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Figueiredo CS, Pinto C, Bevilacqua IP, Cortez IL, Pereira F, do Pinho AS, Pagnussat AS. Teleassessment using five times sit-to-stand test in older adults with and without Parkinson's disease: Guidelines and barriers. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2114. [PMID: 39138839 DOI: 10.1002/pri.2114] [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: 02/21/2024] [Revised: 06/04/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND AND PURPOSE Assessing lower limb strength, balance, and fall risk are crucial components of rehabilitation, especially for the older adult population. With the growing interest in telehealth, teleassessment has been investigated as an alternative when in-person assessments are not possible. The Five Times Sit-to-Stand test (5TSTS) provides a quick measure of balance during chair transfers, muscle power, endurance, and the hability to change and maintain body position, and is highly recommended by guidelines. However, the literature is unclear about the viability and safety of teleassessment using the 5TSTS in older adults with and without Parkinson's disease (PD). This study aimed to evaluate the reliability of teleassessment using the 5TSTS and to determine its feasibility and safety for older adults with and without PD. METHODS This cross-sectional study included older adults with and without PD who were evaluated remotely through a videoconference platform. To ensure effective and comprehensive instructions for the test, we developed a guideline called OMPEPE (an acronym for: Objective; Materials; Position-Start; Execution; Position-End; Environment). We assessed the 5TSTS intra- and inter-rater reliability by comparing scores obtained from the same examiner and from different examiners, respectively. Participants and examiners completed online surveys to provide information about feasibility and safety. RESULTS Twelve older adults with PD and 17 older adults without PD were included in this study (mean ages 69.0 and 67.6 years, respectively). Based on the participants' perspectives and the absence of adverse effects, teleassessment using the 5TSTS is feasible and safe for older adults with and without PD. Excellent intra- and inter-rater reliability (intraclass correlation coefficient >0.90) was found for all measurements of the 5TSTS. DISCUSSION This study demonstrated the feasibility, safety, and reliability of teleassessment using the 5TSTS. The guidelines developed may help health professionals minimize barriers and safely conduct an online assessment that includes a physical test such as the 5TSTS in older adults with or without PD. In addition to addressing technological barriers, the OMPEPE guideline might ensure the optimal execution of evaluations. CONCLUSION Teleassessment using the 5TSTS for older adults with and without PD is feasible and safe. Both synchronous (i.e., live) and asynchronous (i.e., recorded) online 5TSTS tests demonstrate excellent intra- and inter-rate reliability.
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Affiliation(s)
- Caroline Santos Figueiredo
- Rehabilitation Sciences Graduate Program Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Pinto
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Isabela Possebon Bevilacqua
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ivan Lima Cortez
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Francisca Pereira
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Alexandre Severo do Pinho
- Rehabilitation Sciences Graduate Program Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
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Tagi VM, Eletti F, Dolor J, Zuccotti G, Montanari C, Verduci E. Telemedicine in nutritional management of children with severe neurological impairment: implication for quality of life. Front Nutr 2024; 11:1452880. [PMID: 39224181 PMCID: PMC11366627 DOI: 10.3389/fnut.2024.1452880] [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: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Children with severe neurological impairment (SNI) frequently present feeding problems requiring a close monitoring of their nutritional status. In addition to constant clinical monitoring of body composition and nutritional indexes in these patients, frequent reports of dietary intake and weight gain variations are useful to ensure proper nutritional management. Furthermore, non-oral feeding is often needed to avoid malnutrition or aspiration pneumonia, constantly necessitating medical assistance. Despite their necessity for frequent hospital accesses, these patients' disabilities represent an important obstacle to accessing care, generating anxiety and concern in children and their families. Telemedicine has proven to be a promising instrument for improving pediatric patients' healthcare in several fields. By breaking down geographical and temporal barriers, telehealth may represent a valuable tool to implement in clinical practice, in order to improve patients' outcomes and quality of life. The aim of this narrative review is to provide an overview of the main nutritional issues in children with SNI, the potential implications of telemedicine in their management and the available evidence regarding the effects and benefits of telehealth.
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Affiliation(s)
- Veronica Maria Tagi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Francesca Eletti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Jonabell Dolor
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Chiara Montanari
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, Milan, Italy
- Metabolic Diseases Unit, Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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Marsili L, Abanto J, Mahajan A, Duque KR, Chinchihualpa Paredes NO, Deraz HA, Espay AJ, Bologna M. Dysrhythmia as a prominent feature of Parkinson's disease: An app-based tapping test. J Neurol Sci 2024; 463:123144. [PMID: 39033737 DOI: 10.1016/j.jns.2024.123144] [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: 06/01/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Smartphone applications (apps) are instruments that assist with objective measurements during the clinical assessment of patients with movement disorders. We aim to test the hypothesis that Parkinson's disease (PD) patients will exhibit an increase in tapping variability and a decrease in tapping speed over a one-year period, compared to healthy controls (HC). METHODS Data was prospectively collected from participants enrolled in our Cincinnati Cohort Biomarker Program, in 2021-2023. Participants diagnosed with PD and age-matched HC were examined over a one-year-interval with a tapping test performed with customized smartphone app. Tapping speed (taps/s), inter-tap intervals and variability (movement regularity), and sequence effect were measured. RESULTS We included 295 PD patients and 62 HC. At baseline, PD subjects showed higher inter-tap variability than HC (coefficient-of-variation-CV, 37 ms [22-64] vs 26 ms [8-51]) (p = 0.007). Conversely, there was no difference in inter-tap intervals (411 ms [199-593] in PD versus 478 ms [243-618] in HC) and tapping speed (3.42[2.70-4.76] taps/s in PD versus 3.21 taps/s [2.57-4.54] in HC) (p > 0.05). Only PD subjects (n = 135), at the one-year follow-up, showed a decreased tapping speed vs baseline (3.44 taps/s [2.86-4.81] versus 3.39 taps/s [2.58,4.30]) (p = 0.036), without significant changes in inter-tap variability (CV, 32 ms [18,55] baseline versus 34 ms [22,59] follow-up) (p = 0.142). No changes were found in HC at the one-year follow up (all p values>0.05). CONCLUSIONS Inter-tap variability (dysrhythmia) but no inter-tap intervals or tapping speed are reliably distinctive feature of an app-based bradykinesia assessment in PD.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Jesus Abanto
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Abhimanyu Mahajan
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Kevin R Duque
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Nathaly O Chinchihualpa Paredes
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Heba A Deraz
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA; Department of Neurology, Cairo University Hospitals, Cairo, Egypt.
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
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Mourits BMP, den Hartog SJ, de Graaf JA, Roozenbeek B, Post MWM, Visser-Meily JMA, Scholten EWM. Exploring patients' experience using PROMs within routine post-discharge follow-up assessment after stroke: a mixed methods approach. J Patient Rep Outcomes 2024; 8:46. [PMID: 38668901 PMCID: PMC11052975 DOI: 10.1186/s41687-024-00724-w] [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: 11/20/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Patient Reported Outcomes Measures (PROMs) are being used increasingly to measure health problems in stroke clinical practice. However, the implementation of these PROMs in routine stroke care is still in its infancy. To understand the value of PROMs used in ischemic stroke care, we explored the patients' experience with PROMs and with the consultation at routine post-discharge follow-up after stroke. METHODS In this prospective mixed methods study, patients with ischemic stroke completed an evaluation questionnaire about the use of PROMs and about their consultation in two Dutch hospitals. Additionally, telephone interviews were held to gain in-depth information about their experience with PROMs. RESULTS In total, 63 patients completed the evaluation questionnaire of which 10 patients were also interviewed. Most patients (82.2-96.6%) found completing the PROMs to be feasible and relevant. Half the patients (49.2-51.6%) considered the PROMs useful for the consultation and most patients (87.3-96.8%) reported the consultation as a positive experience. Completing the PROMs provided 51.6% of the patients with insight into their stroke-related problems. Almost 75% of the patients found the PROMs useful in giving the healthcare provider greater insight, and 60% reported discussing the PROM results during the consultation. Interviewed patients reported the added value of PROMs, particularly when arranging further care, in gaining a broader insight into the problems, and in ensuring all important topics were discussed during the consultation. CONCLUSIONS Completing PROMs appears to be feasible for patients with stroke attending post-discharge consultation; the vast majority of patients experienced added value for themselves or the healthcare provider. We recommend that healthcare providers discuss the PROM results with their patients to improve the value of PROMs for the patient. This could also improve the willingness to complete PROMs in the future.
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Affiliation(s)
- B M P Mourits
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - S J den Hartog
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - B Roozenbeek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - E W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Yakubu AO, Olalude O, Salami M, Amuta AC, Amusa A, Salaudeen HA, Awoyemi AJ. Telemedicine and Neurology: A Survey of Neurology Patients in a Nigerian Tertiary Hospital. Cureus 2024; 16:e57916. [PMID: 38725763 PMCID: PMC11081517 DOI: 10.7759/cureus.57916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Background Telemedicine has been recognized as a viable solution for addressing the shortage of medical professionals in developing countries such as Nigeria. Tele-neurology has the potential to provide remote consultations and care for patients with neurological conditions, thereby reducing the burden of travel and improving access to medical care. Despite its growing popularity, there is a lack of research on patient's views on this mode of care delivery in Nigeria. This study was conducted to investigate patient's perspectives on the use of tele-neurology in Nigeria. Methodology A descriptive cross-sectional study was conducted among 398 neurology patients at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. The data obtained were analyzed using descriptive statistics and a chi-square test using p < 0.05. Results Only 3% of our respondents had previously used telemedicine, with 78.1% of the respondents open to using telemedicine as a means of consultation. The disadvantages of telemedicine noted include limitations in assessing neurological status (94.7%), difficulty in explaining health conditions (84.4%), and lack of technical support (14.6%). The majority of respondents (96.5%) believed telemedicine will help in saving time. There was a statistically significant association between propensity to use telemedicine and time spent in the hospital (0.045) and time off work (<0.001). The propensity to use telemedicine was statistically significant to the use of email (0.001) and type of email address (0.001). Conclusion The findings suggested that there is a need for healthcare providers and policymakers to invest in developing telemedicine to improve access to care.
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Affiliation(s)
- Aliu O Yakubu
- Department of Old Age Psychiatry, University Hospital Wishaw NHS Trust, Wishaw, GBR
| | - Oluwakemi Olalude
- Department of Internal Medicine, Lagos State University Teaching Hospital, Lagos, NGA
| | - Mayowa Salami
- Department of Paediatrics, Princess Royal Maternity Hospital NHS Trust, Glasgow, GBR
| | - Augustine C Amuta
- Department of Health and Wellness, Prince George's County Health Department, Upper Marlboro, USA
| | - Abeedat Amusa
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
| | - Hasanat A Salaudeen
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
| | - Ayodeji J Awoyemi
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
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Prater AR, McConnell JT, Yedulla NR, Peterson EL, Banka TR, Day CS. The Impact of Experience Versus Decision Aids on Patient Preference Toward Virtual Care. TELEMEDICINE REPORTS 2024; 5:59-66. [PMID: 38558954 PMCID: PMC10979688 DOI: 10.1089/tmr.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
Introduction Virtual care utilization has increased in recent years bringing questions of how to best inform patients regarding their use. Decision aids (DAs) are tools created to assist patients in making informed decisions about their health care. This study seeks to determine whether a DA or previous experience could better educate and influence patient's preference on virtual care. Methods One hundred fifty participants from an orthopedic clinic of a multi-hospital system were divided into three groups. Group 1 (Virtual Care Cohort) had at least one previous virtual care visit and was surveyed with the Telemedicine Satisfaction Questionnaire (TSQ). Group 2 (In-person with Decision Aid) and Group 3 (In-person without Decision Aid) had no virtual care experience. Group 2 received a validated virtual care DA with a knowledge test. Both groups were also administered the TSQ. Results After the DA, patients improved their score on 3 of 4 virtual care knowledge questions. Each cohort demonstrated a positive perception of virtual care; however, the specific reasons for their favorable views varied. The DA cohort did not show increased preference toward virtual care compared with the non-DA group and only responded significantly higher regarding encounter comfort. Patients with previous experience in virtual care responded most favorably to the majority of survey questions regarding their virtual care preferences when compared with both virtual care naive cohorts. Discussion and Conclusion We found that patient experience was the most important factor in influencing patient preference toward virtual care. Although the DA increased their virtual care knowledge it did not increase their preference; therefore, efforts should be placed at encouraging patient to experience virtual care.
