Development of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)

Preliminary effectiveness and production time and costs of three-dimensional printed orthoses in chronic hand conditions: an interventional feasibility study

OBJECTIVE

To assess the preliminary effectiveness of three-dimensional printed orthoses compared with conventionally custom-fabricated orthoses in persons with chronic hand conditions on performance of daily activities, hand function, quality of life, satisfaction, and production time and costs.

DESIGN

Interventional feasibility study.

SUBJECTS

Chronic hand orthotic users (n = 21).

METHODS

Participants received a new three-dimensional printed orthosis according to the same type as their current orthosis, which served as the control condition. Primary outcome was performance of daily activities (Patient-Reported Outcomes Measurement Information System-Upper Extremity; Michigan Hand Questionnaire). Secondary outcomes were hand function, quality of life, and satisfaction. Furthermore, production time and costs were recorded.

RESULTS

At 4 months' follow-up, no significant differences were found between three-dimensional printed orthoses and participants' existing conventional orthoses on activity performance, hand function, and quality of life. Satisfaction with the three-dimensional printed orthosis was significantly higher and the production time and costs for three-dimensional printed orthoses were significantly lower compared with conventional orthoses. The three-dimensional printed orthosis was preferred by 79% of the participants.

CONCLUSIONS

This feasibility study in chronic hand conditions suggests that three-dimensional printed orthoses are similar to conventional orthoses in terms of activity performance, hand function, and quality of life. Satisfaction, and production time and costs favoured the three-dimensional printed hand orthoses.

Exercise Responses During Outdoor Versus Virtual Reality Indoor Arm+FES-Leg Cycling in Individuals with Spinal Cord Injury

Background: Virtual reality (VR)-enhanced indoor hybrid cycling in people with spinal cord injury (SCI) can be comparable to outdoor hybrid cycling. Method: Eight individuals with chronic thoracic-lesion SCI performed voluntary arm and electrically assisted leg cycling on a hybrid recumbent tricycle. Exercises were conducted outdoors and indoors incorporating VR technology in which the outdoor environment was simulated on a large flat screen monitor. Electrical stimulation was applied bilaterally to the leg muscle groups. Oxygen uptake (VO2), heart rate, energy expenditures, and Ratings of Perceived Exertion were measured over a 30-minute outdoor test course that was also VR-simulated indoors. Immediately after each exercise, participants completed questionnaires to document their perceptual-psychological responses. Results: Mean 30-minute VO2 was higher for indoor VR exercise (average VO2-indoor VR-exercise: 1316 ± mL/min vs. outdoor cycling: 1255 ± 53 mL/min; highest VO2-indoor VR-exercise: 1615 ± 67 mL/min vs. outdoor cycling: 1725 ± 67 mL/min). Arm and leg activity counts were significantly higher during indoor VR-assisted hybrid functional electrical stimulation (FES) cycling than outdoors; 42% greater for the arms and 23% higher for the legs (P < 0.05). Similar responses were reported for exercise effort and perceptual-psychological outcomes during both modes. Conclusion: This study proposes that combining FES and VR technology provides new opportunities for physical activity promotion or exercise rehabilitation in the SCI population, since these modes have similar "dose-potency" and self-perceived effort. Human Research Ethics Committee of the University of Sydney Ref. No. 01-2010/12385.

Assistive Technology utilization among stroke survivors in Kano, Northwest Nigeria: A cross-sectional study

Mobility impairments and participation restrictions are common occurrences post-stroke, which may necessitate the need to utilize Assistive Technology (AT). This study investigated the prevalence, pattern, and satisfaction with AT utilization in stroke survivors (SS). The study was conducted in two hospitals in Kano, Nigeria. The QUBEC user evaluation of satisfaction with AT (QUEST) questionnaire and the Rivermead Mobility Index were used to assess satisfaction with AT utilization and mobility, respectively. Pearson correlation and independent t-test were used to determine the relationship and gender difference among the outcomes, respectively. A total of 280 SS participated; however, only 115 (41.07%) were AT users. The commonly used AT was wheelchair 84 (73%), while the least used was walking frame 3 (2.6%). About two-thirds of the participants were quite or very satisfied with their ATs. The duration of AT utilization is positively related to stroke duration (r = 0.940) but negatively related to mobility level (r = -0.246). There is no significant gender difference in duration and satisfaction with AT utilization. AT like wheelchairs seems uncommonly utilized among SS in Kano, Nigeria, likely due to patients' lack of knowledge of use, economic factors, and culture among others.

A patient-centered 'test-drive' strategy for ankle-foot orthosis prescription: Protocol for a randomized participant-blinded trial

BACKGROUND

Ankle-foot orthoses (AFOs) are commonly used to overcome mobility limitations related to lower limb musculoskeletal injury. Despite a multitude of AFOs to choose from, there is scant evidence to guide AFO prescription and limited opportunities for AFO users to provide experiential input during the process. To address these limitations in the current prescription process, this study evaluates a novel, user-centered and personalized 'test-drive' strategy using a robotic exoskeleton ('AFO emulator') to emulate commercial AFO mechanical properties (i.e., stiffness). The study will determine if brief, in-lab trials (with emulated or actual AFOs) can predict longer term preference, satisfaction, and mobility outcomes after community trials (with the actual AFOs). Secondarily, it will compare the in-lab experience of walking between actual vs. emulated AFOs.

METHODS AND ANALYSIS

In this participant-blinded, randomized crossover study we will recruit up to fifty-eight individuals with lower limb musculoskeletal injuries who currently use an AFO. Participants will walk on a treadmill with three actual AFOs and corresponding emulated AFOs for the "in-lab" assessments. For the community trial assessment, participants will wear each of the actual AFOs for a two-week period during activities of daily living. Performance-based and user-reported measures of preference and mobility will be compared between short- and long-term trials (i.e., in-lab vs. two-week community trials), and between in-lab trials (emulated vs. actual AFOs).

TRIAL REGISTRATION

The study was prospectively registered at www.clininicaltrials.gov (Clinical Trials Study ID: NCT06113159). Date: November 1st 2023. https://classic.clinicaltrials.gov/ct2/show/NCT06113159.

A systematic review of the psychometric properties of Quebec user evaluation of satisfaction with assistive technology (QUEST)

PURPOSE

The aim of this systematic review was to evaluate the psychometric properties of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST).

MATERIALS AND METHODS

Searches were conducted in August 2021 on four electronic databases: MEDLINE, CINAHL, Scopus, and Web of Science. Eligible papers included cross-sectional validation studies evaluating the psychometric properties of all QUEST versions. Cronbach's alpha, intraclass correlation coefficient, and comparison tools were reported. Study quality and risk of bias were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

RESULTS

Nineteen studies were included in this systematic review. Results showed that the QUEST and QUEST 2.0 were available in 10 languages, and most validation studies analysed this tool in patients using mobility devices in various clinical conditions. One article analysed the child version (QUEST 2.1) in English. The most analysed psychometric property was Cronbach's alpha for internal consistency in 14 out of 19 studies, with values ranging between 0.74 and 0.79. Overall, 17 out of 19 studies were of adequate quality, though responsiveness was never studied.

CONCLUSION

Our systematic review showed that the QUEST and its subsequent versions are reliable and valid measurement instruments to evaluate satisfaction in patients with different disabilities using various assistive technologies. This study provides useful information on the instrument's psychometric properties in different populations and cultures.

Quantifying patient experiences with therapeutic neurorehabilitation technologies: a scoping review

PURPOSE

Neurorehabilitation technologies are a novel approach to providing rehabilitation for patients with neurological conditions. There is a need to explore patient experiences. This study aimed; 1) To identify available questionnaires that assess patients' experiences with neurorehabilitation technologies, and 2) where reported, to document the psychometric properties of the identified questionnaires.

MATERIALS AND METHODS

Four databases were searched (Medline, Embase, Emcare and PsycInfo). The inclusion criteria were all types of primary data collection that included neurological patients of all ages who had experienced therapy with neurorehabilitation technologies and completed questionnaires to assess these experiences.

RESULTS

Eighty-eight publications were included. Fifteen different questionnaires along with many self-developed scales were identified. These were categorised as; 1) self-developed tools, 2) specific questionnaire for a particular technology, and 3) generic questionnaires originally developed for a different purpose. The questionnaires were used to assess various technologies, including virtual reality, robotics, and gaming systems. Most studies did not report any psychometric properties.

CONCLUSION

Many tools have been used to evaluate patient experiences, but few were specifically developed for neurorehabilitation technologies and psychometric data was limited. A preliminary recommendation would be use of the User Satisfaction Evaluation Questionnaire to evaluate patient experience with virtual reality systems.

