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Pilli K, Worne B, Simpson G. Clinician experiences with using assistive technology in brain injury rehabilitation: a survey of clinician capability, attitudes, and barriers. BRAIN IMPAIR 2023; 24:185-203. [PMID: 38167181 DOI: 10.1017/brimp.2023.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND The rise in assistive technology (AT) solutions to support people with an acquired brain injury (ABI) has warranted clinicians to build capability in assisting clients to select goal-centred AT. The study explored, amongst ABI clinicians, (a) capability, attitudes, and barriers with AT implementation, (b) age-related differences in technology self-efficacy and capability (c) strategies to support AT use in rehabilitation and (d) thematic analysis of AT-related experiences. METHOD Mixed methods design. Online survey circulated to ABI clinicians across New South Wales, Australia, comprising purpose-designed items as well as the Modified Computer Self-Efficacy Scale (MCSES; range 0-100). RESULTS Clinicians (n = 123) were evenly distributed across decadal age groups. The majority were female (90%, n = 111) and one-third were occupational therapists.Clinicians scored strongly on the MCSES (Mdn = 76, IQR = 19), with younger age groups significantly associated with higher scores (H[3] = 9.667, p = .022). Most clinicians (92%) were knowledgeable of mainstream technology for personal use, but over half (65%) reported insufficient knowledge of suitable AT for clients. Clinicians reported positive attitudes towards AT, however, time to research and develop proficiency with a range of AT was the primary barrier (81%).Thematic analysis suggested that whilst the ideal AT experience is client-motivated requiring multidisciplinary guidance, the clinician role and experience with AT is evolving, influenced by rapid technological advancement and extrinsic opportunities to access AT. CONCLUSIONS Whilst clinicians have positive attitudes towards AT, there is a gap in clinician implementation. There is need to support further resources to build clinician capability and access to AT.
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Affiliation(s)
- Kavya Pilli
- Liverpool Brain Injury Unit, Liverpool Hospital, Sydney, Australia
| | - Brendan Worne
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Grahame Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Aravind N, Treacy D, Chagpar S, Harvey LA, Glinsky JV, Sherrington C, Hassett LM. Implementing digital devices to increase mobility training for people receiving inpatient rehabilitation: protocol for a feasibility hybrid type II randomized controlled trial. Pilot Feasibility Stud 2023; 9:69. [PMID: 37098616 PMCID: PMC10126551 DOI: 10.1186/s40814-023-01298-y] [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: 09/01/2022] [Accepted: 04/10/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND People with mobility limitations can benefit from rehabilitation programs incorporating intensive, repetitive, and task-specific exercises using digital devices such as virtual reality gaming systems, tablet and smartphone applications, and wearable devices. The Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial (n = 300) showed improvements in mobility in people using these types of digital devices in addition to their usual rehabilitation care when the intervention was provided by an additional study-funded physiotherapist. However, it is not clear if this intervention can be implemented by hospital physiotherapists with a usual clinical load. The AMOUNT Implementation trial aims to explore the feasibility of conducting a large-scale implementation trial. METHODS A pragmatic, assessor blinded, feasibility hybrid type II randomized controlled trial will be undertaken at a public hospital in Australia. There will be two phases. Phase I (Implementation phase) will involve implementing the digital devices into physiotherapy practice. Physiotherapists from the rehabilitation ward will receive a multifaceted implementation strategy guided by the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model. The implementation strategy includes identifying and training a clinical champion; providing digital devices and education and training; facilitating use of the devices through clinical reasoning sessions and journal clubs; and audit and feedback of exercise dosage documentation. Phase II (Trial phase) will involve randomising 30 eligible inpatients from the same ward into either usual care or usual care plus an additional 30 min or more of exercises using digital devices. This intervention will be provided by the physiotherapists who took part in the implementation phase. We will collect data on feasibility, implementation, and patient-level clinical outcomes. The three primary outcome measures are the extent to which physiotherapists document the dosage of exercises provided to participants (feasibility criteria: exercise practice sheets complete for ≥85% of all participants); ability to recruit participants; and fidelity to the protocol of using digital devices to prescribe exercises (feasibility criteria: average of ≥ 30mins per day for > 50% intervention participants). DISCUSSION This feasibility study will provide important information to guide the planning and conduct of a future large-scale implementation trial. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry; ACTRN12621000938808; registered 19/07/2021. Trial sponsor: Prince of Wales Hospital. 320-346 Barker Street, Randwick, NSW, 2031, Australia. PROTOCOL VERSION 6.2 7th April 2021.
