Human factors in the development and implementation of telerehabilitation systems

System Integrated Digital Empowering and teleRehabilitation to promote patient Activation and well-Being in chronic disabilities: A usability and acceptability study

Introduction

Telerehabilitation systems represent a promising way for the management of chronic disability, delivering technology-enabled rehabilitation outside the hospital setting. However, usability and acceptability assessment with users represents a critical starting point when using digital healthcare solutions. This study aims at evaluating the user experience with a Telerehabilitation system (SIDERA^∧B) from the end-user side.

Methods

SIDERA^∧B consists of an asynchronous delivery of rehabilitation activities through multimedia digital contents and tele-monitoring of vital parameters with technological devices for individualized, home-based management of chronic conditions. Usability (with the System Usability Scale, SUS) and acceptability (using the Technology Acceptance Model, TAM - and The Service User Technology Acceptance Questionnaire, SUTAQ) data were analyzed from the dataset of the SIDERA^∧B project (N = 112 patients with Chronic Heart Failure, Parkinson's Disease and Chronic Obstructive Pulmonary Disease). The possible influence of five external factors (i.e., technological expertise, education, sex, age, and level of disability) on TAM domains was tested using Spearman's Correlation analysis.

Results

Results showed a satisfactory level of technological usability (SUS Median = 77.5) and good scores in usability and learnability SUS subdomains (mean scores > 2.5). Regarding technological acceptability, participants showed high scores (Median > 4) in "Behavioral Intention", "Perceived Usefulness", and "Perceived Ease of Use" TAM domains. Finally, results from the SUTAQ scale highlighted that the SIDERA^∧B system obtained optimal scores in all domains, especially in "Increased accessibility," "Care personnel concerns," and "Satisfaction." Age (rho = -0.291, p = 0.002) and disability level (WHODAS Total score: rho = -0.218, p = 0.021) were the two external factors inversely associated with the Perceived Ease of Use.

Discussion

The age of digital transformation requires everyone to understand, accept and master the changes affecting modern-day healthcare. The usability and acceptability of the SIDERA^∧B system were high across all end-users, despite the medium-low level of the technological expertise of the sample. These findings support the efficiency and the suitability of these digital solutions in the modern digital age transition of rehabilitation from inside to outside the clinic.

Nigerian physiotherapists’ knowledge, attitude, and practice of digital physical therapy: a cross-sectional study

Background

The increasing demand for physical therapy services worldwide calls for innovations to be made to meet the challenges of service delivery. However, little is known about the knowledge, attitude, and practice (KAP) of digital physical therapy among Nigerian physiotherapists. Hence, this study aimed to evaluate the level of KAP of digital physical therapy among physiotherapists in Nigeria.

Methods

This cross-sectional study purposively recruited 150 Nigerian physiotherapists. Copies of modified and validated questionnaires on the KAP of digital physical therapy from a previous study were sent to registered and licensed physiotherapists via electronic survey to assess the KAP of digital physical therapy. Descriptive and inferential statistics were used to analyze the data. Alpha level was set at p < 0.05.

Results

The mean age of the respondents was 29.76 ± 6.95 years. Most participants (81.3%) have a knowledge level above average, while 18.7% have below average. Furthermore, most (76.0%) of the respondents had a positive attitude toward digital physical therapy. In addition, more than two-thirds, 69.3% uses digital physical therapy platforms for physical therapy practice. Knowledge, attitude, and practice were not significantly associated with sociodemographic characteristics (p > 0.05). Furthermore, there was no significant association between knowledge, attitude, and practice (p > 0.05).

Conclusion

Many Nigerian physiotherapists demonstrated adequate knowledge, positive attitude, and good practice of digital physical therapy. However, knowledge, attitude, and practice of digital physical therapy were not influenced by sociodemographic characteristics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43161-022-00118-3.

Two-sided perspective on tele-speech therapy: Experiences of stuttering patients, and their parents

The purpose of this study was to investigate the benefits and challenges of the tele-speech therapy from the perspective of patients who stutter, and their parents. Semi-structured interviews were conducted with 12 patients and three parents in two rehabilitation centers. Data were analyzed using a qualitative content analysis approach proposed by Graneheim and Lundman. Seven categories were determined: accessible treatment, motivation of comfort in tele-speech therapy, challenges of tele-therapy, satisfaction, virtual competency, lower quality compared to face-to-face therapy, and uncertainty about the effectiveness of tele-speech therapy. The participants had a two-sided perspective regarding tele-speech therapy. Positive experiences included benefitting from more qualified therapists at multiple locations, faster access to treatment, and saving cost and time. Negative experiences and challenges consisted of low-quality of technology infrastructure for rehabilitation including low quality of shared images and videos, ineffective communication, insufficient sympathy, indirect communication, and technology incompetency. Findings showed that the participants were interested in the application of tele-speech therapy, as this method could increase their accessibility and provide the opportunity to choose proper therapists. The determined benefits and challenges can provide the policy-makers with beneficial information to implement tele-speech therapy.

