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Cordella C, Kiran S. Quantifying Dosage in Self-Managed Speech-Language Therapy: Exploring Components of Cumulative Intervention Intensity in a Real-World Mobile Health Data Set. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1513-1523. [PMID: 38573233 DOI: 10.1044/2024_ajslp-23-00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE Cumulative Intervention Intensity (CII) is a proposed framework for conceptualizing and calculating dose that has been used to quantify intensity of speech-language therapy (SLT) in highly controlled laboratory studies and clinical trials. However, it is unknown whether CII can be applied to characterize the practice patterns of patients undertaking at-home, self-managed SLT. The current study leverages real-world mobile health data to investigate the applicability of CII parameters to self-managed SLT, including the interrelationships between individual CII parameters and their utility for identifying naturally occurring subgroups of patient users. METHOD Anonymized data from 2,223 poststroke survivors who used the Constant Therapy application were analyzed. Four quantitative CII parameters-dose, session frequency, session duration, and total intervention duration-were calculated per user over a 3-month analysis period using raw session-level data. We conducted correlation analyses at the level of the individual and group to examine the degree of relatedness between each of the CII parameters. CII parameter measures were additionally used as inputs to a k-mean clustering analysis to identify practice pattern subgroups. RESULTS Results demonstrate the feasibility of calculating components of CII based on available usage statistics from a commercial app for self-managed SLT. Specifically, results suggest that, although CII parameters are related, session frequency offers complementary and nonoverlapping information (cf. dose, session duration, total intervention duration) about dosage. Clustering results show that practice patterns can be broadly differentiated according to the (a) amount and (b) frequency of practice. CONCLUSIONS The calculation of CII may provide both users and clinicians with a fuller picture of at-home, self-managed practice habits than looking at any one dosage component alone. The study represents a first step toward more comprehensive and theoretically grounded dose reporting for self-managed SLT. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25511191.
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Affiliation(s)
- Claire Cordella
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Swathi Kiran
- Department of Speech, Language & Hearing Sciences, Boston University, MA
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Kumar A, Khurana D, Pattanaik S, Kumar M, Kaur S, Krishnan NC, Ghai S, Modi M, Nagi M, Chellappa R, Gairolla J, Munjal DK, Kumar P. A mobile application-based post-stroke care strategy for survivors and their caregivers for prevention and management of post-stroke complications - "Stroke Home Care:" Development and feasibility. J Neurosci Rural Pract 2024; 15:217-226. [PMID: 38746514 PMCID: PMC11090587 DOI: 10.25259/jnrp_411_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/10/2023] [Indexed: 05/16/2024] Open
Abstract
Objectives In developing nations such as India, a disparity exists between the available resources for stroke rehabilitation and the substantial burden of stroke cases. Consequently, the provision of cost-effective and multidisciplinary post-stroke rehabilitation care to stroke survivors becomes of paramount importance. The utilization of mobile applications (apps) for stroke care has been on the rise, offering a personalized and pragmatic solution with the potential for wider reach in settings constrained by limited resources. To address the unmet needs in the prevention and management of post-stroke complications, we conceptualized a strategy known as a mobile application-based post-stroke care strategy for both survivors and their caregivers. Materials and Methods The scope of the app's focus was determined based on the incidence of post-stroke complications within a prospective cohort of stroke patients, in conjunction with existing literature. An initial "web-based mobile app" prototype was crafted to align with the identified focus area. Before the development of the final app version, a feasibility study was conducted involving 30 participant dyads (comprising a patient and a caregiver). Content validity was evaluated by a panel of 20 stroke experts encompassing neurologists, nurses, physiotherapists, and psychologists. Results The "Stroke Home Care" (SHC) mobile app was conceived as a web-based educational tool aimed at preventing and managing post-stroke complications. It seeks to train caregivers of immobile stroke patients in the administration of preventive and therapeutic care procedures, thereby potentially enhancing survivors' quality of life and alleviating caregivers' burden. The feasibility and validity studies indicated "high satisfaction" levels among most caregivers and experts (>75%), with the remainder expressing "satisfaction" and no "dissatisfaction" regarding app utilities. Stroke experts unanimously deemed the app "appropriate", with consensus on contents, video quality, video length, and voice clarity. Caregivers reported "satisfactory" user experiences, encountering no issues during app installation or operation. Suggestions from both caregivers and experts were integrated into the final app version. Conclusion The "SHC" app represents a feasible and well-received innovation tailored for the use by caregivers of stroke survivors. Consequently, the initial feasibility of the developed app serves as a precursor to a randomized controlled clinical trial aimed at substantiating its effectiveness within the post-stroke survivor and caregiver population. Notably, within resource-constrained contexts, this app has the potential to be a pivotal tool for post-stroke care.