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Affiliation(s)
- Aaron R. Prater
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jack T. McConnell
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nikhil R. Yedulla
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Trevor R. Banka
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Charles S. Day
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
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Accorsi TAD, dos Santos GGR, Nemoto RP, Moreira FT, De Amicis K, Köhler KF, Cordioli E, Pedrotti CHS. Telemedicine and patients with heart failure: evidence and unresolved issues. EINSTEIN-SAO PAULO 2024; 22:eRW0393. [PMID: 38451690 PMCID: PMC10948100 DOI: 10.31744/einstein_journal/2024rw0393] [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: 11/24/2022] [Accepted: 10/26/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.
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Affiliation(s)
| | | | - Renato Paladino Nemoto
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karine De Amicis
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karen Francine Köhler
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Özden F, Özkeskin M, Ekici E, Tümtürk İ, Ekmekci Ö, Yüceyar N. Opinions, satisfaction and expectations of individuals with multiple sclerosis about telerehabilitation services. Clin Neurol Neurosurg 2024; 237:108162. [PMID: 38325037 DOI: 10.1016/j.clineuro.2024.108162] [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: 07/06/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The opinions, satisfaction, and expectations of telemedicine can provide essential data for remote health services in individuals with Multiple Sclerosis (MS). The study aimed to demonstrate the views (barriers-benefits), satisfaction, and expectations of individuals with MS about telerehabilitation services. METHODS A prospective cross-sectional was conducted with 82 individuals with MS who received telerehabilitation services for at least one year. The participants have completed SymptoMScreen, Beck Depression Inventory (BDI), Telehealth Usability Questionnaire (TUQ), Telemedicine Satisfaction Questionnaire (TSQ), Telehealth Barriers Questionnaire (TBaQ and Telehealth Benefits Questionnaire (TBeQ). RESULTS As the age of individuals with MS increased, TUQ (r: -0.517, p < 0.001) and TBeQ (r: -0.383, p < 0.001) decreased, while TSQ (r: 0.405, p < 0.001) and TBaQ (r: 0.390, p < 0.001) increased. SymptoMScreen score (r: -0.288, p < 0.05) was weakly associated with TUQ. In addition, TUQ, TSQ, TBeQ, and TBaQ were strongly correlated (p < 0.001). CONCLUSION In order to improve usability and satisfaction in telerehabilitation services, the age, symptom severity, and education levels of individuals with MS should be considered. Telehealth methods with high usability should be preferred to increase patient satisfaction.
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Affiliation(s)
- Fatih Özden
- Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla, Turkey.
| | - Mehmet Özkeskin
- Ege University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, İzmir, Turkey.
| | - Ece Ekici
- Toros University, School of Health Sciences, Department of Physiotherapy and Rehabilitation, Mersin, Turkey
| | - İsmet Tümtürk
- Süleyman Demirel University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Isparta, Turkey
| | - Özgül Ekmekci
- Ege University, Faculty of Medicine, Department of Neurology, İzmir, Turkey
| | - Nur Yüceyar
- Ege University, Faculty of Medicine, Department of Neurology, İzmir, Turkey
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Oliveira NKD, Santos LHCGD, Reis GCD, Pereira ND. Reliability and validity of remote Life Space Assessment: LSA in persons with chronic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-6. [PMID: 38325388 PMCID: PMC10849820 DOI: 10.1055/s-0044-1779297] [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: 06/07/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND StepWatch Activity Monitor (SAM) is used to measure the mobility of chronic hemiparetic patients and the Life Space Assessment (LSA) scale was developed to assess the displacement of hemiparetic patients in different contexts through self-reporting. Studies that apply the LSA remotely and correlate it with the number of steps measured by the SAM were not found. OBJECTIVE To evaluate the measurement properties of the LSA applied remotely and to evaluate the correlation between the LSA scale score and the number of steps measured by the SAM in post-stroke chronic hemiparetic patients. METHODS Nineteen patients participated in the study. The LSA scale was applied remotely and later, face to face. The SAM measured the steps taken by the participants over a period of three consecutive days. The correlation between the LSA and the SAM was performed using Pearson's correlation. The measurement properties calculated of remote LSA were the intraclass correlation coefficient (ICC), Cronbrach's alpha, standard error of measurement (SEM), and smallest real difference (SRD). RESULTS The reproducibility of the LSA scale between remote and face-to-face applications was considered excellent with ICC = 0.85 (IC 95% 0.62-0.94); SEM = 8.4; SRD = 23.2, and Cronbach's alpha = 0.85. The correlation between SAM and LSA was positive, considered moderate (r = 0.51) and significant (p = 0.025). CONCLUSION The LSA is a reproducible measure for post-stroke chronic hemiparetic patients even if applied remotely and can be used as a remote measurement for mobility in a real-world environment for people with chronic hemiparesis after stroke.
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Barboza NM, Laskovski L, Volpe RP, Silva TCOD, Pereira LA, Silva PGBD, Smaili SM. Perceptions of individuals with Parkinson's disease about a telerehabilitation protocol performed during the COVID-19 pandemic: a qualitative study. Disabil Rehabil 2024:1-10. [PMID: 38264886 DOI: 10.1080/09638288.2024.2305687] [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: 08/18/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE To understand the perceptions and meaning of the experience of individuals with Parkinson's disease (PD) when participating in a telerehabilitation protocol during COVID-19 pandemic. METHODS This is a qualitative descriptive analytical study with a phenomenological basis, regarding the individuals' perceptions of telerehabilitation. The interviews were conducted by a semi-structured interview guide and carried out via recorded phone calls, which were later transcribed, categorized, and analyzed based on the principles of phenomenology according to the propositions of Martins and Bicudo. RESULTS From the qualitative analysis, four themes that configure the structure of the phenomenon emerged: 1) Expectations regarding physical therapy through telerehabilitation during the pandemic; 2) Experiences of the new routine; 3) Perceptions about oneself in the light of the proposed telerehabilitation program; 4) A view of the protocol. CONCLUSION Apprehension and fear were present during the implementation of the protocol, however, previous experience with face-to-face physical therapy and the team allowed feelings of happiness, contentment, welcomeness, and satisfaction with the possibility of resuming the activities. The individuals actively participated in the program with commitment and co-responsibility, but the lack of physical contact, limited equipment, and constant concern for the safety and individuality of the participants must be emphasized.
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Affiliation(s)
- Natália Mariano Barboza
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Larissa Laskovski
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Renata Pasquarelli Volpe
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Taís Caroline Oliveira da Silva
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Larissa Alessandra Pereira
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Patrícia Gonçalves Broto da Silva
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
| | - Suhaila Mahmoud Smaili
- Neurofunctional Physical Therapy Research Group (GPFIN), Postgraduate Program in Rehabilitation Sciences, State University of Londrina, Paraná, Brazil
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Stanton B, Chalder T, Carvalho C. Cognitive behavioural therapy for neurologists. Pract Neurol 2024; 24:22-27. [PMID: 37932039 DOI: 10.1136/pn-2023-003857] [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] [Accepted: 09/27/2023] [Indexed: 11/08/2023]
Abstract
In neurological practice, we take pride in accurate diagnosis and using neuroscience to develop novel disease-modifying therapies, but we sometimes neglect symptom management and the treatment of distress. Most patients with neurological disorders report that their mental health needs are not being met. Of the many forms of psychological therapy, cognitive behavioural therapy (CBT) is the most likely to be available to our patients. This article sets out to answer the following questions: (1) What is CBT? (2) What will patients experience if they have CBT? (3) Is CBT effective for people with neurological disorders? (4) Who is most suitable for CBT? (5) How and where can a neurologist refer their patients for CBT? (6) Can we as neurologists use aspects of the CBT model in our own consultations?
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Affiliation(s)
- Biba Stanton
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London, London, UK
| | - Carolina Carvalho
- Department of Psychological Medicine, King's College London, London, UK
- School of Psychology, University of Surrey, Guildford, UK
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12
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Sivertseva SA, Anfilofeva KS, Zotova AV, Kazantsev VA, Belkina AY, Volkova LI, Guseva ME, Boyko AN. [The effectiveness of tele-rehabilitation for patients with multiple sclerosis during the COVID-19 pandemic in 2020-2021 was evaluated in this study]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:75-81. [PMID: 38529866 DOI: 10.17116/jnevro202412403175] [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] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of telerehabilitation (TELEREBT) of patients with multiple sclerosis (MS) in the context of the coronavirus pandemic 2020-2021. MATERIAL AND METHODS The study included 37 patients with MS who underwent a course of teleRBT. The course included 10 classes of 60 minutes for 10 days with a two-day break. Various questionnaires and scales were used to assess the effectiveness, as well as an assessment of the neurological status. RESULTS 19 patients refused to participate in the program. The level of disability on the EDSS scale decreased from 4.86±1.19 at the initial level to 4.73±1.12 after the course of teleRBT, while no statistically significant changes were found. CONCLUSION TeleRPT in patients can be an effective way to correct existing disorders. Further research is required to establish the effectiveness of teleRBT.
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Affiliation(s)
- S A Sivertseva
- Tyumen Regional Center for Multiple Sclerosis - AO MSCH «Neftyanik», Tyumen, Russia
- Ural State Medical University, Ekaterinburg, Russia
| | - K S Anfilofeva
- Tyumen Regional Center for Multiple Sclerosis - AO MSCH «Neftyanik», Tyumen, Russia
| | - A V Zotova
- Tyumen Regional Center for Multiple Sclerosis - AO MSCH «Neftyanik», Tyumen, Russia
| | - V A Kazantsev
- Tyumen Regional Center for Multiple Sclerosis - AO MSCH «Neftyanik», Tyumen, Russia
- Ural State Medical University, Ekaterinburg, Russia
| | - A Yu Belkina
- Ural State Medical University, Ekaterinburg, Russia
- LLC «Brain Institute Clinic», Ekaterinburg, Russia
| | - L I Volkova
- Ural State Medical University, Ekaterinburg, Russia
| | - M E Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
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13
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Dombrowski W, Mims A, Kremer I, Cano Desandes P, Rodrigo-Herrero S, Epps F, Snow T, Gutierrez M, Nasta A, Epperly MB, Manaloto K, Hansen JC. Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community. J Alzheimers Dis 2024; 100:87-117. [PMID: 38848182 PMCID: PMC11307099 DOI: 10.3233/jad-231491] [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] [Accepted: 04/25/2024] [Indexed: 06/09/2024]
Abstract
Background Globally, much work has been done by nonprofit, private, and academic groups to develop best practices for the care of people living with dementia (PLWD), including Alzheimer's disease. However, these best practices reside in disparate repositories and tend to focus on one phase of the patient journey or one relevant group. Objective To fill this gap, we developed a Dementia Ideal Care Map that everyone in the dementia ecosystem can use as an actionable tool for awareness, policy development, funding, research, training, service delivery, and technology design. The intended audience includes (and not limited to) policymakers, academia, industry, technology developers, health system leaders, clinicians, social service providers, patient advocates, PLWD, their families, and communities at large. Methods A search was conducted for published dementia care best practices and quality measures, which were then summarized in a visual diagram. The draft diagram was analyzed to identify barriers to ideal care. Then, additional processes, services, technologies, and quality measures to overcome those challenges were brainstormed. Feedback was then obtained from experts. Results The Dementia Ideal Care Map summarizes the ecosystem of over 200 best practices, nearly 100 technology enablers, other infrastructure, and enhanced care pathways in one comprehensive diagram. It includes psychosocial interventions, care partner support, community-based organizations; awareness, risk reduction; initial detection, diagnosis, ongoing medical care; governments, payers, health systems, businesses, data, research, and training. Conclusions Dementia Ideal Care Map is a practical tool for planning and coordinating dementia care. This visualized ecosystem approach can be applied to other conditions.
