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El Aoufy K, Melis MR, Magi CE, Bellando-Randone S, Tamburini M, Bandini G, Moggi-Pignone A, Matucci-Cerinic M, Bambi S, Rasero L. Evidence for telemedicine heterogeneity in rheumatic and musculoskeletal diseases care: a scoping review. Clin Rheumatol 2024; 43:2721-2763. [PMID: 38985235 PMCID: PMC11330403 DOI: 10.1007/s10067-024-07052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
Telemedicine and digital health represent alternative approaches for clinical practice; indeed, its potential in healthcare services for prevention, diagnosis, treatment, rehabilitation, and disease monitoring is widely acknowledged. These are all crucial issues to consider when dealing with chronic Rheumatic and Musculoskeletal Diseases (RMDs). The aim was to determine the current state of telemedicine in the field of rheumatology, considering the tools and devices in use as well as the Patient Reported Outcomes. A scoping review was performed following the PRISMA-ScR, retrieving articles through five databases from 1990 to 2022. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) original research papers in the English language with available abstracts, and (III) telehealth and telemedicine are provided as healthcare services. Within the 62 included studies, multiple tools of telemedicine were used: 21/62 websites/online platforms, 18/62 mobile applications, 16/62 telephone contacts, 5/62 video-consultations, and 1/62 wearable devices. Outcomes were classified based on the economic, clinical, and humanistic framework. Clinical outcomes assessed through digital tools were pain, disease activity, and serum uric acid levels. Humanistic outcomes have been grouped according to four categories (e.g., mental and physical function, health management, and health perception). The heterogeneity of digital tools in the field of rheumatology highlights the challenge of implementing reliable research into clinical practice. Effective telerehabilitation models have been presented, and the use of a tight control strategy has also been mentioned. Future research should focus on establishing studies on other RMDs as well as summarizing and formulating clinical guidelines for RMDs. Key Points • Evidence for the usefulness of telemedicine and digital health for managing and monitoring rheumatic and musculoskeletal diseases is progressively increasing. • Several digital tools effectively measure clinical and humanistic and patient reported outcomes in rheumatic and musculoskeletal diseases. • Integrating diverse digital tools in rheumatology is challenging yet promising. • Future research should focus on developing standardized recommendations for practical use of telemedicine in daily practice.
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Affiliation(s)
- Khadija El Aoufy
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Maria Ramona Melis
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Camilla Elena Magi
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology, Careggi University Hospital, Florence, Italy
| | - Matteo Tamburini
- University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
- Università Vita Salute San Raffaele, Milan, Italy
| | - Stefano Bambi
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Laura Rasero
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
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Zhu D, Zhao J, Wang M, Cao B, Zhang W, Li Y, Zhang C, Han T. Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e53798. [PMID: 38696250 PMCID: PMC11099817 DOI: 10.2196/53798] [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: 10/19/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA. OBJECTIVE This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications. METHODS A systematic literature search was conducted using the keywords "Knee Osteoarthritis," "Behavior Therapy," and "Digitization" in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data. RESULTS A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study. CONCLUSIONS The results demonstrate that "goals and planning" and "repetition and substitution" are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting.
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Affiliation(s)
- Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Jianan Zhao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Mingxuan Wang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Bochen Cao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Yunlong Li
- Department of Design, Jiangxi Science and Technology Normal University, Shanghai, China
| | - Chenqi Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Han
- School of Design, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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Weber F, Müller C, Bahns C, Kopkow C, Färber F, Gellert P, Otte I, Vollmar HC, Brannath W, Diederich F, Kloep S, Rothgang H, Dieter V, Krauß I, Kloek C, Veenhof C, Collisi S, Repschläger U, Böbinger H, Grüneberg C, Thiel C, Peschke D. Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial. BMC Musculoskelet Disord 2023; 24:221. [PMID: 36959595 PMCID: PMC10034894 DOI: 10.1186/s12891-023-06255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
Introduction Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care. Methods This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation. Discussion After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs. Trial registration German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-023-06255-7.