Iranian translation and psychometric of the Quebec user evaluation of satisfaction with Assistive technology (QUEST2.0) on wheelchair users

PURPOSE

QUEST2.0 is a practical tool specifically applied to assessing the satisfaction for awide array of assistive technology in a standard manner. Therefore, this study set to translate and evaluate the validity and reliability of the Iranian version of the QUEST2.0in Persian-speaking users of manual and electronic wheelchairs in Iran.

METHODS

The present study recruited 130 users of manual and electric wheelchairs. Psychometric properties, including; content validity and construct validity and internal consistency and test-retest reliability, were testified.

RESULTS

The content validity index of the questionnaire was 92%. The internal consistency was determined to be 0.89,0.88 and 0.74, respectively, for the whole questionnaire and dimensions of the device, and services. The test-retest reliability was 0.85, 0.80, and 0.94, respectively, for the whole questionnaire and dimensions of the device and services. Factor analysis confirmed the two-factor structure of the questionnaire. In the two-factor model, 57.75% of the total variance was explained by these two factors, of which 45.8% pertained to the first factor (device) and 11.95% to the second factor (service).

CONCLUSIONS

The results showed that QUEST2.0 had both valid and reliable for measuring satisfaction with assistive technology among wheelchair users. The assessment will also help facilitate the quality improvement processes in using assistive technology devices.

Utility and usability of a wearable system and progressive-challenge cued exercise program for encouraging use of the more involved arm at-home after stroke-a feasibility study with case reports

BACKGROUND

Understanding the role of adherence to home exercise programs for survivors of stroke is critical to ensure patients perform prescribed exercises and maximize effectiveness of recovery.

METHODS

Survivors of hemiparetic stroke with impaired motor function were recruited into a 7-day study designed to test the utility and usability of a low-cost wearable system and progressive-challenge cued exercise program for encouraging graded-challenge exercise at-home. The wearable system comprised two wrist-worn MetaMotionR+ activity monitors and a custom smartphone app. The progressive-challenge cued exercise program included high-intensity activities (one repetition every 30 s) dosed at 1.5 h per day, embedded within 8 h of passive activity monitoring per day. Utility was assessed using measures of system uptime and cue response rate. Usability and user experience were assessed using well-validated quantitative surveys of system usability and user experience. Self-efficacy was assessed at the end of each day on a visual analog scale that ranged from 0 to 100.

RESULTS

The system and exercise program had objective utility: system uptime was 92 ± 6.9% of intended hours and the rate of successful cue delivery was 99 ± 2.7%. The system and program also were effective in motivating cued exercise: activity was detected within 5-s of the cue 98 ± 3.1% of the time. As shown via two case studies, accelerometry data can accurately reflect graded-challenge exercise instructions and reveal differentiable activity levels across exercise stages. User experience surveys indicated positive overall usability in the home settings, strong levels of personal motivation to use the system, and high degrees of satisfaction with the devices and provided training. Self-efficacy assessments indicated a strong perception of proficiency across participants (95 ± 5.0).

CONCLUSIONS

This study demonstrates that a low-cost wearable system providing frequent haptic cues to encourage graded-challenge exercise after stroke can have utility and can provide an overall positive user experience in home settings. The study also demonstrates how combining a graded exercise program with all-day activity monitoring can provide insight into the potential for wearable systems to assess adherence to-and effectiveness of-home-based exercise programs on an individualized basis.

Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial

BACKGROUND

Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process.

OBJECTIVE

This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction.

METHODS

A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system's implications.

RESULTS

Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates.

CONCLUSIONS

Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52365.

Users' satisfaction and experiences in using assistive devices distributed by a rehabilitation centre in Bangladesh: a cross-sectional study

PURPOSE

This study aimed to understand Bangladeshi users' satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals' wellbeing.

METHOD

We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data.

RESULTS

We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh.

CONCLUSION

These findings indicate that the provision of assistive devices requires accommodating individuals' needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities.IMPLICATIONS FOR REHABILITATIONIt is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities.There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation.Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities.Future research could (i) include user's satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.

Use of wearables among Multiple Sclerosis patients and healthcare Professionals: A scoping review

INTRODUCTION

Multiple sclerosis (MS) is an increasingly prevalent chronic, autoimmune, and inflammatory central nervous system illness, whose common symptoms undermine the quality of life of patients and their families. Recent technical breakthroughs potentially offer continuous, reliable, sensitive, and objective remote monitoring solutions for healthcare. Wearables can be useful for evaluating falls, fatigue, sedentary behavior, exercise, and sleep quality in people with MS (PwMS).

OBJECTIVE

This scoping review of relevant literature explores studies investigating the perceptions of patients and healthcare professionals (HCPs) about the use of wearable technologies in the management of MS.

METHODS

The Joanna Briggs Institute methodology for scoping reviews was used. The search strategy was applied to the databases, MEDLINE via Ovid, Embase, APA PsycInfo, and CINAHL. Further searches were performed in IEEE, Scopus, and Web of Science. The review considered studies reporting quantitative or qualitative data on perceptions and experiences of PwMS and HCPs concerning wearables' usability, satisfaction, barriers, and facilitators.

RESULTS

10 studies were included in this review. Wearables' usefulness and accessibility, ease of use, awareness, and motivational tool potential were patient-perceived facilitators of use. Barriers related to anxiety and frustration, complexity, and the design of wearables. Perceived usefulness and system requirements are identified as facilitators of using wearables by HCPs, while data security concerns and fears of increased workload and limited effectiveness in the care plan are identified as barriers to use wearables.

CONCLUSIONS

This review contributes to our understanding of the benefits of wearable technologies in MS by exploring perceptions of both PwMS and HCPs. The scoping review provided a broad overview of facilitators and barriers to wearable use in MS. There is a need for further studies underlined with sound theoretical frameworks to provide a robust evidence-base for the optimal use of wearables to empower healthcare users and providers.

Evaluation of a new assistive technology: the StandBar

PURPOSE

Evaluate the potential of a wheelchair assistive technology (StandBar) to promote power wheelchair users' ability to safely stand independently from their power wheelchair and determine the impact of the device use on psychological well-being for both power wheelchair users and their caregivers.

MATERIALS AND METHODS

A convenience sample of 11 power wheelchair users and caregiver dyads provided study data. Participants included power wheelchair users who were existing StandBar users or currently in training with the StandBar as part of their rehabilitation. Assessments were conducted at baseline and at six-month follow-up and included physiological assessments and functional testing with and without the StandBar. Monthly follow-up phone calls were completed to collect information on adverse events (e.g., falls, hospitalizations, and skin breakdown). A qualitative interview assessed StandBar users' and caregivers' perception at six-month follow-up.

RESULTS AND CONCLUSIONS

StandBar use provided power wheelchair users a higher level of independence, confidence, and safety. All participants highly recommended StandBar use to others with similar levels of functional impairment. StandBar use allowed many participants the ability to complete functional tasks that were otherwise not possible without assistance. Qualitative interviews reported improved independence and psychological well-being for StandBar users as well as reduced levels of anxiety and burden of care by caregivers. The StandBar is a cost-effective assistive technology that promotes independence and functionality for power wheelchair users and improves the psychological well-being of users and their caregivers. Implications for RehabilitationStandBar allows power wheelchair users to:Minimize negative effects of immobilization.Increase independence for activities of daily living (grooming, hygiene, toileting, transfers) and instrumental activities of daily living (social experiences).Improve their quality of life through increasing independence and confidence.Reduce need for assistance and corresponding caregiver burden.

A retrospective chart review of the patient population accessing augmentative & alternative communication at an urban assistive technology center

The purpose of this study was to 1) identify and describe the population seeking alternative and augmentative communication (AAC) evaluations at an assistive technology (AT) center in the Midwestern United States and 2) describe the AAC device features or services participants identify as most important at their initial AAC evaluations. Charts of 53 participants seeking AAC interventions at an AT center in the Midwestern United States were retrospectively reviewed. Information from the QUEST 2.0 was used to determine what AT features were identified as most important. The majority of participants seen at the AT center had progressive diseases. Across all of the participants, ease of use and effectiveness were identified as the "most important" aspects of an AAC device satisfaction. These findings highlight the importance of determining who is accessing AAC services across AT centers to determine whether barriers to AAC services exist. Moreover, patients report regarding what variables they deem as most important reflect the fact that excellent service-delivery may not overcome the importance of other variables, such as ease of use that impact AAC use.