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Affiliation(s)
- Wen Dombrowski
- CATALAIZE, Chicago, IL, USA
- USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Adrienne Mims
- Rainmakers Strategic Solutions, Atlanta, GA, USA
- National Committee for Quality Assurance – NCQA, Washington, DC, USA
- NAPA Advisory Council, Washington, DC, USA
| | - Ian Kremer
- Leaders Engaged on Alzheimer’s Disease – LEAD Coalition, Washington, DC, USA
| | - Pedro Cano Desandes
- Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí – I3PT-CERCA, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Silvia Rodrigo-Herrero
- Memory Unit, Department of Neurology, Juan Ramon Jimenez University Hospital, Huelva, Spain
| | - Fayron Epps
- School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA
| | - Teepa Snow
- Positive Approach, LLC, Efland, NC, USA
- Snow Approach, Inc., Hillsborough, NC, USA
| | | | - Anil Nasta
- Roche Diagnostics Corporation, Indianapolis, IN, USA
| | | | - Katrina Manaloto
- Neurotech Collider Lab, University of California, Berkeley, Berkeley, CA, USA
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14
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Pinto C, Figueiredo C, Mabilia V, Cruz T, Jeffrey ER, Pagnussat AS. A Safe and Feasible Online Dance Intervention for Older Adults With and Without Parkinson's Disease. J Dance Med Sci 2023; 27:253-267. [PMID: 37537758 DOI: 10.1177/1089313x231186201] [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] [Indexed: 08/05/2023]
Abstract
Introduction: Dancing is one way of maintaining an active lifestyle, and online dance interventions in group settings can be a solution when in-person classes are impossible. This study investigated the feasibility and potential clinical effects of an online dance program for older adults with and without Parkinson disease (PD). Methods: Participants attended 2 weekly dance classes in the same videoconference room for 2 months. The dance activities were mainly performed while seated (around 75%). Researchers monitored feasibility (ie, adherence, attendance, and technological barriers) and safety. Pre- and post-intervention assessments investigated self-perceptions, effects on emotional domains, quality of life, activity-specific balance confidence, lower-limb functional mobility, and PD non-motor symptoms. Individuals also reported their self-perceptions regarding technology usability, enjoyment, and social interaction. Results: Most of the participants with PD (n = 12) had moderate PD (Hoehn & Yahr score) and presented a greater risk of falls when compared to participants without PD (n = 14). Overall, we found a high rate of adherence (100%), attendance (87.5%-91.7%), and safety (100%) for both groups. No falls or near-falls occurred during the sessions. Only the PD group ameliorated emotional domains (anxiety and depression) and improved lower-limb functional mobility. All participants reported feeling safe and perceived benefits, although over a third of older adults with PD reported moderate difficulties in using technology and in socializing with the group. Conclusion: This online dance protocol is feasible, safe, and a potential strategy to improve clinical parameters in older adults and people with moderate PD.
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Affiliation(s)
- Camila Pinto
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Caroline Figueiredo
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Vinicius Mabilia
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Thainara Cruz
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Aline Souza Pagnussat
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Department of Physical Therapy, Georgia State University (GSU), Atlanta, USA
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Conti L, Marzorati C, Grasso R, Ferrucci R, Priori A, Mameli F, Ruggiero F, Pravettoni G. Home-Based Treatment for Chronic Pain Combining Neuromodulation, Computer-Assisted Training, and Telemonitoring in Patients With Breast Cancer: Protocol for a Rehabilitative Study. JMIR Res Protoc 2023; 12:e49508. [PMID: 37971805 PMCID: PMC10690524 DOI: 10.2196/49508] [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: 05/31/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Chronic pain is a disabling symptom frequently reported in patients with breast cancer with a prevalence ranging from 25% to 60%, representing a major health issue. It has negative consequences on health status, causing psychological distress and affecting quality of life. Furthermore, the clinical management of chronic pain is often inadequate, and many patients do not benefit from the administration of pharmacological treatments. Alternative therapeutic options have been implemented to improve the psychophysical well-being of patients, including neuromodulation and complementary interventions. OBJECTIVE We aimed to investigate the effectiveness of a home care strategy combining computerized rehabilitation, transcranial direct current stimulation (tDCS), and remote telemonitoring via a web-based platform in patients with breast cancer suffering for chronic pain. METHODS A web-based structured survey aimed at monitoring chronic pain and its effect on psychological functions will be delivered to patients with breast cancer through social media and email. In total, 42 patients with breast cancer affected by chronic pain will be recruited during the medical screening visit. The patients will be randomly divided into 3 treatment groups that will carry out either tDCS only, exercise therapy only, or a combination of both over a 3-week period. All the treatments will be delivered at the patients' home through the use of a system including a tablet, wearable inertial sensors, and a tDCS programmable medical device. Using web-based questionnaires, the perception of pain (based on the pain self-efficacy questionnaire, visual analogue scale, pain catastrophizing scale, and brief pain inventory) and psychological variables (based on the hospital and anxiety depression scale and 12-item short form survey) will be assessed at the beginning of treatment, 1 week after the start of treatment, at the end of treatment, 1 month after the start of treatment, and 3 months after the start of treatment. The system's usability (based on the mobile app rating scale and system usability scale) and its involvement in the decision-making process (based on the 9-item shared decision-making questionnaire) will be also evaluated. Finally, at the end of the treatment, a digital focus group will be conducted with the 42 patients to explore their unexpressed needs and preferences concerning treatment. RESULTS The study project is scheduled to start in June 2023, and it is expected to be completed by August 2025. CONCLUSIONS We expect that the combination of tDCS and telemedicine programs will reduce pain perceived by patients with breast cancer and improve their mental well-being more effectively than single interventions. Furthermore, we assume that this home-based approach will also improve patients' participation in routine clinical care, reducing disparities in accessing health care processes. This integrated home care strategy could be useful for patients with breast cancer who cannot find relief from chronic pain with pharmacological treatments or for those who have limited access to care due to poor mobility or geographical barriers, thus increasing the patients' empowerment and reducing health care costs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49508.
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Affiliation(s)
- Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberta Ferrucci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- ASST Santi Paolo e Carlo San Paolo University Hospital, Milan, Italy
- Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Mameli
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Ruggiero
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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16
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Al-Faraj A, Ukonu N, Mohtar O, Jha V, Chen DT, Vincent Lau KH. Telemedicine in Neurology: Challenges and Opportunities. RESEARCH SQUARE 2023:rs.3.rs-3470381. [PMID: 37961526 PMCID: PMC10635366 DOI: 10.21203/rs.3.rs-3470381/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objective Our objective is to explore challenges encountered by neurologists with the use of telemedicine in neurology. Methods A cross- sectional study via an anonymous survey to explore neurologists' experiences with telemedicine. They survey was sent to randomly selected 200 participants from Academic Institutions in the United States. Descriptive statistics were reported as percentages for each survey question. Results 110 neurologists completed the survey. Fifty-one percent of neurologists stated that they experienced technological issues in (1%-20%) of telemedicine visits and 57% of neurologists needed technological assistance from informational technology support. With regards to the impact of limited neurological examination via telemedicine, 34% of neurologists agreed that the limited examination makes them worried that they are providing a suboptimal care to patients and 55% recommended a subsequent in-person visit (in 1%-20% of telemedicine visits) for further evaluation. Among the challenges that hindered patients' ability to participate in telemedicine visits, 95% of neurologists rated patients' technological challenges with setting up telemedicine to be the most common issue encountered, 37% of neurologists rated patient's cognitive/mental disability to be the second most common challenge to complete telemedicine visits as well as availability of interpreter services for non-English speaking patients. Neurologists rated improving administrative support (39%), integration of EMR for video and telephone calls (37%), and sufficient time allotment to complete telemedicine visits (27%) to be the most important issues to address to optimize the use of telemedicine in neurology. Significance Potential opportunities to improve neurologists' experiences in telemedicine include improving technological support, integration of virtual platforms within the EMR, and adequate administrative support. Patients with cognitive/physical disabilities may need additional support to engage in the health system via telemedicine.
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Affiliation(s)
- Abrar Al-Faraj
- Boston University Chobanian & Avedisian School of Medicine
| | - Nene Ukonu
- Boston university School of Public Health
| | | | | | - Dickson T Chen
- Boston University Chobanian & Avedisian School of Medicine
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17
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Leavy B, Sedhed J, Kalbe E, Åkesson E, Franzén E, Johansson H. Design of the STEPS trial: a phase II randomized controlled trial evaluating eHealth-supported motor-cognitive home training for Parkinson's disease. BMC Neurol 2023; 23:356. [PMID: 37794320 PMCID: PMC10548709 DOI: 10.1186/s12883-023-03389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Electronic health (eHealth) technology offers the potential to support and motivate physical activity for symptom management in Parkinson's disease (PD). It is also recommended that motor exercise in PD be complemented with cognitive training aimed at attentional or executive functions. This paper describes the protocol for a double-blind randomized controlled trial to evaluate the effects of motor-cognitive training in the home environment, supported by eHealth. METHODS/DESIGN The Support for home Training using Ehealth in Parkinsons diseaSe (STEPS) is a double-blind single center randomized controlled trial. Two parallel groups will include in total 120 participants with mild to moderate PD who will receive either (i) the intervention (a progressive 10-week individualized motor-cognitive eHealth training with cognitive behavioral elements to increase physical activity levels) or (ii) an active control group (an individualized 10-week paper-based home exercise program). The active control group will not receive motor-cognitive exercises or cognitive behavioral approaches to increase physical activity level. The primary outcome is walking capacity assessed by the six-minute walk test (6MWT). Secondary outcomes will include gait performance during single and dual task conditions, gait speed, functional mobility and lower limb strength, balance, physical activity behavior and a range of patient reported outcome measures relevant in PD. DISCUSSION The STEPS trial will answer the question whether 10 weeks of eHealth supported motor-cognitive exercise in the home environment can improve walking capacity in PD when compared to a standard paper exercise program. Findings from this study will also strengthen the evidence concerning the efficacy of PD-specific eHealth interventions with a view meeting future health care demands by addressing issues of inaccessibility to specialized neurological rehabilitation in PD. TRIAL REGISTRATION ClinicalTrials.gov August 2022, NCT05510739.
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Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden.
| | - Jenny Sedhed
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elisabet Åkesson
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
- Theme Womens Health and Allied Health Professionals, Medical unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Research and development unit, Stockholm, Sweden
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Montemurro S, Mondini S, Pucci V, Durante G, Riccardi A, Maffezzini S, Scialpi G, Signorini M, Arcara G. Tele-Global Examination of Mental State (Tele-GEMS): an open tool for the remote neuropsychological screening. Neurol Sci 2023; 44:3499-3508. [PMID: 37248426 PMCID: PMC10226870 DOI: 10.1007/s10072-023-06862-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
Tele-neuropsychology, i.e., the application of remote audio-visual technologies to neuropsychological evaluation or rehabilitation, has become increasingly popular and widespread during and after the COVID-19 pandemic. New tools with updated normative data and appropriate methodological developments are necessary. We present Tele-GEMS, a telephone-based cognitive screening developed on N = 601 Italian participants. It yields a global score tapping on orientation, memory, spatial representation, language, and pragmatic abilities. Its administration lasts about 10 min. Clinical cut-offs are provided, accounting for demographic variables (age, education, and sex) and also for a comprehensive index taking into account cognitively stimulating life experiences that can build up a cognitive reserve. Tele-GEMS shows good internal consistency and a good inter-rater agreement. The test includes the thresholds for estimating a significant change after repeated measurements. Tele-GEMS has a good construct validity as assessed with MoCA and a suitable criterion validity assessed with its in-person version (GEMS). All the materials and the instructions, including scripts and an online Application for the automatic calculation of cut-offs, are accessible on OSF at https://osf.io/t3bma/ under a Creative Commons license.
