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Langerak AJ, Regterschot GRH, Selles RW, Meskers CGM, Evers M, Ribbers GM, van Beijnum BJF, Bussmann JBJ. Requirements for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients: a user-centred approach. Disabil Rehabil Assist Technol 2024; 19:1392-1404. [PMID: 36905631 PMCID: PMC11073044 DOI: 10.1080/17483107.2023.2183993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Telerehabilitation systems have the potential to enable therapists to monitor and assist stroke patients in achieving high-intensity upper extremity exercise in the home environment. We adopted an iterative user-centred approach, including multiple data sources and meetings with end-users and stakeholders to define the user requirements for home-based upper extremity rehabilitation using wearable motion sensors for subacute stroke patients. METHODS We performed a requirement analysis consisting of the following steps: 1) context & groundwork; 2) eliciting requirements; 3) modelling & analysis; 4) agreeing requirements. During these steps, a pragmatic literature search, interviews and focus groups with stroke patients, physiotherapists and occupational therapists were performed. The results were systematically analysed and prioritised into "must-haves", "should-haves", and "could-haves". RESULTS We formulated 33 functional requirements: eighteen must-have requirements related to blended care (2), exercise principles (7), exercise delivery (3), exercise evaluation (4), and usability (2); ten should-haves; and five could-haves. Six movement components, including twelve exercises and five combination exercises, are required. For each exercise, appropriate exercise measures were defined. CONCLUSION This study provides an overview of functional requirements, required exercises, and required exercise measures for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients, which can be used to develop home-based upper extremity rehabilitation interventions. Moreover, the comprehensive and systematic requirement analysis used in this study can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context.
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Affiliation(s)
- A. J. Langerak
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G. R. H. Regterschot
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - R. W. Selles
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C. G. M. Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - M. Evers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - G. M. Ribbers
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B. J. F. van Beijnum
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - J. B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Langerak AJ, D'Olivo P, Thijm OSA, Regterschot GRH, Meskers CGM, Rozendaal MC, Visch VT, Bussmann JBJ. Stroke patients' motivation for home-based upper extremity rehabilitation with eHealth tools. Disabil Rehabil 2024:1-11. [PMID: 38339778 DOI: 10.1080/09638288.2024.2304091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE eHealth-based exercise therapies were developed to increase stroke patients' adherence to home-based motor rehabilitation. However, these eHealth tools face a rapid decrease in use after a couple of weeks. This study investigates stroke patients' motivation for home-based upper extremity rehabilitation with eHealth tools and their relation with Basic Psychological Needs. MATERIALS AND METHODS This is a qualitative study using thematic analysis. We conducted semi-structured interviews with stroke patients with upper extremity motor impairments, who were discharged home from a rehabilitation centre, after they interacted with a novel eHealth coach demonstrator in their homes for five consecutive days. RESULTS We included ten stroke patients. Thematic analysis resulted in eight themes for home-based rehabilitation motivation: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness. Those themes are embedded into three Basic Psychological Needs: "Autonomy", "Competence", and "Relatedness". CONCLUSION Eight motivational themes related to the three Basic Psychological Needs describe stroke patients' motivation for home-based upper extremity rehabilitation. We recommend considering those themes when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient's needs and reduce motivational decreases in home-based rehabilitation.