A scoping review of gaze and eye tracking-based control methods for assistive robotic arms

Background: Assistive Robotic Arms are designed to assist physically disabled people with daily activities. Existing joysticks and head controls are not applicable for severely disabled people such as people with Locked-in Syndrome. Therefore, eye tracking control is part of ongoing research. The related literature spans many disciplines, creating a heterogeneous field that makes it difficult to gain an overview. Objectives: This work focuses on ARAs that are controlled by gaze and eye movements. By answering the research questions, this paper provides details on the design of the systems, a comparison of input modalities, methods for measuring the performance of these controls, and an outlook on research areas that gained interest in recent years. Methods: This review was conducted as outlined in the PRISMA 2020 Statement. After identifying a wide range of approaches in use the authors decided to use the PRISMA-ScR extension for a scoping review to present the results. The identification process was carried out by screening three databases. After the screening process, a snowball search was conducted. Results: 39 articles and 6 reviews were included in this article. Characteristics related to the system and study design were extracted and presented divided into three groups based on the use of eye tracking. Conclusion: This paper aims to provide an overview for researchers new to the field by offering insight into eye tracking based robot controllers. We have identified open questions that need to be answered in order to provide people with severe motor function loss with systems that are highly useable and accessible.

Go Zika Go: feasibility study with modified motorized ride-on cars for the mobility of children with Congenital Zika Syndrome (CZS)

PURPOSE

To explore the feasibility of an intervention using modified ride-on cars in terms of acceptability and potential changes in goal attainment, mobility, social function, and participation of children with Congenital Zika Syndrome (CZS).

MATERIALS AND METHODS

A pre- and post-intervention feasibility study was conducted with children with CZS, levels IV and V of the Gross Motor Function Classification System (GMFCS). The intervention consisted of 12 weeks of training (3 times a week for 40 min per session) and 4 weeks of follow-up. The primary outcomes included adherence, satisfaction, and learning in mobility. Secondary outcomes encompassed goal attainment, mobility, social/cognitive function, and participation. Descriptive statistics were performed. To explore potential individual changes with the intervention, Wilcoxon test was used to analyze Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) data and Young Children's Participation and Environment Measure (YC-PEM)/Participation and Environment Measure for Children and Youth (PEM-CY), along with standard error measurements of the PEDI-CAT domains.

RESULTS

Four children participated (median age 4.75 years; two females: three at level V on the GMFCS). Adherence was 75% of the total intervention time, and family members reported being satisfied or very satisfied. Children showed gains in learning the use of the modified ride-on cars and an increase in goal attainment after the intervention. Individual changes were observed in the PEDI-CAT domains (mobility and social/cognitive), but there were no significant changes in participation outcomes.

CONCLUSIONS

Children with CZS at GMFCS levels IV and V can learn to use motorized ride-on cars, attainment goals, and experience satisfaction.

The most used questionnaires for evaluating the usability of robots and smart wearables: A scoping review

Background

As the field of robotics and smart wearables continues to advance rapidly, the evaluation of their usability becomes paramount. Researchers may encounter difficulty in finding a suitable questionnaire for evaluating the usability of robotics and smart wearables. Therefore, the aim of this study is to identify the most commonly utilized questionnaires for assessing the usability of robots and smart wearables.

Methods

A comprehensive search of databases, including PubMed, Web of Science, and Scopus, was conducted for this scoping review. Two authors performed the selection of articles and data extraction using a 10-field data extraction form. In cases of disagreements, a third author was consulted to reach a consensus. The inclusions were English-language original research articles that utilized validated questionnaires to assess the usability of healthcare robots and smart wearables. The exclusions comprised review articles, non-English publications, studies not focused on usability, those assessing clinical outcomes, articles lacking questionnaire details, and those using non-validated or researcher-made questionnaires. Descriptive statistics methods (frequency and percentage), were employed to analyze the data.

Results

A total of 314 articles were obtained, and after eliminating irrelevant and duplicate articles, a final selection of 50 articles was included in this review. A total of 17 questionnaires were identified to evaluate the usability of robots and smart wearables, with 10 questionnaires specifically for wearables and 7 questionnaires for robots. The System Usability Scale (50%) and Post-Study System Usability Questionnaire (19.44%) were the predominant questionnaires utilized to assess the usability of smart wearables. Moreover, the most commonly used questionnaires for evaluating the usability of robots were the System Usability Scale (56.66%), User Experience Questionnaire (16.66%), and Quebec User Evaluation of Satisfaction with Assistive Technology (10%).

Conclusion

Commonly employed questionnaires serve as valuable tools in assessing the usability of robots and smart wearables, aiding in the refinement and optimization of these technologies for enhanced user experiences. By incorporating user feedback and insights, designers can strive towards creating more intuitive and effective robotic and wearable solutions.

Exoskeleton Usability Questionnaire: a preliminary evaluation questionnaire for the lower limb industrial exoskeletons

Exoskeleton robots are a promising solution to reduce musculoskeletal disorders (MSDs) in different work environments, but a specific usability scale for evaluating them is lacking. This study aimed to develop and verify a preliminary Exoskeleton Usability Questionnaire (EUQ) for the lower limb exoskeletons by creating a draft survey questionnaire from existing questions in prior studies. An experiment was conducted with 20 participants who performed a specific task while wearing three lower limb robots and provided subjective feedback using the developed questionnaire. Data were analysed using exploratory and confirmatory factor analysis (CFA), resulting in a usability evaluation questionnaire for exoskeleton robots clustered into four main factors: mobility, adjustability, handling and safety. This study's findings are expected to be useful in evaluating the usability of the lower limb exoskeletons in both general production sites and agricultural work, which can aid in reducing the prevalence of lower limb MSDs.Practitioner Summary: This study developed a preliminary subjective usability evaluation questionnaire for exoskeleton robots. The questionnaire is clustered into four main factors: mobility, adjustability, handling and safety. These findings provide a valuable tool for assessing exoskeleton usability, potentially reducing musculoskeletal disorders (MSDs) in various work environments.

Evaluation of an interphalangeal-joint prosthetic hand in trans-radial prosthesis users

BACKGROUND

A body-powered functional and cosmetically appeasing hand with moving interphalangeal joints (IPJ-Hand) was created. Function and satisfaction with the IPJ-Hand, conventional hand (CH) and functional hook (FH) in trans-radial prosthesis users were evaluated.

METHODS

Eight participants with trans-radial amputations were provided with three prosthetic hands and performed the Nine Hole Peg Test (NHPT), Brief Activity Measure of Upper Limb Amputees (BAM-ULA) and Quebec User Evaluation of Satisfaction with Assistive Technology QUEST).

RESULTS

The data are shown as the median and interquartile range (IQR) due to skewed data distribution. Differences across hands were seen in NHPT with CH 57 (13.3), FH 49.5 (26.5), IPJ-H and 49 (14.8) seconds respectively. BAM-ULA, 10 (1.5), FH 10 (0.7), and IPJ-Hand 10 (1.7). QUEST scores, FH 28.5 (7.2) with the highest score, IPJ-Hand 26 (6.8), and lastly CH 25.5 (9.2).

CONCLUSION

Individual participant results varied, with some participants performing better on the NHPT when using the IPJ-Hand when compared to the CH and FH. No differences between hands on the BAM-ULA were seen, and although no large differences in QUEST were observed, users performed best using IPJ-Hand.Key messagesAn interphalangeal joint prosthetic hand (IPJ-Hand) offers the similar function of a prosthetic hook, and the appearance of a conventional hand, but with improved dexterity.Minimal resources are needed to create the IPJ-Hand for prosthesis wearers.

Test-Retest Reliability of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA): A Cohort Study

IMPORTANCE

Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected assistive devices like accessible smartphones, tablets, laptops, and apps.

OBJECTIVE

To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool.

DESIGN

Repeated-measures cohort study with a time frame of 7 to 21 days.

SETTING

Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions.

PARTICIPANTS

Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female.

INTERVENTION

Not applicable.

OUTCOMES AND MEASURES

The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90).

RESULTS

On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88).

CONCLUSIONS AND RELEVANCE

The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.

CHECGAIT: A Functional Electrical Stimulation Clinical Pathway to Reduce Foot Drop during Walking in Adult Patients with Upper Motor Neuron Lesions

Foot drop during the swing phase of gait and at initial foot contact is a current kinematic abnormality that can occur following an upper motor neuron (UMN) lesion. Functional electrical stimulation (FES) of the common peroneal nerve through an assistive device is often used in neuro-rehabilitation to help patients regain mobility. Although there are FES-specific guideline recommendations, it remains a challenge for clinicians to appropriately select patients eligible for the daily use of FES devices, as very few health insurance systems cover its cost in Europe. In Luxembourg, since 2018, successfully completing an FES clinical pathway called CHECGAIT is a prerequisite to receiving financial coverage for FES devices from the national health fund (Caisse Nationale de Santé-CNS). This study describes the structure and steps of CHECGAIT and reports our experience with a cohort of 100 patients enrolled over a three-year period. The clinical and gait outcomes of all patients were retrospectively quantified, and a specific analysis was performed to highlight differences between patients with and without an FES device prescription at the end of a CHECGAIT. Several significant gait differences were found between these groups. These results and CHECGAIT may help clinicians to better select patients who can most benefit from this technology in their daily lives. In addition, CHECGAIT could provide significant savings to public health systems by avoiding unnecessary deliveries of FES devices.

