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Najafi P, Hadizadeh M, Cheong JPG, Motl RW, Abdullah S, Mohafez H, Poursadeghfard M. Effects of tele-exercise training on physical and mental health and quality of life in multiple sclerosis: Do the effects differ by modality and clinical disease course? Mult Scler Relat Disord 2023; 80:105129. [PMID: 37977056 DOI: 10.1016/j.msard.2023.105129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Tele-exercise training has improved mental and physical health and quality of life (QOL) in people with multiple sclerosis (PwMS), but there is little known about the comparability of effects across modalities and clinical disease courses. OBJECTIVE To evaluate the effect of tele-Pilates and tele-yoga training on physical and mental factors and QOL in PwMS, with a focus on two phenotype classifications - relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS). METHODS Eighty-two persons with RRMS (n = 48) and SPMS (n = 34) were randomly assigned into tele-Pilates (n = 29), tele-yoga (n = 26), or control (n = 27). The tele-exercis training was conducted three times per week for eight weeks. RESULTS Significant time × group interactions were observed for QoL (p = 0.01), physical activity levels (p < 0.001), mental health (p = 0.05), and a decline in depression (p = 0.002) following tele-Pilates and tele-yoga. The corresponding subfactors, including pain, energy, emotional well-being, and role limitation due to emotional and physical problems, have shown significant improvements after interventions compared with control (all p < 0.05). The effects of exercise over control did not depend on MS phenotype (all p > 0.05). DISCUSSION Tele-yoga and tele-Pilates exercises improved QoL and mental and physical health in PwMS, and the benefits were similar across both MS phenotypes. These findings highlight the potential of implementing tele-yoga and tele-Pilates as non-pharmacological mind-body symptomatic treatments for individuals with both RRMS and SPMS.
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Affiliation(s)
- Parisa Najafi
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Maryam Hadizadeh
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
| | | | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States.
| | - Suhailah Abdullah
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Hamidreza Mohafez
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gross IT, Whitfill T, Redmond B, Couturier K, Bhatnagar A, Joseph M, Joseph D, Ray J, Wagner M, Auerbach M. Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial. Neonatology 2020; 117:159-166. [PMID: 31905354 DOI: 10.1159/000504853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous research has described technical aspects of telemedicine and the clinical impact of provider-to-patient telemedicine; however, little is known about provider-to-provider telemedical interventions. OBJECTIVE The primary aim of this study was to compare two telemedicine delivery modes on the quality of a simulated neonatal resuscitation. Our secondary aim was to evaluate the providers' task load. METHODS This was a prospective, single-center, randomized, simulation-based trial comparing a remote neonatal team leader ("teleleader") versus a remote consultant ("teleconsultant"). Participants resuscitated a simulated, apneic, and bradycardic neonate. Performance was assessed by video review and task load was measured by the self-reported NASA task load index (NASA-TLX) tool. In the teleleader group, one remote neonatal specialist assumed the role of team leader in the resuscitation. In the teleconsultant group, the same remote specialist assumed the role of teleconsultant. RESULTS Twenty-two participants were included in the analyses. The teleleader group was associated with a higher overall checklist score compared to teleconsultants (median score 68%, interquartile range [IQR]: 66-69 vs. 58%, IQR: 42-62; p = 0.016). No significant difference was seen in overall subjective workload as measured by the NASA-TLX tool. However, mental demand and frustration were significantly greater with teleconsultants compared to teleleaders (mean mental demand: 14.1 vs. 17.0 out of 21; frustration: 7.9 vs. 14.7 out of 21). CONCLUSIONS Simulated neonates randomized to teams with teleleaders received significantly better resuscitative care compared to those randomized to teams with teleconsultants. Mental demand and frustration were higher for providers in the teleconsultant compared to teleleader teams.