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Affiliation(s)
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
- Centro di Ateneo Servizi Clinici Universitari Psicologici (SCUP), Università di Padova, Padova, Italy
- Human Inspired Technology Research Centre HIT, University of Padova, Padova, Italy
| | - Veronica Pucci
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
- Human Inspired Technology Research Centre HIT, University of Padova, Padova, Italy
| | - Giorgia Durante
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
| | - Alice Riccardi
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
| | - Sabrina Maffezzini
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
| | - Graziana Scialpi
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
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Perron AE, Garg H, Gallagher S, Kennedy B, Oxborough S, Schultz E, Thielman G, Zhang Q. Addressing Opportunities and Barriers in Telehealth Neurologic Physical Therapy: Strategies to Advance Practice. J Neurol Phys Ther 2023; 47:227-237. [PMID: 37725807 DOI: 10.1097/npt.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND PURPOSE Since the COVID-19 pandemic, the use and implementation of telehealth has expanded, with implementation moving ahead of best practice recommendations due to necessity. Telehealth has improved access and care coordination for patients with various neurologic conditions; however, information regarding therapeutic intensity, safety, and appropriateness is lacking. In 2021, the Academy of Neurologic Physical Therapy formed a Telehealth Taskforce to provide clinical and educational resources for its members and the neurologic physical therapy (PT) community. The purpose of this special interest article is to provide consensus-driven best practice resources developed by the Taskforce and describe the process of creating these resources to assist with telehealth implementation in neurologic PT practice, advocate for continued utilization, and shine light on opportunities for future research. SUMMARY OF KEY POINTS In this special interest article, we describe the process, challenges, and opportunities of developing and disseminating resources to educate, train, and support telehealth implementation in neurologic clinical practice. Four key strategies to facilitate telehealth implementation emerged: (1) increase knowledge of resources related to telehealth and mobile applications; (2) develop and disseminate evidence-based and consensus-based best practice recommendations for telehealth in neurologic PT; (3) provide future recommendations for integrating telehealth in PT, education, research, and clinical practice; and (4) encourage advocacy for inclusion of telehealth within the PT community. We explain the need to continue research and provide recommendations to expand telehealth research in neurologic clinical practice. RECOMMENDATIONS FOR CLINICAL PRACTICE This article highlights the potential and future of telehealth in neurologic PT practice. Our recommendations provide current clinical tools and resources for telehealth implementation following a knowledge-to-action framework and suggest areas for future research.Video Abstract available for more insights from the authors (see the Video, the Supplemental Digital Content, available at: http://links.lww.com/JNPT/A447).
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Affiliation(s)
- Aimee E Perron
- Massachusetts General Hospital Institute of Health Professions, Boston, and Genesis Rehabilitation Services, Andover, Massachusetts (A.E.P.); Office of Research and Sponsored Projects, Rocky Mountain University of Health Professions, Provo, Utah (H.G.); South Valley Physical Therapy, Denver, Colorado (S.G.); St Francis University, Loretto, Pennsylvania (B.K.); M Health Fairview Minneapolis, Minnesota (S.O.); Re+active Physical Therapy and Wellness, Los Angeles, California (E.S.); St Joseph's University, Philadelphia, Pennsylvania (G.T.); and Hawaii Pacific University, Honolulu, Hawaii (Q.Z.)
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20
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Fernández-Lago H, Climent-Sanz C, Bravo C, Bosch-Barceló P, Masbernat-Almenara M, Sanjuan-Sánchez D, Briones-Vozmediano E. Physiotherapists' experiences on assisting physiotherapy users during the COVID-19 pandemic with lockdown measures in Spain. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2015. [PMID: 37203867 DOI: 10.1002/pri.2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/28/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Physiotherapists had faced a new healthcare scenario characterised by the restrictions caused by the COVID-19 pandemic. PURPOSE To explore the impact of the COVID-19 pandemic on the physiotherapy profession from the perspective of physiotherapists working in the public and private sectors. METHODS Qualitative study based on semi-structured personal interviews with 16 physiotherapists working in public, private, or public-private partnership sectors in Spain. The data were collected between March and June 2020. Inductive qualitative content analysis was performed. RESULTS The participants (13 women, 3 men; aged 24-44 years) had professional experience in diverse healthcare settings (primary, hospital, home, consultations, insurance companies, associations). Five categories were identified: (1) the impact of lockdown on the health of physiotherapy users; (2) managing the demand for physiotherapy services during lockdown; (3) introducing protocols and protective measures in physiotherapy consultations; (4) changes in therapeutic approaches; and (5) future expectations in the physiotherapy care model. Physiotherapists perceived that lockdown caused a decline in the functionality of people with chronic conditions, together with a reduction in the physiotherapy services. Difficulties in prioritising users considered urgent became evident, and the inclusion of prophylactic measures affected treatment duration differently depending on the care setting and the pandemic prompted the use of telerehabilitation. DISCUSSION The pandemic affected the functional status of chronic physiotherapy users and made treatment time, quality of care and triage protocols visible. In physiotherapy, technological barriers need to be solved, such as digital literacy, families without resources, situations of dependency and cultural barriers.
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Affiliation(s)
- Helena Fernández-Lago
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
| | - Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
| | - Cristina Bravo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
| | - Pere Bosch-Barceló
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
| | - María Masbernat-Almenara
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
| | | | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
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Judica E, Tropea P, Bouça-Machado R, Marín M, Calarota E, Cozma L, Badea R, Ahmed M, Brach M, Ferreira JJ, Corbo M. Personalized Integrated Care Promoting Quality of Life for Older People: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47916. [PMID: 37486732 PMCID: PMC10407767 DOI: 10.2196/47916] [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: 04/06/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Alzheimer disease (AD) and Parkinson disease (PD) are the 2 most common neurodegenerative diseases affecting millions of people worldwide. The Personalized Integrated Care Promoting Quality of Life for Older People (PC4L) project proposes an integrated, scalable, and interactive care ecosystem that can be easily adapted to the needs of several neurodegenerative and chronic diseases, care institutions, and end user requirements. OBJECTIVE The study protocol developed within the framework of the PC4L project aims to iteratively test the integrated platform and its modules, and focuses primarily on assessing the impact of the proposed solution (ie, the PC4L platform) on patients' quality of life, as well as its usability and feasibility on a large-scale sample size in 3 different scenarios (home, neurorehabilitation, and day care centers). METHODS A prospective multicenter clinical study is conducted in 5 European countries (Germany, Italy, Portugal, Romania, and Spain) at 6 different pilot centers, for 3 months, in patients with PD, Parkinsonism, AD, and other dementias (ODs). Patients were randomized in a ratio of 1:1 to the intervention group (use of the PC4L system) or the control group (no intervention). The PC4L system consists mainly of a wristband for monitoring parameters such as steps and levels of physical activity, and the PC4L app, which includes different engaging functionalities. Both groups are assessed through baseline and end-of-study clinical evaluations, including assessment of quality of life through the EQ-5D-3L scale. RESULTS The study protocol is part of a project approved and funded by the European Commission Horizon 2020 (grant agreement number 875221). The ethics committees of all involved centers reviewed and approved the study protocol. The study began with the recruitment phase in September 2022, and enrollment ended in February 2023. Recruitment is now closed (April 2023). The results of this study are expected to be published in summer 2023. A total of 558 patients, 279 per study group, were recruited. The results will allow to clarify the impact of PC4L on quality of life, will assess the empowerment of patients and the medical resources use, as well as the usability of the final version of the PC4L system. It will also provide information on the support of the system as a tool to facilitate the decision-making process. CONCLUSIONS The PC4L project intends to test a technology-based, integrated, scalable, and interactive care platform on patients with neurodegenerative diseases and proposes a good coordinated care model between all involved actors. Future developments of the PC4L solution may involve caregivers and socio-health professionals in the decision-making process in order to facilitate efficient communication between all stakeholders and ensure reliable and protected access to data within Europe. TRIAL REGISTRATION ClinicalTrials.gov NCT05538455; https://clinicaltrials.gov/study/NCT05538455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47916.
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Affiliation(s)
- Elda Judica
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Peppino Tropea
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | | | | | - Elisa Calarota
- Wohlfahrtswerk für Baden-Wurttemburg, Stuttgart, Germany
| | - Liviu Cozma
- University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Badea
- University and Emergency Hospital of Bucharest, Bucharest, Romania
| | - Mona Ahmed
- Institute of Sport and Exercise Sciences, Münster University, Münster, Germany
| | - Michael Brach
- Institute of Sport and Exercise Sciences, Münster University, Münster, Germany
| | | | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
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22
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Fortunato F, Bianchi F, Ricci G, Torri F, Gualandi F, Neri M, Farnè M, Giannini F, Malandrini A, Volpi N, Lopergolo D, Silani V, Ticozzi N, Verde F, Pareyson D, Fenu S, Bonanno S, Nigro V, Peduto C, D'Ambrosio P, Zeuli R, Zanobio M, Picillo E, Servidei S, Primiano G, Sancricca C, Sciacco M, Brusa R, Filosto M, Cotti Piccinelli S, Pegoraro E, Mongini T, Solero L, Gadaleta G, Brusa C, Minetti C, Bruno C, Panicucci C, Sansone VA, Lunetta C, Zanolini A, Toscano A, Pugliese A, Nicocia G, Bertini E, Catteruccia M, Diodato D, Atalaia A, Evangelista T, Siciliano G, Ferlini A. Digital health and Clinical Patient Management System (CPMS) platform utility for data sharing of neuromuscular patients: the Italian EURO-NMD experience. Orphanet J Rare Dis 2023; 18:196. [PMID: 37480080 PMCID: PMC10360326 DOI: 10.1186/s13023-023-02776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 06/18/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The development of e-health technologies for teleconsultation and exchange of knowledge is one of the core purposes of European Reference Networks (ERNs), including the ERN EURO-NMD for rare neuromuscular diseases. Within ERNs, the Clinical Patient Management System (CPMS) is a web-based platform that seeks to boost active collaboration within and across the network, implementing data sharing. Through CPMS, it is possible to both discuss patient cases and to make patients' data available for registries and databases in a secure way. In this view, CPMS may be considered a sort of a temporary storage for patients' data and an effective tool for data sharing; it facilitates specialists' consultation since rare diseases (RDs) require multidisciplinary skills, specific, and outstanding clinical experience. Following European Union (EU) recommendation, and to promote the use of CPMS platform among EURO-NMD members, a twelve-month pilot project was set up to train the 15 Italian Health Care Providers (HCPs). In this paper, we report the structure, methods, and results of the teaching course, showing that tailored, ERN-oriented, training can significantly enhance the profitable use of the CPMS. RESULTS Throughout the training course, 45 professionals learned how to use the many features of the CPMS, eventually opening 98 panels of discussion-amounting to 82% of the total panels included in the EURO-NMD. Since clinical, genetic, diagnostic, and therapeutic data of patients can be securely stored within the platform, we also highlight the importance of this platform as an effective tool to discuss and share clinical cases, in order to ease both case solving and data storing. CONCLUSIONS In this paper, we discuss how similar course could help implementing the use of the platform, highlighting strengths and weaknesses of e-health for ERNs. The expected result is the creation of a "map" of neuromuscular patients across Europe that might be improved by a wider use of CPMS.