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Affiliation(s)
- Nisha Aravind
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia.
| | - Daniel Treacy
- Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, Australia
- Department of Health Sciences, Macquarie University, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Leanne M Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
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Ryan JL, Beal DS, Levac DE, Fehlings DL, Wright FV. Integrating Transcranial Direct Current Stimulation into an Existing Inpatient Physiotherapy Program to Enhance Motor Learning in an Adolescent with Traumatic Brain Injury: A Case Report. Phys Occup Ther Pediatr 2023:1-19. [PMID: 36624962 DOI: 10.1080/01942638.2022.2163214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Describe how transcranial direct current stimulation (tDCS) was incorporated into an inpatient physiotherapy program for an adolescent with severe traumatic brain injury (TBI), detail the motor learning focus of the physiotherapy sessions, and summarize gross motor progress. METHOD This case report describes an adolescent who received 20 minutes of anodal tDCS immediately prior to 16 physiotherapy sessions over four weeks. Potential side effects were tracked pre/post tDCS. Gross motor outcomes were measured pre-intervention, post-intervention, and three months post-intervention. Physiotherapy session content was analyzed using therapist documentation and the Motor Learning Strategies Rating Instrument. RESULTS The youth tolerated tDCS well. The primary side effect was itchiness under the electrodes during tDCS sessions. His mobility progressed from wheelchair use pre- 'tDCS + physiotherapy' to ambulation with a walker post-intervention. His Gross Motor Function Measure score increased 33.1% points pre/post intervention. Session tasks often had several foci (e.g., skill acquisition, strength, and balance) with task focus changing as the youth progressed. Various motor learning strategies were layered within tasks to support performance and learning. CONCLUSIONS tDCS was successfully integrated into an existing inpatient physiotherapy program for an adolescent with TBI. This protocol provides a structure for implementing, monitoring, and measuring tDCS + physiotherapy in pediatric rehabilitation.
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Affiliation(s)
- Jennifer L Ryan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Danielle E Levac
- School of Rehabilitation, University of Montreal, Montreal, Canada
| | - Darcy L Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Aliprandi M, Pan Y, Mosley C, Gough S. What is the cost of including virtual reality in neurological rehabilitation? A scoping review. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2094102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Martina Aliprandi
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Yvonne Pan
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Chiara Mosley
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
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Clemente KAP, da Silva SV, Vieira GI, de Bortoli MC, Toma TS, Ramos VD, de Brito CMM. Barriers to the access of people with disabilities to health services: a scoping review. Rev Saude Publica 2022; 56:64. [PMID: 35792776 PMCID: PMC9239543 DOI: 10.11606/s1518-8787.2022056003893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.
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Affiliation(s)
- Karina Aparecida Padilha Clemente
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Simone Vieira da Silva
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Gislene Inoue Vieira
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Maritsa Carla de Bortoli
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Tereza Setsuko Toma
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Vinícius Delgado Ramos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto de Medicina Física e Reabilitação. São Paulo, SP, Brasil.
| | - Christina May Moran de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brasil.
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Mashizume Y, Zenba Y, Takahashi K. Occupational Therapists' Perceptions of Robotics Use for Patients With Chronic Stroke. Am J Occup Ther 2021; 75:23067. [PMID: 34787638 DOI: 10.5014/ajot.2021.046110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The effectiveness of robotic therapy in stroke rehabilitation has been established by many studies, and occupational therapists should consider using robotics in their clinical practice. However, little is known about occupational therapy practitioners' experience using robotics. OBJECTIVE To explore occupational therapists' perceptions of the mechanisms and outcomes of occupational therapy using robotics with chronic stroke patients. DESIGN Qualitative study with semistructured focus group interviews. Data were analyzed using thematic analysis. SETTING Hospitals and institutions in Japan in which occupational therapists used robotics in their clinical practice. PARTICIPANTS Twenty-seven occupational therapists with experience in using robotics with chronic stroke patients as a self-training method that involved repetitive movements of a paralyzed upper extremity. Participants were interviewed in nine focus groups. RESULTS Five themes-(1) body function, (2) values, (3) performance skills, (4) occupational performance, and (5) participation-and 12 subthemes were identified on the basis of the Occupational Therapy Practice Framework: Domain and Process (3rd ed.). Participants indicated that robotics improved patients' body function and promoted a desire for independence, which resulted in improved occupational performance and participation in their desired occupations. CONCLUSIONS AND RELEVANCE Occupational therapists regarded robotics as an adjunct to other therapy, which improved patients' body function and promoted their desire for independence. What This Article Adds: Findings from this research provide insights into using robotics to enhance occupational therapy practice.
