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Uddin M, Ganapathy K, Syed-Abdul S. Digital Technology Enablers of Tele-Neurorehabilitation in Pre- and Post-COVID-19 Pandemic Era - A Scoping Review. Int J Telerehabil 2024; 16:e6611. [PMID: 39022438 PMCID: PMC11250154 DOI: 10.5195/ijt.2024.6611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Neurorehabilitation (NR), a major component of neurosciences, is the process of restoring a patient's damaged/disorganized neurological function, through training, therapy, and education, while focusing on patient's independence and well-being. Since the advent of the COVID-19 pandemic, various applications of telecare and telehealth services surged drastically and became an integral part of current clinical practices. Tele-Neurorehabilitation (TNR) is one of such applications. When rehabilitation services were disrupted globally due to lockdown and travel restrictions, the importance of TNR was recognized, especially in developed, low, and middle-income countries. With exponential deployment of telehealth interventions in neurosciences, TNR has become a distinct stand-alone sub-specialty of neurosciences and telehealth. Digital technologies, such as wearables, robotics, and Virtual Reality (VR) have enabled TNR to improve the quality of patients' lives. Providing NR remotely using digital technologies and customized digital devices is now a reality, and likely to be the new norm soon. This article provides an overview of the needs, utilization, and deployment of TNR, and focuses on digital technology enablers of TNR in pre- and post-COVID-19 pandemic era.
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Affiliation(s)
- Mohy Uddin
- Research Quality Management Section, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Krishnan Ganapathy
- Distinguished Visiting Professor IIT Kanpur & Director Apollo Telemedicine Networking Foundation, India
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Bindschedler A, Ziller C, Gerber EY, Behrendt F, Crüts B, Parmar K, Gerth HU, Gäumann S, Dierkes W, Schuster-Amft C, Bonati LH. Feasibility of an Application-Based Outpatient Rehabilitation Program for Stroke Survivors: Acceptability and Preliminary Results for Patient-Reported Outcomes. Bioengineering (Basel) 2024; 11:135. [PMID: 38391621 PMCID: PMC10886035 DOI: 10.3390/bioengineering11020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The majority of stroke survivors experience long-term impairments. Regular physical activity and other lifestyle modifications play an important role in rehabilitation. Outpatient rehabilitation using telemedicine might be suitable to improve functional ability and long-term secondary prevention. The Strokecoach Intervention Program (SIP, Strokecoach GmbH, Cologne, Germany) comprises training, coaching and monitoring with the aim of improving or at least maintaining functional independence and preventing further stroke through more targeted physical activity. The SIP is provided as blended care, which refers to the integrated and coordinated delivery of healthcare services that combines traditional in-person interactions with technology-mediated interventions, optimizing the use of both face-to-face and virtual modalities to enhance patient outcomes. OBJECTIVE The aim of this study was to evaluate the acceptance of the SIP by the participants and its practical application, as well as to obtain initial indications of effects of the SIP on the basis of patient-related outcome measures, blood pressure measurements and recording of physical activity in parallel with the intervention. METHODS Data from individuals with stroke participating in the SIP were analyzed retrospectively. Within the SIP, participants received an application-based training program, were instructed to measure their blood pressure daily and to wear an activity tracker (pedometer). During the intervention period of either 6 or 12 weeks, the participants were supported and motivated by a personal coach via a messenger application. The primary outcomes of the analysis were recruitment, acceptance of and satisfaction with the SIP. Secondary outcomes included functional measures, mobility and health-related quality of life. RESULTS A total of 122 individuals with stroke could be recruited for the SIP. A total of 96 out of 122 were able to start the program (54% female, mean age 54.8 (SD = 13.1), 6.1 (SD = 6.6) years after stroke onset) and 88 completed the SIP. Participants wore the activity tracker on 66% and tracked their blood pressure on 72% of their intervention days. A further analyzed subgroup of 38 participants showed small improvements in patient-reported outcomes such as health-related quality of life (SF-36) with an increase of 12 points in the subdomain mental health, vitality (12.6) and physical functioning (9.1). However, no statistically significant improvements were found in other performance-based measures (Timed Up and Go test, gait speed). CONCLUSIONS This study showed that a blended therapy approach for stroke survivors with mild to moderate impairments in the chronic phase is feasible and was highly accepted by participants, who benefitted from the additional coaching.
