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Garofano M, Vecchione C, Calabrese M, Rusciano MR, Visco V, Granata G, Carrizzo A, Galasso G, Bramanti P, Corallo F, Izzo C, Ciccarelli M, Bramanti A. Technological Developments, Exercise Training Programs, and Clinical Outcomes in Cardiac Telerehabilitation in the Last Ten Years: A Systematic Review. Healthcare (Basel) 2024; 12:1534. [PMID: 39120237 PMCID: PMC11311841 DOI: 10.3390/healthcare12151534] [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: 07/01/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are associated with very high rates of re-hospitalization and mortality worldwide, so the complexity of these pathologies requires frequent access to hospital facilities. The guidelines also emphasize the importance of cardiac rehabilitation (CR) programs, which have demonstrated a favorable effect on outcomes, and cardiac telerehabilitation (CTR) could represent an innovative healthcare delivery model. The aim of our review is to study how technologies used in rehabilitation have changed over time and also to understand what types of rehabilitation programs have been used in telerehabilitation. METHODS We searched randomized controlled trials (RCTs) in three electronic databases, PubMed, Web of Science, and Scopus, from January 2015 to January 2024, using relevant keywords. Initially, 502 articles were found, and 79 duplicates were identified and eliminated with EndNote. RESULTS In total, 16 RCTs fulfilled the pre-defined criteria, which were analyzed in our systematic review. The results showed that after CTR, there was a significant improvement in main outcome measures, as well as in relation to technological advances. CONCLUSIONS Moreover, compared to center-based rehabilitation, CTR can offer further advantages, with better cost-effectiveness, the breakdown of geographical barriers, and the improvement of access to treatment for the female population, which is traditionally more socially committed.
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Affiliation(s)
- Marina Garofano
- Department of Medicine, Surgery and Dentistry, University of Cagliari, 09124 Cagliari, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Mariaconsiglia Calabrese
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Maria Rosaria Rusciano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Giovanni Granata
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Placido Bramanti
- Faculty of Psychology, University eCampus, 22060 Novedrate, Italy;
| | | | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
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Abstract
Stroke remains a major cause of disability. Intensive rehabilitation therapy can improve outcomes, but most patients receive limited doses. Telehealth methods can overcome obstacles to delivering intensive therapy and thereby address this unmet need. A specific example is reviewed in detail, focused on a telerehabilitation system that targets upper extremity motor deficits after stroke. Strengths of this system include provision of daily therapy associated with very high patient compliance, safety and feasibility in the inpatient or home setting, comparable efficacy to dose-matched therapy provided in-clinic, and a holistic approach that includes assessment, education, prevention, and activity-based therapy.
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Affiliation(s)
- Steven C Cramer
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA.
| | - Brittany M Young
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Anne Schwarz
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Tracy Y Chang
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Michael Su
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
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Lee EL, Jang MH, Lee BJ, Han SH, Lee HM, Choi SU, Shin MJ. Home-Based Remote Rehabilitation Leads to Superior Outcomes for Older Women With Knee Osteoarthritis: A Randomized Controlled Trial. J Am Med Dir Assoc 2023; 24:1555-1561. [PMID: 37699531 DOI: 10.1016/j.jamda.2023.08.013] [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: 02/07/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES To examine the effects of a home-based lower-extremity strengthening exercise program in community-dwelling older women with knee osteoarthritis. DESIGN Randomized controlled trial. SETTING AND PARTICIPANTS Women aged ≥60 years with knee osteoarthritis and Kellgren-Lawrence grade 1 or 2 on anteroposterior/lateral radiographs of both knee joints. METHODS Patients (n = 36) were randomly divided into experimental (EG) and control (CG) groups. The EG performed home-based remote rehabilitation lower-extremity strengthening exercises for 8 weeks, whereas the CG received no intervention. Assessment was performed at baseline and week 8. The primary outcome was the five-times sit-to-stand test (FTSST) result. Secondary outcomes included timed up-and-go (TUG) test results, knee extensor and flexor strength, quadriceps (rectus femoris) muscle activity, skeletal muscle index, blood pressure (BP), visual analog scale (VAS) scores, C-reactive protein level, and erythrocyte sedimentation rate. RESULTS A statistically significant difference in the FTSST times was observed between the groups after 8 weeks of intervention (EG: 7.95 ± 1.08 seconds, CG: 10.01 ± 2.03 seconds, P < .001). In the EG, the TUG test score decreased by 0.75 ± 0.80 seconds (P = .002), right and left knee flexor strength increased by 4.69 ± 6.05 kg (P = .007) and 3.98 ± 6.98 kg (P = .038), respectively, and the right knee extensor root mean square (RMS) ratio increased by 1.24 ± 0.39 (P = .027). Additionally, systolic and diastolic BP decreased by 9.50 ± 10.75 mm Hg (P = .005) and 4.25 ± 4.91 mm Hg (P = .003), respectively. In the CG, the VAS scores decreased by 9.10 ± 13.68 mm (P = .022). CONCLUSIONS AND IMPLICATIONS The home-based exercise program using a remote rehabilitation medical device was effective in improving lower extremity strength and function in community-dwelling older women with knee osteoarthritis. This finding suggests that the remote rehabilitation medical device may be used as an alternative to exercise interventions for patients with knee osteoarthritis.