Prosthesis for bilateral equinus foot: A case study

BACKGROUND

Although surgical treatment for equinus foot has been widely described in the literature, less attention has been paid to orthopedic treatment with prostheses, which constitutes an interesting alternative approach. It has been described in the literature for treating lower-limb inequality, but not for equinus foot. The aim of this article is to report that the use of prosthetics can be a valid means of managing bilateral equinus foot.

CASE DESCRIPTION AND METHODS

In the present case report, we describe the management of an irreducible bilateral equinus in a 45-year-old patient with poliomyelitis sequelae, starting with orthoses and orthopedic shoes, followed by prostheses. We measured the evolution of the patient's spatiotemporal gait parameters, his autonomy, and his satisfaction with a QUEST score.

FINDINGS AND OUTCOMES

Despite the deterioration of the patient's physical abilities due to the onset of a postpoliomyelitis syndrome, his gait parameters and his autonomy were maintained while using the prostheses. His tolerance of the prostheses improved even more greatly, as shown by his QUEST score, which increased from 2.95 to 4.67 of 5.

CONCLUSION

The use of prostheses was at least as effective and even better tolerated than orthoses and orthopedic shoes by this patient. Despite the occurrence of a postpoliomyelitis syndrome, the prostheses helped to maintain his walking performances, while improving his satisfaction.

Design and fabrication of a custom molded splint for tetraplegics

Background

The key rehabilitation goal for cervical cord injury is promoting functional hand movement. Patients with mid to low-level cervical spinal cord injury can achieve the useful tenodesis grasp with the assistance of upper extremity orthosis. In this study, a custom molded writing device was fabricated and applied on cervical cord injured patients with the aim of hand rehabilitation.

Methods

A total of fourteen individuals with cervical spinal cord injury at C6-C7 level were recruited for the study. They were divided into two groups, where the experimental group was prescribed with the custom molded writing device and the standard-of-care group was prescribed with the traditionally available writing device. The performance of the devices was evaluated using the Quest 2.0 questionnaire and the quality of writing after an intervention time of 4 weeks.

Result

The group that used custom molded writing device performed comparatively better when compared to the conventional design. The data showed a significant difference with average QUEST scores of 4.47 ± 0.33 for the group using the wrist-driven writing device and 3.04 ± 0.70 for group using the conventional design. For better understanding of the device's performance, the writing with both the splints was also assessed.

Conclusion

A writing device using the tenodesis grasp was fabricated to rehabilitate the writing skills of individuals with cervical spinal cord injuries. The performance of the device provided a favorable result indicating to elaborate the study for future references.

[Motion analysis in lower limb exoprosthetics-possibilities and limitations]

BACKGROUND

Gait analysis is of high relevance in prosthetics as it is an essential part of the fitting process. The documentation of movement by means of videos and instrumented methods is becoming increasingly important in prosthetics as benefits of a complex prosthesis can best be shown by structured observation.

PROCEDURE

A movement analysis should always be preceded by an anamnesis and clinical examination in order to detect functional limitations of the examined person and thus to establish correlations to gait deviations. Additionally, the orthopaedic aid should be evaluated as well. In addition to walking on level ground, walking on everyday obstacles such as stairs and ramps is also of interest when observing people using prosthetic limbs. Functional tests can be used to determine the functional status more comprehensively. An instrumental-3D gait analysis is indicated for specific questions, especially regarding kinetic parameters.

The Effectiveness of Compression Garments for Reducing Pain in Non-Vascular Ehlers-Danlos Syndromes: A Prospective Observational Cohort Study

Patients with Ehlers-Danlos Syndrome (EDS) frequently suffer from severe chronic pain. We carried out an observational cohort study to assess the effectiveness of compression garments (CGs) for reducing this pain. Patients with non-vascular EDS were given custom-made Cerecare^® CGs during a visit to a specialist clinic (visit V0). They were followed up over 2 years with visits every 6 months (V1-V4). At each visit, pain was assessed for the joints treated with CGs using a visual analogue scale (VAS; 0-100 mm). Additional measures were obtained to assess neuropathic pain (painDETECT questionnaire), proprioception/balance (Berg Balance Scale), and functional independence, amongst others. Data were analyzed for 67 patients with EDS (hypermobile: 91%; classical: 6%; kyphoscoliotic: 3%). For the most painful joint, the mean VAS rating was 71.5 ± 22.8 mm at V0; this decreased to 53.5 ± 25.5 mm at V1 and 45.7 ± 29 mm at V4 (t-tests: p < 0.0001). From V0 to V4, improvements were also seen for pain at the other joints, neuropathic pain, functional independence, proprioception/balance, and the incidence of sprains and dislocations/subluxations, although not all comparisons were statistically significant (p < 0.05 level). These results indicate that CGs may effectively reduce the pain and joint instability in non-vascular EDS patients.

Preliminary effectiveness of 3D-printed orthoses in chronic hand conditions: study protocol for a non-randomised interventional feasibility study

INTRODUCTION

Hand orthoses are often provided to improve performance of activities of daily life (ADL). Yet, the manufacturing process of conventional custom-fabricated hand orthoses is a time-consuming and labour-intensive process. Even though three-dimensional (3D) printing of orthoses is a rapidly growing area that can facilitate the manufacturing process of hand orthoses, evidence on the effectiveness, costs and production time of 3D-printed orthoses in chronic hand conditions is scarce. This study aims to assess (1) the preliminary effectiveness of 3D-printed orthoses compared with conventionally custom-fabricated orthoses in persons with chronic hand conditions, (2) production time and costs of both orthoses and (3) experiences of the participants and orthotists with the manufacturing process of the 3D-printed orthosis.

METHODS AND ANALYSIS

In this prospective non-randomised interventional feasibility study, 20 adults with various chronic hand conditions using a conventional thumb, wrist or wrist-thumb orthosis will be provided with a 3D-printed corresponding type of orthosis. Assessments will be done 2 weeks prior to the intervention and at baseline for the conventional orthosis, and at 1 month and 4 months follow-up for the 3D-printed orthosis. The primary outcome is change from baseline in ADL performance (custom short form Dutch-Flemish Patient-Reported Outcomes Measurement Information System-Upper Extremity; ADL domain Michigan Hand Outcomes Questionnaire Dutch language version (MHQ-DLV)) at 4 months follow-up. Secondary outcomes include general hand function (MHQ-DLV), satisfaction with the orthosis (Dutch Client Satisfaction with Device; Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology), usability (in-house questionnaire) and quality of life (EuroQoL 5-Dimension 5-Level). Costs and production time of the conventional and 3D-printed orthoses will be prospectively recorded. Experiences regarding the manufacturing process will be obtained from participants and orthotists (in-house questionnaire).

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the Amsterdam UMC, Academic Medical Centre, has waived the requirement for ethical review of this study. Results will be disseminated through peer-reviewed journals, scientific conferences, and media aimed at a broad audience including patients.

TRIAL REGISTRATION NUMBER

NCT05320211.

Comparison of compensatory shoulder movements, functionality and satisfaction in transradial amputees fitted with two prosthetic myoelectric hooks

The functionalities of myoelectric hooks, such as whether they allow wrist movements, as well as the volume and design of the devices, may impact how fitted transradial amputees use their upper limbs. The aim of the current study was to compare two prosthetic myoelectric hooks in terms of compensatory shoulder movements, functionality and user satisfaction. This monocentric, randomized, controlled, cross-over trial evaluated eight transradial amputees fitted with two prosthetic myoelectric hooks, the Greifer and the Axon-Hook, during two consecutive periods. At the end of each period, shoulder abduction (mean and percentage of time with shoulder abduction > 60°) and manual dexterity were assessed using the Box and Blocks Test (BBT) on both sides, and satisfaction was assessed with the Evaluation of Satisfaction with Assistive Technology questionnaire. For each patient, data obtained with the BBT on the amputated side were compared with those obtained on the non-amputated side. Shoulder abduction was significantly higher with the Greifer (60.9°± 20.3°, p = 0.03) than with the Axon-Hook (39.8°± 16.9°) and also than with the NA side (37.6 ± 19.4°, p = 0.02). Shoulder abduction on the NA side (37.6 ± 19.4°) was close to that of the Axon-Hook (39.8°± 16.9°). The percentage of time spent with shoulder abduction > 60° during the BBT was higher with the Greifer than with the Axon-Hook or with the NA side (53.3 ± 34.4%, 17.6 ± 27.0% and 18.4 ± 34.9%, respectively), but the differences were not significant (p = 0.15). A significant strong negative correlation was found between shoulder abduction and wrist position with the Axon-Hook (r = -0.86; p < 0.01), but not with the Greifer. Manual dexterity and satisfaction did not differ significantly between the two devices. These results revealed compensatory movements, such as shoulder abduction in transradial amputees equipped with hooks, themselves influenced by the prosthetic device settings.