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Affiliation(s)
| | - Carina Ziller
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
| | - Eve-Yaël Gerber
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Faculty of Psychology, University of Basel, 4055 Basel, Switzerland
| | - Frank Behrendt
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- School of Engineering and Computer Science, Bern University of Applied Sciences, 2501 Biel, Switzerland
| | | | - Katrin Parmar
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
| | - Hans Ulrich Gerth
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Szabina Gäumann
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
| | | | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- School of Engineering and Computer Science, Bern University of Applied Sciences, 2501 Biel, Switzerland
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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Shariat A, Najafabadi MG, Nakhostin Ansari N, Anastasio AT, Bagheri K, Hassanzadeh G, Farghadan M. Outcome Measures Utilized to Assess the Efficacy of Telerehabilitation for Post-Stroke Rehabilitation: A Scoping Review. Brain Sci 2023; 13:1725. [PMID: 38137173 PMCID: PMC10741539 DOI: 10.3390/brainsci13121725] [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: 11/07/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Outcome measures using telerehabilitation (TR) in the context of post-stroke rehabilitation are an area of emerging research. The current review assesses the literature related to TR for patients requiring post-stroke rehabilitation. The purpose of this study is to survey the outcome measures used in TR studies and to define which parts of the International Organization of Functioning are measured in trials. METHODS TR studies were searched in Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, Google Scholar, and Web of Science, The Cochrane Central Register of Controlled Trials (Cochrane Library), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Physiotherapy Evidence Database (PEDro) from 2016 to June 2023. Two reviewers individually assessed the full text. Discrepancies regarding inclusion or exclusion were resolved by an additional reviewer. RESULTS A total of 24 studies were included in the current review. The findings were synthesized and presented taking into account their implications within clinical practice, areas of investigation, and strategic implementation. CONCLUSIONS The scoping review has recognized a broad range of outcome measures utilized in TR studies, shedding light on gaps in the current literature. Furthermore, this review serves as a valuable resource for researchers and end users (such as clinicians and policymakers), providing insights into the most appropriate outcome measures for TR. There is a lack of studies examining the required follow-up after TR, emphasizing the need for future research in this area.
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Affiliation(s)
- Ardalan Shariat
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (A.S.); (G.H.)
| | - Mahboubeh Ghayour Najafabadi
- Department of Motor Behavior, Faculty of Sport Sciences and Health, University of Tehran, Tehran 1439957131, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran 141556559, Iran;
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | | | - Kian Bagheri
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, USA;
| | - Gholamreza Hassanzadeh
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (A.S.); (G.H.)
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Mahsa Farghadan
- Department of Artificial Intelligence, Faculty of Computer Engineering, Islamic Azad University of South Tehran Branch, Tehran 4147654919, Iran;
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Seinsche J, de Bruin ED, Saibene E, Rizzo F, Carpinella I, Ferrarin M, Moza S, Ritter T, Giannouli E. A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study. JMIR Hum Factors 2023; 10:e48845. [PMID: 38060283 PMCID: PMC10739244 DOI: 10.2196/48845] [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: 05/09/2023] [Revised: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). OBJECTIVE This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. METHODS At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants' perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire-3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. RESULTS A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system's usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ρ=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ρ=-0.35; P=.02) and the UTAUT total score (ρ=-0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. CONCLUSIONS The study's findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system's feasibility and effectiveness.