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Affiliation(s)
- Ashok Kumar
- National Institute of Nursing Education, Chandigarh, India
| | - Dheeraj Khurana
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Smita Pattanaik
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Kumar
- Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sukhpal Kaur
- National Institute of Nursing Education, Chandigarh, India
| | | | - Sandhya Ghai
- National Institute of Nursing Education, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Nagi
- National Institute of Nursing Education, Chandigarh, India
| | - Rajan Chellappa
- Department of Physical Medicine and Rehabilitation, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Divesh Kumar Munjal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pramod Kumar
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Brouns B, Meesters JJL, de Kloet AJ, Vliet Vlieland TPM, Houdijk S, Arwert HJ, van Bodegom-Vos L. What works and why in the implementation of eRehabilitation after stroke - a process evaluation. Disabil Rehabil Assist Technol 2024; 19:345-359. [PMID: 35730242 DOI: 10.1080/17483107.2022.2088867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) - including cognitive/physical exercise applications, activity-tracking, psycho-education - after stroke resulted in health-related improvements. This study investigated what worked and why in the implementation. METHODS Implementation activities (information provision, integration of Fast@home, instruction and motivation) were performed for 14 months and evaluated, using the Medical Research Council framework for process evaluations which consists of three evaluation domains (implementation, mechanisms of impact and contextual factors). Implementation activities were evaluated by field notes/surveys/user data, it's mechanisms of impact by surveys and contextual factors by field notes/interviews among 11 professionals. Surveys were conducted among 51 professionals and 73 patients. User data (n = 165 patients) were extracted from the eRehabilitation applications. RESULTS Implementation activities were executed as planned. Of the professionals trained to deliver the intervention (33 of 51), 25 (75.8%) delivered it. Of the 165 patients, 82 (49.7%) were registered for Fast@home, with 54 patient (65.8%) using it. Mechanisms of impact showed that professionals and patients were equally satisfied with implementation activities (median score 7.0 [IQR 6.0-7.75] versus 7.0 [6.0-7.5]), but patients were more satisfied with the intervention (8.0 [IQR 7.0-8.0] versus 5.5 [4.0-7.0]). Guidance by professionals was seen as most impactful for implementation by patients and support of clinical champions and time given for training by professionals. Professionals rated the integration of Fast@home as insufficient. Contextual factors (financial cutbacks and technical setbacks) hampered the implementation. CONCLUSION Main improvements of the implementation of eRehabilitation are related to professionals' perceptions of the intervention, integration of eRehabilitation and contextual factors.Implication for rehabilitationTo increase the use of eRehabilitation by patients, patients should be supported by their healthcare professional in their first time use and during the rehabilitation process.To increase the use of eRehabilitation by healthcare professionals, healthcare professionals should be (1) supported by a clinical champion and (2) provided with sufficient time for learning to work and getting familiar with the eRehabilitation program.Integration of eRehabilitation in conventional stroke rehabilitation (optimal blended care) is an important challenge and a prerequisite for the implementation of eRehabilitation in the clinical setting.
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Affiliation(s)
- Berber Brouns
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jorit J L Meesters
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Arend J de Kloet
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Sander Houdijk
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
| | - Henk J Arwert
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Rehabilitation, Haaglanden Medical Center, the Hague, the Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
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Hestetun-Mandrup AM, Toh ZA, Oh HX, He HG, Martinsen ACT, Pikkarainen M. Effectiveness of digital home rehabilitation and supervision for stroke survivors: A systematic review and meta-analysis. Digit Health 2024; 10:20552076241256861. [PMID: 38832099 PMCID: PMC11146002 DOI: 10.1177/20552076241256861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/26/2024] [Indexed: 06/05/2024] Open
Abstract
Objective Stroke survivors often experience residual impairments and motor decline post-discharge. While digital home rehabilitation combined with supervision could be a promising approach for reducing human resources, increasing motor ability, and supporting rehabilitation persistence there is a lack of reviews synthesizing the effects. Thus, this systematic review and meta-analysis aimed to synthesize the effect of digital home rehabilitation and supervision in improving motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function among stroke survivors. Methods Six electronic databases, grey literature, ongoing studies, and reference lists were searched for relevant studies. Two investigators independently reviewed titles, abstracts, screened full texts for eligibility and performed data extraction. Meta-analysis of 13 independent studies were grouped into four separate meta-analyses. The Grading of Recommendations, Assessments, Development and Evaluations (GRADE) tool was used for evaluating the overall quality of the evidence. Results Meta-analyses showed no statistically significant difference between intervention (digital home rehabilitation) and control groups (home training/clinic-based) of all outcomes including motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function. In the sub-group analysis digital home rehabilitation was associated with better quality of arm use (standardized mean difference = 0.68, 95% confidence interval: [0.27, 1.09], p = 0.001). Conclusions This result indicated that digital home rehabilitation has similar effects and could potentially replace home training or clinic-based services. This review highlights better-targeted digital motor interventions to examine the effects of interventions further. The quality of evidence was moderate to high in motor and self-reported arm outcomes, and low for balance and quality of life.