Acceptance of Remote Assistive Robots with and without Human-in-the-Loop for Healthcare Applications

Assistive social robots aim to facilitate outpatient-care including required safety critical measures. Accepting a robot to perform such measures, e.g., operate in close physical interaction for medical examinations, requires human trust towards the robot. Human-in-the-loop (HIL) applications where the robot is teleoperated by a human expert can help the person to accept even risky tasks performed by a robot. Therefore, the assistive humanoid GARMI was designed to enable HIL applications with varying autonomy. In this study, we use GARMI to understand which tasks in the framework of care may be accepted depending on human socio-demographics and user beliefs as well as the level of robot autonomy. Firstly, we seek to understand the general acceptance of GARMI using the Almere questionnaire. Secondly, we ask adults to rate their willingness to use several functionalities of GARMI. Lastly, we investigate the effect of the introduction method of GARMI on user acceptance. We assemble all relevant factors on acceptance to provide direction in the user-centered design process of assistive robots. The results of 166 participants show that alongside others, trust towards the robot and utilitarian variables such as perceived usefulness are the most influencing factors on the acceptance of GARMI and should be considered for the design of robotic semi-autonomous outpatient-services.

Telerehabilitation Use With Spinal Cord Injury: Occupational Therapists' Perspective

IMPORTANCE

Telerehabilitation provides people with spinal cord injury (SCI) an alternative mode of accessing specialized health care. Further research on occupational therapy practitioners' perspectives of telerehabilitation may provide additional evidence for clinical practice implementation.

OBJECTIVE

To explore urban occupational therapists' perspectives on the benefits of and barriers to telerehabilitation use with SCI.

DESIGN

A qualitative study design using a demographic questionnaire and a single, individual semistructured interview. Thematic analyses included member checking, constant comparative analysis, triangulation, and self-description and self-reflexivity.

SETTING

Residential and community settings.

PARTICIPANTS

Six occupational therapists with a range of experience in SCI rehabilitation were recruited using purposeful sampling.

RESULTS

Six participants were interviewed, and four primary themes emerged: (1) communication, (2) personal factors, (3) benefits, and (4) barriers.

CONCLUSIONS AND RELEVANCE

Telerehabilitation offers numerous potential benefits for SCI intervention. This study provides an understanding of practitioner concerns and potential barriers to use. The results indicate that a hybrid model incorporating both in-person and distance-based treatment is likely optimal. What This Article Adds: Our results provide information that addresses practitioner concerns and recommendations for the use of telerehabilitation with people with SCI. As practitioner concerns are identified and addressed, telerehabilitation may increase in the U.S. health care system, potentially facilitating an alternative treatment delivery method for underserved populations.

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.

MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study

BACKGROUND

Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction.

OBJECTIVE

In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch-informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation.

METHODS

We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life.

RESULTS

Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100).

CONCLUSIONS

This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.

B, C.T. S, B. AA, Fatoye C, Maikudi L, Fatoye F. Awareness, Attitude and Expectations of Physiotherapy Students on Telerehabilitation

BACKGROUND AND OBJECTIVE

Explosion in information technology knowledge and utilization among young people, referred to as digital natives, seems less explored in the health sector and training. This study was aimed to assess awareness, attitude and expectations of physiotherapy students on telerehabilitation.

METHODS

This cross-sectional survey employed systematic probability sampling technique to recruit 200 physiotherapy students. A self-developed questionnaire which was tested for its face and content validity was used to obtain data. Data was analysed using descriptive and inferential statistics. Alpha level was set at p < 0.05.

RESULTS

The mean age of the respondents was 21.2 ± 2.04 years. There was higher prevalence of moderate awareness (43%) and positive attitude towards telerehabilitation (39%). Majority of the respondents (62%) had high expectation towards future telerehabilitation products and services. There was significant association between level of awareness of telerehabilitation and age (X 2 = 7.119; p = 0.001).

DISCUSSION

The responding students in this study are by age in the class of digital natives, who should be conversant with technology. This could account for the higher moderate level of awareness of telerehabilitation. However, the higher rates of negative attitude towards telerehabilitation could be attributed to prevailing barriers to its utilization in Nigeria. Nonetheless, a large percentage of the students had high expectations for the future of telerehabilitation.

