Physiotherapists' and Physiotherapy Students' Perspectives on the Use of Mobile or Wearable Technology in Their Practice

Rehabilitation clinicians' use of mainstream wireless technologies in practice: a scoping review

PURPOSE

This scoping review was conducted to understand the barriers, facilitators, and education and training needs of rehabilitation clinicians in their use of mainstream wireless technologies (MWT) to support people with disabilities and older adults. It was also conducted to understand the functional skills of clients that were targeted with MWT use.

MATERIALS AND METHODS

This scoping review was reported using PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) and the Population (or Participants)/Concept/Context) framework. We searched PubMed; ProQuest to access APA PsycINFO; Web of Science Core Collection; and EBSCOhost to access Cumulated Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE ALL, and Education Resources Information Center (ERIC). Articles published between 2015-2022 were retrieved.

RESULTS

A total of 90 articles were included. Most interventions were apps, smartphones, and tablets; were geared toward adults; and targeted motor, cognitive and speech skills. An infographic on barriers and facilitators was generated as a decision support tool for clinicians when implementing MWT. The topic, format, timing, and source of information clinicians need are also delineated.

CONCLUSION

MWT such as apps, smartphones and tablets are being used by rehabilitation clinicians to address motor, cognitive, and speech skills, most commonly in adults. Clinicians voice a need for more education and training. Barriers and facilitators exist at the clinician-, technology-, client-, institution-, and policy levels.Implications For RehabilitationA total of 90 articles from 2015-2022 were included in this scoping reviewMost interventions were apps, smartphones, and tablets; were geared toward adults; and targeted motor, cognitive and speech skills.An infographic was generated as a decision support tool for clinicians when implementing mainstream wireless technologies in clinical practice.Clinicians' education and training needs with regard to mainstream wireless technologies are broad. Materials on a variety of topics, in different formats, from multiple sources are needed.This review also discusses implications of findings on policy, technology development, and future research.

Using activity-based therapy for individuals with spinal cord injury or disease: Interviews with physical and occupational therapists in rehabilitation hospitals

OBJECTIVE

To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings.

DESIGN

Qualitative study.

SETTING

Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups.

PARTICIPANTS

Twelve PTs and ten OTs from nine sites across eight provinces participated.

OUTCOME MEASURES

To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description.

RESULTS

We identified three themes that influenced therapists' use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists' decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients' motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations).

CONCLUSIONS

The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.

Physiotherapists' Perceptions and Willingness to Use Telerehabilitation in Greece: A Cross-Sectional Study

Introduction Coronavirus disease 2019 (COVID-19) has affected the healthcare system and the practice of physiotherapists. Telerehabilitation is an alternative method of delivering physiotherapy services. The aim of this study was to investigate physiotherapists' knowledge, beliefs, and willingness to use telerehabilitation in Greece during the COVID-19 pandemic. Materials and methods In this cross-sectional study, Greek physiotherapists completed an online survey between January and February 2022. A questionnaire was distributed via the Panhellenic Physiotherapy Association (PSF). The questionnaire involved 26 items on demographic background, use of technology, overall perceptions, the experience of telerehabilitation, and their opinion on the future of telerehabilitation. The study protocol was approved by the Ethical Committee of the University of Patras, Greece. Results Participants in this study were 213 physiotherapists (female 57.7%; mean age 39.84±8 years). Most physiotherapists (n=118; 55.4%) were working in a private clinic in the areas of outpatient orthopedics, geriatrics, and neurorehabilitation. Overall, most participants (55%) reported increased use of telerehabilitation strategies during the COVID-19 pandemic. A total of 130 physiotherapists (n=61.3%) believed that telerehabilitation may be beneficial as a supplementary way of patient management. Greek physiotherapists made use of low-cost and easily accessible digital technologies, such as mobile phones and online meeting tools (e.g., Skype, Zoom). Although most physiotherapists (79.8%) reported that they wanted to receive more information about digital technology and telerehabilitation, only 42.1% of them did intend to work remotely after the pandemic. Conclusion Most of the participants were willing to deliver physiotherapy via telerehabilitation. Specific education and training programs need to be provided to physiotherapists during and after the pandemic. Healthcare managers should consider the use of telerehabilitation and design guidelines and policies to manage telerehabilitation practices in Greece.