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Affiliation(s)
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
- Singapore General Hospital, Singapore
- National University Health System, Singapore
| | - Hui Xian Oh
- Singapore General Hospital, Singapore
- National University Health System, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
- National University Health System, Singapore
| | | | - Minna Pikkarainen
- Oslomet -Oslo Metropolitan University, Oslo, Norway
- University of Oulu, Oulu, Finland
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Epalte K, Tomsone S, Vētra A, Bērziņa G. Patient experience using digital therapy "Vigo" for stroke patient recovery: a qualitative descriptive study. Disabil Rehabil Assist Technol 2023; 18:175-184. [PMID: 33155507 DOI: 10.1080/17483107.2020.1839794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The digital assistant "Vigo" is a computer-generated artificial intelligence-based application that serves as a digital assistant to a stroke patient and his family. With its conversational chatbot and gamification elements it counsels, educates, and trains the stroke patient and patient's family on stroke, rehabilitation, care, and other related issues. AIM This study describes insights about The digital assitant "Vigo" usability from a patients' perspective. METHODS Twelve patients tested the application at their home environment. Three semi-structured interviews were conducted with each participant to obtain information on the usability of the application. Deductive thematic analyses were used to analyze trancripts. RESULTS Participants expressed their opinions on music, pictures, video and audio files, chat options, layout, text, name of application and stand that is used for placement of devices on which "Vigo" is installed on. All participants generally evaluated application as transparent, understandable, and handy. The overall design of the application was rated as good. Participants were mostly unsatisfied with difficulty level and diversity of exercises. CONCLUSIONS Participants had a positive attitude towards using tablet tehchnologies in their home environment. Users of digital assistant "Vigo" acknowledged its ability to support, give educational information and increase participation in therapeutic activities.Implications for rehabilitationTablet application can support, give educational information, and increase participation in therapeutic activities for persons after stroke.As home-based rehabilitation tool, the content of the application must be simple, flexible, and diverse, to face the challenges of meeting each individual's goals, functional needs and abilities.
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Affiliation(s)
- Klinta Epalte
- Department of Rehabilitation, Rīga Stradiņš University, Rīga, Latvia
| | - Signe Tomsone
- Department of Rehabilitation, Rīga Stradiņš University, Rīga, Latvia
| | - Aivars Vētra
- Department of Rehabilitation, Rīga Stradiņš University, Rīga, Latvia
| | - Guna Bērziņa
- Department of Rehabilitation, Rīga Stradiņš University, Rīga, Latvia.,Rīga East University Hospital, Rīga, Latvia
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Szeto SG, Wan H, Alavinia M, Dukelow S, MacNeill H. Effect of mobile application types on stroke rehabilitation: a systematic review. J Neuroeng Rehabil 2023; 20:12. [PMID: 36694257 PMCID: PMC9872745 DOI: 10.1186/s12984-023-01124-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Stroke is a significant contributor of worldwide disability and morbidity with substantial economic consequences. Rehabilitation is a vital component of stroke recovery, but inpatient stroke rehabilitation programs can struggle to meet the recommended hours of therapy per day outlined by the Canadian Stroke Best Practices and American Heart Association. Mobile applications (apps) are an emerging technology which may help bridge this deficit, however this area is understudied. The purpose of this study is to review the effect of mobile apps for stroke rehabilitation on stroke impairments and functional outcomes. Specifically, this paper will delve into the impact of varying mobile app types on stroke rehabilitation. METHODS This systematic review included 29 studies: 11 randomized control trials and 18 quasi-experimental studies. Data extrapolation mapped 5 mobile app types (therapy apps, education apps, rehab videos, reminders, and a combination of rehab videos with reminders) to stroke deficits (motor paresis, aphasia, neglect), adherence to exercise, activities of daily living (ADLs), quality of life, secondary stroke prevention, and depression and anxiety. RESULTS There were multiple studies supporting the use of therapy apps for motor paresis or aphasia, rehab videos for exercise adherence, and reminders for exercise adherence. For permutations involving other app types with stroke deficits or functional outcomes (adherence to exercise, ADLs, quality of life, secondary stroke prevention, depression and anxiety), the results were either non-significant or limited by a paucity of studies. CONCLUSION Mobile apps demonstrate potential to assist with stroke recovery and augment face to face rehabilitation, however, development of a mobile app should be carefully planned when targeting specific stroke deficits or functional outcomes. This study found that mobile app types which mimicked principles of effective face-to-face therapy (massed practice, task-specific practice, goal-oriented practice, multisensory stimulation, rhythmic cueing, feedback, social interaction, and constraint-induced therapy) and education (interactivity, feedback, repetition, practice exercises, social learning) had the greatest benefits. Protocol registration PROPSERO (ID CRD42021186534). Registered 21 February 2021.