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Affiliation(s)
- Yuki Mashizume
- Yuki Mashizume, MS, OTR, is Graduate Student, Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan;
| | - Yosuke Zenba
- Yosuke Zenba, MBA, OTR, is Assistant Professor, Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Kayoko Takahashi
- Kayoko Takahashi, ScD, OTR, is Professor, Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
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Bower KJ, Verdonck M, Hamilton A, Williams G, Tan D, Clark RA. What Factors Influence Clinicians' Use of Technology in Neurorehabilitation? A Multisite Qualitative Study. Phys Ther 2021; 101:6124063. [PMID: 33522582 DOI: 10.1093/ptj/pzab031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/30/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Technology is being increasingly used for physical assessment and interventions in health care settings. However, clinical adoption is relatively slow, and the factors affecting use remain underexplored. This study aimed to investigate factors influencing technology use by clinicians working in neurorehabilitation. METHODS In this qualitative study, 9 physical therapists and 9 occupational therapists (N = 18) were recruited from urban and regional locations in Australia and in Singapore. Three 60-minute focus groups were conducted via video conferencing. Each group comprised 3 physical therapists and 3 occupational therapists working across different neurorehabilitation settings. Participants were asked to discuss which technologies they used in their workplace for physical assessment and treatment and barriers, motivators, and future desires for technology use. Transcripts were analyzed independently using an inductive approach to generate codes and themes. RESULTS Our results comprised 3 themes and 7 categories. These were encompassed by a single overarching theme, namely "Technology use is influenced by the benefits and challenges of the technology itself, users, and organizational context." Themes showed that technology should promote effective interventions, is preferred if easy to use, and should be dependable. Furthermore, clinical reasoning is important, and users have varying levels of receptivity and confidence in technology use. Also, organizational resources are required, along with supportive cultures and processes, to facilitate technology use. CONCLUSIONS The themes identified multiple and interlinking factors influencing clinicians' use of technology in neurorehabilitation settings. Clinicians often consider context-specific benefits and challenges when deciding whether to use technology. Although our study found that clinicians generally perceived technology as having a beneficial role in improving health outcomes, there were several challenges raised. Therefore, the characteristics of the technology itself, individual users, and organizational context should be considered. IMPACT These findings will guide successful technology implementation and future developments.
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Affiliation(s)
- Kelly J Bower
- The University of Melbourne, Department of Physiotherapy, Melbourne School of Health Sciences, Alan Gilbert Building, 161 Barry St, Carlton VIC Australia 3053.,University of the Sunshine Coast, School of Health and Sport Sciences, Sippy Downs, Queensland, Australia
| | - Michele Verdonck
- University of the Sunshine Coast, School of Health and Sport Sciences, Sippy Downs, Queensland, Australia
| | - Anita Hamilton
- University of the Sunshine Coast, School of Health and Sport Sciences, Sippy Downs, Queensland, Australia
| | - Gavin Williams
- The University of Melbourne, Department of Physiotherapy, Melbourne School of Health Sciences, Alan Gilbert Building, 161 Barry St, Carlton VIC Australia 3053.,Epworth HealthCare, Department of Physiotherapy, Richmond, Victoria, Australia
| | - Dawn Tan
- Singapore General Hospital, Department of Physiotherapy, National Heart Centre Building, Singapore
| | - Ross A Clark
- University of the Sunshine Coast, School of Health and Sport Sciences, Sippy Downs, Queensland, Australia
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Hamilton C, Lovarini M, van den Berg M, McCluskey A, Hassett L. Usability of affordable feedback-based technologies to improve mobility and physical activity in rehabilitation: a mixed methods study. Disabil Rehabil 2021; 44:4029-4038. [PMID: 33645384 DOI: 10.1080/09638288.2021.1884904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore physiotherapists' views on the usability of feedback-based technologies used in physical rehabilitation. MATERIALS AND METHODS A mixed methods study which was nested within a randomised controlled trial to investigate the effectiveness of affordable feedback-based technologies to improve mobility and physical activity within aged care and neurological rehabilitation. Technologies included virtual reality systems, handheld device apps and wearable devices. Physiotherapists (n = 11) who were involved in prescribing technologies during the trial rated the usability of 11 different devices using the System Usability Scale (SUS), then attended a focus group. Descriptive