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Affiliation(s)
- Eun-Lee Lee
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Myung Hun Jang
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | - Sang Hun Han
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan, Republic of Korea
| | | | | | - Myung Jun Shin
- Department of Rehabilitation Medicine and Biomedical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Pusan, Republic of Korea.
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Bise CG, Cupler Z, Mathers S, Turner R, Sundaram M, Catelani MB, Dahler S, Popchak A, Schneider M. Face-to-face telehealth interventions in the treatment of low back pain: A systematic review. Complement Ther Clin Pract 2023; 50:101671. [PMID: 36379145 PMCID: PMC9613794 DOI: 10.1016/j.ctcp.2022.101671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Christopher G Bise
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA; UPMC Health Plan - Department of Health Economics, USA.
| | - Zachary Cupler
- Physical Medicine & Rehabilitation Services, Butler VA Healthcare System, USA
| | - Sean Mathers
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Rose Turner
- Department of Medicine, Health Science Library System, University of Pittsburgh, USA
| | - Meenakshi Sundaram
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Maria Beatriz Catelani
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Sarah Dahler
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Adam Popchak
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Michael Schneider
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
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Wu W, Zhang Y, Zhang Y, Peng B, Xu W. Clinical Effectiveness of Home-Based Telerehabilitation Program for Geriatric Hip Fracture Following Total Hip Replacement. Orthop Surg 2022; 15:423-431. [PMID: 36448261 PMCID: PMC9891946 DOI: 10.1111/os.13521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of a six-month home-based telerehabilitation based on the Internet-based rehabilitation management system coupled with conventional outpatient care in elderly patients with hip fractures following total hip replacement (THR). METHODS Elderly patients (aged over 65 years) with first hip fractures who underwent THR between March 2018 and September 2018 in Tianjin Hospital were enrolled in this study. Patients were divided into two groups: telerehabilitation group (n = 43) and telephone group (n = 42). A Internet-based telerehabilitation management system was established and applied on patients in the telerehabilitation group. For patients in the telephone group, the rehabilitation intervention was administered through conventional outpatient care (telephone along with outpatient follow-up). Data from the Harris hip scale (HHS), functional independence measure (FIM), self-rating anxiety scale (SAS), and postoperative complications at 1, 3, and 6 months after surgery were collected and compared between the two groups. RESULTS A total of 85 elderly patients completed the 6-month follow-up assessment. Results showed that the HHS score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (66.35 ± 4.63 vs 63.48 ± 4.49), 3 months (76.33 ± 4.52 vs 71.81 ± 3.84), and 6 months (84.23 ± 3.13 vs 77.29 ± 4.95) after surgery (P < 0.001). The FIM score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (89.00 ± 5.63 vs 73.35 ± 8.70), 3 months (100.16 ± 4.56 vs 92.81 ± 5.17), and 6 months (111.70 ± 3.13 vs 98.64 ± 5.12) after surgery (P < 0.001). The SAS score was significantly lower in the telerehabilitation group than in the telephone group at 1 month (42.40 ± 3.07 vs 46.21 ± 3.53), 3 months (36.77 ± 2.26 vs 40.24 ± 1.66), and 6 months (29.26 ± 1.63 vs 33.81 ± 2.62) after surgery (P < 0.001). The overall complication rate was significantly lower in the telerehabilitation group than in the telephone group (14% vs 40.5%) (P < 0.05). CONCLUSION Internet-based rehabilitation management system can not only promote the physical rehabilitation of patients, but also play a positive role in psychological rehabilitation and the prevention of complications, which provides new ideas and methods for clinical rehabilitation.