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Affiliation(s)
- Stephen G. Szeto
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428UHN Toronto Rehab Institute, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Hoyee Wan
- grid.17063.330000 0001 2157 2938Division of Plastic, Reconstructive, and Aesthetic Surgery, University of Toronto, Toronto, Canada
| | - Mohammad Alavinia
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sean Dukelow
- grid.22072.350000 0004 1936 7697Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather MacNeill
- grid.17063.330000 0001 2157 2938Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada ,grid.492573.e0000 0004 6477 6457Physical Medicine & Rehabilitation, Hennick Bridgepoint Hospital, Sinai Health System, Toronto, Canada
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The telehealth program of occupational therapy among older people: an up-to-date scoping review. Aging Clin Exp Res 2023; 35:23-40. [PMID: 36344805 PMCID: PMC9640899 DOI: 10.1007/s40520-022-02291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The average life expectancy of older people is increasing, and most seniors desire to age at home and are capable of living independently. Occupational therapy (OT) is client-centered and uses patients' meaningful activities, or occupations, as treatment methods, thus playing an important role in later adulthood. Telemedicine removes the constraints of time and space, and the combination of OT and telemedicine can greatly improve medical efficiency and clinical effectiveness. AIMS The purpose of this scoping review was to examine the scope and effectiveness of telehealth OT for older people. METHODS This scoping review was conducted following the methodological framework proposed by Arksey and O'Malley. We searched the literature in five databases following the PICOS (Population, Intervention, Comparison, Outcome, Study design) guideline, from inception to April 2022. Two trained reviewers independently retrieved, screened, and extracted data, and used a descriptive synthesizing approach to summarize the results. RESULTS The initial search yielded 1249 studies from databases and manual searches, of which 20 were eligible and were included in the final review. A thematic analysis revealed five main themes related to telehealth OT: occupational assessment, occupational intervention, rehabilitation counseling, caregiver support, and activity monitoring. CONCLUSIONS Telehealth OT has been used widely for older people, focusing primarily on occupational assessment and intervention provided conveniently for occupational therapists and older clients. In addition, telehealth OT can monitor patients' activities and provide rehabilitation counseling and health education for the elderly and their caregivers, thus improving the security of their home life and the efficacy of OT. During the COVID-19 pandemic, telehealth will be an effective alternative to face-to-face modalities.
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Baker C, Foster AM, D'Souza S, Godecke E, Shiggins C, Lamborn E, Lanyon L, Kneebone I, Rose ML. Management of communication disability in the first 90 days after stroke: a scoping review. Disabil Rehabil 2022; 44:8524-8538. [PMID: 34919449 DOI: 10.1080/09638288.2021.2012843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke. PURPOSE To explore the scope of literature for the management of communication disability in the first 90 days after stroke. MATERIALS AND METHODS A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF). RESULTS A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia). CONCLUSION A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required.IMPLICATIONS FOR REHABILITATIONInterdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes.There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning.Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care).
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Affiliation(s)
- Caroline Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia
| | - Abby M Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia.,School of Primary & Allied Health Care, Monash University, Melbourne, Australia
| | - Sarah D'Souza
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,School of Health Sciences, University of East Anglia, Norwich, UK
| | - Edwina Lamborn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lucette Lanyon
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Ian Kneebone
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadlands, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Miao M, Rietdijk R, Brunner M, Debono D, Togher L, Power E. Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review. J Med Internet Res 2022; 24:e38100. [PMID: 35881432 PMCID: PMC9328122 DOI: 10.2196/38100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076211035988.