Feasibility of a wearable inertial sensor to assess motor complications and treatment in Parkinson's disease

BACKGROUND

Wearable sensors-based systems have emerged as a potential tool to continuously monitor Parkinson's Disease (PD) motor features in free-living environments.

OBJECTIVES

To analyse the responsivity of wearable inertial sensor (WIS) measures (On/Off-Time, dyskinesia, freezing of gait (FoG) and gait parameters) after treatment adjustments. We also aim to study the ability of the sensor in the detection of MF, dyskinesia, FoG and the percentage of Off-Time, under ambulatory conditions of use.

METHODS

We conducted an observational, open-label study. PD patients wore a validated WIS (STAT-ONTM) for one week (before treatment), and one week, three months after therapeutic changes. The patients were analyzed into two groups according to whether treatment changes had been indicated or not.

RESULTS

Thirty-nine PD patients were included in the study (PD duration 8 ± 3.5 years). Treatment changes were made in 29 patients (85%). When comparing the two groups (treatment intervention vs no intervention), the WIS detected significant changes in the mean percentage of Off-Time (p = 0.007), the mean percentage of On-Time (p = 0.002), the number of steps (p = 0.008) and the gait fluidity (p = 0.004). The mean percentage of Off-Time among the patients who decreased their Off-Time (79% of patients) was -7.54 ± 5.26. The mean percentage of On-Time among the patients that increased their On-Time (59% of patients) was 8.9 ± 6.46. The Spearman correlation between the mean fluidity of the stride and the UPDRS-III- Factor I was 0.6 (p = <0.001). The system detected motor fluctuations (MF) in thirty-seven patients (95%), whilst dyskinesia and FoG were detected in fifteen (41%), and nine PD patients (23%), respectively. However, the kappa agreement analysis between the UPDRS-IV/clinical interview and the sensor was 0.089 for MF, 0.318 for dyskinesia and 0.481 for FoG.

CONCLUSIONS

It's feasible to use this sensor for monitoring PD treatment under ambulatory conditions. This system could serve as a complementary tool to assess PD motor complications and treatment adjustments, although more studies are required.

The Safety and Feasibility of Lower Body Positive Pressure Treadmill Training in Individuals with Chronic Stroke: An Exploratory Study

BACKGROUND

Lower body positive pressure (LBPP) may provide a novel intervention for gait training in neurological conditions. Nonetheless, studies investigating the safety and feasibility of LBPP in patients with stroke are insufficient.

OBJECTIVES

The purpose of this study was to evaluate the safety and feasibility of LBPP as a rehabilitation intervention for individuals with chronic stroke.

METHODS

Individuals with chronic stroke were recruited from the community to participate in LBPP gait training three times a week for six weeks. The LBPP's safety and feasibility were documented throughout the study and at the end of six weeks. Safety and feasibility referred to the incidence of adverse events, complications, the participant and therapist satisfaction questionnaire, and the device limitation including but not limited to technical issues and physical constraints. In addition, blood pressure, pulse rate, and oxygen saturation were taken pre- and post-session. Dependent t-tests were used to analyze the difference between assessments. A Wilcoxon test was used to assess the ordinal data (Trial registration number NCT04767334).

RESULTS

Nine individuals (one female, eight males) aged 57 ± 15.4 years were enrolled. All participants completed the intervention without adverse events. All participants reported positive scores from 4 (very satisfying) to 5 (extremely satisfying) in the safety and feasibility questionnaire. No significant differences were observed in blood pressure and oxygen saturation during the intervention sessions. However, significant increases were observed in heart rate from 82.6 ± 9.1 beats/min (pre-session) to 88.1 ± 6.8 beats/min (post-session) (p = 0.027).

CONCLUSIONS

LBPP is a safe and feasible rehabilitation tool to use with individuals with chronic stroke.

Barriers and facilitators to bracing in adults with painful degenerative scoliosis: a single-centred mixed-method feasibility study

BACKGROUND

Conservative treatments including bracing and exercise therapy are prescribed on the first-line in adults with degenerative scoliosis. However, adherence to conservative treatments is low. We aimed to assess barriers and facilitators to bracing in adults with painful degenerative scoliosis.

METHODS

We conducted a single-centred mixed-method pilot and feasibility study. All patients scheduled for a multidisciplinary custom-made bracing consultation, from July 2019 to January 2020, in a French tertiary care centre, were screened. Patients were eligible if they had painful adult degenerative scoliosis and a prescription for a rigid custom-made lumbar-sacral orthosis. The primary outcome was barriers and facilitators to bracing assessed by a qualitative approach using semi-structured interviews. Secondary outcomes were back pain, spine-specific activity limitations, symptoms of depression and satisfaction with bracing post-intervention assessed by a quantitative approach.

RESULTS

Overall, 56 patients were screened and 14 (25%) were included. Mean age was 68.2 (12.3) years. Mean follow-up was 9.8 (2.0) months. Barriers to bracing were increased limitations in some activities, discomfort in hot weather and burden of aesthetic appearance. Facilitators to bracing were reduced pain, improved activities of daily living, suitable weight and improved spinal alignment. Participants self-implemented solutions to enhance adherence. The mean reduction from baseline in pain intensity was 1.7 (2.3) of 10 points, and 6 of 13 patients (46%) had pain intensity < 4 of 10 points.

CONCLUSION

Bracing is a feasible intervention for people with painful adult degenerative scoliosis. Patients self-implemented their own solutions to enhance adherence.

The Rasch Analysis Shows Poor Construct Validity and Low Reliability of the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0) Questionnaire

This study aims to test the construct validity and reliability of the Quebec User Evaluation of Satisfaction with assistive Technology 2.0 (QUEST)-device, an eight-item questionnaire for measuring satisfaction with assistive devices. We collected 250 questionnaires from 79 patients and 32 caregivers. One QUEST was completed for each assistive device. Five assistive device types were included. QUEST was tested with the Rasch analysis (Many-Facet Rating Scale Model: persons, items, and device type). Most patients were affected by neurological disabilities, and most questionnaires were about mobility devices. All items fitted the Rasch model (InfitMS range: 0.88-1.1; OutfitMS: 0.84-1.28). However, the ceiling effect of the questionnaire was large (15/111 participants totalled the maximum score), its targeting poor (respondents mean measure: 1.90 logits), and its reliability was 0.71. The device classes had different calibrations (range: -1.18 to 1.26 logits), and item 3 functioned differently in patients and caregivers. QUEST satisfaction measures have low reliability and weak construct validity. Lacking invariance, the QUEST total score is unsuitable for comparing the satisfaction levels of users of different device types. The differential item functioning suggests that the QUEST could also be problematic for comparing satisfaction in patients and caregivers.

Rehabilitation engineers, technologists, and technicians: Vital members of the assistive technology team

The rehabilitation engineering professions include rehabilitation engineers, rehabilitation technologists / assistive technologists and rehabilitation technicians. The purpose of this white paper is to define the rehabilitation engineering professions, describe educational pathways for the field of rehabilitation engineering, and describe the role of the rehabilitation engineering professions in a multitude of professional settings. An ad-hoc committee was convened by the Rehabilitation Engineering and Technologists (RE&T) Professional Standards Group (PSG) at the 2013 annual meeting, RESNA Conference in Seattle, Washington. The ad-hoc committee reviewed over 80 different sources in preparing the white paper, which included peer reviewed journal articles, conference proceedings, professional organization websites. Based on this review, in addition to expert opinion and stakeholder feedback, the committee developed the following definitions.Rehabilitation Engineer (RE) uses the innovative and methodical application of scientific knowledge and technology to design and develop a device, system or process, which is intended to satisfy the human needs of an individual with a disability.Rehabilitation Technologist / Assistive Technologist (RT/AT) combines scientific and engineering knowledge and methods with technical skills to complement engineering activities for an individual with a disability.Rehabilitation Technician (RTn) works with equipment, primarily assembling and testing component parts of devices or systems that have been designed by others for individuals with disabilities; usually under direct supervision of a rehabilitation engineer or rehabilitation technologist / assistive technologist. Their preferences are given to assembly, repair, or evolutionary improvements to technical equipment by learning its characteristics, rather than by studying the scientific or engineering basis for its original design.This whitepaper provides a framework for future discussions on the advancement of the rehabilitation engineering professions with the goal of improving the quality of life of individuals with disabilities through the application of science and technology.