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Affiliation(s)
- Wei‐yong Wu
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | | | | | - Bing Peng
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Wei‐guo Xu
- Department of OrthopaedicsTianjin HospitalTianjinChina
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Algarni FS, Alshammari MO, Sidimohammad U, Khayat SA, Aljabbary A, Altowaijri AM. Tele-Rehabilitation Service from the Patient's Perspective: A Cross-Sectional Study. J Patient Exp 2022; 9:23743735221130820. [PMID: 36226035 PMCID: PMC9549184 DOI: 10.1177/23743735221130820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study aimed to describe patients' perceptions of tele-rehabilitation (TR) and investigate the association between TR-related factors and both the patients' age and type of rehabilitation services. A cross-sectional survey was conducted to obtain data about patients' demographic and medical information, technological familiarity as well as patients' experience and opinions about TR. The 227 patients completing the survey reported a mean ± SD age of 40.7 ± 13.9 years and musculoskeletal disorders as the most common condition treated by TR. The majority of patients expressed satisfaction and confidence with their therapists' ability to assess and treat their problems using TR. Approximately 75.3% of participants stated that therapists demonstrated a strong understanding of their health conditions, while 82% reported that TR entailed a convenient service during COVID-19. The study found associations between age and patient's ability and confidence to use technology as well as a relationship between the type of treatment received and participants' overall opinions. Patients demonstrated acceptance, confidence, and satisfaction with TR during COVID-19. Patient age and treatment type fulfill a major role in patients' perceptions of TR.
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Affiliation(s)
- Fahad Saad Algarni
- Department of Rehabilitation Sciences, College of Applied Medical
Sciences, King Saud University, Riyadh, Saudi Arabia,Fahad Saad Algarni, Department of Health
Rehabilitation Sciences at College of Applied Medical Sciences, King Saud
University, Riyadh, Saudi Arabia.
| | - Majed O Alshammari
- Department of Rehabilitation Medicine, King Saud University Medical
City, King Saud University, Riyadh, Saudi Arabia
| | - Umkalthoum Sidimohammad
- Department of Rehabilitation Medicine, King Saud University Medical
City, King Saud University, Riyadh, Saudi Arabia
| | - Sarah A Khayat
- Department of Rehabilitation Medicine, King Saud University Medical
City, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Aljabbary
- Department of Rehabilitation Medicine, King Saud University Medical
City, King Saud University, Riyadh, Saudi Arabia
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Lim H, Marjanovic N, Luciano C, Madhavan S. Feasibility and Acceptability of Game-Based Cortical Priming and Functional Lower Limb Training in a Remotely Supervised Home Setting for Chronic Stroke: A Case Series. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:775496. [PMID: 36188982 PMCID: PMC9397891 DOI: 10.3389/fresc.2022.775496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
Background Movement-based priming has been increasingly investigated to accelerate the effects of subsequent motor training. The feasibility and acceptability of this approach at home has not been studied. We developed a game-based priming system (DIG-I-PRIMETM) that engages the user in repeated ankle movements using serious games. We aimed to determine the feasibility, acceptability, and preliminary motor benefits of an 8-week remotely supervised telerehabilitation program utilizing game-based movement priming combined with functional lower limb motor training in chronic stroke survivors. Methods Three individuals with stroke participated in a telerehabilitation program consisting of 20-min movement-based priming using the DIG-I-PRIMETM system followed by 30-min of lower limb motor training focusing on strength and balance. We evaluated feasibility using reported adverse events and compliance, and acceptability by assessing participant perception of the game-based training. Motor gains were assessed using the 10-m walk test and Functional Gait Assessment. Results All participants completed 24 remotely supervised training sessions without any adverse events. Participants reported high acceptability of the DIG-I-PRIMETM system, reflected by high scores on satisfaction, enjoyment, user-friendliness, and challenge aspects of the system. Participants reported overall satisfaction with our program. Post-training changes in the 10-m walk test (0.10–0.31 m/s) and Functional Gait Assessment (4–7 points) exceeded the minimal clinically important difference. Conclusion Our results indicate that a remotely supervised game-based priming and functional lower limb exercise program is feasible and acceptable for stroke survivors to perform at home. Also, improved walking provides preliminary evidence of game-based priming to be beneficial as a telerehabilitation strategy for stroke motor recovery.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Nicholas Marjanovic
