A Novel Virtual Coaching System Based on Personalized Clinical Pathways for Rehabilitation of Older Adults-Requirements and Implementation Plan of the vCare Project

The Transformative Power of Virtual Hospitals for Revolutionising Healthcare Delivery

Objectives: The objective of this narrative review is to explore the advantages and limitations of VHs in delivering healthcare, including access to specialized professionals, streamlined communication, efficient scheduling, integration of electronic health records, ongoing monitoring, and support, transcending geographical boundaries, and resource optimization. Methods: Review of literature. Results: The national healthcare systems are facing an alarming rise in pressure due to global shifts. Virtual hospitals (VH) offer a practical solution to numerous systemic challenges, including rising costs and increased workloads for healthcare providers. VH also facilitate the delivery of personalized services and enable the monitoring of patients beyond the conventional confines of healthcare settings, reducing the reliance on waiting medicine carried out in doctors' offices or hospitals. Conclusion: VH can mirror the conventional healthcare referral system.

Identification of Ethical Issues and Practice Recommendations Regarding the Use of Robotic Coaching Solutions for Older Adults: Narrative Review

BACKGROUND

Technological advances in robotics, artificial intelligence, cognitive algorithms, and internet-based coaches have contributed to the development of devices capable of responding to some of the challenges resulting from demographic aging. Numerous studies have explored the use of robotic coaching solutions (RCSs) for supporting healthy behaviors in older adults and have shown their benefits regarding the quality of life and functional independence of older adults at home. However, the use of RCSs by individuals who are potentially vulnerable raises many ethical questions. Establishing an ethical framework to guide the development, use, and evaluation practices regarding RCSs for older adults seems highly pertinent.

OBJECTIVE

The objective of this paper was to highlight the ethical issues related to the use of RCSs for health care purposes among older adults and draft recommendations for researchers and health care professionals interested in using RCSs for older adults.

METHODS

We conducted a narrative review of the literature to identify publications including an analysis of the ethical dimension and recommendations regarding the use of RCSs for older adults. We used a qualitative analysis methodology inspired by a Health Technology Assessment model. We included all article types such as theoretical papers, research studies, and reviews dealing with ethical issues or recommendations for the implementation of these RCSs in a general population, particularly among older adults, in the health care sector and published after 2011 in either English or French. The review was performed between August and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases. Selected publications were analyzed using the European Network of Health Technology Assessment Core Model (version 3.0) around 5 ethical topics: benefit-harm balance, autonomy, privacy, justice and equity, and legislation.

RESULTS

In the 25 publications analyzed, the most cited ethical concerns were the risk of accidents, lack of reliability, loss of control, risk of deception, risk of social isolation, data confidentiality, and liability in case of safety problems. Recommendations included collecting the opinion of target users, collecting their consent, and training professionals in the use of RCSs. Proper data management, anonymization, and encryption appeared to be essential to protect RCS users' personal data.

CONCLUSIONS

Our analysis supports the interest in using RCSs for older adults because of their potential contribution to individuals' quality of life and well-being. This analysis highlights many ethical issues linked to the use of RCSs for health-related goals. Future studies should consider the organizational consequences of the implementation of RCSs and the influence of cultural and socioeconomic specificities of the context of experimentation. We suggest implementing a scalable ethical and regulatory framework to accompany the development and implementation of RCSs for various aspects related to the technology, individual, or legal aspects.

e-VITA study protocol: EU-Japan virtual coach for smart aging

Aim

The aim of this study is to report a trial protocol for assessing the improvement of older adults' well-being, promoting active and healthy aging, and reducing the risks of social exclusion, using a virtual coach.

Background

Increased longevity brings with it reduced autonomy and independence, and it is therefore necessary to act with preventive measures that can promote active and healthy aging. With the development of technology, new tools have appeared, including virtual coaches, which can enable people to lead a healthy lifestyle by identifying individual needs and goals and providing personalized recommendations and advice. However, it is important that these coaches take into consideration the inter-individual and cross-cultural differences of each person.

Design

A randomized controlled trial is proposed.