CONCLUSION

Nigerian physiotherapy students have moderate awareness and high expectation for future telerehabilitation applications. However, a larger number of them hold negative attitude towards it use.

Using the Technology Acceptance Model to Identify Factors That Predict Likelihood to Adopt Tele-Neurorehabilitation

Tele-neurorehabilitation has the potential to reduce accessibility barriers and enhance patient outcomes through a more seamless continuum of care. A growing number of studies have found that tele-neurorehabilitation produces equivalent results to usual care for a variety of outcomes including activities of daily living and health related quality of life. Despite the potential of tele-neurorehabilitation, this model of care has failed to achieve mainstream adoption. Little is known about feasibility and acceptability of tele-neurorehabilitation and most published studies do not use a validated model to guide and evaluate implementation. The technology acceptance model (TAM) was developed 20 years ago and is one of the most widely used theoretical frameworks for predicting an individual's likelihood to adopt and use new technology. The TAM3 further built on the original model by incorporating additional elements from human decision making such as computer anxiety. In this perspective, we utilize the TAM3 to systematically map the findings from existing published studies, in order to explore the determinants of adoption of tele-neurorehabilitation by both stroke survivors and prescribing clinicians. We present evidence suggesting that computer self-efficacy and computer anxiety are significant predictors of an individual's likelihood to use tele-neurorehabilitation. Understanding what factors support or hinder uptake of tele-neurorehabilitation can assist in translatability and sustainable adoption of this technology. If we are to shift tele-neurorehabilitation from the research domain to become a mainstream health sector activity, key stakeholders must address the barriers that have consistently hindered adoption.

Technical Features, Feasibility, and Acceptability of Augmented Telerehabilitation in Post-stroke Aphasia-Experiences From a Randomized Controlled Trial

Background: Post-stroke aphasia is a communication disorder where existing evidence favors intensive therapy methods. Telerehabilitation represents a service model for geographically remote settings, or other barriers to clinic attendance or to facilitate an augmentation of therapy across a continuum of care. Evidence to support efficiency, feasibility, and acceptability is however still scarce. Appraising aphasia telerehabilitation in controlled trials beyond its effectiveness, by investigating feasibility and acceptability, may facilitate implementation into clinical practice. Methods: In our pilot randomized controlled trial, we investigated the feasibility and acceptability of speech and language therapy by videoconference, in addition to usual care, in people with aphasia following stroke. To improve functional, expressive language, a tailored intervention was given 1 h per day, five times per week over four consecutive weeks. Feasibility measures included evaluation of technical setup using diary logs. Acceptability was investigated by examining adherence and satisfaction with therapy alongside evaluation of data safety and privacy. Results: Feasibility and acceptability data were collected in relation to 556.5 h of telerehabilitation delivered to 30 participants over a 2-years intervention period by three speech-language pathologists. Protocol adherence was high, with a tolerable technical fault rate; 86 faults were registered over 541 video sessions. Most (80%; n = 30) of the participants experienced zero to three faults. The main cause of technical failures was flawed internet connection, causing delayed or interrupted therapy. Total satisfaction with telerehabilitation was rated good or very good by 93.1% (n = 29) of participants and two of three speech-language pathologists. Within a moderate variance of technical failure, participants experiencing more faults were more satisfied. No serious events regarding security and privacy were reported. Our model is feasibly and ready to be implemented across a range of clinical settings and contexts. Conclusions: Synchronous telerehabilitation for post-stroke aphasia is feasible and acceptable and shows tolerable technical fault rates with high satisfaction among patients and pathologists. Within a low rate of faults, satisfaction was not negatively influenced by fault frequency. Access to clinical and technical expertise is needed when developing telerehabilitation services. Telerehabilitation may be a viable service delivery model for aphasia rehabilitation. Trial Registration: ClinicalTrials.gov, ID: NCT02768922.

Therapist-Guided Telerehabilitation for Adult Cochlear Implant Users: Developmental and Feasibility Study

BACKGROUND

Cochlear implants can provide auditory perception to many people with hearing impairment who derive insufficient benefits from hearing aid use. For optimal speech perception with a cochlear implant, postoperative auditory training is necessary to adapt the brain to the new sound transmitted by the implant. Currently, this training is usually conducted via face-to-face sessions in rehabilitation centers. With the aging of society, the prevalence of age-related hearing loss and the number of adults with cochlear implants are expected to increase. Therefore, augmenting face-to-face rehabilitation with alternative forms of auditory training may be highly valuable.