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Affiliation(s)
- Franziska Weber
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carsten Müller
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Carolin Bahns
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Francesca Färber
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ina Otte
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Horst Christian Vollmar
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Werner Brannath
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Freya Diederich
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Stephan Kloep
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Valerie Dieter
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Inga Krauß
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Corelien Kloek
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Cindy Veenhof
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Sandra Collisi
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Ute Repschläger
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Hannes Böbinger
- grid.492243.a0000 0004 0483 0044Innovationsfonds & Produktportfolio, Techniker Krankenkasse, Hamburg, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Dirk Peschke
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
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Kamilu Sulaiman S, Wong AYL, Liangchi Li L, Fordjour Antwi-Afari M, Ou H, Wh Tsang H. The use of mobile health technology in the management of osteoarthritis: A scoping review with scientometric analyses. Int J Med Inform 2023; 170:104937. [PMID: 36493537 DOI: 10.1016/j.ijmedinf.2022.104937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although mHealth technology is an emerging approach for enabling self-management/education of hip/knee osteoarthritis (OA) that may reduce burdens in primary and secondary care, no scoping review has been conducted to comprehensively review the scope of mHealth technology in managing hip/knee OA. This scoping review and scientometric analyses aimed to summarize the current state of research on the use of mHealth technology (mobile applications/web-based interventions) for self-management/education of adults with hip/knee OA, identify key research activities, and provide future directions on the development/usage of mHealth technology. METHODS The Arksey and O'Malley methodological framework was employed, augmented with scientometric analyses. Six databases were searched from inception to 31 May 2021. Findings were reported according to the PRISMA extension for scoping review. Co-word, co-author, and co-citation scientometric analyses were conducted to examine the social and intellectual connections of the research field (e.g., research hotspots and researcher collaborations). RESULTS Twenty mHealth programs for promoting self-management of hip/knee OA were identified. The programs mainly included exercises or directives on performance of exercises. Compared to no interventions, mHealth technology was usable and might be more effective in improving pain, physical function, and quality of life in individuals with OA. The scientometric analyses identified multiple co-occurring keywords that reflected conceptual properties of this research domain. Although some intellectual connections among authors, research articles, and journals were noted, there were insufficient international collaborations in this field. DISCUSSION While individual small-scale studies highlighted promising short-term effects of mHealth technology in self-managing hip/knee OA, many mHealth technologies were developed without clinicians' and/or patients' contributions. Future mHealth programs should be developed based on a strong theoretical background and professional inputs. The long-term benefits and cost-effectiveness of mHealth technologies, user experience, as well as cross-cultural adaptation of these technologies should be evaluated.
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Affiliation(s)
- Surajo Kamilu Sulaiman
- Bayero University Kano, Nigeria; Guangzhou Medical University, China; The Hong Kong Polytechnic University, Hong Kong.
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Schweda S, Müller G, Munz B, Sudeck G, Martus P, Dierkes K, Krauss I. Implementation and evaluation of an individualized physical exercise promotion program in people with manifested risk factors for multimorbidity (MultiPill-Exercise): a study protocol for a pragmatic randomized controlled trial. BMC Public Health 2022; 22:1174. [PMID: 35698074 PMCID: PMC9190168 DOI: 10.1186/s12889-022-13400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/11/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multimorbidity is a major problem in Europe, increasing the need for prevention and rehabilitation programs. In Germany no guidelines have been developed that focus on patients with multiple chronic non-communicable diseases (NCDs). Benefits of physical activity (PA) and exercise in NCDs have been proven, but most interventions focus on single conditions. The evaluation of the effectiveness, efficiency and safety of PA programs in patients suffering from multiple NCDs and the feasibility of the implementation within the health care service remain open research questions. METHODS The multi-site randomized controlled pragmatic trial includes 320 sedentary subjects with at least two of the following NCDs, either manifested or in a pre-stage with evident risk factors: Cardio-vascular disease, Diabetes mellitus type 2, knee/ hip osteoarthritis and obesity. Participants will be recruited from general practitioners and medical specialists and randomized to standard care of a statutory health insurance or MultiPill-Exercise. Standard care includes a choice of one or a maximum of two 8- to 12-week health programs, including nutrition, exercise, relaxation or special disease management programs. MultiPill-Exercise is based on the bio-psycho-social health model, considering a person-oriented perspective in light of given individual characteristics and context factors. The 24-weeks intervention focuses on aerobic and strengthening exercises in line with the WHO PA recommendations. Psychological and pedagogical elements along with behavior change techniques are implemented to ease the initiation and maintenance of exercise participation and lifestyle change, including nutrition. Primary outcome will be short- and long-term PA measured with the European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ). Secondly, the effectiveness of the program on generic, disease specific, economic, and exercise behavioral parameters, as well as program adherence and safety will be evaluated. DISCUSSION Results of this trial evaluate the PA intervention program in people with multiple NCDs in a real-life scenario. It will serve as a proof of concept with the opportunity of translation into routine practice. This approach, as a multi-site RCT with its rigorous methods and standardized operating procedures for the conduction of the intervention, will allow valid conclusions for the implementation of PA interventions in people with multimorbidity. TRIAL REGISTRATION The trial was registered at www.drks.de (ID: DRKS00025033 ) on 30th September 2021.
