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Kim Y, Kim M, Kim J, Song TJ. Efficacy and feasibility of a digital speech therapy for post-stroke dysarthria: protocol for a randomized controlled trial. Front Neurol 2024; 15:1305297. [PMID: 38356882 PMCID: PMC10865504 DOI: 10.3389/fneur.2024.1305297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background Dysarthria is a motor speech disorder caused by various neurological diseases, particularly stroke. Individuals with post-stroke dysarthria experience impaired speech intelligibility, communication difficulties, and a reduced quality of life. However, studies on the treatment of post-stroke dysarthria are lacking. Digital speech therapy applications have the advantages of being personalized and easily accessible. However, evidence for their efficacy is not rigorous. Moreover, no studies have investigated both the acute to subacute, and chronic phases of stroke. This study aims to investigate the efficacy and feasibility of digital speech therapy applications in addressing these gaps in dysarthria treatment. Methods and design This study is a multicenter, prospective, randomized, evaluator-blinded non-inferiority trial. We aim to recruit 76 participants with post-stroke dysarthria. Eligible participants will be stratified based on the onset period of stroke into acute to subacute, and chronic phases. Participants will be randomized in a 1:1 to receive either a personalized digital speech therapy application or conventional therapy with a workbook for 60 min daily, 5 days a week, for 4 weeks. The primary outcome is the improvement in speech intelligibility. This will be measured by how accurately independent listeners can transcribe passages read by the participants. Secondary outcomes, which include speech function, will be evaluated remotely by speech-language pathologists. This includes the maximum phonation time, oral diadochokinetic rate, and percentage of consonants correct. Participants' psychological well-being will also be assessed using self-report questionnaires, such as depressive symptoms (Patient Health Questionnaire-9) and quality of life (Quality of Life in the Dysarthric Speaker scale). The trial will also assess the feasibility, participant adherence, and usability of the application. Rigorous data collection and monitoring will be implemented to ensure patient safety. Conclusion This trial aims to investigate the efficacy and feasibility of digital speech therapy applications for treating post-stroke dysarthria. The results could establish foundational evidence for future clinical trials with larger sample sizes. Clinical trial registration Clinicaltrials.gov, identifier: NCT05865106.
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Affiliation(s)
- Yuyoung Kim
- HCI Lab, Yonsei University, Seoul, Republic of Korea
| | - Minjung Kim
- HCI Lab, Yonsei University, Seoul, Republic of Korea
| | - Jinwoo Kim
- HCI Lab, Yonsei University, Seoul, Republic of Korea
- HAII Corporation, Seoul, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Stanic T, Saygin Avsar T, Gomes M. Economic Evaluations of Digital Health Interventions for Children and Adolescents: Systematic Review. J Med Internet Res 2023; 25:e45958. [PMID: 37921844 PMCID: PMC10656663 DOI: 10.2196/45958] [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: 01/23/2023] [Revised: 06/13/2023] [Accepted: 08/03/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions. OBJECTIVE This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities. METHODS We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation. RESULTS We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%). CONCLUSIONS This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes.
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Affiliation(s)
- Tijana Stanic
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Tuba Saygin Avsar
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, United Kingdom
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3
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Wali R. Integration of Telehealth in Routine Perinatal Care: A Model of Care for Primary Healthcare Clinics in Saudi Arabia. Cureus 2023; 15:e47295. [PMID: 38021871 PMCID: PMC10657159 DOI: 10.7759/cureus.47295] [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] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
This study aims to introduce a new model of antenatal/postnatal care that integrates virtual clinics with the current model of care, including a discussion on the current model, pre-existing barriers, and prenatal framework, and the need for transition to telehealth beyond the pandemic. In antenatal primary health care centers, such as King Abdulaziz Medical City (KAMC), low-risk antenatal/postnatal care receives clinical care through complete physical attendance in antenatal/postnatal clinics in primary care clinics for pregnancy follow-up and in tertiary hospitals for fetal ultrasound and invasive procedures if needed. Pregnancy is confirmed through a regular family medicine (FM) clinic where risk assessment through history, physical examination, and investigations are carried out. If the pregnant woman is at low risk, she will be started on folic acid, 1 mg or 5 mg based on the risk assessment (if it was not received before). Pregnant women will be given a telehealth appointment for the lab results. Concomitantly, the pregnant women will receive an appointment in the antenatal clinics, which board-certified family physicians run. High-risk patients will be referred to the hospital for further care. Current postnatal care is delivered through regular booking with the FM clinic through physical attendance sometimes, and virtual care is provided upon physican/patient request. Current care meets the past quality care and patient expectations. However, with the current Saudi Vision 2030 and after the experience with virtual care during the COVID-19 pandemic, the current services need to move a step forward to meet the rapidly developing medical care/needs in Saudi Arabia. Various challenges must be addressed, and new models must be included in clinical care for pregnant and postnatal women. Introducing virtual antenatal/postnatal care to the current care could be a new era in maternity primary health care; this model will move the clinical care provided to pregnant/postnatal women a step forward that meets the excellence of high-quality, evidence-based medical care.