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Affiliation(s)
- Fernanda Fortunato
- Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Medical Genetics Unit, Department of Mother and Child, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Francesca Bianchi
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Francesca Torri
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Francesca Gualandi
- Medical Genetics Unit, Department of Mother and Child, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Marcella Neri
- Medical Genetics Unit, Department of Mother and Child, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Marianna Farnè
- Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Medical Genetics Unit, Department of Mother and Child, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Fabio Giannini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Alessandro Malandrini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Nila Volpi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Diego Lopergolo
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università Degli Studi Di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università Degli Studi Di Milano, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università Degli Studi Di Milano, Milan, Italy
| | - Davide Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Fenu
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Bonanno
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples, Italy
| | - Cristina Peduto
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Paola D'Ambrosio
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberta Zeuli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mariateresa Zanobio
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Esther Picillo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Serenella Servidei
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Sancricca
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Monica Sciacco
- Neuromuscular and Rare Disease Unit, Department of Neuroscience, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Brusa
- Neuromuscular and Rare Disease Unit, Department of Neuroscience, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- ASST Spedali Civili Di Brescia, Brescia, Italy
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- ASST Spedali Civili Di Brescia, Brescia, Italy
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Elena Pegoraro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Tiziana Mongini
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Luca Solero
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Giulio Gadaleta
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Chiara Brusa
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Carlo Minetti
- Pediatric Neurology Unit and Muscle Unit, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Valeria A Sansone
- The NEMO (NEuroMuscular Omniservice) Clinical Center, Milan, Italy
- Neurorehabilitation Unit, University of Milan, Milan, Italy
| | | | - Alice Zanolini
- The NEMO (NEuroMuscular Omniservice) Clinical Center, Milan, Italy
| | - Antonio Toscano
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- ERN-NMD Center of Messina, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessia Pugliese
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giulia Nicocia
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Daria Diodato
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Antonio Atalaia
- Service of Neuromyology, APHP-GH Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Teresinha Evangelista
- Neuromuscular Morphology Unit, Institute of Myology, GHU Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Alessandra Ferlini
- Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
- Medical Genetics Unit, Department of Mother and Child, Sant'Anna University Hospital of Ferrara, Ferrara, Italy.
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Asci F, Marsili L, Suppa A, Saggio G, Michetti E, Di Leo P, Patera M, Longo L, Ruoppolo G, Del Gado F, Tomaiuoli D, Costantini G. Acoustic analysis in stuttering: a machine-learning study. Front Neurol 2023; 14:1169707. [PMID: 37456655 PMCID: PMC10347393 DOI: 10.3389/fneur.2023.1169707] [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: 02/21/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Background Stuttering is a childhood-onset neurodevelopmental disorder affecting speech fluency. The diagnosis and clinical management of stuttering is currently based on perceptual examination and clinical scales. Standardized techniques for acoustic analysis have prompted promising results for the objective assessment of dysfluency in people with stuttering (PWS). Objective We assessed objectively and automatically voice in stuttering, through artificial intelligence (i.e., the support vector machine - SVM classifier). We also investigated the age-related changes affecting voice in stutterers, and verified the relevance of specific speech tasks for the objective and automatic assessment of stuttering. Methods Fifty-three PWS (20 children, 33 younger adults) and 71 age-/gender-matched controls (31 children, 40 younger adults) were recruited. Clinical data were assessed through clinical scales. The voluntary and sustained emission of a vowel and two sentences were recorded through smartphones. Audio samples were analyzed using a dedicated machine-learning algorithm, the SVM to compare PWS and controls, both children and younger adults. The receiver operating characteristic (ROC) curves were calculated for a description of the accuracy, for all comparisons. The likelihood ratio (LR), was calculated for each PWS during all speech tasks, for clinical-instrumental correlations, by using an artificial neural network (ANN). Results Acoustic analysis based on machine-learning algorithm objectively and automatically discriminated between the overall cohort of PWS and controls with high accuracy (88%). Also, physiologic ageing crucially influenced stuttering as demonstrated by the high accuracy (92%) of machine-learning analysis when classifying children and younger adults PWS. The diagnostic accuracies achieved by machine-learning analysis were comparable for each speech task. The significant clinical-instrumental correlations between LRs and clinical scales supported the biological plausibility of our findings. Conclusion Acoustic analysis based on artificial intelligence (SVM) represents a reliable tool for the objective and automatic recognition of stuttering and its relationship with physiologic ageing. The accuracy of the automatic classification is high and independent of the speech task. Machine-learning analysis would help clinicians in the objective diagnosis and clinical management of stuttering. The digital collection of audio samples here achieved through smartphones would promote the future application of the technique in a telemedicine context (home environment).
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Affiliation(s)
- Francesco Asci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Luca Marsili
- Department of Neurology, James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Italy
| | - Giovanni Saggio
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | | | - Pietro Di Leo
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Martina Patera
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lucia Longo
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Giovanni Costantini
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
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Lu M, Crooks RE, Pricop DF, Cox E, Anghelescu B, Hamilton M, Martino D, Bruno V, Josephson CB, Patten S, Smith EE, Roach P. Patient experiences of virtual care across specialist neuroscience and psychiatry clinics related to the second wave of the COVID-19 pandemic in Calgary, Alberta. HEALTH AND TECHNOLOGY 2023; 13:523-533. [PMID: 37303978 PMCID: PMC10152010 DOI: 10.1007/s12553-023-00754-2] [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: 02/06/2023] [Accepted: 04/25/2023] [Indexed: 06/13/2023]
Abstract
Purpose The emergence of the COVID-19 (SARS-CoV-2) pandemic has led to public health restrictions and a shift towards virtual care and telehealth. The aim of this study was to explore barriers and facilitators of virtual care from the perspective of neurological and psychiatric patients. Methods One-on-one interviews were conducted remotely using telephone and online video teleconferencing. There was a total of 57 participants, and a thematic content analysis was conducted using NVivo software. Results The two main themes were (1) virtual health service delivery and (2) virtual physician/patient interaction, with subthemes around how virtual care improved accessibility of care for patients and improved patient-centered care; how privacy and technical issues impact patients using virtual care; and the need for relationality and connection between health care providers and patients while using virtual care. Conclusions This study showed that virtual care can increase accessibility and efficiency for patients and providers, indicating its potential for ongoing use in the delivery of clinical care. Virtual care was found to be an acceptable mode of healthcare delivery from the perspective of patients; however, there is a continued need for relationship-building between care providers and patients.
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Affiliation(s)
- Michelle Lu
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1 AB Canada
| | - Rachel E. Crooks
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1 AB Canada
| | - Diana F. Pricop
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, T2N 2T9 AB Canada
| | - Emily Cox
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
| | - Beatrice Anghelescu
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
| | - Mark Hamilton
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Veronica Bruno
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Colin B. Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB 3D10, T2N 4Z6 Canada
| | - Scott Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, T2N 2T9 AB Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB 3D10, T2N 4Z6 Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1 AB Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB 3D10, T2N 4Z6 Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
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Wang J, Ren M, Wang H, Bai Z, Zeng K. Analysis of urgent inpatient neurologic consultations in a large tertiary hospital center: Follow-up on the effect of standardized training of residents. Brain Behav 2023; 13:e2983. [PMID: 36974339 PMCID: PMC10176006 DOI: 10.1002/brb3.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Clinical neurology is difficult for young residents. To familiarize with neurological emergencies as soon as possible for young doctors, the urgent inpatient neurologic consultations were analyzed. METHODS A retrospective study was conducted on the urgent inpatient neurologic consultations in a large tertiary hospital for 4 consecutive years. RESULTS A total of 1437 cases were included, and the annual consultation cases gradually decreased from 573 to 257, involving 29 clinical departments. The disorders of urgent inpatient neurologic consultations were divided into three categories: neurological disorders (77.8%), non-neurological disorders (10.4%), and undiagnosed disorders (11.8%), common causes in consultation were disturbance of consciousness (36.0%), convulsions/stiffness (13.6%), limb weakness (8%), and mental disorder (5.6%). Common neurological disorders included acute cerebrovascular disease (33.6%), epilepsy/status epilepticus (15.8%), and metabolic or infectious toxic encephalopathy (14.9%). CONCLUSION Urgent inpatient neurologic consultations involve multidisciplinary critical diseases, mainly neurological diseases. The standardized training of residents may help to rapidly improve the comprehensive diagnosis and treatment ability of young residents and is suitable for use in hospitals at all levels.
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Affiliation(s)
- Jiafang Wang
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyAffiliated Hospital of Chongqing Three Gorges Medical CollegeChongqingChina
| | - Min Ren
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Hong Wang
- Finance DepartmentFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zhenzhen Bai
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Kebin Zeng
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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26
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Brito SAFD, Scianni AA, Peniche PDC, Faria CDCDM. Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist. Clin Rehabil 2023; 37:415-435. [PMID: 36448251 DOI: 10.1177/02692155221129834] [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: 12/05/2022]
Abstract
OBJECTIVE To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. DESIGN Systematic review. SUBJECTS Individuals with neurological conditions. INTERVENTION Not applicable. MAIN MEASURES The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. RESULTS From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as "sufficient" in a study with appropriate methodological quality ("very good" or "adequate"). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. CONCLUSION The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. REGISTRATION NUMBER CRD42021257662.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula da Cruz Peniche
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Zhang Z, Liu F, Wong J, Xue K, Zhou M, Long J, Qu S, Li J, Yang Q, Wang Y. Reliability of Longshi scale with remote assessment of smartphone video calls for stroke patients' activities of daily living. J Stroke Cerebrovasc Dis 2023; 32:106950. [PMID: 36542891 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106950] [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: 09/05/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The impairment of activities of daily living (ADL) has brought a heavy burden to the life of patients after stroke. Timely and accurate assessment of patients' activities of daily living is very necessary, which determines the whole process of diagnosis, rehabilitation and prognosis of patients. However, the patients with limited mobility or transportation are difficulted to gain high quality assessment services. This study aimed to explore the reliability of remote Longshi Assessment Scale of Activities of Daily Life (Longshi Scale) with smartphone video calls by comparing the consistency of remote assessment and bedside assessment, as well as the test-retest reliability of the remote assessment. The evaluation duration of these two methods was recorded and the level of satisfaction of patients was investigated. METHODS In this prospective study, a total of 129 stroke survivors were recruited and accepted a bedside face-to-face assessment and a remote assessment by video calls. The Longshi Scale was used for both bedside and remote assessment and conducted with the inquiry between patients and evaluators. A satisfaction questionnaire was also launched. RESULTS The result of disability level evaluated from the bedside and remote assessments was highly consistent. The intraclass correlation coefficient with weighted kappa (wK) value was 0.86 (95% confidence interval, 0.80∼0.92). And test-retest of the remote assessment indicated an excellent agreement beyond chance, and its correlation coefficient with wK value was 0.96 (95% confidence interval, 0.92∼1.00). It took 74.44±55.3 s to complete the bedside assessment and 90.86±63.30 s to complete the remote assessment of Longshi Scale. There was no statistical significance in the assessment duration between these two methods (P = 0.056). Satisfaction surveys showed more than 85% of participants were satisfied or very satisfied with remote Longshi scale assessment. CONCLUSIONS The remote assessment of Longshi Scale with smartphone video calls is reliable and has high acceptance. This method can be readily implemented to evaluate the ADL of stroke patients to improve the capacity of rehabilitation and health services in remote areas.
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Affiliation(s)
- Zeyu Zhang
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China; Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fang Liu
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - John Wong
- School of Nursing and Department of Occupational Therapy, MGH Institute of Health Professions, MA, United States
| | - Kaiwen Xue
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China; Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Mingchao Zhou
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jianjun Long
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Sheng Qu
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China; Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jiehui Li
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China; Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Qingqing Yang
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China; Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yulong Wang
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China; Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
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28
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Torres-Castaño A, Abt-Sacks A, Toledo-Chávarri A, Suarez-Herrera JC, Delgado-Rodríguez J, León-Salas B, González-Hernández Y, Carmona-Rodríguez M, Serrano-Aguilar P. Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3694. [PMID: 36834388 PMCID: PMC9962592 DOI: 10.3390/ijerph20043694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.