statistics and framework analysis were used for analysis. RESULTS Fitbit devices (mean 89.8, SD 9.3), Fysiogaming (mean 75.6, SD 15.3) and Xbox Kinect (mean 75.5, SD 11.2) rated in the acceptable range (>70) on the SUS. Three key factors on usability emerged from the focus groups: (1) Key device features relating to practicalities (ease of set up and use, reliability, safety) and therapeutic benefit (customisation, high active practice time, useful feedback) are important for usability; (2) Usability depends on the context of use; and (3) Usability can be enhanced with technical, clinical, environmental and financial support. CONCLUSIONS Health service managers and clinicians should consider key device features identified, contextual factors of their service, and supports available when selecting technologies for use in clinical practice. Further collaboration between clinicians, researchers and technology developers would benefit future technology development, particularly taking into consideration the identified key device features from this study.IMPLICATIONS FOR REHABILITATIONTechnology selection should be based on key device features relating to both practicalities and therapeutic benefit.Contextual factors and available supports should also be considered when selecting technologies.Key usability features identified in this study such as ease of set up, reliability and customisability should be considered in the design of future feedback-based technologies to optimise usability in physical rehabilitation.
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Affiliation(s)
- Caitlin Hamilton
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Meryl Lovarini
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Maayken van den Berg
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health, Sydney, Australia.,Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, Australia
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Weber H, Barr C, Gough C, van den Berg M. How Commercially Available Virtual Reality-Based Interventions Are Delivered and Reported in Gait, Posture, and Balance Rehabilitation: A Systematic Review. Phys Ther 2020; 100:1805-1815. [PMID: 32691059 DOI: 10.1093/ptj/pzaa123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/31/2020] [Accepted: 04/20/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Virtual reality (VR) technologies are increasingly used in physical rehabilitation; however, it is unclear how VR interventions are being delivered, and, in particular, the role of the therapist remains unknown. The purpose of this study was to systematically evaluate how commercially available VR technologies are being implemented in gait, posture, and balance rehabilitation, including justification, content, procedures, and dosage of the intervention and details of the therapist role. METHODS Five databases were searched between 2008 and 2018. Supervised interventional trials with >10 adult participants using commercially available VR technologies to address mobility limitations were independently selected by 2 authors. One author extracted reported intervention characteristics into a predesigned table and assessed methodological quality, which was independently verified by a second author. A total of 29 studies were included. RESULTS Generally, minimal clinical reasoning was provided to justify technology or activity selection, with recreational systems and games used most commonly (n = 25). All but 1 study used a single interventional technology. When explicitly described, the intervention was delivered by a physical therapist (n = 14), a therapist assistant (n = 2), both (n = 1), or an occupational therapist (n = 1). Most studies reported supervision (n = 12) and safeguarding (n = 8) as key therapist roles, with detail of therapist feedback less frequently reported (n = 4). Therapist involvement in program selection, tailoring, and progression was poorly described. CONCLUSION Intervention protocols of VR rehabilitation studies are incompletely described and generally lack detail on clinical rationale for technology and activity selection and on the therapist role in intervention design and delivery, hindering replication and translation of research into clinical practice. Future studies utilizing commercially available VR technologies should report all aspects of intervention design and delivery and consider protocols that allow therapists to exercise clinical autonomy in intervention delivery. IMPACT STATEMENT The findings of this systematic review have highlighted that VR rehabilitation interventions targeting gait, posture, and balance are primarily delivered by physical therapists, whose most reported role was supervision and safeguarding. There was an absence of detail regarding complex clinical skills, such as tailoring of the intervention and reasoning for the choice of technology and activity. This uncertainty around the role of the therapist as an active ingredient in VR-based rehabilitation hinders the development of implementation guidelines. To inform the optimal involvement of therapists in VR rehabilitation, it is essential that future studies report on all aspects of VR intervention design and delivery.
