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Amabili G, Maranesi E, Margaritini A, Benadduci M, Barbarossa F, Casaccia S, Nap HH, Bevilacqua R. Usability and Feasibility Assessment of a Social Assistive Robot for the Older People: Results from the GUARDIAN Project. Bioengineering (Basel) 2023; 11:20. [PMID: 38247896 PMCID: PMC10813054 DOI: 10.3390/bioengineering11010020] [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: 11/20/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
In Italy, many people aged over 65 cannot live independently, causing an overall decrease in their quality of life and a need for social and health care. Due to the lack of both formal and informal caregivers, technological solutions become of paramount importance in this scenario. This article describes the user-centered development of the GUARDIAN ecosystem, consisting of a social robot integrated with two mobile applications which aim to monitor, coach, and keep the older user company in order to prolong his/her independence at home. In particular, the advancements from the alpha to the beta prototype of the ecosystem are described, achieved through the feedback collected from 41 end users-older people and their carers-that have tested the system for 6 weeks. By enhancing human-robot interaction, a positive improvement in terms of usability and acceptability of the system was retrieved. However, to increase the perceived usefulness and the impact on older users' lives, it is necessary to make the entire system more customizable, and more capable in providing support for daily activities.
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Affiliation(s)
- Giulio Amabili
- IRCCS INRCA Scientific Direction, 60124 Ancona, Italy; (G.A.); (A.M.); (M.B.); (F.B.); (R.B.)
| | - Elvira Maranesi
- IRCCS INRCA Scientific Direction, 60124 Ancona, Italy; (G.A.); (A.M.); (M.B.); (F.B.); (R.B.)
| | - Arianna Margaritini
- IRCCS INRCA Scientific Direction, 60124 Ancona, Italy; (G.A.); (A.M.); (M.B.); (F.B.); (R.B.)
| | - Marco Benadduci
- IRCCS INRCA Scientific Direction, 60124 Ancona, Italy; (G.A.); (A.M.); (M.B.); (F.B.); (R.B.)
| | - Federico Barbarossa
- IRCCS INRCA Scientific Direction, 60124 Ancona, Italy; (G.A.); (A.M.); (M.B.); (F.B.); (R.B.)
| | - Sara Casaccia
- Department of Industrial Engineering, Università Politecnica delle Marche, 60121 Ancona, Italy;
| | - Henk Herman Nap
- National Expertise Centre Long-Term Care, Vilans, 3527 GV Utrecht, The Netherlands;
| | - Roberta Bevilacqua
- IRCCS INRCA Scientific Direction, 60124 Ancona, Italy; (G.A.); (A.M.); (M.B.); (F.B.); (R.B.)
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Martinengo L, Jabir AI, Goh WWT, Lo NYW, Ho MHR, Kowatsch T, Atun R, Michie S, Tudor Car L. Conversational agents in healthcare: a scoping review of their behavior change techniques and underpinning theory (Preprint). J Med Internet Res 2022; 24:e39243. [PMID: 36190749 PMCID: PMC9577715 DOI: 10.2196/39243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Conversational agents (CAs) are increasingly used in health care to deliver behavior change interventions. Their evaluation often includes categorizing the behavior change techniques (BCTs) using a classification system of which the BCT Taxonomy v1 (BCTTv1) is one of the most common. Previous studies have presented descriptive summaries of behavior change interventions delivered by CAs, but no in-depth study reporting the use of BCTs in these interventions has been published to date. Objective This review aims to describe behavior change interventions delivered by CAs and to identify the BCTs and theories guiding their design. Methods We searched PubMed, Embase, Cochrane’s Central Register of Controlled Trials, and the first 10 pages of Google and Google Scholar in April 2021. We included primary, experimental studies evaluating a behavior change intervention delivered by a CA. BCTs coding followed the BCTTv1. Two independent reviewers selected the studies and extracted the data. Descriptive analysis and frequent itemset mining to identify BCT clusters were performed. Results We included 47 studies reporting on mental health (n=19, 40%), chronic disorders (n=14, 30%), and lifestyle change (n=14, 30%) interventions. There were 20/47 embodied CAs (43%) and 27/47 CAs (57%) represented a female character. Most CAs were rule based (34/47, 72%). Experimental interventions included 63 BCTs, (mean 9 BCTs; range 2-21 BCTs), while comparisons included 32 BCTs (mean 2 BCTs; range 2-17 BCTs). Most interventions included BCTs 4.1 “Instruction on how to perform a behavior” (34/47, 72%), 3.3 “Social support” (emotional; 27/47, 57%), and 1.2 “Problem solving” (24/47, 51%). A total of 12/47 studies (26%) were informed by a behavior change theory, mainly the Transtheoretical Model and the Social Cognitive Theory. Studies using the same behavior change theory included different BCTs. Conclusions There is a need for the more explicit use of behavior change theories and improved reporting of BCTs in CA interventions to enhance the analysis of intervention effectiveness and improve the reproducibility of research.