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Affiliation(s)
- Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - José Carlos Suarez-Herrera
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- UNITWIN/UNESCO Chair, Research, Planning and Development of Local Health Systems, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Janet Delgado-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Department of Philosophy I, University of Granada, 18071 Granada, Spain
| | - Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Montserrat Carmona-Rodríguez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pedro Serrano-Aguilar
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Tenerife, Spain
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29
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Nguyen BK, Eltahir HZ, Barinsky GL, Ying YLM, Hsueh WD. Telemedicine and Otolaryngology in the COVID-19 Era. Ann Otol Rhinol Laryngol 2023; 132:148-154. [PMID: 35227085 PMCID: PMC9834621 DOI: 10.1177/00034894221081613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The global Coronavirus disease 2019 (COVID-19) pandemic has resulted in an expansion of telemedicine. The purpose of this study is to present our experience with outpatient telemedicine visits within a single institution's Department of Otolaryngology during the initial COVID-19 era. STUDY DESIGN Retrospective chart review. METHODS This was a single-institution study conducted within the Department of Otolaryngology at an urban tertiary care center. Data on outpatient visits was obtained from billing and scheduling records from January 6 to May 28, 2020. Visits were divided into "pre-shutdown" and "post-shutdown" based on our state's March 23, 2020 COVID-19 shutdown date. RESULTS A total of 3447 of 4340 (79.4%) scheduled visits were completed in the pre-shutdown period as compared to 1451 of 1713 (84.7%) in the post-shutdown period. The proportion of telemedicine visits increased (0.7%-81.2%, P < .001). Overall visit completion rate increased following the shutdown (80.2%-84.7%, P < .001). Subspecialties with an increase in visit completion rate were general (76.9%-88.0%, P = .002), otology (77.4%-87.2%, P < .001), and rhinology (80.0%-86.2%, P = .003). Patients with Medicaid and Medicare had higher appointment completion rates following the transition to telemedicine visits (80.7%-85.7%, P = .002; 76.9%-84.7%, P = .001). Older age was associated with decreased appointment cancellation pre-shutdown (OR 0.994 [0.991-0.997], P < .001) but increased appointment cancellation post-shutdown (OR 1.008 [1.001-1.014], P = .015). Mean COVID-19 risk scores were unchanged (P = .654). CONCLUSIONS COVID-19 has led to major changes in outpatient practice, with a significant shift from in-person to telemedicine visits following the mandatory shutdown. An associated increase in appointment completion rates was observed, reflecting a promising viable alternative to meet patient needs during this unprecedented time.
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Affiliation(s)
- Brandon K. Nguyen
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA,Brandon Nguyen, MD, Department of
Otolaryngology – Head and Neck Surgery, Rutgers University School of Medicine,
90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
| | - Hafiah Z. Eltahir
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L. Barinsky
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yu-Lan Mary Ying
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wayne D. Hsueh
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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30
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León-Salas B, González-Hernández Y, Infante-Ventura D, de Armas-Castellano A, García-García J, García-Hernández M, Carmona-Rodríguez M, Olazarán J, Dobato JL, Rodríguez-Rodríguez L, Trujillo-Martín MM. Telemedicine for neurological diseases: A systematic review and meta-analysis. Eur J Neurol 2023; 30:241-254. [PMID: 36256522 DOI: 10.1111/ene.15599] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to systematically review the effectiveness and safety of telemedicine combined with usual care (in-person visits) compared to usual care for the therapeutic management and follow-up assessment of neurological diseases. METHODS The electronic databases MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched (June 2021). Randomized controlled trials (RCTs) on patients of any age with neurological diseases were considered. Two reviewers screened and abstracted data in duplicate and independently and assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials (RoB 2). When possible, pooled effect estimates were calculated. RESULTS Of a total of 3018 records initially retrieved, 25 RCTs (n = 2335) were included: 11 (n = 804) on stroke, four (n = 520) on Parkinson's disease, three (n = 110) on multiple sclerosis, two (n = 320) on epilepsy, one (n = 63) on dementia, one (n = 23) on spina bifida, one (n = 40) on migraine, one (n = 22) on cerebral palsy and one (n = 433) on brain damage. Types of telemedicine assessed were online visits (11 studies), tele-rehabilitation (seven studies), telephone calls (three), smartphone apps (two) and online computer software (two). The evidence was quite limited except for stroke. Compared to usual care alone, telemedicine plus usual care was found to improve depressive symptoms, functional status, motor function, executive function, generic quality of life, healthcare utilization and healthy lifestyle in patients in post-stroke follow-up. CONCLUSIONS Well-designed and executed RCTs are needed to confirm our findings on stroke and to have more scientific evidence available for the other neurological diseases.
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Affiliation(s)
- Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Aythami de Armas-Castellano
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Javier García-García
- Quality and Patient Safety Unit, Nuestra Señora de Candelaria University Hospital, Tenerife, Spain
| | - Miguel García-Hernández
- Teaching Unit of Family and Community Medicine 'La Laguna-Tenerife Norte', Primary Care Management of Tenerife, Canary Islands Health Service (SCS), Tenerife, Spain
| | - Montserrat Carmona-Rodríguez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.,Health Technology Assessment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Olazarán
- Neurology Service, Gregorio Marañón University Hospital, Madrid, Spain
| | - José Luis Dobato
- Neurology Service, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - María M Trujillo-Martín
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
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31
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O’Neil J, Barnes K, Morgan Donnelly E, Sheehy L, Sveistrup H. Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review. Digit Health 2023; 9:20552076231183233. [PMID: 37377560 PMCID: PMC10291871 DOI: 10.1177/20552076231183233] [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: 08/24/2022] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Background The clinical adoption of telerehabilitation accelerated rapidly over the last few years, creating opportunities for clinicians and researchers to explore the use of digital technologies and telerehabilitation in the assessment of deficits related to neurological conditions. The objectives of this scoping review were to identify outcome measures used to remotely assess the motor function and participation in people with neurological conditions and report, when available, the psychometric data of these remote outcome measures. Methods MEDLINE (Ovid), CINAHL, PubMed, PsychINFO, EMBASE, and Cochrane databases were searched between December 13, 2020, and January 4, 2021, for studies investigating the use of remote assessments to evaluate motor function and participation in people with neurological conditions. An updated search was completed on May 9, 2022, using the same databases and search terms. Two reviewers independently screened each title and abstract, followed by full-text screening. Data extraction was completed using a pre-piloted data extraction sheet where outcome measures were reported as per the International Classification of Functioning, Disability and Health. Results Fifty studies were included in this review. Eighteen studies targeted outcomes related to body structures and 32 targeted those related to activity limitation and participation restriction. Seventeen studies reported psychometric data; of these, most included reliability and validity data. Conclusion Clinical assessments of motor function of people living with neurological conditions can be completed in a telerehabilitation or remote context using validated and reliable remote assessment measures.
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Affiliation(s)
- Jennifer O’Neil
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Keely Barnes
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lisa Sheehy
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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32
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Eze CE, Dorsch MP, Coe AB, Lester CA, Buis LR, Farris KB. Facilitators and barriers to blood pressure telemonitoring: A mixed-methods study. Digit Health 2023; 9:20552076231187585. [PMID: 37529536 PMCID: PMC10387707 DOI: 10.1177/20552076231187585] [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] [Received: 11/16/2022] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Background Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring. Objective The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF). Methods This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient-provider communication preferences. A joint display was used in the mixed-methods analysis. Results Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants' e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance. Conclusion Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.
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Affiliation(s)
- Chinwe E Eze
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Corey A Lester
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen B Farris
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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33
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Prieto-Avalos G, Sánchez-Morales LN, Alor-Hernández G, Sánchez-Cervantes JL. A Review of Commercial and Non-Commercial Wearables Devices for Monitoring Motor Impairments Caused by Neurodegenerative Diseases. BIOSENSORS 2022; 13:72. [PMID: 36671907 PMCID: PMC9856141 DOI: 10.3390/bios13010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Neurodegenerative diseases (NDDs) are among the 10 causes of death worldwide. The effects of NDDs, including irreversible motor impairments, have an impact not only on patients themselves but also on their families and social environments. One strategy to mitigate the pain of NDDs is to early identify and remotely monitor related motor impairments using wearable devices. Technological progress has contributed to reducing the hardware complexity of mobile devices while simultaneously improving their efficiency in terms of data collection and processing and energy consumption. However, perhaps the greatest challenges of current mobile devices are to successfully manage the security and privacy of patient medical data and maintain reasonable costs with respect to the traditional patient consultation scheme. In this work, we conclude: (1) Falls are most monitored for Parkinson's disease, while tremors predominate in epilepsy and Alzheimer's disease. These findings will provide guidance for wearable device manufacturers to strengthen areas of opportunity that need to be addressed, and (2) Of the total universe of commercial wearables devices that are available on the market, only a few have FDA approval, which means that there is a large number of devices that do not safeguard the integrity of the users who use them.
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Affiliation(s)
- Guillermo Prieto-Avalos
- Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
| | - Laura Nely Sánchez-Morales
- CONACYT-Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
| | - Giner Alor-Hernández
- Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
| | - José Luis Sánchez-Cervantes
- CONACYT-Tecnológico Nacional de México/I.T. Orizaba, Av. Oriente 9 No. 852 Col. Emiliano Zapata, Orizaba 94320, Veracruz, Mexico
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Tabaeeian RA, Hajrahimi B, Khoshfetrat A. A systematic review of telemedicine systems use barriers: primary health care providers' perspective. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2022. [DOI: 10.1108/jstpm-07-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.
Design/methodology/approach
This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.
Findings
Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.
Originality/value
This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.
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Rini JF, Tsoy E, Peet B, Best J, Tanner JA, Asken BM, Sanchez A, Apple AC, VandeVrede L, Stephens ML, Erkkinen M, Kramer JH, Miller BL. Feasibility and Acceptability of a Multidisciplinary Academic Telemedicine System for Memory Care in Response to COVID-19. Neurol Clin Pract 2022; 12:e199-e209. [PMID: 36540141 PMCID: PMC9757120 DOI: 10.1212/cpj.0000000000200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/26/2022] [Indexed: 01/30/2023]
Abstract
Background and Objectives In response to the restrictions imposed by the COVID-19 pandemic, the University of California San Francisco Memory and Aging Center (UCSF MAC) has deployed a comprehensive telemedicine model for the diagnosis and management of Alzheimer disease and related dementias. This review summarizes a large academic behavioral neurology clinic's experience transitioning to telemedicine services, including the impact on clinic care indicators, access metrics, and provider's experience. We compared these outcomes from 3 years before COVID-19 to 12 months after the transition to video teleconferencing (VTC) encounters. Methods Patient demographics and appointment data (dates, visit types, and departments) were extracted from our institution's electronic health record database from January 1, 2017, to May 1, 2021. We present data as descriptive statistics and comparisons using Wilcoxon rank-sum tests and Fisher exact tests. The results of anonymous surveys conducted among the clinic's providers are reported as descriptive findings. Results After the implementation of telemedicine services, the proportion of clinic encounters completed via VTC increased from 1.9% to 86.4%. There was a statistically significant decline in both the percentage of scheduled appointments that were canceled (32.9% vs 27.9%; p < 0.01) and total cancelations per month (mean 240.3 vs 179.4/mo; p < 0.01). There was an increase in the percentage of completed scheduled appointments (60.2% vs 64.8%; p < 0.01) and an increase in the average estimated commuting distance patients would need to drive for follow-up appointments (mean 49.8 vs 54.7 miles; p < 0.01). The transition to telemedicine services did not significantly affect the clinic's patient population as measured by age, gender, estimated income, area deprivation index, or self-reported racial/ethnic identity. The results of the provider survey revealed that physicians reported a more positive experience relative to neuropsychologists. Both types of providers reported telemedicine services as a reasonable equivalent and acceptable alternative to in-person evaluations with notable caveats. Discussion UCSF MAC's comprehensive integration of telemedicine services maintained critical ambulatory care to patients living with dementia during the COVID-19 pandemic. The recognized benefits of our care model suggest dementia telemedicine may be used as a feasible and equivalent alternative to in-person ambulatory care in the after COVID-19 era.