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Affiliation(s)
- Simone Schweda
- Department of Sports Medicine, Faculty of Medicine, University Hospital, Medical Clinic, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany.
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany.
| | - Gerhard Müller
- Allgemeine Ortskrankenkasse AOK Baden-Wuerttemberg, Presselstrasse 19, 70191, Stuttgart, Germany
| | - Barbara Munz
- Department of Sports Medicine, Faculty of Medicine, University Hospital, Medical Clinic, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Gorden Sudeck
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
- Department of Sports Science Tuebingen, Faculty of Economic and Social Science, Eberhard Karls University Tuebingen, Wilhelmstrasse 124, 72074, Tuebingen, Germany
| | - Peter Martus
- Department for Clinical Epidemiology and Applied Biostatistics, Faculty of Medicine, University Hospital, Medical Clinic, Silcherstrasse 5, 72076, Tuebingen, Germany
| | - Katja Dierkes
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
- Department of Sports Science Tuebingen, Faculty of Economic and Social Science, Eberhard Karls University Tuebingen, Wilhelmstrasse 124, 72074, Tuebingen, Germany
| | - Inga Krauss
- Department of Sports Medicine, Faculty of Medicine, University Hospital, Medical Clinic, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
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Sassenberg K, Roesel I, Sudeck G, Bernecker K, Durst J, Krauss I. The Relation of Attitude Toward Technology and Mastery Experience After an App-Guided Physical Exercise Intervention: Randomized Crossover Trial. JMIR Form Res 2022; 6:e28913. [PMID: 35179500 PMCID: PMC8900907 DOI: 10.2196/28913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/26/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Physical exercise has been found to assert a positive impact on many muscular conditions. Exercise under face-to-face supervision is the gold standard, but access to it is limited, for instance, for economic reasons. App-guided therapy is an intervention that is more affordable and easily accessible. However, attitude toward technology is a key predictor for media adoption and is therefore expected to shape user experience during app-guided therapy. This might be of particular importance for mastery experience, which is crucial for promoting exercise-related self-efficacy and perceived usefulness of the interaction. Both should empower patients to continuously exercise. Objective This study sought to test whether attitudes toward technology predict mastery experience and perceived usefulness of the interaction after an app- versus a physiotherapist-guided treatment. We expect that attitudes toward technology positively predict both outcomes in case of the app-guided but not in case of the physiotherapist-guided treatment. Methods Patients (n=54) with clinically diagnosed hip osteoarthritis participated in 2 training sessions with the same exercise intervention, once guided by an app on a tablet computer and once guided by a physiotherapist in a German university hospital. The order of the sessions was randomized. Attitude toward technology was assessed as predictor before the first session, while mastery experience and the global perceived usefulness of interaction as self-reported outcomes after each session. Results In line with our hypotheses, attitude toward technology predicted mastery experience (b=0.16, standard error=0.07, P=.02) and usefulness of interaction (b=0.17, standard error=0.06, P=.01) after the app-based training but not after the training delivered by a physiotherapist (P>.3 in all cases). Mastery experience was lower for the app-based training but reached a very similar level as the physiotherapist-guided training for those holding a very positive attitude toward technology. Conclusions The attitude toward technology predicts the extent of mastery experience after app-guided exercise therapy. As mastery experience is highly important for self-efficacy and future exercise behavior, attitudes toward technology should be considered when delivering app-guided exercise treatments. Trial Registration German Clinical Trials Register DRKS00015759; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015759
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Affiliation(s)
- Kai Sassenberg
- Social Processes Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany.,School of Science, University of Tübingen, Tübingen, Germany
| | - Inka Roesel
- Department of Sports Medicine, University Hospital Tübingen, University of Tübingen, Tübingen, Germany.,Institute for Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Gorden Sudeck
- Institute of Sports Science, University of Tübingen, Tübingen, Germany.,Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
| | | | - Jennifer Durst
- Department of Sports Medicine, University Hospital Tübingen, University of Tübingen, Tübingen, Germany.,Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
| | - Inga Krauss
- Department of Sports Medicine, University Hospital Tübingen, University of Tübingen, Tübingen, Germany.,Interfaculty Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