Methods

This study will recruit 240 healthy subjects aged 65 years and older. Participants will be assigned to an experimental group that will receive the e-VITA system or to the control group that will receive an information booklet only. The primary outcome measure is the person's quality of life (QoL). Data will be collected at baseline, 3 months after the trial, and at the end of the trial, after 6 months.

Discussion

This study will evaluate the effectiveness of the e-VITA system, consisting of a virtual coach, several sensors for monitoring, a smartphone for use at home, and a booklet, in improving the older person's quality of life. The increased perceived well-being will also be linked to improvements in other areas of the person's life, psychological and cognitive status, the area of sociality, nutrition, and eHealth literacy.

Empowering Smart Aging: Insights into the Technical Architecture of the e-VITA Virtual Coaching System for Older Adults

With a substantial rise in life expectancy throughout the last century, society faces the imperative of seeking inventive approaches to foster active aging and provide adequate aging care. The e-VITA initiative, jointly funded by the European Union and Japan, centers on an advanced virtual coaching methodology designed to target essential aspects of promoting active and healthy aging. This paper describes the technical framework underlying the e-VITA virtual coaching system platform and presents preliminary feedback on its use. At its core is the e-VITA Manager, a pivotal component responsible for harmonizing the seamless integration of various specialized devices and modules. These modules include the Dialogue Manager, Data Fusion, and Emotional Detection, each making distinct contributions to enhance the platform's functionalities. The platform's design incorporates a multitude of devices and software components from Europe and Japan, each built upon diverse technologies and standards. This versatile platform facilitates communication and seamless integration among smart devices such as sensors and robots while efficiently managing data to provide comprehensive coaching functionalities.

A deep learning system to monitor and assess rehabilitation exercises in home-based remote and unsupervised conditions

In the domain of physical rehabilitation, the progress in machine learning and the availability of cost-effective motion capture technologies have paved the way for innovative systems capable of capturing human movements, automatically analyzing recorded data, and evaluating movement quality. This study introduces a novel, economically viable system designed for monitoring and assessing rehabilitation exercises. The system enables real-time evaluation of exercises, providing precise insights into deviations from correct execution. The evaluation comprises two significant components: range of motion (ROM) classification and compensatory pattern recognition. To develop and validate the effectiveness of the system, a unique dataset of 6 resistance training exercises was acquired. The proposed system demonstrated impressive capabilities in motion monitoring and evaluation. Notably, we achieved promising results, with mean accuracies of 89% for evaluating ROM-class and 98% for classifying compensatory patterns. By complementing conventional rehabilitation assessments conducted by skilled clinicians, this cutting-edge system has the potential to significantly improve rehabilitation practices. Additionally, its integration in home-based rehabilitation programs can greatly enhance patient outcomes and increase access to high-quality care.

A database of physical therapy exercises with variability of execution collected by wearable sensors

This document introduces the PHYTMO database, which contains data from physical therapies recorded with inertial sensors, including information from an optical reference system. PHYTMO includes the recording of 30 volunteers, aged between 20 and 70 years old. A total amount of 6 exercises and 3 gait variations were recorded. The volunteers performed two series with a minimum of 8 repetitions in each one. PHYTMO includes magneto-inertial data, together with a highly accurate location and orientation in the 3D space provided by the optical system. The files were stored in CSV format to ensure its usability. The aim of this dataset is the availability of data for two main purposes: the analysis of techniques for the identification and evaluation of exercises using inertial sensors and the validation of inertial sensor-based algorithms for human motion monitoring. Furthermore, the database stores enough data to apply Machine Learning-based algorithms. The participants' age range is large enough to establish age-based metrics for the exercises evaluation or the study of differences in motions between different groups.