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Affiliation(s)
- Isabel T Gross
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA,
| | - Travis Whitfill
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brooke Redmond
- Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katherine Couturier
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambika Bhatnagar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica Ray
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Marc Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Thirumalai M, Rimmer JH, Johnson G, Wilroy J, Young HJ, Mehta T, Lai B. TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study. JMIR Mhealth Uhealth 2018; 6:e10181. [PMID: 29798832 PMCID: PMC5992455 DOI: 10.2196/10181] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/15/2018] [Accepted: 05/08/2018] [Indexed: 01/30/2023] Open
Abstract
Background People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results During testing of the app’s effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis).
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - George Johnson
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Rimmer JH, Lai B, Young HJ. Bending the Arc of Exercise and Recreation Technology Toward People With Disabilities. Arch Phys Med Rehabil 2016; 97:S247-51. [DOI: 10.1016/j.apmr.2016.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 02/09/2016] [Accepted: 02/15/2016] [Indexed: 10/21/2022]
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Grogan-Johnson S, Meehan R, McCormick K, Miller N. Results of a National Survey of Preservice Telepractice Training in Graduate Speech-Language Pathology and Audiology Programs. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/cicsd_42_s_122] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Doarn CR, Pruitt S, Jacobs J, Harris Y, Bott DM, Riley W, Lamer C, Oliver AL. Federal efforts to define and advance telehealth--a work in progress. Telemed J E Health 2014; 20:409-18. [PMID: 24502793 PMCID: PMC4011485 DOI: 10.1089/tmj.2013.0336] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/19/2013] [Accepted: 12/21/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The integration of telecommunications and information systems in healthcare is not new or novel; indeed, it is the current practice of medicine and has been an integral part of medicine in remote locations for several decades. The U.S. Government has made a significant investment, measured in hundreds of millions of dollars, and therefore has a strong presence in the integration of telehealth/telemedicine in healthcare. However, the terminologies and definitions in the lexicon vary across agencies and departments of the U.S. Government. The objective of our survey was to identify and evaluate the definitions of telehealth/telemedicine across the U.S. Government to provide a better understanding of what each agency or department means when it uses these terms. METHODOLOGY The U.S. Government, under the leadership of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, established the Federal Telemedicine (FedTel) Working Group, through which all members responded to a survey on each agency or department's definition and use of terms associated with telehealth. RESULTS AND CONCLUSIONS Twenty-six agencies represented by more than 100 individuals participating in the FedTel Working Group identified seven unique definitions of telehealth in current use across the U.S. Government. Although many definitions are similar, there are nuanced differences that reflect each organization's legislative intent and the population they serve. These definitions affect how telemedicine has been or is being applied across the healthcare landscape, reflecting the U.S. Government's widespread and influential role in healthcare access and service delivery. The evidence base suggests that a common nomenclature for defining telemedicine may benefit efforts to advance the use of this technology to address the changing nature of healthcare and new demands for services expected as a result of health reform.
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Affiliation(s)
- Charles R. Doarn
- NASA Headquarters, Washington, D.C
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sherilyn Pruitt
- Office for the Advancement of Telehealth, U.S. Department of Health and Human Services, Rockville, Maryland
| | | | - Yael Harris
- Division of Healthcare Quality Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, Maryland
| | - David M. Bott
- Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, Baltimore, Maryland
| | - William Riley
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Anthony L. Oliver
- Office for the Advancement of Telehealth, U.S. Department of Health and Human Services, Rockville, Maryland
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Abstract
BACKGROUND As telehealth takes advantage of improved networks, there is a growing need to understand the infrastructure needs of future telehealth developments. This work aims to predict such needs based on current trends and research. MATERIALS AND METHODS We conducted a literature review of telehealth with a focus on advanced network infrastructure. We drew inferences from our previous demonstrator projects in advanced telehealth, but the most important findings emerged from interviews with a panel of thought leaders. RESULTS Our results show that there will be simultaneous and coupled evolution of telehealth through the space spanned by three axes: care models, clinical applications, and technology. We also consider a two-dimensional model of reach and complexity to describe future applications. Universal access to advanced networks will drive fundamental changes in healthcare deliver. The biggest change will be seen in home and mobile health care delivery, forming part of a trend toward patient-centric models. Other aspects of decentralization in healthcare systems will include networks of caregivers. Besides this reach trend, the complexity trend will include integrating multiple-channel applications and seamlessly moving large datasets in real time among hospitals, other medical facilities, and homes. There is a need to provide infrastructure that does not have an upper limit on quality of service and allows telehealth to address mobility, usability, interoperability, intelligence, and adaptability in a systematic way.