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Affiliation(s)
- Julia Seinsche
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Enrico Saibene
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Francesco Rizzo
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Ilaria Carpinella
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maurizio Ferrarin
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | - Tanja Ritter
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eleftheria Giannouli
- Movement Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Rintala A, Kossi O, Bonnechère B, Evers L, Printemps E, Feys P. Mobile health applications for improving physical function, physical activity, and quality of life in stroke survivors: a systematic review. Disabil Rehabil 2023; 45:4001-4015. [PMID: 36325613 DOI: 10.1080/09638288.2022.2140844] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the effectiveness of mobile health applications (mHealth apps) containing a physical training component on physical function and physical activity in stroke rehabilitation. MATERIALS AND METHODS A systematic literature search was conducted in three databases for studies published from inception to 12 July 2022. Clinical trials including mHealth apps with a physical training component were included using outcomes of physical function and physical activity. Quality of life was extracted as a secondary outcome. RESULTS Five RCTs, two non-RCTs, and four uncontrolled clinical trials were included with a total of 264 stroke survivors. Eleven apps were identified with a physical training component using features of gamification (six apps), exercise prescription (three apps), and physical activity (two apps). Six out of seven studies reported statistically significant improvements in physical function in favor of the experimental group, with the most robust findings for upper extremity function. For physical activity, statistically significant improvements were seen in the experimental groups. Only one study showed significant improvement in quality of life. Overall study quality was fair. CONCLUSIONS mHealth apps containing a physical training component are promising for physical function and physical activity in stroke rehabilitation. Further research is warranted to confirm these conclusions.Implications for rehabilitationDesign content of mobile apps with a physical training component were focused on gamification, exercise prescription, and physical activityUsing mobile app-delivered therapy seem promising for improving upper extremity function in stroke rehabilitationUsing mobile apps also supported an increase of physical activity in people with strokeStudies using mobile apps should report more specifically the dosage of physical training and adherenceUsing mobile apps seems promising as an additional tool for clinical work, however, more studies are required to understand their effectiveness in stroke rehabilitation.
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Affiliation(s)
- A Rintala
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - O Kossi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - B Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - L Evers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - E Printemps
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Seinsche J, de Bruin ED, Saibene E, Rizzo F, Carpinella I, Ferrarin M, Ifanger S, Moza S, Giannouli E. Feasibility and Effectiveness of a Personalized Home-Based Motor-Cognitive Training Program in Community-Dwelling Older Adults: Protocol for a Pragmatic Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49377. [PMID: 37943591 PMCID: PMC10667977 DOI: 10.2196/49377] [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: 05/30/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Exergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management. OBJECTIVE The aim of this study is to test the feasibility and effectiveness of this novel training system. METHODS A total of 180 older adults from Switzerland, Italy, and Cyprus aged ≥60 years with a prescription for rehabilitation are randomly allocated to an intervention group or a control group. Both groups continue with their usual care, whereas participants in the intervention group additionally perform a 2-week supervised exergame training program at rehabilitation centers, followed by a 10-week home training program under remote supervision. The assessment system is used to indicate the start level of each participant, and, in both intervention periods, standardized progression rules are applied. The measures of feasibility include adherence, attrition, exergame enjoyment, willingness to perform such a training program, and the number and types of help requests. Effectiveness is assessed in terms of cognitive and physical functioning, balance confidence, and quality of life. RESULTS Data collection started in February 2023 and is ongoing. Final measurements are expected to be performed in January 2024. CONCLUSIONS Owing to the user-centered design approach, the Cocare system is expected to be user-friendly and offers several novel features to cover the whole continuum of care. This pragmatic trial will provide valuable information regarding final necessary adaptations and subsequent implementation efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT05751551; https://www.clinicaltrials.gov/study/NCT05751551. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49377.
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Affiliation(s)
- Julia Seinsche
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Enrico Saibene
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Francesco Rizzo
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Ilaria Carpinella
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maurizio Ferrarin
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Sarina Ifanger
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | | | - Eleftheria Giannouli
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Lee C, Ahn J, Lee BC. A Systematic Review of the Long-Term Effects of Using Smartphone- and Tablet-Based Rehabilitation Technology for Balance and Gait Training and Exercise Programs. Bioengineering (Basel) 2023; 10:1142. [PMID: 37892872 PMCID: PMC10604191 DOI: 10.3390/bioengineering10101142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Recent advances in wearable motion sensors, mobile devices, the Internet of Things, and telecommunications have created new potential for telerehabilitation. Recognizing that there is no systematic review of smartphone- or tablet-based balance and gait telerehabilitation technology for long-term use (i.e., four weeks or more), this systematic review summarizes the effects of smartphone- or tablet-based rehabilitation technology on balance and gait exercise and training in balance and gait disorders. The review examined studies written in English published from 2013 to 2023 in Web of Science, Pubmed, Scopus, and Google Scholar. Of the 806 studies identified, 14 were selected, and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was applied to evaluate methodological quality. The systematic review concluded that all 14 studies found balance and gait performance improvement after four weeks or more of balance and gait telerehabilitation. Ten of the 14 studies found that carry-over effects (improved functional movements, muscle strength, motor capacity, cognition, and reduced fear of falling and anxiety levels) were maintained for weeks to months. The results of the systematic review have positive technical and clinical implications for the next-generation design of rehabilitation technology in balance and gait training and exercise programs.