OBJECTIVE

The purpose of this multidisciplinary study was to evaluate the newly developed internet-based teletherapeutic multimodal system Train2hear, which enables adult cochlear implant users to perform well-structured and therapist-guided hearing rehabilitation sessions on their own.

METHODS

The study was conducted in 3 phases: (1) we searched databases from January 2005 to October 2018 for auditory training programs suitable for adult cochlear implant users; (2) we developed a prototype of Train2hear based on speech and language development theories; (3) 18 cochlear implant users (mean age 61, SD 15.4 years) and 10 speech and language therapists (mean age 34, SD 10.9 years) assessed the usability and the feasibility of the prototype. This was achieved via questionnaires, including the System Usability Scale (SUS) and a short version of the intrinsic motivation inventory (KIM) questionnaires.

RESULTS

The key components of the Train2hear training program are an initial analysis according to the International Classification of Functioning, Disability and Health; a range of different hierarchically based exercises; and an automatic and dynamic adaptation of the different tasks according to the cochlear implant user's progress. In addition to motivational mechanisms (such as supportive feedback), the cochlear implant user and therapist receive feedback in the form of comprehensive statistical analysis. In general, cochlear implant users enjoyed their training as assessed by KIM scores (mean 19, SD 2.9, maximum 21). In terms of usability (scale 0-100), the majority of users rated the Train2hear program as excellent (mean 88, SD 10.5). Age (P=.007) and sex (P=.01) had a significant impact on the SUS score with regard to usability of the program. The therapists (SUS score mean 93, SD 9.2) provided slightly more positive feedback than the cochlear implant users (mean 85, SD 10.3).

CONCLUSIONS

Based on this first evaluation, Train2hear was well accepted by both cochlear implant users and therapists. Computer-based auditory training might be a promising cost-effective option that can provide a highly personalized rehabilitation program suited to individual cochlear implant user characteristics.

An Acceptability Study Of A Personal Portable Device Storing Critical Health Information To Ensure Treatment Continuity Of Home-Dwelling Older Adults In Case Of A Disaster

AIMS

DEPPAS ("Dispositivo Electrónico Personal y Portable en Salud" or Personal, Portable Electronic Health Device in English) is a portable device in form of a bracelet that allows storing electronic health records of older adults experiencing chronic illnesses. The device seeks to support the vital sustainability of older adults by storing critical health information when electronic or paper records have been lost as a consequence of a disaster. Older adults are particularly vulnerable to experience negative consequences in this context. The present study explores the end-user acceptability of DEPPAS in order to inform the next design stages of the device.

METHODS

Twenty home-dwelling urban male and female older adults enrolled in a chronic health management program were invited to participate in two focus groups. A prototype of DEPPAS was presented and reactions to health service disruption scenarios were explored. Focus groups were transcribed. Content analysis based on the Technology Acceptance Model was conducted.

RESULTS

Older adults are acutely aware of their vulnerable health status. Participants report overall positive reactions to DEPPAS. The device was associated with feelings of relief and an increased sense of control over their health management. DEPPAS is perceived as useful, usable, and safe. Even though concerns regarding confidentiality were raised, benefits are perceived as more relevant than potential risks. Participants agree that its usefulness could be extended beyond disaster situations to everyday health care management. Implications for future development and limitations are discussed.

CONCLUSION

The conceptual design DEPPAS shows a high level of acceptability by this end user and a high potential to be integrated with other complementary technologies (e.g. GPS, medication reminders) that could significantly contribute to improving health management in disaster situations.

A home-video method to assess infant gross motor development: parent perspectives on feasibility

Background

Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants’ gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents’ perspective.

Methods

Parents of 59 typically developing infants (0–19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method.

Results

Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant’s motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant.

Conclusion

The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems.

The development and feasibility of an online aphasia group intervention and networking program - TeleGAIN

PURPOSE

Aphasia group therapy offers many benefits, however people with aphasia report difficulty accessing groups and speech-language pathologists are faced with many challenges in providing aphasia group therapy. Telerehabilitation may offer an alternative service delivery option. An online aphasia group therapy program - Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN) - has been developed according to the guidelines of the Medical Research Council (MRC) framework for complex interventions. The purpose of this paper is to describe the development of TeleGAIN and the results of a pilot trial to determine feasibility and acceptability.

METHOD

The development of TeleGAIN was informed through literature reviews in relevant topic areas, consideration of expert opinion and application of the social cognitive theory. TeleGAIN was then modelled through a feasibility pilot trial with four people with aphasia.

RESULT

TeleGAIN appeared to be feasible and acceptable to participants and able to be implemented as planned. Participant satisfaction with treatment was high and results suggested some potential for improvements in language functioning and communication-related quality of life.