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
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10
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Braley M, Pierce JS, Saxena S, De Oliveira E, Taraboanta L, Anantha V, Lakhan SE, Kiran S. A Virtual, Randomized, Control Trial of a Digital Therapeutic for Speech, Language, and Cognitive Intervention in Post-stroke Persons With Aphasia. Front Neurol 2021; 12:626780. [PMID: 33643204 PMCID: PMC7907641 DOI: 10.3389/fneur.2021.626780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Post-stroke aphasia is a chronic condition that impacts people's daily functioning and communication for many years after a stroke. Even though these individuals require sustained rehabilitation, they face extra burdens to access care due to shortages in qualified clinicians, insurance limitations and geographic access. There is a need to research alternative means to access intervention remotely, such as in the case of this study using a digital therapeutic. Objective: To assess the feasibility and clinical efficacy of a virtual speech, language, and cognitive digital therapeutic for individuals with post-stroke aphasia relative to standard of care. Methods: Thirty two participants completed the study (experimental: average age 59.8 years, 7 female, 10 male, average education: 15.8 years, time post-stroke: 53 months, 15 right handed, 2 left handed; control: average age 64.2 years, 7 female, 8 male, average education: 15.3 years, time post-stroke: 36.1 months, 14 right handed, 1 left handed). Patients in the experimental group received 10 weeks of treatment using a digital therapeutic, Constant Therapy-Research (CT-R), for speech, language, and cognitive therapy, which provides evidence-based, targeted therapy with immediate feedback for users that adjusts therapy difficulty based on their performance. Patients in the control group completed standard of care (SOC) speech-language pathology workbook pages. Results: This study provides Class II evidence that with the starting baseline WAB-AQ score, adjusted by −0.69 for every year of age, and by 0.122 for every month since stroke, participants in the CT-R group had WAB-AQ scores 6.43 higher than the workbook group at the end of treatment. Additionally, secondary outcome measures included the WAB-Language Quotient, WAB-Cognitive Quotient, Brief Test of Adult Cognition by Telephone (BTACT), and Stroke and Aphasia Quality of Life Scale 39 (SAQOL-39), with significant changes in BTACT verbal fluency subtest and the SAQOL-39 communication and energy scores for both groups. Conclusions: Overall, this study demonstrates the feasibility of a fully virtual trial for patients with post-stroke aphasia, especially given the ongoing COVID19 pandemic, as well as a safe, tolerable, and efficacious digital therapeutic for language/cognitive rehabilitation. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04488029.
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Affiliation(s)
- Michelle Braley
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Charlestown, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,The Learning Corp, Newton, MA, United States
| | - Jordyn Sims Pierce
- Constant Therapy Health, Lexington, MA, United States.,Pierce Health Consultants, Lenox, MA, United States
| | - Sadhvi Saxena
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Emily De Oliveira
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Definitive Healthcare, Boston, MA, United States
| | | | - Veera Anantha
- Constant Therapy Health, Lexington, MA, United States
| | - Shaheen E Lakhan
- The Learning Corp, Newton, MA, United States.,Global Neuroscience Initiative Foundation, Boston, MA, United States.,Virginia Tech, Blacksburg, VA, United States
| | - Swathi Kiran
- Constant Therapy Health, Lexington, MA, United States.,Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
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11
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De Cock E, Batens K, Feiken J, Hemelsoet D, Oostra K, De Herdt V. The feasibility, usability and acceptability of a tablet-based aphasia therapy in the acute phase following stroke. JOURNAL OF COMMUNICATION DISORDERS 2021; 89:106070. [PMID: 33418143 DOI: 10.1016/j.jcomdis.2020.106070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
QUESTION Independent practice via an application with a language exercise program for aphasia, as an add-on to conventional care can be a good solution to intensify aphasia therapy. The aim of this prospective trial was to investigate the feasibility, usability and acceptability of the newly-developed aphasia exercise program in the 'Speech Therapy App (STAPP)' in the acute phase post-stroke. METHODS All eligible people with aphasia following stroke (<2 weeks post-stroke) admitted to the Stroke Unit of Ghent University Hospital were recruited in this prospective clinical trial between September 2018 and December 2019. After linguistic assessments and two short training sessions, participants were asked to practice independently with 'STAPP' for at least 30 min/day during hospitalization. Exercises were individually tailored and adjusted if necessary. Outcome was measured by recruitment, adherence and retention rates, usability questionnaires and a visual analogue scale for satisfaction. RESULTS Twenty-five (mean age 65 years (SD = 17), 14 females) of 31 eligible people with aphasia were enrolled in this trial (recruitment rate = 81 %). All participants but one (23/24) practiced with the language app until the end of hospitalization (retention rate = 96 %). Ten participants practiced at least 30 min/day (adherence rate = 42 %). Participants reported they learned to work quickly with the app (92 %; agreed/totally agreed), the app was easy to use (88 %), they could work independently (79 %), practiced their language (67 %) and wanted to continue working with the app at home (79 %). Acceptability was high (median satisfaction rate 91 %; IQR = 75-100). CONCLUSION The aphasia exercise program in 'STAPP' is feasible to use as an additional rehabilitation tool along with standard of care in the acute phase post-stroke. Further research is needed to assess the efficacy. CLINICAL TRIAL REGISTRATION-URL: https://clinicaltrials.gov/ct2/show/NCT03679637.
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Affiliation(s)
- Elien De Cock
- Stroke Unit, Department of Neurology, Ghent University Hospital, Ghent, Belgium; Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Katja Batens
- Stroke Unit, Department of Neurology, Ghent University Hospital, Ghent, Belgium; Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Judith Feiken
- Center for Rehabilitation, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
| | - Dimitri Hemelsoet
- Stroke Unit, Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Kristine Oostra
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Veerle De Herdt
- Stroke Unit, Department of Neurology, Ghent University Hospital, Ghent, Belgium.