Potential of digitalization within physiotherapy: a comparative survey

Background

Due to the global digitalization, implementation of digital elements into daily work can support physiotherapists’ work but may also pose some challenges. Only little is known about physiotherapists’ attitude towards digitalization. This study primarily aimed to analyze physiotherapists’ attitude towards digitalization and to what extend digital tools have been implemented into their daily work. In second analysis, participants’ characteristics such as age, working place, gender and mode of survey participation were assessed.

Methods

A 12-main-item survey amongst voluntary course participants of one physiotherapeutic training center was conducted via paper-based as well as online questionnaires between July 2018 and June 2019 including questions on participants’ general as well as particular attitude towards digitalization, the use of (mobile) applications and possible advantages and disadvantages of the ongoing digital transformation. Sub-analysis was performed for age (≤40 years versus > 40 years), gender, mode of participation (paper vs. online) and working place (practice vs. hospital).

Results

Overall, 488 physiotherapists participated in the survey. In comparison of the age groups, younger participants had more concerns about data security (p = 0.042) and insufficient financial remuneration (p < 0.001). Younger participants stated higher satisfaction with data literacy than their counterparts (p = 0.0001). Physiotherapists working in the outpatient sector, rather than in hospitals, expected digitalization to increase more in relevance (p < 0.001). The online respondents (OG) indicated that they had more knowledge about key aspects of the current legal situation regarding digitalization than participants completing the paper-based survey (p = 0.002). 50.4% of the considered digitalization as useful for their job.

Conclusions

The majority of participants saw high potential for digitalization in the physiotherapy sector. Younger physiotherapists seem to be more concerned about data security and insufficient financial remuneration. Physiotherapists in the outpatient sector seem to see more potential in digital transformations. General concerns like missing reimbursement, lack of data security or knowledge on legal frameworks should be addressed in the future. Further studies should focus on identifying specific digital tools which can support physiotherapists.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07931-5.

Investigating the use of digital health tools in physiotherapy: facilitators and barriers

BACKGROUND

Digital tools are becoming more and more common in healthcare. Their potential to improve treatment, monitoring, and coaching in physiotherapy has been recognized. Yet studies report that the adoption of digital health tools in ambulatory physiotherapy is rather low and that their potential is underexploited.

OBJECTIVE

This paper aims to investigate how digital health tools in general, and the mobile health tool physitrack^TM (hereafter the app) more particularly, are used in outpatient physiotherapy clinics and also to identify what facilitates or hinders the app's use.

METHODS

The paper is part of a larger study and adopts an ethnographic approach. It is based on observational and interview data collected at two outpatient clinics.

RESULTS

We reveal how physiotherapists and patients use the app in physiotherapy and identify 16 interdependent factors, on the macro-, meso-, and micro-level, that either facilitate or hinder its use.

CONCLUSIONS

We argue that a single factor's facilitating or hindering impact cannot be grasped in isolation but needs to be investigated as one piece of a dynamic interplay. Further qualitative research is required, especially to shed more light on the app's compatibility with physiotherapy practice and use in therapist-patient interactions.

Perceived Usefulness of Telerehabilitation of Musculoskeletal Disorders: A Belgium-France Pilot Study during Second Wave of COVID-19 Pandemic

BACKGROUND

COVID-19 has affected the practice of physiotherapy, and telerehabilitation (TR) may be seen as an alternative model of care if it is accepted by patients and physiotherapists. This study investigates the perceived usefulness of TR and the intention to use it among physiotherapists and patients from Belgium and France concerned with musculoskeletal disorders (MSDs) during the pandemic period.