CONCLUSION

TeleGAIN appeared to be feasible and acceptable, however the study highlighted issues related to technology, clinical implementation and participant-specific factors that should be addressed prior to a larger trial.

Adaptive, Multisensorial, Physiological and Social: The Next Generation of Telerehabilitation Systems

Some people require special treatments for rehabilitating physical, cognitive or even social capabilities after an accident or degenerative illness. However, the ever-increasing costs of looking after an aging population, many of whom suffer chronic diseases, is straining the finances of healthcare systems around Europe. This situation has given rise to a great deal of attention being paid to the development of telerehabilitation (TR) systems, which have been designed to take rehabilitation beyond hospitals and care centers. In this article, we propose which features should be addressed in the development of TR systems, that is, they should consider adaptive, multisensorial, physiological and social aspects. For this aim, the research project Vi-SMARt is being conducted for evaluating whether and how different technologies, such as virtual reality (VR), multi-sensorial feedback, or telemonitoring, may be exploited for the development of the next generation of TR systems. Beyond traditional aural and visual feedback, the exploitation of haptic sense by using devices such as haptic gloves or wristbands, can provide patients with additional guidance in the rehabilitation process. For telemonitoring, Electroencephalography (EEG) devices show signs of being a promising approach, not only to monitor patients’ emotions, but also to obtain neuro-feedback useful for controlling his/her interaction with the system and thus to provide a better rehabilitation experience.

The feasibility of delivering constraint-induced language therapy via the Internet

Objective

This study is designed to determine the feasibility of the provision of an evidenced-based aphasia therapy, constraint-induced language therapy, via telerehabilitation. It describes the computer software that was developed specifically for the delivery of constraint-induced language therapy in the online environment and presents two case studies.

Methods

Two participants with chronic aphasia were assessed before and after a two-week intensive treatment block of constraint-induced language therapy delivered via Web-based videoconferencing. The group-based, dual card request game utilized in face-to-face constraint-induced language therapy was transformed into an innovative and user-friendly Web-based game - Internet constraint-induced language therapy (iCILT). Participants accessed iCILT via the Internet from their own home every weekday for two weeks. Language and quality of life measures were administered pre- and post-therapy in order to detect treatment effects. Participant satisfaction information was also recorded.

Results

Online delivery of iCILT was technically feasible and participant satisfaction was high with a number of benefits associated with telerehabilitation identified by participants. Post-treatment performance for language functioning and communication-related quality of life was variable for each participant, however improvements in naming were noted.

Conclusions

Constraint-induced language therapy delivered via telerehabilitation may be a feasible alternative to traditional face-to-face therapy for people with chronic aphasia.

Patient and health care professional perspectives on using telehealth to deliver pulmonary rehabilitation

The objective of this study was to identify the necessary features of pulmonary telerehabilitation (P-TR) from the perspectives of individuals living with chronic lung disease and health care professionals (HCPs) who deliver pulmonary rehabilitation (PR). Focus groups were carried out with patients (n = 26) and HCPs (n = 26) to elicit and explore their opinions about the critical elements of in-person PR and ideas for how these elements could be supported using technology. A questionnaire was used to assess technology use, PR experience, and general health status. Four key elements of PR were identified as critical to P-TR: the social aspect of PR; communicating with HCPs for education and support; using biosensors for monitoring and promoting self-knowledge; and the evolution of support with progress over time. A range of technology-enabled devices and programs were suggested as means to recreate aspects of these integral elements. Consultations with patients and HCPs suggest that users are interested in technology and want to ensure it recreates the important aspects of PR. Patients and HCPs identified similar key elements for P-TR. The opinions and suggestions of patients and HCPs should be the driving force of innovation if P-TR is to succeed in improving health outcomes.

Telemedicine in chronic obstructive pulmonary disease

Telemedicine is a medical application of advanced technology to disease management. This modality may provide benefits also to patients with chronic obstructive pulmonary disease (COPD). Different devices and systems are used. The legal problems associated with telemedicine are still controversial. Economic advantages for healthcare systems, though potentially high, are still poorly investigated. A European Respiratory Society Task Force has defined indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of COPD patients including those undergoing home mechanical ventilation.

We need much more evidence before telemedicine can be considered as real progress in the management of COPD patientshttp://ow.ly/Rko8305tpnJ

Proposal and Evaluation of a Telerehabilitation Platform Designed for Patients With Partial Rotator Cuff Tears: A Preliminary Study

Objective

To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears.

Methods

During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale.