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Affiliation(s)
- Chihyeong Lee
- Department of Physical Education, Seoul National University, Seoul 08826, Republic of Korea;
| | - Jooeun Ahn
- Department of Physical Education, Seoul National University, Seoul 08826, Republic of Korea;
- Institute of Sport Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Beom-Chan Lee
- Institute of Sport Science, Seoul National University, Seoul 08826, Republic of Korea
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA
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Morrow C, Woodbury M, Simpson AN, Almallouhi E, Simpson KN. Determining the Marginal Cost Differences of a Telehealth Versus an In-person Occupational Therapy Evaluation Session for Stroke Survivors Using Time-driven Activity-based Costing. Arch Phys Med Rehabil 2023; 104:547-553. [PMID: 36513124 PMCID: PMC10967225 DOI: 10.1016/j.apmr.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the marginal cost differences and care delivery process of a telerehabilitation vs outpatient session. DESIGN This study used a time-driven activity-based costing approach including (1) observation of rehabilitation sessions and creation of manual time stamps, (2) structured and recorded interviews with 2 occupational therapists familiar with outpatient therapy and 2 therapists familiar with telerehabilitation, (3) collection of standard wages for providers, and (4) the creation of an iterative flowchart of both an outpatient and telerehabilitation session care delivery process. SETTING Telerehabilitation and outpatient therapy evaluation. PARTICIPANTS Three therapists familiar with care deliver for telerehabilitation or outpatient therapy (N=3). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Marginal cost difference between telerehabilitation and outpatient therapy evaluations. RESULTS Overall, telerehabilitation ($225.41) was more costly than outpatient therapy ($168.29) per session for a cost difference of $57.12. Primary time drivers of this finding were initial phone calls (0 minutes for OP therapists vs 35 minutes for TR) and post documentation (5 minutes for OP vs 30 minutes for TR) demands for telerehabilitation. CONCLUSIONS Telerehabilitation is an emerging platform with the potential to reduce costs, improve health care inequities, and facilitate better patient outcomes. Improvements in documentation practices, staffing, technology, and reimbursement structuring would allow for a more successful translation.
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Affiliation(s)
- Corey Morrow
- College of Health Professions, Medical University of South Carolina, Charleston, SC; Department of Occupational Therapy, Whitworth University, Spokane, WA.
| | - Michelle Woodbury
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Annie N Simpson
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Eyad Almallouhi
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Kit N Simpson
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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Triantafyllidis A, Segkouli S, Zygouris S, Michailidou C, Avgerinakis K, Fappa E, Vassiliades S, Bougea A, Papagiannakis N, Katakis I, Mathioudis E, Sorici A, Bajenaru L, Tageo V, Camonita F, Magga-Nteve C, Vrochidis S, Pedullà L, Brichetto G, Tsakanikas P, Votis K, Tzovaras D. Mobile App Interventions for Parkinson's Disease, Multiple Sclerosis and Stroke: A Systematic Literature Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3396. [PMID: 37050456 PMCID: PMC10098868 DOI: 10.3390/s23073396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
Central nervous system diseases (CNSDs) lead to significant disability worldwide. Mobile app interventions have recently shown the potential to facilitate monitoring and medical management of patients with CNSDs. In this direction, the characteristics of the mobile apps used in research studies and their level of clinical effectiveness need to be explored in order to advance the multidisciplinary research required in the field of mobile app interventions for CNSDs. A systematic review of mobile app interventions for three major CNSDs, i.e., Parkinson's disease (PD), multiple sclerosis (MS), and stroke, which impose significant burden on people and health care systems around the globe, is presented. A literature search in the bibliographic databases of PubMed and Scopus was performed. Identified studies were assessed in terms of quality, and synthesized according to target disease, mobile app characteristics, study design and outcomes. Overall, 21 studies were included in the review. A total of 3 studies targeted PD (14%), 4 studies targeted MS (19%), and 14 studies targeted stroke (67%). Most studies presented a weak-to-moderate methodological quality. Study samples were small, with 15 studies (71%) including less than 50 participants, and only 4 studies (19%) reporting a study duration of 6 months or more. The majority of the mobile apps focused on exercise and physical rehabilitation. In total, 16 studies (76%) reported positive outcomes related to physical activity and motor function, cognition, quality of life, and education, whereas 5 studies (24%) clearly reported no difference compared to usual care. Mobile app interventions are promising to improve outcomes concerning patient's physical activity, motor ability, cognition, quality of life and education for patients with PD, MS, and Stroke. However, rigorous studies are required to demonstrate robust evidence of their clinical effectiveness.