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Affiliation(s)
- Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Westin Wei Tin Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Nicholas Yong Wai Lo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University Singapore, Singapore, Singapore
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Cambridge, MA, United States
- Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, London, United Kingdom
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Cooper C, Green S, Hartstein A, Fergus A. The impact of pain neuroscience education in a Hispanic-American population: A mixed-methods exploratory study. Physiother Theory Pract 2022:1-14. [PMID: 35383528 DOI: 10.1080/09593985.2022.2060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic pain and pain catastrophization are growing problems across the United States, within the Hispanic-American population. Pain neuroscience education (PNE) changes pain knowledge and beliefs in many populations, but its impact on reconceptualization in people of Hispanic-American origin is unknown. PURPOSE Explore the changes in pain knowledge in Hispanic-American individuals and the process involved in reconceptualization following a PNE lecture. METHODS Eight Hispanic-American adults participated in a mixed-methods exploratory study. The Revised Neurophysiology of Pain Questionnaire (R-NPQ) was completed before, immediately after, and eight months after an adapted PNE lecture. A focus group involving four participants discussed the impact of PNE. Transcripts were translated and theme coded, and a concept map was developed by consensus. RESULTS R-NPQ scores improved from 25.3% to 43.5% post-lecture, and the number of unsure responses decreased from 41.5% to 18.4%. At eight months, R-NPQ scores remained stable (44.2%) but unsure responses increased (28.9%). Themes that contributed to the process of change included cognitive dissonance, relevance of instruction, idea exchange through peer interaction, reflection, confidence, changed behaviors, and educational utility. CONCLUSION While small improvements in knowledge and perception of pain appeared to occur with the PNE, knowledge remained low. Consideration of adult learning principles such as applicability, peer-interaction, the confrontation of beliefs, and reflection throughout PNE may enhance its impact. Future investigation should explore the efficacy of this intervention, when compared or combined with other techniques in the treatment of Hispanic-Americans experiencing persistent pain.
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Affiliation(s)
- Christine Cooper
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Savannah Green
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Aaron Hartstein
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Andrea Fergus
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
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Bevilacqua R, Casaccia S, Cortellessa G, Astell A, Lattanzio F, Corsonello A, D’Ascoli P, Paolini S, Di Rosa M, Rossi L, Maranesi E. Coaching Through Technology: A Systematic Review into Efficacy and Effectiveness for the Ageing Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165930. [PMID: 32824169 PMCID: PMC7459778 DOI: 10.3390/ijerph17165930] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
Background: Despite the evidence on the positive role of self-management, the adoption of health coaching strategies for older people is still limited. To address these gaps, recent efforts have been made in the ICT sector in order to develop systems for delivering coaching and overcoming barriers relating to scarcity of resources. The aim of this review is to examine the efficacy of personal health coaching systems for older adults using digital virtual agents. Methods: A systematic review of the literature was conducted in December 2019 analyzing manuscripts from four databases over the last 10 years. Nine papers were included. Results: Despite the low number of studies, there was evidence that technology-integrated interventions can deliver benefits for health over usual care. However, the review raises important questions about how to maintain benefits and permanence of behavior change produced by short-term interventions. Conclusion: These systems offer a potential tool to reduce costs, minimize therapist burden and training, and expand the range of clients who can benefit from them. It is desirable that in the future the number of studies will grow, considering other aspects such as the role of the virtual coaches’ characteristics, social-presence, empathy, usability, and health literacy.
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Affiliation(s)
- Roberta Bevilacqua
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (R.B.); (F.L.); (P.D.); (L.R.); (E.M.)
| | - Sara Casaccia
- Department of Industrial Engineering and Mathematical Sciences, Polytechnic University of Marche, 60121 Ancona, Italy;
| | | | - Arlene Astell
- Occupaitonal Sciences & Occupational Therapy, Univeristy of Toronto, Toronto, M5G 2A2 ON, Canada;
| | - Fabrizia Lattanzio
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (R.B.); (F.L.); (P.D.); (L.R.); (E.M.)
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy;
| | - Paola D’Ascoli
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (R.B.); (F.L.); (P.D.); (L.R.); (E.M.)
| | - Susy Paolini
- Unit of Neurology, IRCCS INRCA, 60124 Ancona, Italy;
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy;
- Correspondence: ; Tel.: +39-0718004604
| | - Lorena Rossi
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (R.B.); (F.L.); (P.D.); (L.R.); (E.M.)
| | - Elvira Maranesi
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (R.B.); (F.L.); (P.D.); (L.R.); (E.M.)