- Mixed Reality Laboratory, Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Cristian Luciano
- Mixed Reality Laboratory, Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
- *Correspondence: Sangeetha Madhavan
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Gilbert AW, Jones J, Stokes M, May CR. Factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting: a qualitative study. BMJ Open 2021; 11:e041038. [PMID: 33632750 PMCID: PMC7908916 DOI: 10.1136/bmjopen-2020-041038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To identify, characterise and explain factors that influence patient preferences, from the perspective of patients and clinicians, for virtual consultations in an orthopaedic rehabilitation setting. DESIGN Qualitative study using semi-structured interviews and abductive analysis. SETTING A physiotherapy and occupational therapy department situated within a tertiary orthopaedic centre in the UK. PARTICIPANTS Patients who were receiving orthopaedic rehabilitation for a musculoskeletal problem. Occupational therapists, physiotherapists or therapy technicians involved in the delivery of orthopaedic rehabilitation for patients with a musculoskeletal problem. RESULTS Twenty-two patients and 22 healthcare professionals were interviewed. The average interview length was 48 minutes. Four major factors were found to influence preference: the situation of care (the ways that patients understand and explain their clinical status, their treatment requirements and the care pathway), the expectations of care (influenced by a patients desire for contact, psychological status, previous care and perceived requirements), the demands on the patient (due to each patients respective social situation and the consequences of choice) and the capacity to allocate resources to care (these include financial, infrastructural, social and healthcare resources). CONCLUSION This study has identified key factors that appear to influence patient preference for virtual consultations in orthopaedic rehabilitation. A conceptual model of these factors, derived from empirical data, has been developed highlighting how they combine and compete. A series of questions, based on these factors, have been developed to support identification of preferences in a clinical setting.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration, North Thames, UK
| | - Jeremy Jones
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration, Wessex, UK
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Telerehabilitation is now a mainstay in health care delivery, with recent trends pointed to continued expansion in the future. Physical therapy (PT) being provided via telehealth, also known as virtual PT, has been demonstrated to provide functional improvements and satisfaction for the consumer and provider, and is applicable in various physical therapy treatment diagnostic areas. Research and technology enhancements will continue to offer new and innovative means to provide physical therapy. This article further provides points to make virtual PT successful and highlights some recommended equipment and outcome recommendations. The future is bright for providing virtual PT.
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Affiliation(s)
- Mark A Havran
- Department of Veterans Affairs, Des Moines, IA, USA; Rehabilitation and Extended Care (117CLC) VA Central Iowa HCS, 3600 30th Street, Des Moines, IA 50310, USA.
| | - Douglas E Bidelspach
- Department of Veterans Affairs, 1700 South Lincoln Avenue, Lebanon, PA 17042, USA
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Cramer SC, Dodakian L, Le V, McKenzie A, See J, Augsburger R, Zhou RJ, Raefsky SM, Nguyen T, Vanderschelden B, Wong G, Bandak D, Nazarzai L, Dhand A, Scacchi W, Heckhausen J. A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke. Front Neurol 2021; 11:611453. [PMID: 33613417 PMCID: PMC7888185 DOI: 10.3389/fneur.2020.611453] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52-65.5), and 129 (52-486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3-56.7) h. Non-compliance doubled during weeks 7-12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5-12.5) points in the arm and 1 (-0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.