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Affiliation(s)
- Andreas Triantafyllidis
- Information Technologies Institute, Centre for Research and Technology Hellas, 57001 Thermi, Greece
| | - Sofia Segkouli
- Information Technologies Institute, Centre for Research and Technology Hellas, 57001 Thermi, Greece
| | - Stelios Zygouris
- Information Technologies Institute, Centre for Research and Technology Hellas, 57001 Thermi, Greece
- Department of Psychology, University of Western Macedonia, 53100 Florina, Greece
| | | | | | | | | | - Anastasia Bougea
- Eginition Hospital, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Nikos Papagiannakis
- Eginition Hospital, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Ioannis Katakis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417 Nicosia, Cyprus
| | - Evangelos Mathioudis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417 Nicosia, Cyprus
| | - Alexandru Sorici
- Department of Computer Science, University Politechnica of Bucharest, 060042 Bucharest, Romania
| | - Lidia Bajenaru
- Department of Computer Science, University Politechnica of Bucharest, 060042 Bucharest, Romania
| | | | | | - Christoniki Magga-Nteve
- Information Technologies Institute, Centre for Research and Technology Hellas, 57001 Thermi, Greece
| | - Stefanos Vrochidis
- Information Technologies Institute, Centre for Research and Technology Hellas, 57001 Thermi, Greece
| | | | | | - Panagiotis Tsakanikas
- Institute of Communication and Computer Systems, National Technical University of Athens, 10682 Athens, Greece
| | - Konstantinos Votis
- Information Technologies Institute, Centre for Research and Technology Hellas, 57001 Thermi, Greece
| | - Dimitrios Tzovaras
- Information Technologies Institute, Centre for Research and Technology Hellas, 57001 Thermi, Greece
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Mathunny JJ, Karthik V, Devaraj A, Jacob J. A scoping review on recent trends in wearable sensors to analyze gait in people with stroke: From sensor placement to validation against gold-standard equipment. Proc Inst Mech Eng H 2023; 237:309-326. [PMID: 36704959 DOI: 10.1177/09544119221142327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the review is to evaluate wearable sensor placement, their impact and validation of wearable sensors on analyzing gait, primarily the postural instability in people with stroke. Databases, namely PubMed, Cochrane, SpringerLink, and IEEE Xplore were searched to identify related articles published since January 2005. The authors have selected the articles by considering patient characteristics, intervention details, and outcome measurements by following the priorly set inclusion and exclusion criteria. From a total of 1077 articles, 142 were included in this study and classified into functional fields, namely postural stability (PS) assessments, physical activity monitoring (PA), gait pattern classification (GPC), and foot drop correction (FDC). The review covers the types of wearable sensors, their placement, and their performance in terms of reliability and validity. When employing a single wearable sensor, the pelvis and foot were the most used locations for detecting gait asymmetry and kinetic parameters, respectively. Multiple Inertial Measurement Units placed at different body parts were effectively used to estimate postural stability and gait pattern. This review article has compared results of placement of sensors at different locations helping researchers and clinicians to identify the best possible placement for sensors to measure specific kinematic and kinetic parameters in persons with stroke.