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Sun T, Xu Y, Xie H, Ma Z, Wang Y. Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers: Pretest-Posttest Study. J Med Internet Res 2021; 23:e28221. [PMID: 34028359 PMCID: PMC8185615 DOI: 10.2196/28221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A scientific, personalized, and quantitative exercise prescription that has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease is highly recommended. However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (eg, prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalized prescription is thus worth exploring. OBJECTIVE The aim of this study was to investigate whether a year-long cloud platform-based and intelligent personalized exercise prescription intervention could improve Chinese middle-aged and older adult community dwellers' health outcomes. METHODS A total of 177 participants (aged 52-85 years; mean 67.93, SD 7.05) were recruited from 2 Chinese community health service centers in Anhui Province, China. The exercise intervention was delivered over 12 months with a single-group pretest-posttest design. After being assessed in terms of physical activity, health-related lifestyle, history of chronic diseases and drug use, family history of disease and cardiovascular function, body composition, bone mineral density, and physical fitness through an eHealth promotion system, participants with relative contraindications for exercise were personally prescribed the health care exercise mode by an intelligent system, while those without relative contraindication and who had a regular exercise habit were prescribed the scientific fitness mode. Paired t tests were used for the analysis. RESULTS A total of 97 participants were classified into the health care mode, and the remaining 80 participants were assigned to the scientific fitness mode. Significant changes in heart rate (mean difference [MD] 2.97; 95% CI 1.1-4.84; P=.002), subendocardial viability ratio (MD -0.13; CI: -1.19 to -0.63; P<.001), weight (MD 0.99; CI 0.29-1.69; P=.006), BMI (MD 0.38; CI 0.11-0.64; P=.006), body fat rate (MD 0.88; CI 0.24-1.51; P=.007), fat mass (MD 0.92; CI 0.33-1.53; P=.003), and brachial-ankle pulse wave velocity (MD: -0.72; CI -1.17 to -0.27; P=.002) were observed among participants with the health care mode exercise prescriptions at the 12-month postintervention versus the baseline assessment, while no changes in systolic blood pressure, diastolic blood pressure, muscle mass, bone mineral density, t value, z value, balance, or ability were discerned. The results showed a functional decline in the physical fitness of both groups, including in handgrip strength (healthcare mode: MD 4.41; scientific fitness mode: MD 3.11), vital capacity (healthcare mode: MD 261.99; scientific fitness mode: MD 250.78), and agility (healthcare mode MD=-0.35; scientific fitness mode: MD=-0.39) with all P values <.001, except handgrip strength in the scientific fitness mode (P=.002). There were no significant differences in other parameters among participants with scientific fitness mode exercise prescriptions. CONCLUSIONS The observations suggest that our exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings.
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Affiliation(s)
- Ting Sun
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Yang Xu
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Hui Xie
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Zuchang Ma
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Yu Wang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
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Carl J, Grüne E, Pfeifer K. What About the Environment? How the Physical Activity-Related Health Competence Model Can Benefit From Health Literacy Research. Front Public Health 2021; 9:635443. [PMID: 33937169 PMCID: PMC8086962 DOI: 10.3389/fpubh.2021.635443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
Research cultivates a multitude of frameworks, models, and theories with different determinants internal and/or external to the individual contributing to the understanding and explaining of physical activity levels. The physical activity–related health competence (PAHCO) model can be located at the interface between research of health literacy and physical activity. Because of its primary person orientation, however, the model has not yet undergone discussions on the relevance of the environment. Encouraged by the developments in the area of health literacy, the goal of the present perspective article was to stimulate some initial reflections on potential solutions for the competence–environment relationship within the PAHCO model. We extracted three potential solutions for this issue. Dubbed the solution of integration, we first discussed that the PAHCO model could be placed into overarching, more holistic, and abstract models of health-enhancing physical activity, such as the capability approach or the socioecological model. Applying a solution of elaboration, researchers could second substantiate existing components of the PAHCO model, such as control competence or self-regulation competence, by further explanations. Characterizing the solution of extension, it would third be possible to introduce (a) separate competence component(s) that highlight(s) the manageability of the environment, for instance, by establishing a (socio)ecological competence. The article concludes with a short overview of potential empirical approaches, given their potential to assist researchers in identifying preferences for the theoretical advancement and to put the development on a stronger evidence base.
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Affiliation(s)
- Johannes Carl
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Eva Grüne
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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