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12
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Kohout J, Verešpejová L, Kříž P, Červená L, Štícha K, Crha J, Trnková K, Chovanec M, Mareš J. Advanced Statistical Analysis of 3D Kinect Data: Mimetic Muscle Rehabilitation Following Head and Neck Surgeries Causing Facial Paresis. SENSORS 2020; 21:s21010103. [PMID: 33375297 PMCID: PMC7795302 DOI: 10.3390/s21010103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 02/01/2023]
Abstract
An advanced statistical analysis of patients’ faces after specific surgical procedures that temporarily negatively affect the patient’s mimetic muscles is presented. For effective planning of rehabilitation, which typically lasts several months, it is crucial to correctly evaluate the improvement of the mimetic muscle function. The current way of describing the development of rehabilitation depends on the subjective opinion and expertise of the clinician and is not very precise concerning when the most common classification (House–Brackmann scale) is used. Our system is based on a stereovision Kinect camera and an advanced mathematical approach that objectively quantifies the mimetic muscle function independently of the clinician’s opinion. To effectively deal with the complexity of the 3D camera input data and uncertainty of the evaluation process, we designed a three-stage data-analytic procedure combining the calculation of indicators determined by clinicians with advanced statistical methods including functional data analysis and ordinal (multiple) logistic regression. We worked with a dataset of 93 distinct patients and 122 sets of measurements. In comparison to the classification with the House–Brackmann scale the developed system is able to automatically monitor reinnervation of mimetic muscles giving us opportunity to discriminate even small improvements during the course of rehabilitation.
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Affiliation(s)
- Jan Kohout
- Department of Computing and Control Engineering, University of Chemistry and Technology Prague, 1905/5 Technická, 16628 Praha 6, Czech Republic; (J.K.); (K.Š.); (J.C.)
| | - Ludmila Verešpejová
- Department of Otorhinolaryngology, 3rd Faculty of Medicine, Charles University Prague, University Hospital Kralovske Vinohrady, 1150/50 Šrobárova, 10034 Praha 10, Czech Republic; (L.V.); (K.T.); (M.C.)
| | - Pavel Kříž
- Department of Mathematics, University of Chemistry and Technology Prague, 1905/5 Technická, 16628 Praha 6, Czech Republic; (P.K.); (L.Č.)
| | - Lenka Červená
- Department of Mathematics, University of Chemistry and Technology Prague, 1905/5 Technická, 16628 Praha 6, Czech Republic; (P.K.); (L.Č.)
| | - Karel Štícha
- Department of Computing and Control Engineering, University of Chemistry and Technology Prague, 1905/5 Technická, 16628 Praha 6, Czech Republic; (J.K.); (K.Š.); (J.C.)
| | - Jan Crha
- Department of Computing and Control Engineering, University of Chemistry and Technology Prague, 1905/5 Technická, 16628 Praha 6, Czech Republic; (J.K.); (K.Š.); (J.C.)
| | - Kateřina Trnková
- Department of Otorhinolaryngology, 3rd Faculty of Medicine, Charles University Prague, University Hospital Kralovske Vinohrady, 1150/50 Šrobárova, 10034 Praha 10, Czech Republic; (L.V.); (K.T.); (M.C.)
| | - Martin Chovanec
- Department of Otorhinolaryngology, 3rd Faculty of Medicine, Charles University Prague, University Hospital Kralovske Vinohrady, 1150/50 Šrobárova, 10034 Praha 10, Czech Republic; (L.V.); (K.T.); (M.C.)
| | - Jan Mareš
- Department of Computing and Control Engineering, University of Chemistry and Technology Prague, 1905/5 Technická, 16628 Praha 6, Czech Republic; (J.K.); (K.Š.); (J.C.)