METHODS

An online questionnaire based on the technology-acceptance model was designed. Sociodemographic data were collected and Likert scales were proposed to assess perceived ease-of-use, perceived usefulness and intention to use TR. Data were collected between 17 January and 17 March 2021; 68 patients and 107 physiotherapists answered.

RESULTS

In total, 88% of patients and 76% physiotherapists had not used TR at the time they answered. Only 12% of patients and 1% of physiotherapists are willing to use TR, and 50% of physiotherapists think they will never use TR compared to 25% of patients. A total of 98% of participants agreed that they had a good mastery of the technological tools requested.

CONCLUSIONS

Physiotherapists are more reluctant to use TR than patients, regardless of convincing EBM results. This is related to their own representation of proper MSD management, which must include the use of hands-on techniques.

An investigation into the use of mHealth in musculoskeletal physiotherapy: Scoping Review (Preprint)

Background

Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth.

Objective

The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence.

Methods

A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction.

Results

Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar.

Conclusions

mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available.

mHealth technologies used to capture walking and arm use behavior in adult stroke survivors: a scoping review beyond measurement properties

PURPOSE

We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice.

MATERIALS AND METHODS

Using Arksey and O'Malley's framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts.

RESULTS

Sixty-four out of 1380 studies were included. A majority reported on lower limb behavior (n = 32), primarily step count (n = 21). Seventeen studies reported on arm-hand behaviors. Twenty-two studies reported metrics of intensity, 10 reported on energy expenditure. Reliability and validity were the most frequently reported properties, both for commercial and non-commercial devices. Facilitators and barriers included: resource costs, technical aspects, perceived usability, and ecological legitimacy. Two additional categories emerged from the survey: safety and knowledge, attitude, and clinical skill.

CONCLUSIONS

This provides an initial foundation for a field experiencing rapid growth, new opportunities and the promise that mHealth technologies affords for envisioning a better future for stroke survivors. We synthesized findings into a set of recommendations for clinicians and clinician-scientists about how best to choose mHealth technologies for one's individual objective.Implications for RehabilitationRehabilitation professionals are encouraged to consider the measurement properties of those technologies that are used to monitor functional locomotor and object-interaction skills in the stroke survivors they serve.Multi-modal knowledge translation strategies (research synthesis, educational courses or videos, mentorship from experts, etc.) are available to rehabilitation professionals to improve knowledge, attitude, and skills pertaining to mHealth technologies.Consider the selection of commercially available devices that are proven to be valid, reliable, accurate, and responsive to the targeted clinical population.Consider usability and privacy, confidentiality and safety when choosing a specific device or smartphone application.

Physiotherapists' use and perceptions of digital remote physiotherapy during COVID-19 lockdown in Switzerland: an online cross-sectional survey

BACKGROUND

The Swiss containment strategy for the COVID-19 pandemic during the first wave in spring 2020 resulted in a moratorium on non-urgent physiotherapy via regular direct patient contact. Consequently, such physiotherapy sessions declined by 84%. This study investigates the impact of this moratorium on the use of digital remote physiotherapy in Switzerland during this period and the perceptions of its use by Swiss physiotherapists (PTs).

METHODS

A cross-sectional online questionnaire was distributed between June and August of 2020 via the Swiss Physiotherapy Association (physioswiss) and various associations of physiotherapy specialists (e.g., sport, pediatric) working in both inpatient and outpatient settings. The questionnaire was designed to capture the demographics of participants and the perceptions of PTs using 33 questions in the following domains: Demography; Attitudes towards digital technology; Private and professional use of digital technology; Use of digital technology during therapy; and, Support requirements. Closed and open-ended questions were included and the frequency of answers was analyzed. Non-parametric inferential statistics were used to identify differences, where appropriate. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adopted.

RESULTS

Participants in the survey were 742 PTs (23.5% male, mean age of 43 years, mean working experience of 18 years) from the German-speaking (75.5%), French-speaking (15.1%), and Italian-speaking (9.4%) regions of Switzerland. The percentage of PTs using digital remote therapy increased from 4.9% prior to the lockdown to 44.6% during the lockdown period. The majority of PTs did not consider that digital remote therapy could complement usual physiotherapy practice and did not plan to continue with digital remote therapy after the pandemic.