Virtual Coaching for Rehabilitation: The Participatory Design Experience of the vCare Project

End-user involvement constitutes an essential goal during the development of innovative solution, not only for the evaluation, but also in codesign, following a user-centered strategy. Indeed, it is a great asset of research to base the work in a user-centered approach, because it allows to build a platform that will respond to the real needs of users. The aims of this work are to present the methodology adopted to involve end-users (i.e., neurological patients, healthy elderly, and health professionals) in the evaluation of a novel virtual coaching system based on the personalized clinical pathways and to present the results obtained from these preliminary activities. Specific activities involving end-users were planned along the development phases and are referred to as participatory design. The user experience of participatory design is constituted by the two different phases: the “end-user's perspective” phase where the user involvement in experiential activities is from an observational point of view, whereas the “field study” phase is the direct participation in these activities. Evaluation tools (i.e., scales, questionnaires, and interviews) were planned to assess different aspects of the system. Thirty patients [14 with poststroke condition and 16 with Parkinson's disease (PD)], 13 healthy elderly, and six health professionals were enrolled from two clinical centers during the two phases of participatory design. Results from “end-user's perspective” phase showed globally a positive preliminary perception of the service. Overall, a positive evaluation (i.e., UEQ median score > 1) was obtained for each domain of the scale in both groups of patients and healthy subjects. The evaluation of the vCare system during the “field study” phase was assessed as excellent (>80 points) from the point of view of both patients and health professionals. According to the majority of patients, the rehabilitation service through the solution was reported to be interesting, engaging, entertaining, challenging and useful for improving impaired motor functions, and making patients aware of their cognitive abilities. Once refined and fine-tuned in the aspects highlighted in the this work, the system will be clinically tested at user's home to measure the real impact of the rehabilitative coaching services.

User Centered Virtual Coaching for Older Adults at Home Using SMART Goal Plans and I-Change Model

Preventive care and telemedicine are expected to play an important role in reducing the impact of an increasingly aging global population while increasing the number of healthy years. Virtual coaching is a promising research area to support this process. This paper presents a user-centered virtual coach for older adults at home to promote active and healthy aging and independent living. It supports behavior change processes for improving on cognitive, physical, social interaction and nutrition areas using specific, measurable, achievable, relevant, and time-limited (SMART) goal plans, following the I-Change behavioral change model. Older adults select and personalize which goal plans to join from a catalog designed by domain experts. Intervention delivery adapts to user preferences and minimizes intrusiveness in the user’s daily living using a combination of a deterministic algorithm and incremental machine learning model. The home becomes an augmented reality environment, using a combination of projectors, cameras, microphones and support sensors, where common objects are used for projection and sensed. Older adults interact with this virtual coach in their home in a natural way using speech and body gestures on projected user interfaces with common objects at home. This paper presents the concept from the older adult and the caregiver perspectives. Then, it focuses on the older adult view, describing the tools and processes available to foster a positive behavior change process, including a discussion about the limitations of the current implementation.

Current aspects regarding “smart homes”/ ambient assisted living (AAL) including rehabilitation specific devices, for people with disabilities/ special needs

Introduction: The population life expectancy has increased (“over half the EU’s population predicted to be over-65 by 2070”), according to recent prevalence studies, being a result of the advancement of technology and medical science. This aging population has implications for society because there is increased number of older people requiring better quality of life. Materials and Methods: AAL represents the systems that may support completely the living area of a person and has the potential to facilitate the elderly to live longer and more safety in their family environments, allowing them to continue their current activities, facilitating participation in more activities at home and in the community and improving the cost-effectiveness, the quality of health and social services. A practical use of technology is the introduction of home networks, which involve notions such as: "smart homes ", “tele-health / tele-care” and even, possibly, “tele-medicine” to allow people with serious illnesses / conditions / and special needs to maintain an appropriate quality of life (QOL) at home. Discussions and Conclusions: AAL can contribute to an increased autonomy, self-confidence and mobility in people whose activity is limited to home environment, such as "the oldest olds” and/ or those with severe neuro-/ loco-motors disabilities, and so to reduce the risk of institutionalization, enhance security, prevent social isolation, thus allowing “older adults to age in place”. An important role in achieving this goal is representing by working in a multidisciplinary team (experts in the field of health - rehabilitation, gerontology -, social experts, technical/ informatics experts, engineering and robotics experts). Keywords: ambient assistive living, quality of life, special needs, tele-medicine, rehabilitation,