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Affiliation(s)
- A J Langerak
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - P D'Olivo
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - O S A Thijm
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - G R H Regterschot
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - M C Rozendaal
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - V T Visch
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - J B J Bussmann
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Regterschot GRH, Bussmann JBJ, Fanchamps MHJ, Meskers CGM, Ribbers GM, Selles RW. Objectively measured arm use in daily life improves during the first 6 months poststroke: a longitudinal observational cohort study. J Neuroeng Rehabil 2021; 18:51. [PMID: 33741017 PMCID: PMC7980644 DOI: 10.1186/s12984-021-00847-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Background It is unclear how arm use in daily life changes after stroke since studies investigating the change in arm use poststroke are scarce. The aim of this study was to investigate the change in arm use during the first six months poststroke. Secondary aim was to compare arm use changes between arm recovery clusters. Methods Arm use was measured during week 3, 12, and 26 poststroke with accelerometers on the wrists and the nonaffected leg. Outcomes were the amount of affected and nonaffected arm use during sitting and standing per day and per sit/stand hour, and the daily ratio between arms. Arm function was measured with the Fugl-Meyer Upper Extremity Scale to identify recovery clusters (poor/moderate/excellent). Generalized estimating equations compared arm use outcomes between time points and between recovery clusters. Results Thirty-three stroke patients participated. Affected arm use per day increased between week 3 and 12 (30 %; p = 0.04) and it increased per sit/stand hour between week 3–12 (31 %; p < 0.001) and between week 3 and 26 (48 %; p = 0.02). Nonaffected arm use per day decreased between week 3 and 12 (13 %; p < 0.001) and between week 3 and 26 (22 %; p < 0.001) and it decreased per sit/stand hour between week 3 and 26 (18 %; p = 0.003). The daily ratio increased between week 3 and 12 (43 %; p < 0.001) and between week 3 and 26 (95 %; p < 0.001). Changes in arm use did not differ significantly between recovery clusters (p = 0.11–0.62). Affected arm use was higher in the excellent recovery cluster (p < 0.001). Conclusions Affected arm use and the ratio between arms increase during the first 26 weeks poststroke especially in patients with excellent arm recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00847-x.
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Affiliation(s)
- G R H Regterschot
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Malou H J Fanchamps
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Douma KW, Regterschot GRH, Krijnen WP, Slager GEC, van der Schans CP, Zijlstra W. Reliability of the Q Force; a mobile instrument for measuring isometric quadriceps muscle strength. BMC Sports Sci Med Rehabil 2016; 8:4. [PMID: 26900478 PMCID: PMC4759727 DOI: 10.1186/s13102-016-0029-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 02/02/2016] [Indexed: 11/15/2022]
Abstract
Background The ability to generate muscle strength is a pre-requisite for all human movement. Decreased quadriceps muscle strength is frequently observed in older adults and is associated with a decreased performance and activity limitations. To quantify the quadriceps muscle strength and to monitor changes over time, instruments and procedures with a sufficient reliability are needed. The Q Force is an innovative mobile muscle strength measurement instrument suitable to measure in various degrees of extension. Measurements between 110 and 130° extension present the highest values and the most significant increase after training. The objective of this study is to determine the test-retest reliability of muscle strength measurements by the Q Force in older adults in 110° extension. Methods Forty-one healthy older adults, 13 males and 28 females were included in the study. Mean (SD) age was 81.9 (4.89) years. Isometric muscle strength of the Quadriceps muscle was assessed with the Q Force at 110° of knee extension. Participants were measured at two sessions with a three to eight day interval between sessions. To determine relative reliability, the intraclass correlation coefficient (ICC) was calculated. To determine absolute reliability, Bland and Altman Limits of Agreement (LOA) were calculated and t-tests were performed. Results Relative reliability of the Q Force is good to excellent as all ICC coefficients are higher than 0.75. Generally a large 95 % LOA, reflecting only moderate absolute reliability, is found as exemplified for the peak torque left leg of −18.6 N to 33.8 N and the right leg of −9.2 N to 26.4 N was between 15.7 and 23.6 Newton representing 25.2 % to 39.9 % of the size of the mean. Small systematic differences in mean were found between measurement session 1 and 2. Conclusion The present study shows that the Q Force has excellent relative test-retest reliability, but limited absolute test-retest reliability. Since the Q Force is relatively cheap and mobile it is suitable for application in various clinical settings, however, its capability to detect changes in muscle force over time is limited but comparable to existing instruments.
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Affiliation(s)
- K W Douma
- Research and Innovation Group in Healthy Aging, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands ; Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G R H Regterschot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences Groningen, Groningen, The Netherlands
| | - W P Krijnen
- Research and Innovation Group in Healthy Aging, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - G E C Slager
- School of Health Care Studies Hanze University of Applied Science Groningen, Groningen, The Netherlands
| | - C P van der Schans
- Research and Innovation Group in Healthy Aging, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands ; Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, Germany
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