CONCLUSIONS

During the lockdown, Swiss PTs adopted various low-cost and easily accessible digital technologies. However, several barriers hampered further implementation of this modality. Specific education and training programs need to be provided among PTs, appropriate digital technologies should be introduced, and a correct reimbursement scheme should be developed.

TRIAL REGISTRATION

COVIDPhysio Registry of World Physiotherapy, registered 15th June 2020 ( https://world.physio/covid-19-information-hub/covid-19-covidphysio-registry ).

Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance

OBJECTIVES

People with progressive multiple sclerosis (PwPMS) report that they recognise the benefits of activity on their physical and psychological health but need support to achieve their physical activity goals. We aimed to systematically develop a theoretically informed intervention that would enable PwPMS to more readily engage in regular physical activity.

DESIGN

We used an intervention mapping approach to inform intervention development.

SETTING

We conducted semistructured interviews with PwPMS and their families/carers and physiotherapists recruited from secondary care settings.

PARTICIPANTS

Fourteen PwPMS with an Expanded Disability Status Scale score of between 6 and 8 and 7 of their families/carers and 13 physiotherapists and 1 physiotherapy technician participated.

RESULTS

Interview data suggested that the development of supportive coaching relationships with physiotherapists could promote the ability of PwPMS to achieve a desirable and achievable physical activity plan. These interview data informed the prototype 'Lifestyle Exercise and Activity Package for Multiple Sclerosis' (LEAP-MS) consisting of a secure multiuser web-based platform (with an education and activity suite, interactive components enabling selection of exercises, goal setting and activity logging), up to six flexible face-to-face or web-based physiotherapy coaching sessions and remote support via an embedded web-based messaging function that all together draw on specific theory-based methods to achieve physical activity behaviour change, namely active learning, reinforcement, modelling, feedback, facilitation, goal setting and guided practice. Implementation is within a multiuser platform accessible to participants, trained physiotherapists and researchers.

CONCLUSIONS

We have followed an inclusive, systematic and transparent process to develop the LEAP-MS intervention that enables detailed description of components, context and guiding principles to inform ongoing evaluation. Importantly, PwPMS expressed the need for autonomy in developing physical activity plans. This has been achieved through the embedding of self-management principles in the design and delivery of the LEAP-MS intervention.

Use of mHealth Technology for Patient-Reported Outcomes in Community-Dwelling Adults with Acquired Brain Injuries: A Scoping Review

The purpose of our scoping review was to describe the current use of mHealth technology for long-term assessment of patient-reported outcomes in community-dwelling individuals with acquired brain injury (ABI). Following PRISMA guidelines, we conducted a scoping review of literature meeting these criteria: (1) civilians or military veterans, all ages; (2) self-reported or caregiver-reported outcomes assessed via mobile device in the community (not exclusively clinic/hospital); (3) published in English; (4) published in 2015-2019. We searched Ovid MEDLINE(R) < 1946 to 16 August 2019, MEDLINE InProcess, EPub, Embase, and PsycINFO databases for articles. Thirteen manuscripts representing 12 distinct studies were organized by type of ABI [traumatic brain injury (TBI) and stroke] to extract outcomes, mHealth technology used, design, and inclusion of ecological momentary assessment (EMA). Outcomes included post-concussive, depressive, and affective symptoms, fatigue, daily activities, stroke risk factors, and cognitive exertion. Overall, collecting patient-reported outcomes via mHealth was feasible and acceptable in the chronic ABI population. Studies consistently showed advantage for using EMA despite variability in EMA timing/schedules. To ensure best clinical measurement, research on post-ABI outcomes should consider EMA designs (versus single time-point assessments) that provide the best timing schedules for their respective aims and outcomes and that leverage mHealth for data collection.