Feasibility of Customized Pillboxes to Enhance Medication Adherence: A Randomized Controlled Trial

OBJECTIVE

To test the (1) feasibility of an assistive technology based pillbox intervention on medication adherence; (2) feasibility of trial procedures; and (3) preliminary effectiveness of the pillbox intervention on medication adherence.

DESIGN

A single-blinded randomized controlled clinical trial was conducted during 2-4 weeks.

SETTING

Researchers recruited a convenience sample to participate in this university laboratory-based study.

PARTICIPANTS

English-speaking consumers of 2 or more daily medications (N=15) participated in the study. Individuals with cognitive impairment or who did not manage their own medications were excluded.

INTERVENTIONS

Participants were randomized to 1 of 3 pillbox interventions: (1) standard-of-care pillbox; (2) customized off-the-shelf pillbox; or (3) customized 3-dimensional (3D) printed pillbox.

MAIN OUTCOME MEASURES

Outcome measures were divided among the 3 goals of the study. In addition to feasibility metrics, the Adherence to Refills and Medications Scale was used to measure the primary outcome measure, medication adherence. The Quebec User Evaluation of Satisfaction with Assistive Technology was used to measure pillbox satisfaction.

RESULTS

Researchers successfully administered 6 standard-of-care, 5 custom off-the-shelf, and 4 custom 3D printed pillboxes. Compared with the standard-of-care pillboxes, customized 3D printed pillboxes had large (d=1.04) and customized off-the-shelf pillboxes had medium (d=0.67) effects on medication adherence.

CONCLUSIONS

Prescription of customized pillboxes using a manualized and novel assistive technology approach that leverages 3D printing is feasible.

Scoping review of remote rehabilitation (telerehabilitation) services to support people with vision impairment

OBJECTIVE

Telerehabilitation for individuals with vision impairment aims to maintain maximum physical and/or psychological functioning through remote service delivery. This review aims to describe the type of telerehabilitation services available to people with vision impairment and summarise evidence on health-related outcomes, well-being and cost-effectiveness.

DESIGN

Scoping review.

DATA SOURCES

CINAHL Plus, MEDLINE, PsycARTICLES, PsychINFO, Embase, PubMed, HMIC and Ovid Emcare were searched, without date restrictions up to 24 May 2021. Charity and government websites, conference proceedings and clinical trial databases were also examined.

ELIGIBILITY CRITERIA

Eligible studies evaluated benefits of telerehabilitation services for adults with vision impairment. Studies were excluded if they were not available in English, or focused on distance learning of visually impaired students.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened articles and extracted data. A risk of bias analysis was performed.

OUTCOME MEASURES

Measures of benefit included performance-based assessment, patient-reported outcomes and cost-effectiveness.

RESULTS

Of 4472 articles, 10 eligible studies were included. Outcomes addressed patient satisfaction (n=4;33.3%), quality-of-life, activities of daily living and well-being (n=4;33.3%), objective visual function (n=2;16.6%) and knowledge relating to ocular symptoms (n=1;8.3%). Two studies addressed multiple outcomes. Cost-effectiveness was addressed in one article (8.3%). Patients were generally satisfied with their experiences, which had a range of positive benefits on functional and quality-of-life outcomes in areas relating to daily activities (eg, reading, making phone calls). Telerehabilitation allowed patients to undertake vision optimisation training to prevent vision deterioration. Grey literature indicated that there are no completed clinical trials relating to low vision telerehabilitation. Charity services had implemented digital skills training to help beneficiaries communicate remotely.

CONCLUSION

While acceptability of telerehabilitation was mostly high, limited real-world data are available which raises questions around the long-term desirability of this approach. Further trials are needed to evaluate telerehabilitation using a robust set of outcome measures.

PROSPERO REGISTRATION NUMBER

CRD42021254825.

Cross-Cultural Validation of Quebec User Satisfaction with Assistive Technology 2.0 for Spanish Population (QUEST-2.0 ES)

Background: Assistive technologies (ATs) are resources to promote the independence and participation of people with a disability. The use of standardized tools, based on outcome measures, is essential for guaranteeing high-quality rates. The Quebec User Evaluation of Satisfaction with AT–2.0 (QUEST) is a scale to assess the satisfaction of people using any AT. Objectives: To translate and culturally validate the QUEST–2.0 for the Spanish population (QUEST 2.0-ES). Methods: A validation cross-design and descriptive study. The test–retest reliability, validity, and internal consistency of QUEST 2.0-ES were studied. It was divided into two phases: Sample 1 was formed by 26 persons; in sample 2, 30 persons participated. The conditions included neurological conditions, amputations, rare diseases, and deafness. Results: Thirty-five men and 21 women participated in total. The majority of AT used were those for mobility. QUEST 2.0-ES analysis showed internal consistency values between the test (α = 0.87) and retest versions (α = 0.89). The internal consistency was high for AT (test, α = 0.83; retest, α = 0.87) and Service (test, α = 0.80; retest, α = 0.80). The temporal reliability (1–2 weeks) for test–retest was 0.88. Conclusion: QUEST 2.0-ES showed good psychometric properties in terms of validity and test–retest reliability, and it is a good tool to assess the user’s satisfaction with ATs and services.

Design and feasibility of the T-GRIP thumb exoskeleton to support the lateral pinch grasp of spinal cord injury patients

Improving the impaired hand function of spinal cord injury patients with a robotic exoskeleton can highly impact their self-management, and ultimately their quality of life. In this paper the design and evaluation of a new, lightweight (50 gram) robotic thumb exoskeleton, called TGRIP, was presented that supports the lateral pinch grasp. The mechanism consists of a linear actuator that was mounted to the dorsal side of the hand, and a force transmission mechanism that flexes the thumb towards the side of the index finger. The thumb movement was controlled through contralateral wrist rotation. Experimental results from an evaluation with three spinal cord injury patients showed that the achieved grip force (^~ 7N) was higher and the overall performance during the Grasp and Release Test was better with the T-GRIP than without device. The device shows great potential for improving the hand function of patients with cervical spinal cord injury by actuating only a single degree of freedom.

[Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study]

BACKGROUND AND OBJECTIVES

The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience.

MATERIAL AND METHODS

The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention.

RESULTS

All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. CONCLUSIóN: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb post Stroke (RHOMBUS II): protocol of a feasibility randomised controlled trial

INTRODUCTION

Upper limb (UL) rehabilitation is most effective early after stroke, with higher doses leading to improved outcomes. For the stroke survivor, the repetition may be monotonous. For clinicians, providing a clinically meaningful level of input can be challenging. As such, time spent engaged in UL activity among subacute stroke survivors remains inadequate. Opportunities for the stroke survivor to engage with UL rehabilitation in a safe, accessible and engaging way are essential to improving UL outcomes following stroke. The NeuroBall is a non-immersive virtual reality (VR) digital system designed for stroke rehabilitation, specifically for the arm and hand. The aim of the Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb post Stroke study is to determine the safety, feasibility and acceptability of the NeuroBall as a rehabilitation intervention for the UL in subacute stroke.

METHODS AND ANALYSIS

A feasibility randomised controlled trial (RCT) will compare the NeuroBall plus usual care with usual care only, in supporting UL rehabilitation over 7 weeks. Twenty-four participants in the subacute poststroke phase will be recruited while on the inpatient or early supported discharge (ESD) stroke pathway. Sixteen participants will be randomised to the intervention group and eight to the control group. Outcomes assessed at baseline and 7 weeks include gross level of disability, arm function, spasticity, pain, fatigue and quality of life (QoL). Safety will be assessed by recording adverse events and using pain, spasticity and fatigue scores. A parallel process evaluation will assess feasibility and acceptability of the intervention. Feasibility will also be determined by assessing fidelity to the intervention. Postintervention, semistructured interviews will be used to explore acceptability with 12 participants from the intervention group, four from the usual care group and with up to nine staff involved in delivering the intervention.

ETHICS AND DISSEMINATION

This trial has ethical approval from Brunel University London's Research Ethics Committee 25257-NHS-Oct/2020-28121-2 and the Wales Research Ethics Committee 5 Bangor (Health and Care Research Wales) REC ref: 20/WA/0347. The study is sponsored by Brunel University London.

CONTACT

Dr Derek Healy, Chair, University Research Ethics committee (Derek.healy@brunel.ac.uk). Trial results will be submitted for publication in peer-reviewed journals, presented at national and international conferences and distributed to people with stroke.