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Affiliation(s)
- Jaison Jacob Mathunny
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Varshini Karthik
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Ashokkumar Devaraj
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - James Jacob
- Department of Physical Therapy, Kindred Healthcare, Munster, IN, USA
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Alayat MS, Almatrafi NA, Almutairi AA, El Fiky AAR, Elsodany AM. The Effectiveness of Telerehabilitation on Balance and Functional Mobility in Patients with Stroke: A Systematic Review and Meta-Analysis. Int J Telerehabil 2022; 14:e6532. [PMID: 38026563 PMCID: PMC10681061 DOI: 10.5195/ijt.2022.6532] [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] [Indexed: 12/01/2023] Open
Abstract
Objective The aim of this systematic review and meta-analysis was to investigate the effectiveness of telerehabilitation on improving balance and functional mobility in stroke survivors. Methods Comprehensive searching was conducted from inception to May 2022. The inclusion criteria were studies evaluating the effectiveness of telerehabilitation in stroke survivors. Data regarding participants, intervention, outcome measures, and main results were extracted. PEDro scale and the Grading of Recommendations Assessment Development and Evaluation (GRADE) were used to assess the methodological quality and quality of evidence, respectively. Data Analysis A total of fourteen articles) 594 patients) were included. A meta-analysis using a random-effect model was performed on thirteen studies )530 patients). Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for balance and functional mobility. Results: PEDro scale revealed ten good-quality studies, three fair-quality studies, and one poor-quality study. According to the available evidence, telerehabilitation has a small effect size in improving both balance (SMD 0.33 [95% CI 0.03 to 0.63]; P =0.03; low quality of evidence) and functional mobility (SMD 0.27 [95% CI 0.02 to 0.52]; P =0.03; low quality of evidence). Conclusion Telerehabilitation may improve balance and functional mobility in stroke survivors. However, it is evident that more high-quality research is required due to the existence of low to very low-quality evidence with limited confidence in the effect estimate. Registration PROSPERO registration number (CRD42022306410).
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Affiliation(s)
- Mohamed Salaheldien Alayat
- Department of Physiotherapy, Applied Medical Science College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nahla Ahmad Almatrafi
- Department of Physiotherapy, Applied Medical Science College, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Amir Abdel Raouf El Fiky
- Department of Physiotherapy, Applied Medical Science College, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy for Neurological Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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12
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Nikolaev VA, Safonicheva OG, Nikolaev AA. Telerehabilitation of Post-Stroke Patients with Motor Function Disorders: A Review. ADVANCES IN GERONTOLOGY 2022. [PMCID: PMC9464491 DOI: 10.1134/s2079057022030109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Stroke is the main reason for disabilities of increasing geriatric population. It affects brain and motor function domains significantly reducing the life quality. Recent coronavirus pandemic raised a question on changing approaches to deliver post-stroke rehabilitation services to geriatric patients due to their high risk of serious illness. This paper presents an overview of current telerehabilitation approaches for motor function recovery and balance training of post-stroke patients. We used papers from peer-reviewed medical journals on stroke telerehabilitation. The review showed exergames, virtual reality (VR), web-platforms, and applications are extensively used in rehabilitation programs to gain clinical outcomes among geriatric stroke patients. Findings indicate telerehabilitation improves older patients’ functional ability via systematic training, positively affecting their life quality. The treatment therapy of older adults using telerehabilitation can be organized synchronously and asynchronously in home-based environment or in-clinic conditions. Telerehabilitation can be used as complementary therapy or as an alternative to conventional treatment. However, further research is required to test a variety of telerehabilitation systems using larger samples of post-stroke geriatric patients.
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Affiliation(s)
- V. A. Nikolaev
- Pirogov Russian National Research Medical University, 117997 Moscow, Russia
- Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - O. G. Safonicheva
- Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - A. A. Nikolaev
- National University of Science and Technology “MISiS”, 119049 Moscow, Russia
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13
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Nikolaev VA, Nikolaev AA. Recent trends in telerehabilitation of stroke patients: A narrative review. NeuroRehabilitation 2022; 51:1-22. [DOI: 10.3233/nre-210330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND: Stroke is the main reason for disabilities worldwide leading to motor dysfunction, spatial neglect and cognitive problems, aphasia, and other speech-language pathologies, reducing the life quality. To overcome disabilities, telerehabilitation (TR) has been recently introduced. OBJECTIVE: The aim of this review was to analyze current TR approaches for stroke patients’ recovery. METHODS: We searched 6 online databases from January 2018 to October 2021, and included 70 research and review papers in the review. We analyzed TR of 995 individuals, which was delivered synchronously and asynchronously. RESULTS: Findings show TR is feasible improving motor function, cognition, speech, and language communication among stroke patients. However, the dose of TR sessions varied significantly. We identified the following limitations: lack of equipment, software, and space for home-based exercises, insufficient internet capacity and speed, unavailability to provide hands on guidance, low digital proficiency and education, high cognitive demand, small samples, data heterogeneity, and no economic evaluation. CONCLUSIONS: The review shows TR is superior or similar to conventional rehabilitation in clinical outcomes and is used as complementary therapy or as alternative treatments. More importantly, TR provides access to rehabilitation services of a large number of patients with immobility, living in remote areas, and during COVID-19 pandemic or similar events.
