing technologies during the trial rated the usability of 11 different devices using the System Usability Scale (SUS), then attended a focus group. Descriptive statistics and framework analysis were used for analysis. RESULTS Fitbit devices (mean 89.8, SD 9.3), Fysiogaming (mean 75.6, SD 15.3) and Xbox Kinect (mean 75.5, SD 11.2) rated in the acceptable range (>70) on the SUS. Three key factors on usability emerged from the focus groups: (1) Key device features relating to practicalities (ease of set up and use, reliability, safety) and therapeutic benefit (customisation, high active practice time, useful feedback) are important for usability; (2) Usability depends on the context of use; and (3) Usability can be enhanced with technical, clinical, environmental and financial support. CONCLUSIONS Health service managers and clinicians should consider key device features identified, contextual factors of their service, and supports available when selecting technologies for use in clinical practice. Further collaboration between clinicians, researchers and technology developers would benefit future technology development, particularly taking into consideration the identified key device features from this study.IMPLICATIONS FOR REHABILITATIONTechnology selection should be based on key device features relating to both practicalities and therapeutic benefit.Contextual factors and available supports should also be considered when selecting technologies.Key usability features identified in this study such as ease of set up, reliability and customisability should be considered in the design of future feedback-based technologies to optimise usability in physical rehabilitation.
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Affiliation(s)
- Caitlin Hamilton
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Meryl Lovarini
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Maayken van den Berg
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health, Sydney, Australia.,Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, Australia
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