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Affiliation(s)
- James Fraser Rini
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Elena Tsoy
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Bradley Peet
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - John Best
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Jeremy A Tanner
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Breton M Asken
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Alejandra Sanchez
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Alexandra C Apple
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Lawren VandeVrede
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Melanie L Stephens
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Michael Erkkinen
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Joel H Kramer
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Bruce L Miller
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
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Physical Activity Coaching via Telehealth for People With Parkinson Disease: A Cohort Study. J Neurol Phys Ther 2022; 46:240-250. [PMID: 36170256 DOI: 10.1097/npt.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Physical activity (PA) has many known benefits for people with Parkinson disease (PD); however, many people do not meet recommended levels of frequency or intensity. We designed Engage-PD, a PA coaching program delivered via telehealth and grounded in self-determination theory to promote PA uptake and facilitate exercise self-efficacy in people with Parkinson disease. This study aimed to determine the feasibility and preliminary efficacy of Engage-PD, and to explore whether baseline characteristics were associated with outcomes. METHODS A single cohort of people with PD (n = 62, Hoehn and Yahr I-III) participated in the 3-month Engage-PD program, which consisted of up to 5 telehealth coaching sessions delivered by physical therapists. Feasibility was evaluated based on recruitment and retention rates, along with participants' feedback. Planned and unplanned PA, exercise self-efficacy (ESE), and individualized goals were assessed pre- and post-intervention. Relationships between baseline characteristics and changes in planned PA and ESE were also evaluated. RESULTS Recruitment (62%) and retention (85%) rates were high, and the intervention was well accepted and perceived by the participants. From pre- to postintervention, participants increased planned PA (d = 0.33), ESE (d = 1.20), and individualized goal performance (d = 1.63) and satisfaction (d = 1.70). Participants with lower baseline planned PA experienced greater improvements in planned PA, and those with lower baseline ESE experienced greater improvements in ESE. DISCUSSION AND CONCLUSIONS A telehealth PA coaching program for people with PD was feasible and potentially efficacious. Physical therapist-led coaching may be an important component of a consultative model of care starting early in the disease process.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A393).
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Mateen FJ. Progress towards the 2030 sustainable development goals: direct and indirect impacts on neurological disorders. J Neurol 2022; 269:4623-4634. [PMID: 35583660 DOI: 10.1007/s00415-022-11180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
The United Nations' Sustainable Development Goals (SDGs) were set forth in 2015 as a blueprint for all nations to create a more sustainable future together. These 17 social, environmental, and economic goals have established targets to meet globally by the year 2030, with a focus on pro-poor initiatives, gender equality, and ending hunger. The relationship of the SDGs with neurological disorders and how the achievement of the SDGs intersects with the future of neurological practice have not been comprehensively examined. However, the incidence of neurological disorders, the outcomes of people living with neurological disorders, and the training of future neurologists can be interlinked, directly or indirectly, with programming for the SDGs and their eventual achievement. Each SDG is reviewed in the context of neurology. This lens can inform programming and policy, enhance research and training, and improve inter-sectoral action for neurological disorders worldwide.
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Affiliation(s)
- Farrah J Mateen
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA.
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Bhadola S, Tang C, Marks A, Kaku MC, Zhou L, Siao P, Vincent Lau K. Disparate healthcare access and telehealth-based hybrid consultations during the COVID-19 pandemic. Work 2022; 73:377-382. [DOI: 10.3233/wor-211463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The coronavirus disease-2019 pandemic led to rapid expansion of telehealth services. This was speculated to improve healthcare access among underserved populations, including individuals unable to take time off work or arrange transportation. OBJECTIVE: We completed a quality improvement project to evaluate the feasibility of hybrid consultations that combined televisits and abbreviated in-person visits for neuromuscular referrals. METHODS: Using a censoring date of August 5, 2021, we reviewed all outpatient neuromuscular consultations from August 5, 2020 to February 5, 2021. For both hybrid and traditional in-person consultations, we reviewed no-show rates, completion rates of ordered diagnostic workup, and billing codes. For hybrid consultations only, we also reviewed intervals between initial televisit and subsequent examination and rates of video-enhanced versus audio-only televisits. RESULTS: During the study period, we completed 153 hybrid and 59 in-person new-patient consultations (no-show rates 9% and 27% respectively.) For hybrid consultations, 77% and 73% of laboratory and imaging studies were completed respectively, compared to 89% and 91% for in-person consultations. For hybrid visits, average RVUs (a marker for reimbursement) per consultation depended on whether audio-only televisits were billed as telephone calls or E/M visits per insurance payer rules, while video-enhanced televisits were uniformly billed as E/M visits. This resulted in average RVUs between 2.09 and 2.26, compared to 2.30 for in-person consultations. CONCLUSIONS: Telehealth-based hybrid neuromuscular consultations are feasible with minor caveats. However, the future of telehealth may be restricted by decreasing reimbursement rates particularly for audio-only televisits, limiting its potential to improve healthcare access.
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Affiliation(s)
- Shivkumar Bhadola
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Connie Tang
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Ariel Marks
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Michelle C. Kaku
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Lan Zhou
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Peter Siao
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - K.H. Vincent Lau
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Movement disorders in coronavirus disease 2019 times: impact on care in movement disorders and Parkinson disease. Curr Opin Neurol 2022; 35:494-501. [PMID: 35787539 DOI: 10.1097/wco.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). RECENT FINDINGS As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. SUMMARY COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought with benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.
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Bianchini E, Onelli C, Morabito C, Alborghetti M, Rinaldi D, Anibaldi P, Marcolongo A, Salvetti M, Pontieri FE. Feasibility, Safety, and Effectiveness of Telerehabilitation in Mild-to-Moderate Parkinson's Disease. Front Neurol 2022; 13:909197. [PMID: 35785358 PMCID: PMC9245570 DOI: 10.3389/fneur.2022.909197] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Parkinson's disease (PD) patients frequently engage in rehabilitation to ameliorate symptoms. During the Coronavirus disease 2019 (COVID-19) pandemic, access to rehabilitation programs has been markedly limited, consequently, telerehabilitation gained popularity. In this prospective, open-label, and pilot study, we aimed to investigate feasibility, safety, and efficacy of telerehabilitation in mild-to-moderate PD patients. Materials and Methods Twenty-three PD patients, with Hoehn and Yahr stage <3, without gait disturbances or dementia and capable of using the televisit platform, were recruited for a 5-week telerehabilitation program, consisting of 1 remote visit with a therapist and a minimum of two sessions of >30-min of self-conducted exercises per week. Patients received video tutorials of exercises and were asked to keep a diary of sessions. At baseline (T0), at the end of the intervention (T1), and 1 month after the end of treatment (T2), patients were remotely assessed with MDS-UPDRS part I-III, PDQ-39, Functional Independence Measure (FIM), and Frontal Assessment Battery scales, respectively. Acceptable compliance to the program was defined as >60% matching of frequency and duration of sessions, whereas optimal compliance was set at >80% matching. Results The dropout rate was 0%. Over 85% of patients reached acceptable adherence cut-off and around 70% reached optimal one. No adverse events were reported during sessions. The repeated measure analysis of variance (rANOVA) showed a significant effect of factor “time” for MDS-UPDRS-III (p < 0.0001) with a mean reduction of 4.217 points between T0 and T1 and return to baseline at T2. No significant effect was found for other outcome measures. Conclusion Our findings demonstrate that telerehabilitation is safe, feasible, and effective on motor symptoms in mild-to-moderate PD patients.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Camilla Onelli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | | | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | | | | | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Sant'Andrea University Hospital, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
- *Correspondence: Francesco E. Pontieri
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Asci F, Scardapane S, Zampogna A, D’Onofrio V, Testa L, Patera M, Falletti M, Marsili L, Suppa A. Handwriting Declines With Human Aging: A Machine Learning Study. Front Aging Neurosci 2022; 14:889930. [PMID: 35601625 PMCID: PMC9120912 DOI: 10.3389/fnagi.2022.889930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHandwriting is an acquired complex cognitive and motor skill resulting from the activation of a widespread brain network. Handwriting therefore may provide biologically relevant information on health status. Also, handwriting can be collected easily in an ecological scenario, through safe, cheap, and largely available tools. Hence, objective handwriting analysis through artificial intelligence would represent an innovative strategy for telemedicine purposes in healthy subjects and people affected by neurological disorders.Materials and MethodsOne-hundred and fifty-six healthy subjects (61 males; 49.6 ± 20.4 years) were enrolled and divided according to age into three subgroups: Younger adults (YA), middle-aged adults (MA), and older adults (OA). Participants performed an ecological handwriting task that was digitalized through smartphones. Data underwent the DBNet algorithm for measuring and comparing the average stroke sizes in the three groups. A convolutional neural network (CNN) was also used to classify handwriting samples. Lastly, receiver operating characteristic (ROC) curves and sensitivity, specificity, positive, negative predictive values (PPV, NPV), accuracy and area under the curve (AUC) were calculated to report the performance of the algorithm.ResultsStroke sizes were significantly smaller in OA than in MA and YA. The CNN classifier objectively discriminated YA vs. OA (sensitivity = 82%, specificity = 80%, PPV = 78%, NPV = 79%, accuracy = 77%, and AUC = 0.84), MA vs. OA (sensitivity = 84%, specificity = 56%, PPV = 78%, NPV = 73%, accuracy = 74%, and AUC = 0.7), and YA vs. MA (sensitivity = 75%, specificity = 82%, PPV = 79%, NPV = 83%, accuracy = 79%, and AUC = 0.83).DiscussionHandwriting progressively declines with human aging. The effect of physiological aging on handwriting abilities can be detected remotely and objectively by using machine learning algorithms.
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Affiliation(s)
| | - Simone Scardapane
- Department of Information, Electronic and Communication Engineering (DIET), Sapienza University of Rome, Rome, Italy
| | | | | | - Lucia Testa
- Department of Informatic, Automatic and Gestional Engineering (DIAG), Sapienza University of Rome, Rome, Italy
| | - Martina Patera
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Falletti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Antonio Suppa
- IRCCS Neuromed Institute, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Antonio Suppa,
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Nie P, Zhang J, Yang X, Shao Y, Zhang X, Liu W, Fu K, Chen J, Zhang J. Remote Programming in Patients With Parkinson's Disease After Deep Brain Stimulation: Safe, Effective, and Economical. Front Neurol 2022; 13:879250. [PMID: 35592473 PMCID: PMC9111520 DOI: 10.3389/fneur.2022.879250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to evaluate the safety, efficiency, and cost expenditure of remote programming in patients with Parkinson's disease (PD) after deep brain stimulation (DBS). Methods A total of 74 patients who underwent DBS at the Department of Neurosurgery, Zhongnan Hospital of Wuhan University between June 2018 and June 2020 were enrolled in this study. There were 27 patients in the remote programming group and 47 patients in the outpatient programming group. Clinical data, programming efficiency, adverse events, expenditure, and satisfaction were compared between the two groups. Results A total of 36 times of remote programming were performed on the 27 patients in the remote programming group, and four had mild adverse events during programming, and the adverse events disappeared within 1 week. The satisfaction questionnaire showed that 97.3% of the patients were satisfied with the surgical effect. The patients in the remote programming group (88.9%) were more likely to receive long-term programming after DBS than the patients in the outpatient programming group (74.5%). The Parkinsonism symptoms improved in both programming groups. The majority (18/27) of patients in the remote programming group lived away from the programming center, while the majority (27/47) of patients in the outpatient programming group lived in Wuhan, where the programming center was located (P = 0.046). The cost per patient per programming was US$ 43.5 in the remote programming group and $59.5 (56–82.7) in the outpatient programming group (P < 0.001). The median time cost for each visit was 30 min (25–30) in the remote programming group and 150 min (135–270.0) in the outpatient programming group (P < 0.001). Conclusion Remote programming is safe and effective after DBS in patients with Parkinson's disease. Moreover, it reduces expenditure and time costs for patients and achieves high satisfaction, particularly for patients living far from programming centers.