Results

Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42–68 years). Pain diminished from a baseline value of 64 mm (range, 40–80 mm) to 16 mm (range, 0–30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51–66 points) to 85 points (range, 70–100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05).

Conclusion

Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

The estimated prevalence of ventilator-dependent individuals in Europe is 6.6 per 100 000 people. The increasing number and costs of these complex patients make present health organisations largely insufficient to face their needs. As a consequence, their burden lays mostly over families. The need to reduce healthcare costs and to increase safety has prompted the development of tele-monitoring for home ventilatory assistance.

A European Respiratory Society Task Force produced a literature research based statement on commonly accepted clinical criteria for indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of these patients.

Many remote health monitoring systems are available, ensuring safety, feasibility, effectiveness, sustainability and flexibility to face different patients' needs. The legal problems associated with tele-monitoring are still controversial. National and European Union (EU) governments should develop guidelines and ethical, legal, regulatory, technical, administrative standards for remote medicine. The economic advantages, if any, of this new approach must be compared to a “gold standard” of home care that is very variable among different European countries and within each European country.

Much more research is needed before considering tele-monitoring a real improvement in the management of these patients.

Feasibility of Telerehabilitation Implementation as a Novel Experience in Rehabilitation Academic Centers and Affiliated Clinics in Tehran: Assessment of Rehabilitation Professionals' Attitudes

Introduction. This study aimed to assess rehabilitation professionals' attitude toward implementation and application of telerehabilitation technology as a novel study in rehabilitation academic centers and affiliated clinics in Tehran. Methods. It was a descriptive cross-sectional study. To collect data, a researcher-designed questionnaire was developed. 141 rehabilitation experts participated in the study. Results. A majority of faculty members (78%) and clinicians (89.7%) either were in “definite agreement” or “somewhat agreed” with implementation and application of this technology, which demonstrates an overall positive attitude. Discussion. Based on the positive attitudes of the majority of participants toward implementation and application of this technology and their preferences in offering different telerehabilitation services, it seems that there is an appropriate and desirable acceptance and administrative culture to implement this technology among rehabilitation experts in Tehran. It is thus expected that implementation and application of this technology will be a promising experience in rehabilitation academic centers and affiliate clinics in Tehran.

Validation of a Kinect-based telerehabilitation system with total hip replacement patients

The evolving telecommunications industry combined with medical information technology has been proposed as a solution to reduce health care cost and provide remote medical services. This paper aims to validate and show the feasibility and user acceptance of using a telerehabilitation system called Kinect Rehabilitation System (KiReS) in a real scenario, with patients attending repeated rehabilitation sessions after they had a Total Hip Replacement (THR). We present the main features of KiReS, how it was set up in the considered scenario and the experimental results obtained in relation to two different perspectives: patients' subjective perceptions (gathered through questionnaires) and the accuracy of the performed exercises (by analysing the data captured using KiReS). We made a full deployment of KiReS, defining step by step all the elements of a therapy: postures, movements, exercises and the therapy itself. Seven patients participated in this trial in a total of 19 sessions, and the system recorded 3865 exercise executions. The group showed general support for telerehabilitation and the possibilities that systems such as KiReS bring to physiotherapy treatment.

Successful remote delivery of a treatment for phonological alexia via telerehab

A growing body of literature supports the effectiveness of the remote delivery of rehabilitation services, i.e., telerehab. Aphasia treatment is particularly well suited for telerehab because of the verbal and visual nature of speech-language therapy, but scientific research investigating aphasia telerehab is in its infancy. No studies to date have evaluated whether treatment of acquired reading disorders by a live clinician can be feasibly, effectively, or efficiently conducted via telerehab. Here we address this gap in the literature by reporting our success remotely remediating the reading deficits of two participants with phonological alexia. We adapted for the telerehab setting a previously validated treatment for phonological alexia (Friedman, Sample, & Lott, 2002 ), which uses a paired-associate design to train reading of problematic words. Both telerehab participants significantly improved their reading of trained words in similar time frames as previous participants (Friedman et al., 2002 ; Kurland et al., 2008 ; Lott, Sample, Oliver, Lacey, & Friedman, 2008 ); furthermore, both participants reported high satisfaction with the telerehab setting. Although telerehab with alexic patients poses unique challenges, we conclude that treatment for alexia via telerehab is nevertheless feasible, may be equally effective as in-person treatment, and saves substantial resources for participants as well as clinicians.

Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study

Objective:

To explore the effectiveness and participant experience of web-based physiotherapy for people moderately affected with Multiple Sclerosis (MS) and to provide data to establish the sample size required for a fully powered, definitive randomized controlled study.

