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French MA, Balasubramanian A, Hansel NN, Penttinen SK, Wise R, Raghavan P, Wegener ST, Roemmich RT, Celnik PA. Impact of automated data flow and reminders on adherence and resource utilization for remotely monitoring physical activity in individuals with stroke or chronic obstructive pulmonary disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.15.24305852. [PMID: 38699312 PMCID: PMC11064997 DOI: 10.1101/2024.04.15.24305852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
As rehabilitation advances into the era of digital health, remote monitoring of physical activity via wearable devices has the potential to change how we provide care. However, uncertainties about patient adherence and the significant resource requirements needed create challenges to adoption of remote monitoring into clinical care. Here we aim to determine the impact of a novel digital application to overcome these barriers. The Rehabilitation Remote Monitoring Application (RRMA) automatically extracts data about physical activity collected via a Fitbit device, screens the data for adherence, and contacts the participant if adherence is low. We compare adherence and estimate the resources required (i.e., time and financial) to perform remote monitoring of physical activity with and without the RRMA in two patient groups. Seventy-three individuals with stroke or chronic obstructive pulmonary disease completed 28 days of monitoring physical activity with the RRMA, while 62 individuals completed 28 days with the data flow processes being completed manually. Adherence (i.e., the average percentage of the day that the device was worn) was similar between groups (p=0.85). However, the RRMA saved an estimated 123.8 minutes or $50.24 per participant month when compared to manual processes. These results demonstrate that automated technologies like the RRMA can maintain patient adherence to remote monitoring of physical activity while reducing the time and financial resources needed. Applications like the RRMA can facilitate the adoption of remote monitoring in rehabilitation by reducing barriers related to adherence and resource requirements.
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Affiliation(s)
- Margaret A French
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, United States of America
| | - Aparna Balasubramanian
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nadia N Hansel
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sharon K Penttinen
- inHealth Precision Medicine Program, Technology Innovation Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Robert Wise
- inHealth Precision Medicine Program, Technology Innovation Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ryan T Roemmich
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
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Singh H, Chan K, Cheung L, Hitzig SL, Musselman KE. The impact of falls and fear of falling on participation, autonomy, and life satisfaction among individuals with spinal cord injury: A brief report. J Spinal Cord Med 2021; 44:S234-S239. [PMID: 34779724 PMCID: PMC8604446 DOI: 10.1080/10790268.2021.1943251] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
CONTEXT Qualitative research suggests that falls can have a negative psychosocial impact on the lives of individuals with spinal cord injury (SCI). However, it is unclear whether these qualitative findings are supported by quantitative psychosocial metrics. This paper examines whether falling and/or having a fear of falling impacts participation, autonomy, and life satisfaction among individuals with SCI. METHODS Falls and fear of falling were tracked over six months using a survey and phone check-ins conducted approximately every three to four weeks. The Life Satisfaction 9 and Impact on Participation and Autonomy Questionnaires were administered at baseline and after six months. Responses on the questionnaires were statistically compared between fallers and non-fallers as well as participants with and without a fear of falling during the tracking period. FINDINGS Of the 65 community-dwelling adults with chronic SCI, 38 were categorized as fallers (aged 54.29 ± 13.73, 19.55 ± 14.20 years post-SCI, AIS A-D) and 27 were non-fallers (aged 57.78 ± 12.21, 17.93 ± 17.24 years post-SCI, AIS A-D). Our results revealed no significant differences between fallers and non-fallers in their perceived participation, autonomy, or life satisfaction at baseline or after six months. At the last check-in, 34 participants denied a fear of falling, while 31 had a fear of falling. Perceived autonomy outdoors (P=0.02), total life satisfaction (P=0.04), satisfaction with life as a whole (P=0.00) and self-care (P=0.01) differed between participants with and without a fear of falling after six months. CONCLUSION Fear of falling, rather than falls, may impact participation, autonomy, and life satisfaction in the SCI population.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Bridgepoint Collaboratory for Research & Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
| | - Lovisa Cheung
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Kristin E. Musselman, SCI Mobility Lab, KITE, Toronto Rehab-University Health Network, 520 Sutherland Drive, Toronto, M4G 3V9, Canada.