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Affiliation(s)
- Steven C. Cramer
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Vu Le
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Alison McKenzie
- Department of Physical Therapy, Chapman University, Orange, CA, United States
| | - Jill See
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Renee Augsburger
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Robert J. Zhou
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Sophia M. Raefsky
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Thalia Nguyen
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | | | - Gene Wong
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Daniel Bandak
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Laila Nazarzai
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Walt Scacchi
- Institute for Software Research, University of California, Irvine, Irvine, CA, United States
| | - Jutta Heckhausen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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Azma K, RezaSoltani Z, Rezaeimoghaddam F, Dadarkhah A, Mohsenolhosseini S. Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial. J Telemed Telecare 2017; 24:560-565. [DOI: 10.1177/1357633x17723368] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Knee osteoarthritis is a major cause of disability among the middle to senior age groups. Despite being effective, office-based physical therapy (OBPT) needs professional human resources and is both costly and time-consuming. We aimed to compare the efficacy of tele-rehabilitation (tele-rehab) compared with OBPT in patients with knee osteoarthritis. Methods In this randomized clinical trial, patients with symptomatic osteoarthritis of the knee were assigned to participate in either a 6-week home-based tele-rehab or an OBPT program between 2015 and 2016. Our primary outcome was the mean change from the baseline until 1 and 6 month's post-intervention in scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used analysis of variance for the repeated measure statistical test. Results A total of 54 patients entered the final analysis, with 27 in each group. The mean age of the patients was 58.2 ± 7.41 years and 60.2% were female. In the tele-rehab and OBPT group, KOOS scores increased from baseline to 6 months post-intervention (50.6 to 83.1 and 49.8 to 81.8) respectively. There was no significant difference between tele-rehab and OBPT groups in any of the studied scales. Discussion The tele-rehab program is as effective as OBPT in improving the function of patients with knee osteoarthritis. Considering the much lower time and cost consumed by tele-rehab, it is the recommended program for the older population living in remote sites.
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Affiliation(s)
- Kamran Azma
- Research Centre of Clinical Biomechanics and Ergonomics, Emam Reza Hospital, Aja University of Medical Sciences, Iran
- Physical Medicine and Rehabilitation Department, Emam Reza Hospital, Aja University of Medical Sciences, Iran
| | - Zahra RezaSoltani
- Physical Medicine and Rehabilitation Department, Emam Reza Hospital, Aja University of Medical Sciences, Iran
| | - Farid Rezaeimoghaddam
- Physical Medicine and Rehabilitation Department, Emam Reza Hospital, Aja University of Medical Sciences, Iran
| | - Afsaneh Dadarkhah
- Physical Medicine and Rehabilitation Department, Emam Reza Hospital, Aja University of Medical Sciences, Iran
| | - Sarasadat Mohsenolhosseini
- Physical Medicine and Rehabilitation Department, Emam Reza Hospital, Aja University of Medical Sciences, Iran
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Possibilities of ICT-supported services in the clinical management of older adults. Aging Clin Exp Res 2017; 29:49-57. [PMID: 28190149 PMCID: PMC5343081 DOI: 10.1007/s40520-016-0711-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/18/2016] [Indexed: 11/12/2022]
Abstract
Services making use of information and communication technology (ICT) are of potential interest to face the challenges of our aging society. Aim of this article is to describe the possible field of application for ICT-supported services in the management of older adults, in particular those with functional impairment. The current status of ICT-supported services is described and examples of how these services can be implemented in everyday practice are given. Upcoming technical solutions and future directions are also addressed. An ICT-supported service is not only the technological tool, but its combination with clinical purposes for which it is used and the way it is implemented in everyday care. Patient’s satisfaction with ICT-supported services is moderate to good. Actual use of patients is higher than those of professionals but very variable. Frequency of use is positively related to clinical outcome. ICT offers a variety of opportunities for the treatment and prevention of frailty and functional decline. Future challenges are related to the intelligence of the systems and making the technologies even more unobtrusive and intuitive.
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