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Affiliation(s)
- Vitaly A. Nikolaev
- Pirogov Russian National Research Medical University (Pirogov Medical University), Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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14
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Malone LA, Mendonca CJ, Kim Y. Active Videogaming Interventions in Adults with Neuromuscular Conditions: A Scoping Review. Games Health J 2022; 11:141-156. [PMID: 35482057 DOI: 10.1089/g4h.2021.0096] [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: 11/12/2022] Open
Abstract
This review synthesized active videogaming (AVG) intervention literature over a 10-year period (2010-2020) for people with neuromuscular conditions (18-64 years of age), examining interventions that aimed to improve health and secondary conditions, physical activity, and outcomes quality of life (QOL). Systematic searches yielded 40 eligible studies. The major groups were multiple sclerosis (40%) and stroke (33%), and the study participants had mostly mild-to-moderate disability who were able to play games in a standing position. Research designs primarily involved randomized controlled trials (65%) and pre/post-trial design without a control group (28%). The majority of interventions used commercial off-the-shelf gaming systems, such as Nintendo Wii and Microsoft Kinect. Studies reported significant improvements in health outcomes, specifically in balance (n = 30/36), mobility (n = 24/27), and cardiorespiratory fitness (n = 6/8). Positive changes were also seen in secondary conditions (n = 8/12), physical activity (n = 3/4), and QOL outcomes (n = 8/16). AVG research for people with neuromuscular conditions has grown in both quantity and quality but several gaps remain. Study findings provide a roadmap for future AVG trials on understudied populations, and highlight technology and targeted outcomes as drivers of future intervention research.
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Affiliation(s)
- Laurie A Malone
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
| | - Christen J Mendonca
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
| | - Yumi Kim
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
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15
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Koulouris D, Menychtas A, Maglogiannis I. An IoT-Enabled Platform for the Assessment of Physical and Mental Activities Utilizing Augmented Reality Exergaming. SENSORS 2022; 22:s22093181. [PMID: 35590871 PMCID: PMC9102367 DOI: 10.3390/s22093181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
Augmented reality (AR) and Internet of Things (IoT) are among the core technological elements of modern information systems and applications in which advanced features for user interactivity and monitoring are required. These technologies are continuously improving and are available nowadays in all popular programming environments and platforms, allowing for their wide adoption in many different business and research applications. In the fields of healthcare and assisted living, AR is extensively applied in the development of exergames, facilitating the implementation of innovative gamification techniques, while IoT can effectively support the users’ health monitoring aspects. In this work, we present a prototype platform for exergames that combines AR and IoT on commodity mobile devices for the development of serious games in the healthcare domain. The main objective of the solution was to promote the utilization of gamification techniques to boost the users’ physical activities and to assist the regular assessment of their health and cognitive statuses through challenges and quests in the virtual and real world. With the integration of sensors and wearable devices by design, the platform has the capability of real-time monitoring the users’ biosignals and activities during the game, collecting data for each session, which can be analyzed afterwards by healthcare professionals. The solution was validated in real world scenarios and the results were analyzed in order to further improve the performance and usability of the prototype.
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Affiliation(s)
| | | | - Ilias Maglogiannis
- Department of Digital Systems, University of Piraeus, 80, M. Karaoli & A. Dimitriou St., 18534 Piraeus, Greece
- Correspondence:
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16
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Mańdziuk M, Krawczyk-Suszek M, Maciejewski R, Bednarski J, Kotyra A, Cyganik W. The Application of Biological Feedback in the Rehabilitation of Patients after Ischemic Stroke. SENSORS 2022; 22:s22051769. [PMID: 35270916 PMCID: PMC8914769 DOI: 10.3390/s22051769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
Balance disorders are the main concern for patients after an ischemic stroke. They are caused by an abnormal force on the affected side or paresis, which causes uneven loading and visuospatial disorders. Minimizing the effects of stroke is possible through properly conducted rehabilitation. One of the known ways to achieve this objective is biological feedback. The lack of proper muscle tone on one side of the body is manifested by the uneven pressure of the lower extremities on the ground. The study and control groups were composed of two equal groups of 92 people each, in which the same set of kinesiotherapeutic exercises were applied. Patients in the study group, in addition to standard medical procedures, exercised five days a week on a Balance Trainer for four weeks. The examination and training with the device were recorded on the first day of rehabilitation, as well as after two and four weeks of training. The assessment was performed using the following functional tests and scales: Brunnström, Rankin, Barthel, Ashworth, and VAS. Patients in the control group started exercising on the Balance Trainer two weeks after the first day of rehabilitation using traditional methods. The study results reveal statistically significant reductions in the time the body’s center of gravity (COG) spent in the tacks, outside the tracks and in the COG distance, lower COG excursions in all directions. Post-stroke patients that received biofeedback training presented significantly better results than patients that did not receive such training.