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Safari R, Jackson J, Sheffield D. Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis. J Med Internet Res 2020; 22:e15365. [PMID: 32706657 PMCID: PMC7428148 DOI: 10.2196/15365] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/13/2019] [Accepted: 02/26/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. OBJECTIVE This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. METHODS A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. RESULTS A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] -0.28, 95% CI -0.38 to -0.18 and SMD -0.26, 95% CI -0.35 to -0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD -0.10, 95% CI -0.17 to 0.03 and SMD -0.17, 95% CI -0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. CONCLUSIONS Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Jessica Jackson
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
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Kang Y, Demiris G. Self-report pain assessment tools for cognitively intact older adults: Integrative review. Int J Older People Nurs 2017; 13:e12170. [PMID: 28980440 DOI: 10.1111/opn.12170] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 08/21/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pain is common in older adults, but it is often underreported or undertreated partly because many consider pain to be a normal consequence of ageing. Among the plethora of available self-report pain assessment tools, there is no synthetised evidence which tools are indicated for use among cognitively intact older adults. PURPOSE OF THE STUDY To understand documented self-report pain assessment tools that have been used among cognitively intact older adults, and to describe their characteristics including overall performance as well as studies demonstrating their use. METHODS A systematic search of the indexed databases PubMed, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) was conducted to identify documented self-report pain assessment tools through peer-reviewed papers, including citations from January 1990 to December 2015. Thirty-five percentage of abstracts were independently evaluated by two raters according to specific criteria. RESULTS Among identified tools, the Iowa Pain Thermometer, the 6-point Verbal Descriptor Scale, the Numeric Rating Scale, the short form Brief Pain Inventory (BPI) and the Geriatric Pain Measure (GPM) may be suitable tools for self-reported pain by cognitively intact older adults based on the statement of the literature. Only two self-report tools (the GPM and the Geriatric Painful Events Inventory) were designed specifically for older adults. CONCLUSIONS More studies are needed to evaluate pain measures' psychometric performance across different settings, racial/ethnic groups and disease categories. Since 80% of older adults have at least one chronic disease, multidimensional tools such as the GPM may need to be used more often for accurate self-report of pain. IMPLICATIONS FOR PRACTICE Examining the psychometric properties of comprehensive self-report pain assessment tools informs recommendations for the selection of tools to be used in clinical practice.
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Affiliation(s)
- Youjeong Kang
- School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- School of Nursing & School of Medicine, University of Washington, Seattle, WA, USA
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Bhattarai P, Phillips JL. The role of digital health technologies in management of pain in older people: An integrative review. Arch Gerontol Geriatr 2016; 68:14-24. [PMID: 27584871 DOI: 10.1016/j.archger.2016.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/08/2016] [Accepted: 08/22/2016] [Indexed: 11/16/2022]
Abstract
Pain is one of the most distressing and debilitating health issues faced by older people. The burden of unrelieved pain experienced by older people and its associated high symptom and economic costs demands consideration of new strategies to better this condition. As the global uptake of digital technology increases, exploring its potential to impact positively on older peoples' pain self-management practices warrants investigation. This integrative review aimed to evaluate the use of digital health technology for management of older people's pain across care-settings. Searches were conducted to identify relevant English language studies published in CINHAL, Medline, Academic Search Complete, EMBASE, Cochrane library databases, and Google and Google Scholar websites. A total of 1003 papers were identified, 9 met the inclusion criteria. The highest level of evidence (Level II) was generated by three Phase II randomized controlled trials. These trials demonstrated the feasibility of computer based interactive or instructive video interventions however there was limited evidence to support their use for reduction of pain intensity and interference. Qualitative evidence demonstrated older people's willingness to use mobile technologies (iPhone or digital pen) to help manage their pain, however, the need of device-use training and connectedness with clinicians were highlighted. In conclusion, there is some evidence that integrating digital health technology into older peoples' pain self-management plan is feasible and acceptable. However, the provision of high-quality technological interventions informed by a thorough understanding of older people's digital technology pain management needs is required to ensure greater integration of this technology in clinical practice.
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Affiliation(s)
- Priyanka Bhattarai
- The University of Notre Dame Australia, School of Nursing, Cnr Broadway and Abercrombie St., (PO Box 944), Broadway, Sydney, NSW 2007, Australia.
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McDonald DD, Soutar C, Chan MA, Afriyie A. A closer look: Alternative pain management practices by heart failure patients with chronic pain. Heart Lung 2015; 44:395-9. [PMID: 26088386 DOI: 10.1016/j.hrtlng.2015.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe alternative non-pharmaceutical non-nutraceutical pain self-management strategies used by people with heart failure (HF) in order to reduce chronic non-cardiac pain. BACKGROUND Little is known about alternative pain self-treatments used by HF patients with chronic pain. METHODS A cross-sectional descriptive design was used with 25 hospitalized HF patients who had chronic pain and used at least one alternative pain treatment. Pain intensity, pain interference with function, and current pain treatments were measured with the Brief Pain Inventory. RESULTS Alternative treatments included walking, stretching, use of heat and cold. Five patients used evidence-based pain treatments for their chronic pain conditions. Patients reported moderate pain intensity and pain interference with activity. CONCLUSIONS Patients with HF and chronic pain use few alternative pain treatments. Screening for chronic pain and referral to Integrative Medicine and/or Palliative care for a pain management consult might reduce the added burden of pain in people with HF.
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Affiliation(s)
- Deborah Dillon McDonald
- University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-2026, USA.
| | - Christina Soutar
- Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA
| | - Maria Agudelo Chan
- Masonicare Partners Home Health and Hospice, 111 Founders Plaza, East Hartford, CT 06108, USA
| | - Angela Afriyie
- Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA
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