- Correspondence:
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13
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Burns SP, Terblanche M, Perea J, Lillard H, DeLaPena C, Grinage N, MacKinen A, Cox EE. mHealth Intervention Applications for Adults Living With the Effects of Stroke: A Scoping Review. Arch Rehabil Res Clin Transl 2020; 3:100095. [PMID: 33778470 PMCID: PMC7984984 DOI: 10.1016/j.arrct.2020.100095] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To conduct a scoping review of mobile health (mHealth) application (app) interventions to support needs of adults living with the effects of stroke reported in the literature. Data Sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus were systematically searched for peer-reviewed publications. Articles were published between January 2007 and September 2020 and met predefined inclusion and exclusion criteria. Study Selection Articles included were written in English language, involved adults older than 18 years, and described an mHealth app specifically tested and/or developed as an intervention for someone with stroke to be used remotely and/or independently without constant provider supervision or assistance. Articles were excluded if they focused on acute management of stroke only, focused on primary prevention, were animal studies, were not an app for smartphone or tablet, and did not describe an empirical study. Data Extraction Two researchers independently screened titles and abstracts for inclusion. The full-text articles were then reviewed for eligibility by the research team. Data were extracted and verified by a third reviewer. Data Synthesis The search yielded 2123 studies and 49 were included for data extraction. The findings reveal that a global surge of studies on mHealth apps for people with stroke have emerged within the past 2 years. Most studies were developed for persons with stroke in the United States and the primary content foci included upper extremity function (31.5%); lower extremity function (5.3%); general exercise, physical activity, and/or functional mobility (23.7%); trunk control (5.3%); medical management and secondary prevention (26.3%); language and speech skills (20.5%); cognitive skills (7.9%); general disability and activities of daily living (5.3%); and home safety (2.6%). Of the included studies, a majority were preliminary in nature, with 36.7% being categorized as pilot or feasibility trials and 24.4% discussing initial design, development, and/or refinement. Conclusions Results from this study reveal that the number of apps specifically developed for people with stroke and described in the scientific literature are growing exponentially. The apps have widely varied content to meet the needs of persons with stroke; however, the studies are generally preliminary in nature, focusing on development, usability, and initial pilot testing. This review highlights the need for additional research and development of mHealth apps targeted for adults with stroke. Development should consider the various and complex needs of people living with the effects of chronic stroke, while large-scale trials are needed to build on the existing evidence.
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Affiliation(s)
- Suzanne P Burns
- School of Occupational Therapy, Texas Woman's University, Denton, Texas
| | | | | | | | - Catalina DeLaPena
- School of Occupational Therapy, Texas Woman's University, Denton, Texas
| | | | - Ashley MacKinen
- School of Occupational Therapy, Texas Woman's University, Denton, Texas
| | - Ella Elaine Cox
- Texas Woman's University Libraries, Texas Woman's University, Denton, Texas
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14
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Gräfitsch A, Kirchhoff P, Hoffmann H, Staerkle RF, Soysal SD, Glauser PM. Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study. JMIR Perioper Med 2020; 3:e15672. [PMID: 33393921 PMCID: PMC7709856 DOI: 10.2196/15672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/07/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hernia repairs account for millions of general surgical procedures performed each year worldwide, with a notable shift to outpatient settings over the last decades. As technical possibilities such as smartphones, tablets, and different kinds of probes are becoming more and more available, such systems have been evaluated for applications in various clinical settings. However, there have been few studies conducted in the surgical field, especially in general surgery. OBJECTIVE We aimed to assess the feasibility of a tablet-based follow up to monitor activity levels after repair of abdominal wall hernias and to evaluate a possible reduction of adverse events by their earlier recognition. METHODS Patients scheduled for elective surgical repair of minor abdominal wall hernias (eg, inguinal, umbilical, or trocar hernias) were equipped with a telemonitoring system, including a tablet, pulse oximeter, and actimeter, for a monitoring phase of 7 days before and 30 days after surgery. Descriptive statistical analyses were performed. RESULTS We enrolled 16 patients with a mean overall age of 48.75 (SD 16.27) years. Preoperative activity levels were reached on postoperative day 12 with a median of 2242 (IQR 0-4578) steps after plunging on the day of surgery. The median proportion of available activity measurements over the entire study period of 38 days was 69% (IQR 56%-81%). We observed a gradual decrease in the proportion of available data for all parameters during the postoperative course. Six out of ten patients (60%) regained preoperative activity levels within 3 weeks after surgery. Overall, patients rated the usability of the system as relatively easy. CONCLUSIONS Tablet-based follow up is feasible after surgical repair of minor abdominal wall hernias, with good adherence rates during the first couple of weeks after surgery. Thus, such a system could be a useful tool to supplement or even replace traditional outpatient follow up in selected general surgical patients.
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Affiliation(s)
- Alexander Gräfitsch
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
- Department of Visceral Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Kirchhoff
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
- ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, Basel, Switzerland
| | - Henry Hoffmann
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
- ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, Basel, Switzerland
| | - Ralph F Staerkle
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Savas D Soysal
- Visceral Surgery Research Laboratory, Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Philippe M Glauser
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
- Department of Visceral Surgery, Spital Dornach, Dornach, Switzerland
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15
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Munsell M, De Oliveira E, Saxena S, Godlove J, Kiran S. Closing the Digital Divide in Speech, Language, and Cognitive Therapy: Cohort Study of the Factors Associated With Technology Usage for Rehabilitation. J Med Internet Res 2020; 22:e16286. [PMID: 32044752 PMCID: PMC7055773 DOI: 10.2196/16286] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/29/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND For stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient's ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient's level of engagement with technology-based therapy are currently unknown. OBJECTIVE This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural). METHODS Data for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An active day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates. RESULTS Data for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (P=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates. CONCLUSIONS An evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials.