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Affiliation(s)
- Jane Li
- Commonwealth Scientific and Industrial Research Organisation Information & Communication Technologies Centre , Marsfield, New South Wales, Australia
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Building the Crossroad Between Inpatient/Outpatient Rehabilitation and Lifelong Community-Based Fitness for People With Neurologic Disability. J Neurol Phys Ther 2013; 37:72-7. [DOI: 10.1097/npt.0b013e318291bbf6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schutte J, Gales S, Filippone A, Saptono A, Parmanto B, McCue M. Evaluation of a telerehabilitation system for community-based rehabilitation. Int J Telerehabil 2012; 4:15-24. [PMID: 25945193 PMCID: PMC4296818 DOI: 10.5195/ijt.2012.6092] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The use of web-based portals, while increasing in popularity in the fields of medicine and research, are rarely reported on in community-based rehabilitation programs. A program within the Pennsylvania Office of Vocational Rehabilitation's Hiram G. Andrews Center, the Cognitive Skills Enhancement Program (CSEP), sought to enhance organization of program and participant information and communication between part- and full-time employees, supervisors and consultants. A telerehabilitation system was developed consisting of (1) a web-based portal to support a variety of clinical activities, and (2) the Versatile Integrated System for Telerehabilitation (VISYTER) video-conferencing system to support the collaboration and delivery of rehabilitation services remotely. This descriptive evaluation examines the usability of the telerehabilitation system incorporating both the portal and VISYTER. Telerehabilitation system users include CSEP staff members from three geographical locations and employed by two institutions. The IBM After-Scenario Questionnaire (ASQ) and Post-Study System Usability Questionnaire (PSSUQ), the Telehealth Usability Questionnaire (TUQ), and two demographic surveys were administered to gather both objective and subjective information. Results showed generally high levels of usability. Users commented that the telerehabilitation system improved communication, increased access to information, improved speed of completing tasks, and had an appealing interface. Areas where users would like to see improvements, including ease of accessing/editing documents and searching for information, are discussed.
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Affiliation(s)
- Jamie Schutte
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Sara Gales
- Pennsylvania Office of Vocational Rehabilitation
| | - Ashlee Filippone
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Andi Saptono
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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Confidence in the use of information management and technology (IM&T) in radiography: Is age a barrier? Radiography (Lond) 2010. [DOI: 10.1016/j.radi.2010.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rabinowitz T, Murphy KM, Amour JL, Ricci MA, Caputo MP, Newhouse PA. Benefits of a telepsychiatry consultation service for rural nursing home residents. Telemed J E Health 2010; 16:34-40. [PMID: 20070161 DOI: 10.1089/tmj.2009.0088] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.
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Affiliation(s)
- Terry Rabinowitz
- Department of Psychiatry, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont 05401, USA.
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Serrano CI, Karahanna E. An Exploratory Study of Patient Acceptance of Walk-In Telemedicine Services for Minor Conditions. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2009. [DOI: 10.4018/jhisi.2009071003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Though healthcare costs continue to soar, the healthcare industry lags other service industries in applying information technology to improve customer (i.e., patient) service, improve access to healthcare services, and reduce costs. One particular area of concern is overuse and overcrowding of emergency departments for nonurgent care. Telemedicine is one potentially important application of information technology in this realm. The objective of this study is to examine the antecedents of patient acceptance of walk-in telemedicine services for minor ailments. Drawing upon theoretical models in the healthcare and technology acceptance literatures and based on salient beliefs elicited during interviews with 29 potential adopters, the authors develop a conceptual model of antecedents of patient acceptance of walk-in telemedicine services for minor conditions. While relative advantage, informational influences, and relationship with one’s physician emerged as important predictors of acceptance, media richness and e-consultation diagnosticity emerged as central concerns for potential adopters. They discuss the study’s implications for research and practice and offer suggestions for future empirical studies.
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