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Affiliation(s)
- Marzena Mańdziuk
- Medical College, University of Information Technology and Management in Rzeszow, 2 Sucharskiego Str., 35-225 Rzeszow, Poland; (M.K.-S.); (W.C.)
- Correspondence:
| | - Marlena Krawczyk-Suszek
- Medical College, University of Information Technology and Management in Rzeszow, 2 Sucharskiego Str., 35-225 Rzeszow, Poland; (M.K.-S.); (W.C.)
| | - Ryszard Maciejewski
- Department of Human Anatomy, Medical University of Lublin, 19 Chodzki Str., 20-093 Lublin, Poland; (R.M.); (J.B.)
| | - Jerzy Bednarski
- Department of Human Anatomy, Medical University of Lublin, 19 Chodzki Str., 20-093 Lublin, Poland; (R.M.); (J.B.)
| | - Andrzej Kotyra
- Department of Electronics and Information Technology, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 38a Nadbystrzycka Str., 20-618 Lublin, Poland;
| | - Weronika Cyganik
- Medical College, University of Information Technology and Management in Rzeszow, 2 Sucharskiego Str., 35-225 Rzeszow, Poland; (M.K.-S.); (W.C.)
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A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study. Brain Sci 2022; 12:brainsci12020213. [PMID: 35203976 PMCID: PMC8870671 DOI: 10.3390/brainsci12020213] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability.
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18
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Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112110116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients’ acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists’ constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy.
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Everard G, Luc A, Doumas I, Ajana K, Stoquart G, Edwards MG, Lejeune T. Self-Rehabilitation for Post-Stroke Motor Function and Activity-A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2021; 35:1043-1058. [PMID: 34696645 DOI: 10.1177/15459683211048773] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands.Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation.Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5.Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes.Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.
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Affiliation(s)
- Gauthier Everard
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Alexandre Luc
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium
| | - Ioannis Doumas
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Khawla Ajana
- Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gaëtan Stoquart
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Martin Gareth Edwards
- Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Ostrowska PM, Śliwiński M, Studnicki R, Hansdorfer-Korzon R. Telerehabilitation of Post-Stroke Patients as a Therapeutic Solution in the Era of the Covid-19 Pandemic. Healthcare (Basel) 2021; 9:654. [PMID: 34072939 PMCID: PMC8229171 DOI: 10.3390/healthcare9060654] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Due to the pandemic caused by the SARS-CoV-2 virus, rehabilitation centres have become less available for neurological patients. This is the result of efforts to physically distance society, to try to slow the spread of the pathogen. Health care facilities were mainly restricted to urgent cases, while most physiotherapy treatments, mainly for patients with chronic conditions, were suspended. Some countries have seen a reduction in acute stroke hospital admissions of from 50% to 80%. One solution to the above problem is the use of telerehabilitation in the home environment as an alternative to inpatient rehabilitation. (2) Aim of the study: The purpose of this review is to analyse the benefits and limitations of teletherapy in relation to the functional condition of post-stroke patients. (3) Methods: Selected publications from 2019 to 2021 on the telerehabilitation of stroke patients were reviewed. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. (4) Results: Studies have proven that teletherapy significantly improves the functional condition of post-stroke patients, resulting in improved quality of life and faster return to independence (while maintaining maximum possible precautions related to the SARS-CoV-2 virus pandemic). (5) Conclusions: Analysis of the study results showed comparable effectiveness of rehabilitation in the tele system to inpatient therapy. However, it should be emphasised that patients undergoing telerehabilitation must meet strict conditions to be eligible for this type of treatment program. However, the strength of the evidence itself supporting the effectiveness of this method ranks low due to the limited number of randomised control trials (RCT), small number of participants, and heterogeneous trials.
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Affiliation(s)
- Paulina Magdalena Ostrowska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland; (M.Ś.); (R.S.); (R.H.-K.)
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