Clinicians' perspectives on inertial measurement units in clinical practice

Inertial measurement units (IMUs) have been increasingly popular in rehabilitation research. However, despite their accessibility and potential advantages, their uptake and acceptance by health professionals remain a big challenge. The development of an IMU-based clinical tool must bring together engineers, researchers and clinicians. This study is part of a developmental process with the investigation of clinicians’ perspectives about IMUs. Clinicians from four rehabilitation centers were invited to a 30-minute presentation on IMUs. Then, two one-hour focus groups were conducted with volunteer clinicians in each rehabilitation center on: 1) IMUs and their clinical usefulness, and 2) IMUs data analysis and visualization interface. Fifteen clinicians took part in the first focus groups. They expressed their thoughts on: 1) categories of variables that would be useful to measure with IMUs in clinical practice, and 2) desired characteristics of the IMUs. Twenty-three clinicians participated to the second focus groups, discussing: 1) functionalities, 2) display options, 3) clinical data reported and associated information, and 4) data collection duration. Potential influence of IMUs on clinical practice and added value were discussed in both focus groups. Clinicians expressed positive opinions about the use of IMUs, but their expectations were high before considering using IMUs in their practice.

Implementation outcome instruments for use in physical healthcare settings: a systematic review

BACKGROUND

Implementation research aims to facilitate the timely and routine implementation and sustainment of evidence-based interventions and services. A glaring gap in this endeavour is the capability of researchers, healthcare practitioners and managers to quantitatively evaluate implementation efforts using psychometrically sound instruments. To encourage and support the use of precise and accurate implementation outcome measures, this systematic review aimed to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings.

METHOD

The following data sources were searched from inception to March 2019, with no language restrictions: MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL and the Cochrane library. Studies that evaluated the measurement properties of implementation outcome instruments in physical healthcare settings were eligible for inclusion. Proctor et al.'s taxonomy of implementation outcomes was used to guide the inclusion of implementation outcomes: acceptability, appropriateness, feasibility, adoption, penetration, implementation cost and sustainability. Methodological quality of the included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Psychometric quality of the included instruments was assessed using the Contemporary Psychometrics checklist (ConPsy). Usability was determined by number of items per instrument.

RESULTS

Fifty-eight publications reporting on the measurement properties of 55 implementation outcome instruments (65 scales) were identified. The majority of instruments assessed acceptability (n = 33), followed by appropriateness (n = 7), adoption (n = 4), feasibility (n = 4), penetration (n = 4) and sustainability (n = 3) of evidence-based practice. The methodological quality of individual scales was low, with few studies rated as 'excellent' for reliability (6/62) and validity (7/63), and both studies that assessed responsiveness rated as 'poor' (2/2). The psychometric quality of the scales was also low, with 12/65 scales scoring 7 or more out of 22, indicating greater psychometric strength. Six scales (6/65) rated as 'excellent' for usability.

CONCLUSION

Investigators assessing implementation outcomes quantitatively should select instruments based on their methodological and psychometric quality to promote consistent and comparable implementation evaluations. Rather than developing ad hoc instruments, we encourage further psychometric testing of instruments with promising methodological and psychometric evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2017 CRD42017065348.

Clinician Perspectives on mRehab Interventions and Technologies for People with Disabilities in the United States: A National Survey

Mobile health and mobile rehabilitation (mHealth and mRehab) services and technologies have attracted considerable interest from healthcare providers, technology vendors, rehabilitation engineers, investors and policy makers in recent years. Successful adoption and use of mHealth/mRehab requires clinician support and engagement, including the ability to identify appropriate use cases and possible barriers to use for themselves and their patients, and acquire adequate knowledge and confidence using mHealth/mRehab interventions. This article reports results from a survey of rehabilitation clinicians in the United States on their attitudes, experience, expectations and concerns regarding mHealth/mRehab interventions and technologies. Over 500 clinicians in physical, occupational, speech, recreation and psychological therapy professions, among others, participated in the survey. Respondents reported that an overwhelming majority of their patients need additional therapy after discharge from inpatient environments, and over half of outpatients need additional therapy between visits. A large majority reported prescribing specific exercises and interventions for patients to work on outside of the clinic. However, only 51% reported being comfortable integrating mRehab technology into their practice; and only 23% feel knowledgeable about rehabilitation technology currently available. Technologies to support mRehab are maturing rapidly. Clinicians recognize the need for mRehab, but their knowledge and confidence prescribing mRehab represents a significant barrier to adoption.