Design:

A randomized controlled pilot study.

Setting:

Rehabilitation centre and participants’ homes.

Subjects:

Thirty community dwelling adults moderately affected by MS (Expanded Disability Status Scale 5-6.5).

Interventions:

Twelve weeks of individualised web-based physiotherapy completed twice per week or usual care (control). Online exercise diaries were monitored; participants were telephoned weekly by the physiotherapist and exercise programmes altered remotely by the physiotherapist as required.

Main measures:

The following outcomes were completed at baseline and after 12 weeks; 25 Foot Walk, Berg Balance Scale, Timed Up and Go, Multiple Sclerosis Impact Scale, Leeds MS Quality of Life Scale, MS-Related Symptom Checklist and Hospital Anxiety and Depression Scale. The intervention group also completed a website evaluation questionnaire and interviews.

Results:

Participants reported that website was easy to use, convenient, and motivating and would be happy to use in the future. There was no statistically significant difference in the primary outcome measure, the timed 25ft walk in the intervention group ( P=0.170), or other secondary outcome measures, except the Multiple Sclerosis Impact Scale ( P=0.048). Effect sizes were generally small to moderate.

Conclusion:

People with MS were very positive about web-based physiotherapy. The results suggested that 80 participants, 40 in each group, would be sufficient for a fully powered, definitive randomized controlled trial.

eFisioTrack: a telerehabilitation environment based on motion recognition using accelerometry

The growing demand for physical rehabilitation processes can result in the rising of costs and waiting lists, becoming a threat to healthcare services' sustainability. Telerehabilitation solutions can help in this issue by discharging patients from points of care while improving their adherence to treatment. Sensing devices are used to collect data so that the physiotherapists can monitor and evaluate the patients' activity in the scheduled sessions. This paper presents a software platform that aims to meet the needs of the rehabilitation experts and the patients along a physical rehabilitation plan, allowing its use in outpatient scenarios. It is meant to be low-cost and easy-to-use, improving patients and experts experience. We show the satisfactory results already obtained from its use, in terms of the accuracy evaluating the exercises, and the degree of users' acceptance. We conclude that this platform is suitable and technically feasible to carry out rehabilitation plans outside the point of care.

Perspectives of speech-language pathologists on the use of telepractice in schools: the qualitative view

Telepractice in speech-language pathology shows the potential to mitigate the current shortage of speech-language pathologists (SLPs) available to serve a growing number of persons with communication disorders. Since a majority of American Speech-Language-Hearing Association (ASHA) certified SLPs work in schools and the population of communicatively impaired clients in schools continues to grow, research into the use of telepractice in the educational setting is warranted. This article reports upon the perspectives of SLPs regarding the use of telepractice in school settings. In-depth qualitative interviews were conducted with five SLPs experienced in the delivery of telepractice. Four major themes emerged: barriers, benefits, reasons for acceptance and use of telepractice, and suggestions to resolve telepractice professional issues.

Managing Patient Factors in the Assessment of Swallowing via Telerehabilitation

Undoubtedly, the identification of patient suitability for a telerehabilitation assessment should be carried out on a case-by-case basis. However, at present there is minimal discussion of how telerehabilitation systems can accommodate and adapt to various patient factors, which may pose challenges to successful service delivery. The current study examines a subgroup of 10 patients who underwent an online assessment of their swallowing difficulties. Although all assessments were completed successfully; there were certain patient factors, which complicated the delivery of the online assessment session. The paper presents a discussion of the main patient factors observed in this cohort including the presence of speech and/or voice disorders, hearing impairment, dyskinesia, and behavioural and/or emotional issues and examines how the assessment session, the telerehabilitation system, and the staff involved were manipulated to accommodate these patient factors. In order for telerehabilitation systems to be more widely incorporated into routine clinical care, systems need to have the flexibility and design capabilities to adjust and accommodate for patients with varying levels of function and physical and psychological comorbidities.

A telerehabilitation platform for home-based automated therapy of arm function

Constraint-Induced Movement Therapy (CI therapy) has been shown to be an effective approach for improving arm function in stroke survivors with mild to severe hemiparesis. Given the time-intensive nature of the intervention, and the inherent costs and travel required to receive in-clinic treatment, the accessibility and availability of CI therapy is limited. To facilitate home-based CI therapy, a telerehabilitation platform has been developed. It consists of a table-top workstation configured with a range of physical task devices (e.g. pegboard, object flipping, threading, vertical reaching). A desktop PC is used to acquire data from sensors embedded in the task devices; display visual instructions, stimuli, and feedback to the patient during tasks; and provide videoconferencing and remote connection capabilities so the therapist can interact with and monitor the patient during at-home therapy sessions. This system has potential to greatly expand access to CI therapy and make it a more realistic option for a larger number of stroke survivors with upper extremity impairment.