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Affiliation(s)
- Pan Nie
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xin Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuyang Shao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiuming Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kai Fu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Center for Functional Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Jie Zhang
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de Brito SAF, Scianni AA, Peniche PDC, Faria CDCDM. Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review protocol. PLoS One 2022; 17:e0265841. [PMID: 35312708 PMCID: PMC8936471 DOI: 10.1371/journal.pone.0265841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Several measurement tools commonly used in face-to-face neurological rehabilitation have been used in telerehabilitation. However, it is not known whether these tools have adequate measurement properties and clinical utility. This systematic review aims to investigate the measurement properties and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological diseases. A systematic review to investigate the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions will be conducted. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. this systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 May 2021 (registration number: CRD42021257662). Electronic searches will be performed in following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic + Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Two trained independent reviewers will select the studies according to the inclusion criteria, and will also extract the data, evaluate the clinical utility and methodological quality. The relevant data such as design, participants, settings, and mode of administration, measurement properties, and clinical utility will be summarized. Disagreements between reviewers will be resolved by consensus or by the decision of a third independent reviewer. Hand searches of other relevant studies will be employed. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the clinical utility scale will be used to assess the methodological quality and clinical utility of these tools, respectively. This systematic review will provide information regarding the measurement properties and the clinical utility of the measurement tools used in neurological telerehabilitation. This information will be useful to assist health professionals in choosing adequate measurement tools and planning new research studies.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula da Cruz Peniche
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Frey J, Cagle J, Johnson KA, Wong JK, Hilliard JD, Butson CR, Okun MS, de Hemptinne C. Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches. Front Neurol 2022; 13:825178. [PMID: 35356461 PMCID: PMC8959612 DOI: 10.3389/fneur.2022.825178] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and "connectomics" will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kara A. Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Justin D. Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher R. Butson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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Rapid development of an integrated remote programming platform for neuromodulation systems through the biodesign process. Sci Rep 2022; 12:2269. [PMID: 35145143 PMCID: PMC8831590 DOI: 10.1038/s41598-022-06098-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
Treating chronic symptoms for pain and movement disorders with neuromodulation therapies involves fine-tuning of programming parameters over several visits to achieve and maintain symptom relief. This, together with challenges in access to trained specialists, has led to a growing need for an integrated wireless remote care platform for neuromodulation devices. In March of 2021, we launched the first neuromodulation device with an integrated remote programming platform. Here, we summarize the biodesign steps taken to identify the unmet patient need, invent, implement, and test the new technology, and finally gain market approval for the remote care platform. Specifically, we illustrate how agile development aligned with the evolving regulatory requirements can enable patient-centric digital health technology in neuromodulation, such as the remote care platform. The three steps of the biodesign process applied for remote care platform development are: (1) Identify, (2) Invent, and (3) Implement. First, we identified the unmet patient needs through market research and voice-of-customer (VOC) process. Next, during the concept generation phase of the invention step, we integrated the results from the VOC into defining requirements for prototype development. Subsequently, in the concept screening phase, ten subjects with PD participated in a clinical pilot study aimed at characterizing the safety of the remote care prototype. Lastly, during the implementation step, lessons learned from the pilot experience were integrated into final product development as new features. Following final product development, we completed usability testing to validate the full remote care system and collected preliminary data from the limited market release experience. The VOC data, during prototype development, helped us identify thresholds for video quality and needs priorities for clinicians and patients. During the pilot study, one subject reported anticipated remote-care-related adverse events that were resolved without sequelae. For usability analysis following final product development, the failure rates for task completion for both user groups were about 1%. Lastly, during the initial 4 weeks of the limited market release experience, a total of 858 remote care sessions were conducted with a 93% success rate. Overall, we developed a remote care platform by adopting a user-centric approach. Although the system intended to address pre-COVID19 challenges associated with disease management, the unforeseen overlap of the study with the pandemic elevated the importance of such a system and an innovative development process enabled us to advance a patient-centric platform to gain regulatory approval and successfully launch the remote care platform to market.
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Sakamaki T, Furusawa Y, Hayashi A, Otsuka M, Fernandez J. Remote Patient Monitoring for Neuropsychiatric Disorders: A Scoping Review of Current Trends and Future Perspectives from Recent Publications and Upcoming Clinical Trials. Telemed J E Health 2022; 28:1235-1250. [PMID: 35073206 PMCID: PMC9508442 DOI: 10.1089/tmj.2021.0489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Telemedicine and remote patient monitoring are rapidly growing fields. This scoping review provides an update on remote patient monitoring for neuropsychiatric disorders from recent publications and upcoming clinical trials. Methods: Publications (PubMed and ICHUSHI; published January 2010 to February 2021) and trials (ClinicalTrials.gov and Japanese registries; active or recruiting by March 2021) that assessed wearable devices for remote management and/or monitoring of patients with neuropsychiatric disorders were searched. The review focuses on disorders with ≥3 publications. Results: We identified 44 publications and 51 active or recruiting trials, mostly from 2019 or 2020. Research on digital devices was most common for Parkinson's disease (11 publications and 19 trials), primarily for monitoring motor symptoms and/or preventing falls. Other disorders (3–5 publications each) included epilepsy (electroencephalogram [EEG] and seizure prediction), sleep disorder (sleep outcomes and behavioral therapies), multiple sclerosis (physical activity and symptoms), depression (physical activity, symptoms, and behavioral therapies), and amyotrophic lateral sclerosis (symptoms). Very few studies focused on newly emerging technologies (e.g., in-ear EEG and portable oximeters), and few studies integrated remote symptom monitoring with telemedicine. Discussion: Currently, development of digital devices for daily symptom monitoring is focused on Parkinson's disease. For the diseases reviewed, studies mostly focused on physical activity rather than psychiatric or nonmotor symptoms. Although the validity and usefulness of many devices are established, models for implementing remote patient monitoring in telehealth settings have not been established. Conclusions: Verification of the clinical effectiveness of digital devices combined with telemedicine is needed to further advance remote patient care for neuropsychiatric disorders.
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Affiliation(s)
- Tetsuo Sakamaki
- Medical Informatics and Decision Sciences, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshihiko Furusawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ayako Hayashi
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masaru Otsuka
- Enterprise Digital Lead, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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Recommendations for the Development of Telemedicine in Poland Based on the Analysis of Barriers and Selected Telemedicine Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031221. [PMID: 35162248 PMCID: PMC8835106 DOI: 10.3390/ijerph19031221] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/04/2023]
Abstract
Technological development around the world has led to the digitalisation of the health system. Along with the digitalisation of the health sector, financial, legal, awareness-related, technological and IT barriers appeared. The aim of the article is to present recommendations for the development of telemedicine services in Poland on the basis of a list of implementation barriers and ways of resolving them in the USA and selected European countries. A literature review was conducted in accordance with the PRISMA-ScR, using the PubMed and Google Scholar databases, Scopus and the OECD iLibrary. A total of 59 literature positions were used, which constituted the references. The article presented the implemented and effective solutions in selected countries. Based on these solutions, recommendations for the development of telemedicine in Poland were presented, as well as successes in the form of telemedicine startups, which can inspire other countries. The analysis of the publications discussed in the article shows that the implementation of telemedicine services should begin with the elimination of barriers limiting the development of telemedicine systems. An important issue in their elimination is to analyse their interconnections and implement such solutions which would have a multi-area coverage.
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Tele-neuro-oncology: Current Practices and Future Directions. Curr Oncol Rep 2022; 24:99-103. [PMID: 35059995 PMCID: PMC8773390 DOI: 10.1007/s11912-021-01176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review The purpose of this review is to describe the current state of telemedicine within neuro-oncology. This article will address the development of tele-neuro-oncology over time with a focus on current use and applications of telemedicine within the field. Current modalities and practical considerations for tele-neuro-oncology visits and opportunities for growth will be highlighted. Recent Findings The use of telemedicine has expanded significantly during the COVID-19 pandemic, particularly within neuro-oncology. The use of telemedicine is widely accepted by neuro-oncologic patients and providers and continues to expand in utilization and scope. The use of tele-neuro-oncology is expected to develop further with opportunities for multidisciplinary and integrated care, clinical trials, research, and education. Summary Telemedicine provides a unique, patient-centered approach to neuro-oncologic care. Telehealth will remain a valuable tool, and its use and role are expected to expand within neuro-oncology.
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Bernini S, Panzarasa S, Sinforiani E, Quaglini S, Cappa SF, Cerami C, Tassorelli C, Vecchi T, Bottiroli S. HomeCoRe for Telerehabilitation in Mild or Major Neurocognitive Disorders: A Study Protocol for a Randomized Controlled Trial. Front Neurol 2022; 12:752830. [PMID: 35002919 PMCID: PMC8733654 DOI: 10.3389/fneur.2021.752830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Given the limited effectiveness of pharmacological treatments for cognitive decline, non-pharmacological interventions have gained increasing attention. Evidence exists on the effectiveness of cognitive rehabilitation in preventing elderly subjects at risk of cognitive decline and in reducing the progression of functional disability in cognitively impaired individuals. In recent years, telerehabilitation has enabled a broader application of cognitive rehabilitation programs. The purpose of this study is to test a computer-based intervention administered according to two different modalities (at the hospital and at home) using the tools CoRe and HomeCoRe, respectively, in participants with Mild or Major Neurocognitive Disorders. Methods: Non-inferiority, single-blind randomized controlled trial where 40 participants with Mild or Major Neurocognitive Disorders will be assigned to the intervention group who will receive cognitive telerehabilitation through HomeCoRe or to the control group who will receive in-person cognitive intervention through CoRe, with the therapist administering the same computer-based exercises. The rehabilitative program will last 6 weeks, with 3 sessions/week, each lasting ~45 min. All the participants will be evaluated on an exhaustive neuropsychological battery before (T0) and after (T1) the intervention; follow-up visits will be scheduled after 6 (T2) and 12 months (T3). Discussion: The results of this study will inform about the comparability (non-inferiority trial) of HomeCoRe with CoRe. Their equivalence would support the use of HomeCoRe for at distance treatment, favoring the continuity of care. Ethics and Dissemination: This study has been approved by the Local Ethics Committee and registered in https://clinicaltrials.gov (NCT04889560). The dissemination plan includes the scientific community through publication in open-access peer-reviewed scientific journals and presentations at national and international conferences. Trial Registration:Clinicaltrials.govhttps://clinicaltrials.gov/ct2/show/NCT04889560 (registration date: May 17, 2021).
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Affiliation(s)
- Sara Bernini
- Dementia Research Center, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy
| | - Silvia Panzarasa
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Elena Sinforiani
- Dementia Research Center, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Stefano F Cappa
- Dementia Research Center, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy.,IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria di Studi Superiori IUSS, Pavia, Italy
| | - Chiara Cerami
- Dementia Research Center, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy.,IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria di Studi Superiori IUSS, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Centre, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Cognitive Psychology Research Center, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy
| | - Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy.,Headache Science and Neurorehabilitation Centre, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy
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Altmann P, Leutmezer F, Ponleitner M, Ivkic D, Krajnc N, Rommer PS, Berger T, Bsteh G. Remote visits for people with multiple sclerosis during the COVID-19 pandemic in Austria: The TELE MS randomized controlled trial. Digit Health 2022; 8:20552076221112154. [PMID: 35847524 PMCID: PMC9277439 DOI: 10.1177/20552076221112154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Continuous monitoring is the hallmark of managing chronic disease. Multiple
sclerosis (MS), in particular, requires patients to visit their treating
neurologists typically twice a year, at least. In that respect, the COVID-19
pandemic made us rethink our communication strategies. This study determined
satisfaction with remote visits for people with MS (pwMS) by comparing
non-inferiority to conventional visits. Methods TELE MS was a randomized controlled trial that was open to any person with
MS. We randomized a volunteer sample of 45 patients. We compared
satisfaction with remote visits (via phone or via videochat) with
conventional outpatient visits. The primary endpoint was patient
satisfaction determined by the Telemedicine Perception Questionnaire (TMPQ,
min: 17 and max: 85 points) with the hypothesis of non-inferiority of
televisits to conventional visits. Physician satisfaction measured on the
PPSM score (Patient and Physician Satisfaction with Monitoring, min: 5 and
max: 25 points) was the secondary endpoint. Results The trial met both endpoints. Mean (SD) TMPQ scores in the individual groups
were 58 (6.7) points for conventional visits, 65 (7.5) points for phone
visits, and 62 (5.5) points for video visits. Physician satisfaction over
the whole cohort was similarly high. Median (range) PPSM scores were 23
(16–25) for the whole cohort, 19 (16–25) for conventional visits, 25 (17–25)
for phone visits, and 25 (16–25) for video visits. Conclusions Televisits in multiple sclerosis yield a high level of satisfaction for both
patients and treating physicians. This concept for remote patient monitoring
adopted during the current pandemic may be communicable to other chronic
diseases as well. ClinicalTrials.gov identifier: NCT04838990
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Affiliation(s)
- Patrick Altmann
- Department of Neurology, Medical University of Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Dominik Ivkic
- Department of Neurology, Medical University of Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Austria
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