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Affiliation(s)
- Heather Weber
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, Australia
| | | | - Claire Gough
- College of Nursing and Health Sciences, Flinders University
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Hassett L, van den Berg M, Weber H, Chagpar S, Wong S, Rabie A, McCluskey A, Lindley RI, Crotty M, Sherrington C. Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial - description of device use and physiotherapy support in the post-hospital phase. Disabil Rehabil 2020; 43:3454-3460. [PMID: 32663066 DOI: 10.1080/09638288.2020.1790679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe device use and physiotherapy support in the post-hospital phase of the AMOUNT rehabilitation trial. METHODS We performed an evaluation of the support required for device use by participants randomised to the intervention group who received digitally-enabled rehabilitation in the post-hospital phase (n = 144). Intervention, additional to standard rehabilitation, utilised eight digital devices (virtual reality videogames, activity monitors and handheld computer devices) to improve mobility and increase physical activity. Participants were taught to use devices during inpatient rehabilitation and were then discharged home to use the devices for the remainder of the 6-month trial. Physiotherapist-participant contact occurred every 1-2 weeks using a health coaching approach, including technology support when required. Intervention datasheets were audited, and descriptive statistics used to report device use and support required. RESULTS Participants (mean (SD) age 70 (18) years; 49% neurological health conditions) used an average of 2 (SD 1) devices (98% used an activity monitor). Eight percent of physiotherapy contact included technology support with 30% provided remotely. Support addressed 845 issues categorised under initial set-up and instruction (27%), education and training (31%), maintenance (23%) and trouble-shooting (19%). CONCLUSION Digital devices can be used for home-based rehabilitation, but ongoing technology support is essential. Clinical Trials Registry: ACTRN12614000936628IMPLICATIONS FOR REHABILITATIONDigital device use at home to support long-term management of health conditions is likely to become increasingly important as the need for rehabilitation increases and rehabilitation resources become more limited.Technology support for set-up and ongoing device use is a critical enabler of home-based digital interventions.Health professionals delivering home-based digital interventions require sufficient training and equipment and may need to vary the mode (e.g., home visit vs. telephone or video conference) depending on the technology support required.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.,Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Maayken van den Berg
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Heather Weber
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Ashley Rabie
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,StrokeEd Collaboration, Sydney, Australia
| | - Richard I Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
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Virtual reality in research and rehabilitation of gait and balance in Parkinson disease. Nat Rev Neurol 2020; 16:409-425. [DOI: 10.1038/s41582-020-0370-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
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Older Adults' Perceptions of the Usefulness of Technologies for Engaging in Physical Activity: Using Focus Groups to Explore Physical Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041144. [PMID: 32053937 PMCID: PMC7068313 DOI: 10.3390/ijerph17041144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/08/2020] [Accepted: 02/09/2020] [Indexed: 02/06/2023]
Abstract
Insufficient physical activity (PA) levels observed among older adults remain extremely high and pose a danger to developing and maintaining their physical literacy (PL). Each person’s level of PL partly depends on their physical and cognitive skills, confidence level, and degree of motivation to practice PA daily. New technologies, such as exergames and wearable fitness trackers, may enable older adults to increase their PL, stimulating uptake and ongoing PA participation. Objective: This focus group study aims to describe older adults’ perceptions of the use of technologies to engage in physical exercise programs. Methods: Fifteen participants were randomly selected from a sample of 40 older adults who completed a randomized controlled trial that investigated the benefits of using technology in the context of group-based exercise programs. Separate post-intervention focus groups were performed with an exergaming group, a conventional physical training group, and a no training group (control). Data were mapped onto constructs from the four domains of PL: affective, physical, cognitive, and behavioral. Results: Generally, participants expressed positive perceptions about the benefits of using technology to engage in PA. These positive feelings outweighed the costs and the lack of familiarization with technology. Common themes for the three groups emerged from the discussions and included familiarization with technology, using fitness tracker to monitor PA, previous exposure to technology, and interaction with peers, staff members, and relatives. In particular, participants from the exergaming group explored the ideas of training their cognitive skills while using the exergame accessories, exercising in an alternative way, competitive versus cooperative play, changes in sense of humor, skill transferability from game to real environment, progressions of the exercise intensities, and the potential use of exergames for rehabilitation. Conclusions: Participants in this study reported positive perceptions about implementing technology into exercise. Emphasizing the benefits of using technology in group-based exercise programs may increase older adults’ PL levels and their future technology adoption. The potential implementation of technology into conventional exercise programs should focus on older adults’ lifelong values, biopsychosocial conditions, and the possibility of reducing age-related risk of injuries and chronic diseases.