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Affiliation(s)
| | | | | | | | - Swathi Kiran
- The Learning Corp, Newton, MA, United States.,Aphasia Research Laboratory, Speech Language and Hearing Sciences, Boston University, Boston, MA, United States
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16
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Kearns Á, Kelly H, Pitt I. Self-reported feedback in ICT-delivered aphasia rehabilitation: a literature review. Disabil Rehabil 2019; 43:1193-1207. [PMID: 31486685 DOI: 10.1080/09638288.2019.1655803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Information and Communication Technologies (ICT) can provide an option for the delivery of intensive aphasia rehabilitation but the users' views (i.e., People with Aphasia) must be considered to ensure satisfaction, motivation and adherence with this mode of rehabilitation. The aim of this literature review is to provide a critical overview of studies where feedback was elicited from participants about their experiences with ICT-delivered aphasia rehabilitation. METHODS A systematic search using six electronic databases was conducted in July 2015 and updated in May 2019. Studies of synchronous telerehabilitation and interventions targeting compensatory strategies were excluded from the review. Studies retrieved were screened for eligibility and information was extracted on the characteristics of each study, methods of data collection and study outcomes. RESULTS Seventeen studies met the inclusion criteria including studies with quantitative, qualitative and mixed-methods research designs. The studies employed a variety of data collection methods, examining a number of ICT-delivered aphasia rehabilitation activities and the findings investigated aspects of feasibility, usability and acceptance of this mode of rehabilitation. CONCLUSIONS The findings indicate ICT-delivered aphasia rehabilitation is considered an acceptable mode of rehabilitation by people with aphasia who reported generally positive feedback, though variation among personal perspectives and experience is noted. There is currently no consensus measure of self-reported feedback in ICT-delivered aphasia rehabilitation.IMPLICATIONS FOR REHABILITATIONICT-delivered aphasia rehabilitation may provide an acceptable mode of rehabilitation for people with aphasia.Exploring self-reported feedback from people with aphasia engaging in ICT-delivered aphasia rehabilitation will provide insights into their experiences of this mode of rehabilitation.This information may help to guide clinicians when collaboratively planning and monitoring ICT-delivered aphasia rehabilitation.Currently there is no consensus measure of self-reported feedback for people with aphasia engaging in ICT-delivered aphasia rehabilitation.
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Affiliation(s)
- Áine Kearns
- Department of Speech and Hearing Sciences, University College Cork, Cork, Republic of Ireland
| | - Helen Kelly
- Department of Speech and Hearing Sciences, University College Cork, Cork, Republic of Ireland
| | - Ian Pitt
- Department of Computer Sciences, University College Cork, Cork, Republic of Ireland
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17
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Kringle EA, Setiawan IMA, Golias K, Parmanto B, Skidmore ER. Feasibility of an iterative rehabilitation intervention for stroke delivered remotely using mobile health technology. Disabil Rehabil Assist Technol 2019; 15:908-916. [PMID: 31216917 DOI: 10.1080/17483107.2019.1629113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Telehealth affords rehabilitation professionals opportunities to expand access to intervention for people in rural areas. Complex interventions have not been adapted for remote delivery using mobile health technologies. Strategy training is a complex intervention that teaches clients skills for identifying barriers and solutions to engagement in meaningful activities. Our goal was to adapt the delivery of strategy training for remote delivery using mobile health technology.Methods: We conducted a sequential descriptive case series study (n = 5) in which community-dwelling participants with chronic stroke and prior exposure to strategy training used the iADAPTS mobile health application for 5 weeks. Expert practitioners advised revisions to the intervention process. Safety was assessed via monitoring occurrence of adverse events and risk for adverse events. Acceptability was assessed via the Client Satisfaction Questionnaire-8 (CSQ-8) and the Patient-Provider Connection Short Form of the Healing Encounters and Attitudes Lists (HEAL PPC).Results: Revisions to the intervention process supported the delivery of strategy training using mobile health technology after stroke. No adverse events occurred and risk for adverse events was managed through the intervention process. Acceptability was high (CSQ-8, 25 to 32; HEAL PPC, 59.9 to 72.5).Conclusions: Strategy training can be adapted for delivery using mobile health technology, with careful consideration to methods for training participants on new technology and the intervention delivery. Future research should establish the efficacy and effectiveness of integrating mobile health in delivery of interventions that promote engagement in client-selected activities and community participation.Implications for rehabilitationTranslating the strategy training intervention from face-to-face to remote delivery required thoughtful adaptation of the intervention protocol.Strategies for training clients to use mobile health technology during intervention may be important when designing remotely delivered mHealth intervention protocols.Client safety should be considered within the design of the intervention protocol for a complex intervention designed to be delivered remotely.Future studies should examine the efficacy of complex rehabilitation interventions such as strategy training on clinical outcomes (e.g., community participation).
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Affiliation(s)
- Emily A Kringle
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - I Made Agus Setiawan
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - Katlyn Golias
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - Bambang Parmanto
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, USA
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