The Potential of Self-Management mHealth for Pediatric Cystic Fibrosis: Mixed-Methods Study for Health Care and App Assessment

Background

Remote care services and patient empowerment have boosted mobile health (mHealth). A study of user needs related to mHealth for pediatric cystic fibrosis (PCF) identified the set of preferred features mobile apps should support; however, the potential use of PCF apps and their suitability to fit into PCF clinical management remains unexplored.

Objective

We examine whether PCF holds potential for the implementation of mHealth care.

Methods

The study is based on a literature review and qualitative analysis of content and was conducted in two parts: (1) we reviewed scientific and gray literature to explore how European countries manage PCF and conducted a qualitative study of 6 PCF units and (2) we performed a systematic review of apps available in the myhealthapps.net repository searching for cystic fibrosis (CF) management and nutrition apps, which we analyzed for characteristics, business models, number of downloads, and usability.

Results

European CF routine care guidelines are acknowledged in most European countries, and treatments are fully covered in almost all countries. The majority of teams in CF units are interdisciplinary. With respect to the systematic review of apps, we reviewed 12 apps for CF management and 9 for general nutrition management in the myhealthapps.net directory. All analyzed apps provided functionalities for recording aspects related to the disease and nutrition such as medication, meals, measurements, reminders, and educational material. None of the apps reviewed in this study supported pancreatic enzyme replacement therapy. CF apps proved to be less appealing and usable than nutrition apps (2.66 [SD 1.15] vs 4.01 [SD 0.90]; P<.001, z-value: –2.6). User needs detected in previous research are partially matched by current apps for CF management.

Conclusions

The health care context for PCF is a unique opportunity for the adoption of mHealth. Well-established clinical guidelines, heterogeneous clinical teams, and coverage by national health care systems provide a suitable scenario for the use of mHealth solutions. However, available apps for CF self-management do not cover essential aspects such as nutrition and education. To increase the adoption of mHealth for CF self-management, new apps should include these features.

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2016-014931

Clinician perceptions of a prototype wearable exercise biofeedback system for orthopaedic rehabilitation: a qualitative exploration

OBJECTIVES

This study explores the opinions of orthopaedic healthcare professionals regarding the opportunities and challenges of using wearable technology in rehabilitation. It continues to assess the perceived impact of an exemplar exercise biofeedback system that incorporates wearable sensing, involving the clinician in the user-centred design process, a valuable step in ensuring ease of implementation, sustained engagement and clinical relevance.

DESIGN

This is a qualitative study consisting of one-to-one semi-structured interviews, including a demonstration of a prototype wearable exercise biofeedback system. Interviews were audio-recorded and transcribed, with thematic analysis conducted of all transcripts.

SETTING

The study was conducted in the orthopaedic department of an acute private hospital.

PARTICIPANTS

Ten clinicians from a multidisciplinary team of healthcare professionals involved in the orthopaedic rehabilitation pathway participated in the study.

RESULTS

Participants reported that there is currently a challenge in gathering timely and objective data for the monitoring of patients in orthopaedic rehabilitation. While there are challenges in ensuring reliability and engagement of biofeedback systems, clinicians perceive significant value in the use of wearable biofeedback systems such as the exemplar demonstrated for use following total knee replacement.

CONCLUSIONS

Clinicians see an opportunity for wearable technology to continuously track data in real-time, and feel that feedback provided to users regarding exercise technique and adherence can further support the patient at home, although there are clear design and implementation challenges relating to ensuring technical accuracy and tailoring rehabilitation to the individual. There was perceived value in the prototype system demonstrated to participants which supports the ongoing development of such exercise biofeedback platforms.