A Game-Based Virtualized Reality Approach for Simultaneous Rehabilitation of Motor Skill and Confidence

Virtualized reality games offer highly interactive and engaging user experience and therefore game-based approaches (GBVR) may have significant potential to enhance clinical rehabilitation practice as traditional therapeutic exercises are often repetitive and boring, reducing patient compliance. The aim of this study was to investigate if a rehabilitation training programme using GBVR could simultaneously improve both motor skill (MS) and confidence (CON), as they are both important determinants of daily living and physical and social functioning. The study was performed using a nondominant hand motor deficit model in nonambidextrous healthy young adults, whereby dominant and nondominant arms acted as control and intervention conditions, respectively. GBVR training was performed using a commercially available tennis-based game. CON and MS were assessed by having each subject perform a comparable real-world motor task (RWMT) before and after training. Baseline CON and MS for performing the RWMT were significantly lower for the nondominant hand and improved after GBVR training, whereas there were no changes in the dominant (control) arm. These results demonstrate that by using a GBVR approach to address a MS deficit in a real-world task, improvements in both MS and CON can be facilitated and such approaches may help increase patient compliance.

Assessment of organizational readiness for e-health in a rehabilitation centre

PURPOSE

The aims of this study were to assess organizational readiness for e-health among the staff of an out-patient rehabilitation centre and to identify the personal characteristics of potential users that may have influenced readiness.

METHODS

A cross-sectional study was conducted with 137 clinicians, 28 managers, and 47 nonclinical staff in a rehabilitation centre in Montreal, Quebec, Canada. All participants completed a self-administered questionnaire assessing organizational readiness for e-health. The measure contained three subscales: Individual, Organizational and Technological. Data were also collected on the users' profile, use of technologies and typical response to new information.

RESULTS

Generally, participants considered themselves ready to adopt e-health in their work (X = 73.8%, SD = 8.5) and they also had a favorable view of the technologies in place (X 73.8%, SD = 7.2). However, they perceived the center as being only moderately ready (X 66.6%, SD = 9.8) for e-health changes. Perceived workload and position/duties in the organization were found to have an impact on readiness for e-health.

CONCLUSIONS

These results underscore the importance of addressing organizational readiness for change as a multidimensional concept. Based on these results, implementation strategies tailored to the specific profile of a rehabilitation organization were identified.

Methodology for analyzing and developing information management infrastructure to support telerehabilitation

The proliferation of advanced technologies led researchers within the Rehabilitation Engineering Research Center on Telerehabilitation (RERC-TR) to devise an integrated infrastructure for clinical services using the University of Pittsburgh (PITT) model. This model describes five required characteristics for a telerehabilitation (TR) infrastructure: openness, extensibility, scalability, cost-effectiveness, and security. The infrastructure is to deliver clinical services over distance to improve access to health services for people living in underserved or remote areas. The methodological approach to design, develop, and employ this infrastructure is explained and detailed for the remote wheelchair prescription project, a research task within the RERC-TR. The availability of this specific clinical service and personnel outside of metropolitan areas is limited due to the lack of specialty expertise and access to resources. The infrastructure is used to deliver expertise in wheeled mobility and seating through teleconsultation to remote clinics, and has been successfully deployed to five rural clinics in Western Pennsylvania.

Telerehabilitation clinical and vocational applications for assistive technology: research, opportunities, and challenges

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper.

Telerehabilitation technologies: accessibility and usability

In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user. This white paper will first present the numerous professional considerations that shape the use of technology in telerehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users’ clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-user capabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches.

Nine human factors contributing to the user acceptance of telemedicine applications: a cognitive-emotional approach

Much attention is paid to the technical aspects of telemedicine in the development of new applications, but the enthusiasm about what is technically possible very often leads to the user acceptance of such products being neglected. The number of successful and sustainable telemedicine applications would be much higher if developers concentrated more on matters related to the cognitive-emotional situation of the users involved in telemedicine. The users include the care and cure providers, as well as the care and cure receivers. Based on an informal literature search and discussions with telemedicine implementation staff, nine factors have been identified which are essential for the user acceptance of telemedicine applications. All of them are connected more to the cognitive-emotional than to the cognitive-rational side of information processing. This suggests that in the future the cognitive-emotional side will need more attention. This in turn implies that the nine points mentioned above have to find their way into requirements engineering, development processes and product life cycles.