TRIAL REGISTRATION NUMBER

ISRCTN11440079; Pre-results.

Can a Hip Brace Improve Short-Term Hip-Related Quality of Life for People With Femoroacetabular Impingement and Acetabular Labral Tears: An Exploratory Randomized Trial

OBJECTIVES

To examine whether a hip brace can improve hip health quality-of-life (QoL) and is well-tolerated in people with femoroacetabular impingement syndrome (FAIS) or symptomatic labral tears after 6 weeks of wear.

DESIGN

Parallel, two-arm, exploratory randomized trial.

SETTING

Hospital and private clinics of orthopaedic surgeons.

PARTICIPANTS

Individuals >18 years with FAIS or labral tears.

INTERVENTIONS

Usual conservative care versus usual conservative care plus a hip brace.

MAIN OUTCOMES

Patient-reported outcomes were assessed with the International Hip Outcome Tool (iHOT-33), and Copenhagen Hip and Groin Outcome Scores (HAGOS). Brace acceptability was measured using the Quebec User Evaluation of Satisfaction with Assistive Technology survey. Independent t-tests assessed between-group differences.

RESULTS

Thirty-eight participants were recruited, 19 each group, 60% women, mean age 39.3 ± 11.8 years, body mass index 25.3 ± 4.4 kg/m2, iHOT-33 36.6 ± 24.8. Three participants dropped out (one usual care, 2 braced). The mean between-group difference for iHOT-33 was 19.4 (95% confidence interval [CI] 1.68-37.06, P = 0.03) favoring the brace. There were improvements in most HAGOS subscale scores favoring the brace. Issues with brace tolerability for some participants were perceived comfort and effectiveness. Three brace-related adverse events were reported.

CONCLUSION

Between-group differences favored the braced group for hip health QoL, pain, symptoms, and function. Although these were promising results, the CIs for the estimates were wide, the small sample size likely a contributing factor. Our results suggest that further investigation of the brace is warranted, we calculated sample sizes and made recommendations for the design of a future trial.

Psychometric evaluation of the Arabic version of the Quebec user evaluation of satisfaction with assistive technology (A-QUEST 2.0) in prosthesis users

BACKGROUND

The evaluation of patient satisfaction and perceptions plays a vital role in determining the quality of prosthesis users' devices and the competency of healthcare services.

AIM

To evaluate the psychometric properties of the Arabic Quebec User Evaluation of Satisfaction with Assistive Technology (A-QUEST 2.0) with prosthetics users.

DESIGN

A methodological study.

SETTING

Saudi Arabia, Turkey.

POPULATION

A convenience sample of outpatient prosthesis users (N.=183).

METHODS

The A-QUEST 2.0 includes two subscales respectively evaluating the user's satisfaction with the device and the services provided. The data for each subscale were investigated using Rasch analysis to evaluate the item fit, reliability indices, item difficulty, local item dependency, and differential item functioning (DIF).

RESULTS

Both subscales met the Rasch criteria for the functioning of rating scale categories. All items showed an acceptable fit to the Rasch model. The person separation indices for the Device and Services subscales were 2.21 (Cronbach's α=0.90) and 1.72 (Cronbach's α=0.85), respectively. Therefore, the two subscales are sensitive enough to distinguish between at least three different levels of satisfaction. The unidimensionality of each subscale was confirmed, and none of the items displayed differential item functioning across age, gender, location of amputation, country, and duration of use.

CONCLUSIONS

Overall, the findings indicate the psychometric evaluation of A-QUEST 2.0 is effective with prosthesis users across different clinical contexts and cultures. Thus, the A-QUEST 2.0 allows for a comprehensive understanding of users' perceptions of prosthesis characteristics, particularly among subjects with lower limb amputations caused by traumatic injuries.

CLINICAL REHABILITATION IMPACT

Our paper provides clinicians dealing with Arabic patients a validated outcome measure for satisfaction with prosthesis. Besides providing information in the development of new products and service delivery. Further studies are necessary to improve the measure's metric quality in different contexts and for different prosthesis devices.

Accelerated wear testing shows that thermoplastic bushings could be a cost-effective and durable alternative to traditional bearings for wheelchair caster use

Introduction

Wheelchair caster bearings often suffer high-risk failures that lead to adverse consequences such as user injuries, suggesting that design improvements are necessary. This study aimed to compare thermoplastic bushings to standard roller bearings for potential improvements in durability and cost-effectiveness.

Methods

The durability and cost-effectiveness of two thermoplastic bushing models and two metallic ball-bearing models were tested using a standard lab-based accelerated wear testing protocol. Bushings and bearings were installed on a standard 8″ caster, and four samples per model underwent testing (16 total samples).

Results

All failures were experienced by the stem rolling element. The thermoplastic bushings experienced higher mean durability than the standard ball-bearings. There were significant differences in durability across the tested models, F(3,12) = 3.88, p = 0.04. The durability of thermoplastic bushing #2 was higher than the standard type ZZ shielded deep groove ball bearings, p < 0.05. There were significant differences in cost-effectiveness across the tested models, F(3,12) = 7.64, p = 0.004. The cost-effectiveness of both thermoplastic bushings were significantly higher compared to type 2RS sealed deep groove bearings, p < 0.05.

Conclusions

The use of thermoplastic bushings can lower product cost and potentially reduce caster failures in the community that are associated with adverse consequences including user injuries.

Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial

Background

Approximately 40–70% of people with Parkinson’s disease (PD) fall each year, causing decreased activity levels and quality of life. Current fall-prevention strategies include the use of pharmacological and non-pharmacological therapies. To increase the accessibility of this vulnerable population, we developed a multidisciplinary telemedicine program using an Information and Communication Technology (ICT) platform. We hypothesized that the risk for falling in PD would decrease among participants receiving a multidisciplinary telemedicine intervention program added to standard office-based neurological care.

Objective

To determine the feasibility and cost-effectiveness of a multidisciplinary telemedicine intervention to decrease the incidence of falls in patients with PD.

Methods

Ongoing, longitudinal, randomized, single-blinded, case-control, clinical trial. We will include 76 non-demented patients with idiopathic PD with a high risk of falling and limited access to multidisciplinary care. The intervention group (n = 38) will receive multidisciplinary remote care in addition to standard medical care, and the control group (n = 38) standard medical care only. Nutrition, sarcopenia and frailty status, motor, non-motor symptoms, health-related quality of life, caregiver burden, falls, balance and gait disturbances, direct and non-medical costs will be assessed using validated rating scales.

Results

This study will provide a cost-effectiveness assessment of multidisciplinary telemedicine intervention for fall reduction in PD, in addition to standard neurological medical care.

Conclusion

In this challenging initiative, we will determine whether a multidisciplinary telemedicine intervention program can reduce falls, as an alternative intervention option for PD patients with restricted access to multidisciplinary care.

Trial registration

ClinicalTrials.gov Identifier: NCT04694443.

Home exercise in the dart-throwing motion plane after distal radius fractures: A pilot randomized controlled trial

INTRODUCTION

During daily functions, our wrist moves through an oblique plane, named the dart-throwing motion (DTM) plane. This plane is considered a more stable plane because the proximal carpal row remains relatively immobile. However, rehabilitation programs that incorporate exercising in the DTM plane have yet to be explored.

PURPOSE OF THE STUDY

The purpose of this study was to evaluate the rehabilitation outcomes after treatment in the DTM plane compared with outcomes after treatment in the sagittal plane after distal radius fracture.

STUDY DESIGN

This is a pilot randomized controlled trial.

METHODS

Subjects after open reduction internal fixation were assigned into a research group (N = 12; ages 48.7 ± 7.3) and a control group (N = 12; ages 50.8 ± 15). The control group activated the wrist in the sagittal plane, whereas the research group activated the wrist in the DTM plane. Range of motion, pain levels, functional hand motor skills tests, and satisfaction from self-training exercise were measured before and after a 12-session intervention.

RESULTS

The outcome measures were similar between the treatment groups. The research group reported significantly higher satisfaction rates than the control group on topics such as general satisfaction (research group: 3.4 ± 0.7, control group: 2. 5 ± 1.2, P = .030), motivation to exert oneself (research group: 2.8 ± 1.0, control group: 2.3 ± 1.2, P = .009), progressed function (research group: 3.4 ± 0.7, control group: 2.4 ± 1.1, P = .012), and self-training contribution to the daily function (research group: 3.4 ± 0.7, control group: 2.5 ± 1.2, P = .030).

DISCUSSION AND CONCLUSION

Pilot results do not favor one treatment method over the other. However, exercising in the DTM plane may contribute to the satisfaction of the client and increase self-training motivation.

