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Weik L, Fehring L, Mortsiefer A, Meister S. Understanding inherent influencing factors to digital health adoption in general practices through a mixed-methods analysis. NPJ Digit Med 2024; 7:47. [PMID: 38413767 PMCID: PMC10899241 DOI: 10.1038/s41746-024-01049-0] [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: 10/18/2023] [Accepted: 02/16/2024] [Indexed: 02/29/2024] Open
Abstract
Extensive research has shown the potential value of digital health solutions and highlighted the importance of clinicians' adoption. As general practitioners (GPs) are patients' first point of contact, understanding influencing factors to their digital health adoption is especially important to derive personalized practical recommendations. Using a mixed-methods approach, this study broadly identifies adoption barriers and potential improvement strategies in general practices, including the impact of GPs' inherent characteristics - especially their personality - on digital health adoption. Results of our online survey with 216 GPs reveal moderate overall barriers on a 5-point Likert-type scale, with required workflow adjustments (M = 4.13, SD = 0.93), inadequate reimbursement (M = 4.02, SD = 1.02), and high training effort (M = 3.87, SD = 1.01) as substantial barriers. Improvement strategies are considered important overall, with respondents especially wishing for improved interoperability (M = 4.38, SD = 0.81), continued technical support (M = 4.33, SD = 0.91), and improved usability (M = 4.20, SD = 0.88). In our regression model, practice-related characteristics, the expected future digital health usage, GPs' digital affinity, several personality traits, and digital maturity are significant predictors of the perceived strength of barriers. For the perceived importance of improvement strategies, only demographics and usage-related variables are significant predictors. This study provides strong evidence for the impact of GPs' inherent characteristics on barriers and improvement strategies. Our findings highlight the need for comprehensive approaches integrating personal and emotional elements to make digitization in practices more engaging, tangible, and applicable.
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Affiliation(s)
- Lisa Weik
- Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Leonard Fehring
- Helios University Hospital Wuppertal, Department of Gastroenterology, Witten/Herdecke University, Wuppertal, Germany
- Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Achim Mortsiefer
- General Practice II and Patient-Centredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Sven Meister
- Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.
- Department Healthcare, Fraunhofer Institute for Software and Systems Engineering ISST, Dortmund, Germany.
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Sharma Y, Cheung L, Patterson KK, Iaboni A. Factors influencing the clinical adoption of quantitative gait analysis technology with a focus on clinical efficacy and clinician perspectives: A scoping review. Gait Posture 2024; 108:228-242. [PMID: 38134709 DOI: 10.1016/j.gaitpost.2023.12.003] [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: 08/18/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Quantitative gait analysis (QGA) has the potential to support clinician decision-making. However, it is not yet widely accepted in practice. Evidence for clinical efficacy (i.e., efficacy and effectiveness), as well as a users' perspective on using the technology in clinical practice (e.g., ease of use and usefulness) can help impact their widespread adoption. OBJECTIVE To synthesize the literature on the clinical efficacy and clinician perspectives on the use of gait analysis technologies in the clinical care of adult populations. METHODS This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included peer-reviewed and gray literature (i.e., conference abstracts). A search was conducted in MEDLINE (Ovid), CENTRAL (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and SPORTDiscus (EBSCO). Included full-text studies were critically appraised using the JBI critical appraisal tools. RESULTS A total of 15 full-text studies and two conference abstracts were included in this review. Results suggest that QGA technologies can influence decision-making with some evidence to suggest their role in improving patient outcomes. The main barrier to ease of use was a clinician's lack of data expertise, and main facilitator was receiving support from staff. Barriers to usefulness included challenges finding suitable reference data and data accuracy, while facilitators were enhancing patient care and supporting clinical decision-making. SIGNIFICANCE This review is the first step to understanding how QGA technologies can optimize clinical practice. Many gaps in the literature exist and reveal opportunities to improve the clinical adoption of gait analysis technologies. Further research is needed in two main areas: 1) examining the clinical efficacy of gait analysis technologies and 2) gathering clinician perspectives using a theoretical model like the Technology Acceptance Model to guide study design. Results will inform research aimed at evaluating, developing, or implementing these technologies. FUNDING This work was supported by the Walter and Maria Schroeder Institute for Brain Innovation and Recovery and AGE-WELL Graduate Student Award in Technology and Aging [2021,2022].
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Affiliation(s)
- Yashoda Sharma
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Andrea Iaboni
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, M5T 1R8 Toronto, ON, Canada.