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Bandini A, Kalsi-Ryan S, Craven BC, Zariffa J, Hitzig SL. Perspectives and recommendations of individuals with tetraplegia regarding wearable cameras for monitoring hand function at home: Insights from a community-based study. J Spinal Cord Med 2021; 44:S173-S184. [PMID: 33960874 PMCID: PMC8604485 DOI: 10.1080/10790268.2021.1920787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Wearable cameras have great potential for producing novel outcome measures of upper limb (UL) function and guiding care in individuals with cervical spinal cord injury (cSCI) living in the community. However, little is known about the perspectives of individuals with cSCI on the potential adoption of this technology. OBJECTIVE To analyze feedback from individuals with cSCI regarding the use of wearable cameras to record daily activities at home, in order to define guidelines for improving the design of this technology and fostering its implementation to optimize UL rehabilitation. DESIGN Mixed-methods study. PARTICIPANTS Thirteen adults with cSCI C3-C8 AIS A-D impairment. MEASURES Interview including survey and semi-structured questions. RESULTS Participants felt that this technology can provide naturalistic information regarding hand use to clinicians and researchers, which in turn can lead to better assessments of UL function and optimized therapies. Participants described the technology as easy-to-use but often reported discomfort that prevented them from conducting long recordings of fully natural activities. Privacy concerns included the possibility to capture household members and personal information displayed on objects (e.g. smartphones). CONCLUSION We provide the first set of guidelines to help researchers and therapists understand which steps need to be taken to translate wearable cameras into outpatient care and community-based research for UL rehabilitation. These guidelines include miniaturized and easy-to-wear cameras, as well as multiple measures for preventing privacy concerns such as avoiding public spaces and providing control over the recordings (e.g. start and stop the recordings at any time, keep or delete a recording).
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Affiliation(s)
- Andrea Bandini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - José Zariffa
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Singh H, Cheung L, Chan K, Flett HM, Hitzig SL, Kaiser A, Musselman KE. Comparing the causes, circumstances and consequences of falls across mobility statuses among individuals with spinal cord injury: A secondary analysis. J Spinal Cord Med 2021; 44:S193-S202. [PMID: 34779733 PMCID: PMC8604457 DOI: 10.1080/10790268.2021.1956252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the occurrence of falls and fall-related injuries, and the circumstances of falls among individuals with spinal cord injury (SCI) who ambulate full-time, use a wheelchair full-time and ambulate part-time. DESIGN A secondary analysis. SETTING Community. PARTICIPANTS Adults with SCI. INTERVENTION None. OUTCOME MEASURES The occurrence and circumstances of falls and fall-related injuries were tracked over six-months using a survey. Participants were grouped by mobility and fall status. A chi-square test compared the occurrence of falls and fall-related injuries, and the time and location of falls, and a negative binomial regression was used to predict the likelihood of falls by mobility status. Kaplan-Meier analysis was used to determine differences in the time to first fall based on mobility status. Group characteristics and causes of falls were described. RESULTS Data from individuals who ambulated full-time (n = 30), used a wheelchair full-time (n = 27) and ambulated part-time (n = 8) were analyzed. Mobility status was a significant predictor of falls (P < 0.01); individuals who used a wheelchair full-time had a third of the likelihood of falling than those who ambulated full-time (P < 0.01). Type of fall-related injuries differed by mobility status. Those who ambulated full-time fell more in the daytime (P < 0.01). Individuals who ambulated full-time and part-time commonly fell while walking due to poor balance, and their legs giving out, respectively. Those who used a wheelchair full-time typically fell while transferring when rushed. CONCLUSION Mobility status influences the likelihood and circumstances of falls. Mobility status should be considered when planning fall prevention education/training for individuals with SCI.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Bridgepoint Collaboratory for Research & Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Lovisa Cheung
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
| | - Heather M. Flett
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anita Kaiser
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Canadian Spinal Research Organization, Toronto, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
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