Scoping review of economic evaluations of assistive technology globally

The paper presents a scoping review of existing economic evaluations of assistive technology (AT). The study methodology utilized a PRISMA flow approach with final included studies that met an adapted PICOS framework. Types of economic evaluations employed, study type and rigor and domains of AT impact were considered and analyzed. The economic evaluations in this study included 13 CBA, 9 CMA, 18 CEAs and 10 CUA. The majority of studies (32 studies in total) mentioned or recorded that AT investment, access and/or usage had impacts on the domain of both informal and formal health care. Specifically, care costs, time, and resources were affected. Our study has found that current AT economic evaluations are limited. This study advocates for a wider use of robust alternative evaluation and appraisal methodologies that can highlight AT value and which would subsequently provide further evidence that may make governments more willing to invest in and shape AT markets.

Development and content validation of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) outcome tool

This study describes the development and content validation of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA), a self-report outcome measure for assessing satisfaction with completing instrumental Activities of Daily Living (IADL) for People With Disabilities (PWD) using internet-Connected Assistive Devices (iCAD). For this study, an iCAD is defined as any information communication technology/electronic device or software that assists with promoting, maintaining, and/or enhancing the ability of a PWD to live independently in society. Phase 1 of development involved generating an initial item pool based on a literature review. Content validity of the EISA was computed in Phase 2 using the Qualtrics on-line research platform. Utilizing the content validity index procedure, EISA demonstrated acceptable content validity: item level (I-CVI of 0.78 or higher) and scale level (S-CVI/Ave of 0.90 or higher). EISA version 1.0 was generated in Phase 3 where it is the first of its kind outcome measure specifically designed for assessing satisfaction with completing IADL for PWD using iCAD.

Wearable Robotic Gait Training in Persons with Multiple Sclerosis: A Satisfaction Study

Wearable exoskeletons have showed improvements in levels of disability and quality of life in people with neurological disorders. However, it is important to understand users’ perspectives. The aim of this study was to explore the patients’ and physiotherapists’ satisfaction from gait training with the EKSO GT^® exoskeleton in people with multiple sclerosis (MS). A cross-sectional study with 54 participants was conducted. Clinical data and self-administered scales data were registered from all patients who performed sessions with EKSO GT^®. To evaluate patients’ satisfaction the Quebec User Evaluation with Assistive Technology and Client Satisfaction Questionnaire were used. A high level of satisfaction was reported for patients and for physiotherapists. A moderate correlation was found between the number of sessions and the patients’ satisfaction score (rho = 0.532; p < 0.001), and an excellent correlation between the physiotherapists’ time of experience in neurology rehabilitation and the satisfaction with the possibility of combining the device with other gait trainings approaches (rho = 0.723; p = 0.003). This study demonstrates a good degree of satisfaction for people with MS (31.3 ± 5.70 out of 40) and physiotherapists (38.50 ± 3.67 out of 45 points) with the EKSO GT^®. Effectiveness, safety and impact on the patients’ gait were the most highly rated characteristics of EKSO GT^®. Features such as comfort or weight of the device should be improved from the patients’ perspectives.

Multicentre, randomised, single-blind, parallel group trial to compare the effectiveness of a Holter for Parkinson's symptoms against other clinical monitoring methods: study protocol

INTRODUCTION

In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson's disease patients (Parkinson's Holter). The effectiveness of these monitoring devices for improving clinical control is not known.

METHODS AND ANALYSIS

This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson's Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months.The primary outcome is the efficiency of the Parkinson's Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor-patient contacts will be analysed. The noninferiority of the Parkinson's Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective.Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson's Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022.

TRIAL REGISTRATION

NCT04176302; https://clinicaltrials.gov/show/NCT04176302.

Load Auditory Feedback Boosts Crutch Usage in Subjects With Central Nervous System Lesions: A Pilot Study

Background: Crutches are the most common walking aids prescribed to improve mobility in subjects with central nervous system (CNS) lesions. To increase adherence to the appropriate level of crutch usage, providing load-related auditory feedback (aFB) may be a useful approach. We sensorized forearm crutches and developed a custom software to provide aFB information to both user and physical therapist (PhT).

Aim: Evaluate aFB effects on load control during gait by a self-controlled case series trial.

Methods: A single experimental session was conducted enrolling 12 CNS lesioned participants. Load on crutch was recorded during 10 Meter Walk Test performed with and without aFB. In both cases, crutch load data, and gait speed were recorded. Usability and satisfaction questionnaires were administered to participants and PhTs involved.

Results: Reliable data were obtained from eight participants. Results showed that compared to the no FB condition, aFB yielded a significant reduction in the mean load on the crutches during gait (p = 0.001). The FB did not influence gait speed or fatigue (p > 0.05). The experience questionnaire data indicated a positive experience regarding the use of aFB from both participants' and PhTs' perspectives.

Conclusion: aFB significantly improves compliance with crutch use and does not affect gait speed or fatigue by improving the load placed on crutches. The FB is perceived by users as helpful, safe, and easy to learn, and does not interfere with attention or concentration while walking. Furthermore, the PhTs consider the system to be useful, easy to learn and reliable.

Head-mounted Visual Assistive Technology-related Quality of Life Changes after Telerehabilitation

SIGNIFICANCE

Head-mounted low vision devices have become a viable alternative to enhance residual vision. This study supports the use of a head-mounted display to improve aspects of functional vision and quality of life. Much is still unknown regarding the required frequency, duration, or potential effectiveness of this telerehabilitation training protocol or what characteristics best identify optimal users.

PURPOSE

A randomized study explored the effect of telerehabilitation on quality of life and functional vision in individuals with low vision using a head-mounted display.

METHODS

We recruited 57 participants (age, 21 to 82 years; mean, 54.5 years) among new prospective eSight Eyewear users, randomized 1:1 into two parallel groups; the experimental group received the telerehabilitation training provided by a low vision therapist, whereas the control group received the self-training standard offered by the device manufacturer and without involvement of a low vision therapist. The primary outcome measures were the impact of telerehabilitation on validated measures of assistive technology-related quality of life: the Psychosocial Impact of Assistive Devices Scale and the Quebec User Evaluation of Satisfaction with Assistive Technology scale. Exploratory outcomes were the assessment of self-reported functional vision using the Veterans Affairs Low Vision Visual Functioning Questionnaire-48 and cybersickness associated with head-mounted display use with the Simulator Sickness Questionnaire.

RESULTS

Assistive technology-related quality of life was improved when measured by the satisfaction scale but not the psychosocial scale within the first 3 months, independently of training type. Overall, functional vision improvement was observed within the first 2 weeks of device use and maintained during the 6-month study, independently of group type. Cybersickness outcomes were similar between training groups and did not change significantly for 6 months.

CONCLUSIONS

eSight Eyewear, either with telerehabilitation or with the manufacturer self-training comparison, improved functional vision and increased users' quality of life within the initial 3 months of device training and practice.

Personalized Telerehabilitation for a Head-mounted Low Vision Aid: A Randomized Feasibility Study

SIGNIFICANCE

A recent trend in low vision rehabilitation has been the use of portable head-mounted displays to enhance residual vision. Our study confirms the feasibility of telerehabilitation and informs the development of evidence-based recommendations to improve telerehabilitation interventions to reduce device abandonment.

PURPOSE

To develop evidence-based recommendations for telerehabilitation, we conducted a feasibility study in preparation for a future randomized trial on the use of head-mounted displays.

METHODS

We recruited novice eSight Eyewear users, randomized 1:1: the experimental group received telerehabilitation by a low vision therapist using video conferencing; the control group completed at home self-training provided by the device manufacturer. The primary feasibility outcomes were whether the recruitment goal of 60 participants (30/group) was attainable within 1 year and how participants judged the accessibility and acceptability of the telerehabilitation. An exploratory outcome was the impact of telerehabilitation on eSight Eyewear use behavior.

RESULTS

Among 333 eSight users, 57 participants were enrolled, of which 35% withdrew from the study, whereas the remainder completed the 6-month follow-up. The withdrawal rate was higher in the control group but did not differ significantly from the experimental group. High accessibility (93% of participants accessed the platform) and global acceptability (100% overall satisfaction) were reported among those who completed the telerehabilitation protocol. The therapist had no difficulty judging the participants' reading performances qualitatively while participants used their device to read their eSkills and VisExc guides. Most participants improved their daily activities, based on qualitative reports of the attained goals. Seventy-nine percent of individuals declined to participate, whereas 16% of participants decided not to use eSight Eyewear anymore.

CONCLUSIONS

The data demonstrated the feasibility of a randomized controlled telerehabilitation study for people with low vision using a head-mounted display. Positive feedback from the participants and the therapist suggests the potential value of this modality for low vision services.