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Oubre B, Lane S, Holmes S, Boyer K, Lee SI. Estimating Ground Reaction Force and Center of Pressure using Low-Cost Wearable Devices. IEEE Trans Biomed Eng 2021; 69:1461-1468. [PMID: 34648428 DOI: 10.1109/tbme.2021.3120346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Ambulatory monitoring of ground reaction force (GRF) and center of pressure (CoP) could improve management of health conditions that impair mobility. Insoles instrumented with force-sensitive resistors (FSRs) are an unobtrusive, low-cost, and low-power technology for sampling GRF and CoP in real-world environments. However, FSRs have variable response characteristics that complicate estimation of GRF and CoP. This study introduces a unique data analytic pipeline that enables accurate estimation of GRF and CoP despite relatively inaccurate FSR responses. This paper also investigates whether inclusion of a complementary knee angle sensor improves estimation accuracy. METHODS Seventeen healthy subjects were equipped with an insole instrumented with six FSRs and a string-based knee angle sensor. Subjects walked in a straight line at self-selected slow, preferred, and fast speeds over an in-ground force platform. Twenty repetitions were performed for each speed. Supervised machine learning models estimated weight-normalized GRF and shoe size-normalized CoP, which were re-scaled to obtain GRF and CoP. RESULTS Anteroposterior GRF, Vertical GRF, and Anteroposterior CoP were estimated with a normalized root mean square error (NRMSE) of less than 5%. Mediolateral GRF and CoP were estimated with an NRMSE of 8.1% and 6.4%$ respectively. Knee angle-related features slightly improved GRF estimates. CONCLUSION Normalized models accurately estimated GRF and CoP despite deficiencies in FSR data. SIGNIFICANCE Ambulatory use of the proposed system could enable objective, longitudinal monitoring of severity and progression for a variety of health conditions.
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Johnson AJ, Palit S, Terry EL, Thompson OJ, Powell-Roach K, Dyal BW, Ansell M, Booker SQ. Managing osteoarthritis pain with smart technology: a narrative review. Rheumatol Adv Pract 2021; 5:rkab021. [PMID: 33928214 PMCID: PMC8068316 DOI: 10.1093/rap/rkab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
Osteoarthritis (OA) is a highly prevalent musculoskeletal condition worldwide. More than 300 million individuals are affected by OA, and pain is the most common and challenging symptom to manage. Although many new advances have led to improved OA-related pain management, smart technology offers additional opportunities to enhance symptom management. This narrative review identifies and describes the current literature focused on smart technology for pain management in individuals with OA. In collaboration with a health sciences librarian, an interdisciplinary team of clinician-scientists searched multiple databases (e.g. PubMed, CINAHL and Embase), which generated 394 citations for review. After inclusion criteria were met, data were extracted from eight studies reporting on varied smart technologies, including mobile health, wearables and eHealth tools to measure or manage pain. Our review highlights the dearth of research in this crucial area, the implications for clinical practice and technology development, and future research needs.
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Affiliation(s)
- Alisa J Johnson
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Shreela Palit
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Osheeca J Thompson
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Brenda W Dyal
- Department of Biobehavioral Nursing Science, College of Nursing
| | - Margaret Ansell
- George A. Smathers Libraries, Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
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Oubre B, Daneault JF, Boyer K, Kim JH, Jasim M, Bonato P, Lee SI. A Simple Low-Cost Wearable Sensor for Long-Term Ambulatory Monitoring of Knee Joint Kinematics. IEEE Trans Biomed Eng 2020; 67:3483-3490. [PMID: 32324536 PMCID: PMC7709863 DOI: 10.1109/tbme.2020.2988438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Accurate monitoring of joint kinematics in individuals with neuromuscular and musculoskeletal disorders within ambulatory settings could provide important information about changes in disease status and the effectiveness of rehabilitation programs and/or pharmacological treatments. This paper introduces a reliable, power efficient, and low-cost wearable system designed for the long-term monitoring of joint kinematics in ambulatory settings. METHODS Seventeen healthy subjects wore a retractable string sensor, fixed to two anchor points on the opposing segments of the knee joint, while walking at three different self-selected speeds. Joint angles were estimated from calibrated sensor values and their derivatives in a leave-one-subject-out cross validation manner using a random forest algorithm. RESULTS The proposed system estimated knee flexion/extension angles with a root mean square error (RMSE) of 5.0°±1.0° across the study subjects upon removal of a single outlier subject. The outlier was likely a result of sensor miscalibration. CONCLUSION The proposed wearable device can accurately estimate knee flexion/extension angles during locomotion at various walking speeds. SIGNIFICANCE We believe that our novel wearable technology has great potential to enable joint kinematic monitoring in ambulatory settings and thus provide clinicians with an opportunity to closely monitor joint recovery, develop optimal, personalized rehabilitation programs, and ultimately maximize therapeutic outcomes.
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