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Affiliation(s)
- Razaz Wali
- Primary Healthcare, Ministry of National Guard Health Affairs, Jeddah, SAU
- Family Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- Family Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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4
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Uwambaye P, Nyiringango G, Musabwasoni SMG, Husain A, Nessa K, Razzaque MS. COVID-19 Pandemic: Adaptation in Antenatal Care for Better Pregnancy Outcomes. Front Glob Womens Health 2021; 1:599327. [PMID: 34816170 PMCID: PMC8593964 DOI: 10.3389/fgwh.2020.599327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Peace Uwambaye
- Department of Preventive & Community Dentistry, School of Dentistry, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Gerard Nyiringango
- Department of Nursing, School of Nursing and Midwifery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Sandra Marie Grace Musabwasoni
- Department of Midwifery, School of Nursing and Midwifery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Ali Husain
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Kamrun Nessa
- Department of Obstetrics & Gynecology, Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Mohammed S Razzaque
- Department of Preventive & Community Dentistry, School of Dentistry, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.,Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States
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Broomhead SC, Mars M, Scott RE, Jones T. EHealth Investment Appraisal in Africa: A Scoping Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059999. [PMID: 34905975 PMCID: PMC8679012 DOI: 10.1177/00469580211059999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
eHealth is an opportunity cost, competing for limited available funds with other
health priorities such as clinics, vaccinations, medicines and even salaries. As
such, it should be appraised for probable impact prior to allocation of funds.
This is especially pertinent as recognition grows for the role of eHealth in
attaining Universal Health Coverage. Despite optimism about eHealth’s potential
role, in Africa there remain insufficient data and skills for adequate economic
appraisals to select optimal investments from numerous competing initiatives.
The aim of this review is to identify eHealth investment appraisal approaches
and tools that have been used in African countries, describe their
characteristics and make recommendations regarding African eHealth investment
appraisal in the face of limited data and expertise. Methods: Literature on
eHealth investment appraisals conducted in African countries and published
between January 1, 2010 and June 30, 2020 was reviewed. Selected papers’
investment appraisal characteristics were assessed using the Joanna Briggs
Institute checklist for economic evaluations and a newly developed Five-Case
Model for Digital Health (FCM-DH) checklist for investment appraisal. 5 papers
met inclusion criteria. Their assessments revealed important appraisal gaps. In
particular, none of the papers addressed risk exposure, affordability,
adjustment for optimism bias, clear delivery milestones, practical plans for
implementation, change management or procurement, and only 1 paper described
plans for building partnerships. Discussion: Using this insight, an extended
5-Case Model is proposed as the foundation of an African eHealth investment
appraisal framework. This, combined with building local eHealth appraisal
capabilities, may promote optimal eHealth investment decisions, strengthen
implementations and improve the number and quality of related publications.
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Affiliation(s)
- Sean C Broomhead
- Department of TeleHealth, College of Health Sciences, 72753University of KwaZulu-Natal, Durban, South Africa.,72753Health Information Systems Program South Africa, Pretoria, South Africa.,72753African Centre for EHealth Excellence, Cape Town, South Africa
| | - Maurice Mars
- Department of TeleHealth, College of Health Sciences, 72753University of KwaZulu-Natal, Durban, South Africa.,College of Nursing and Health Sciences, 72753Flinders University, Adelaide, South Australia
| | - Richard E Scott
- Department of TeleHealth, College of Health Sciences, 72753University of KwaZulu-Natal, Durban, South Africa.,Department of Community Health Sciences, Cumming School of Medicine, 72753University of Calgary, Calgary, Canada
| | - Tom Jones
- 72753African Centre for EHealth Excellence, Cape Town, South Africa
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Kim H, Cho NB, Kim J, Kim KM, Kang M, Choi Y, Kim M, You H, Nam SI, Shin S. Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study. JMIR Mhealth Uhealth 2020; 8:e22080. [PMID: 33012704 PMCID: PMC7600016 DOI: 10.2196/22080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. International Registered Report Identifier (IRRID) RR2-10.2196/19585
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Affiliation(s)
- HyangHee Kim
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Bin Cho
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinwon Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Kyung Min Kim
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minji Kang
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Younggeun Choi
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Minjae Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Heecheon You
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Seok In Nam
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Soyeon Shin
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
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