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Hassett L, van den Berg M, Lindley RI, Crotty M, McCluskey A, van der Ploeg HP, Smith ST, Schurr K, Howard K, Hackett ML, Killington M, Bongers B, Togher L, Treacy D, Dorsch S, Wong S, Scrivener K, Chagpar S, Weber H, Pinheiro M, Heritier S, Sherrington C. Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial. PLoS Med 2020; 17:e1003029. [PMID: 32069288 PMCID: PMC7028259 DOI: 10.1371/journal.pmed.1003029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 01/22/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation. METHODS AND FINDINGS We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0-3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0-3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference -0.2, 95% CI -2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%-19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes. CONCLUSIONS In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted. TRIAL REGISTRATION The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN12614000936628.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maayken van den Berg
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Richard I. Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Annie McCluskey
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- StrokeEd Collaboration, Sydney, New South Wales, Australia
| | - Hidde P. van der Ploeg
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stuart T. Smith
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Karl Schurr
- StrokeEd Collaboration, Sydney, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maree L. Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Maggie Killington
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Bert Bongers
- Faculty of Design, Architecture and Building, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Leanne Togher
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Treacy
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simone Dorsch
- StrokeEd Collaboration, Sydney, New South Wales, Australia
- Physiotherapy Department and Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Physiotherapy Department and Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Katharine Scrivener
- StrokeEd Collaboration, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather Weber
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephane Heritier
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
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Flynn N, Kuys S, Froude E, Cooke D. Introducing robotic upper limb training into routine clinical practice for stroke survivors: Perceptions of occupational therapists and physiotherapists. Aust Occup Ther J 2019; 66:530-538. [PMID: 31292975 DOI: 10.1111/1440-1630.12594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Robot-assisted therapy for the upper limb (RT-UL) is an emerging form of intervention for stroke survivors with upper limb deficits. However, there is limited knowledge regarding therapists' perceptions of RT-UL and the factors influencing the implementation of RT-UL into the clinical setting. This is important when considering that therapists in Australia are primarily responsible for the prescription of RT-UL in daily practice. This study aimed to explore occupational therapists' and physiotherapists' perceptions of RT-UL and the perceived barriers and enablers influencing implementation. METHODS Two discipline-specific focus groups were conducted involving occupational therapists (n = 6) and physiotherapists (n = 6). Participants were members of the same multidisciplinary team working in an Australian public health rehabilitation facility where RT-UL (i.e. InMotion2) was being introduced for the first time. Focus groups explored therapist perceptions of the new RT-UL as well as perceived barriers and enablers to implementation. Focus groups were recorded, transcribed and deductively analysed using the Theoretical Domains Framework (TDF). RESULTS Out of the 14 domains of the TDF, 7 were raised by participants during the focus groups: environmental context and resources, beliefs about consequences, optimism, knowledge, skills, social influences, and social and professional role and identity. Therapists' expressed their optimism towards the introduction of RT-UL but believed successful implementation would be primarily dependent on the availability of clinical leadership, training and a suitable client mix. CONCLUSION Therapists perceived that RT-UL would provide opportunity for increased upper limb practice particularly for patients with severe upper limb impairment. To facilitate implementation, support of RT-UL should come from both management and clinical leaders and training include RT-UL efficacy, device functionality and patient suitability. The availability of a single RT-UL device in a workplace may create unique interdisciplinary and logistical challenges.
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Affiliation(s)
- Nicholas Flynn
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia
| | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Deirdre Cooke
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia.,Mater Private Hospital Rehabilitation Unit, South Brisbane, Queens land, Australia
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