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Kurtaiş Aytür Y. Prerequisites and barriers to telerehabilitation in patients with neurological conditions: A narrative review. NeuroRehabilitation 2024:NRE240092. [PMID: 39269858 DOI: 10.3233/nre-240092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND A field of study that uses telerehabilitation (TR) is neurorehabilitation; however, standards for medical and technological applications, medicolegal and ethical regulations, and other aspects of neuro-TR are still being developed. OBJECTIVE To address the prerequisites and barriers for implementing TR in neurorehabilitation in the light of present findings. METHODS A narrative review was conducted based on specific questions about the prerequisites for neuro-TR and barriers to its implication. According to a foreground search strategy in the context of neurorehabilitation using TR in neurological patient population, PubMed, EMBASE and Cochrane databases were searched and reviewed. RESULTS Barriers and prerequisites for neuro-TR were mostly grouped under the categories of administrative/organizational, human (beneficiaries/providers), technical, and ethical. Apart from the technical framework, knowledge and the presence of an administrative leader responsible for overseeing TR are crucial prerequisites. The internet and technological constraints rank highest among the barriers. CONCLUSION Since neuro-TR is relatively new with minimal guidelines and regulations, highly technologic, and lack of established practices, it is imperative to determine and fully comprehend the criteria for its uses. After the prerequisites are established, it is imperative to recognize and address implementation constraints, which may differ depending on the community's infrastructure and neurologic condition.
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Affiliation(s)
- Yeşim Kurtaiş Aytür
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
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Lundquist CB, Brunner IC. Cross-cultural adaptation of the Functional Ambulation Categories (FAC) in Danish patients with acquired brain injury. Disabil Rehabil 2024; 46:4287-4294. [PMID: 37752874 DOI: 10.1080/09638288.2023.2261371] [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: 03/14/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE The Functional Ambulation Categories (FAC) is a measurement tool used to classify walking ability according to the amount of physical support required. In this study, the FAC is translated into Danish and the reliability and validity of the FAC are established in a population of patients with acquired brain injury (ABI). METHODS The study took place in a neuro-rehabilitation setting. The translation process followed an accepted forward-backward translation method in six steps. For the assessment of clinometric properties a cross-sectional study design was applied. Interrater reliability was assessed with weighted Cohen's kappa. Construct validity of the FAC was assessed with Spearman's rho by correlating the FAC to walking velocity assessed with the 10-meter walk test and to the number of daily steps assessed with accelerometers. RESULTS The FAC was successfully translated into Danish. For the assessment of clinometric properties, 53 patients were included. Almost perfect interrater reliability was found (κ = 0.92, p < 0.0001). Construct validity was high between FAC and walking velocity (r2 = 0.87, p < 0.0001) and moderate between FAC and the number of daily steps (r2 = 0.62, p < 0.0001). CONCLUSION The Danish version of the FAC was found reliable and valid for use in-patients with ABI.
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Affiliation(s)
| | - Iris Charlotte Brunner
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ouendi N, Avril E, Dervaux B, Pudlo P, Wallard L. Effectiveness of Telerehabilitation Programs in Elderly with Hip or Knee Arthroplasty: A Systematic Review. Telemed J E Health 2024; 30:1507-1521. [PMID: 38574249 DOI: 10.1089/tmj.2023.0622] [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] [Indexed: 04/06/2024] Open
Abstract
Background: Lower limb osteoarthritis (OA) often generates musculoskeletal pain causing functional impairment and decreasing mobility, autonomy, and quality of life. Patients with OA are commonly prescribed specific care for total hip arthroplasty or total knee arthroplasty (THA or TKA), when patients present symptoms that are refractory to nondrug treatments. Currently, when patients are discharged from orthopedic surgery, they are either referred to a rehabilitation department, or sent directly home with assistance such as remote monitoring by teleconsultation or a mobile application. In recent years, there has been an evolution in digital health and in particular telerehabilitation. To determine utility and effectiveness, the aim of this systematic review was to highlight and evaluate different telerehabilitation programs using new information and communication technologies. Methods: Five databases, ScienceDirect, PubMed, Web of Sciences, Scopus, and Google scholar, were searched until 30 June 30, 2023. All studies written in English and meeting our inclusion criteria were included. Databases were screened for "Total Hip Arthroplasty," "Total Knee Arthroplasty," "Total Hip Replacement," "Total Knee Replacement," "Rehabilitation," "Physical Activity," "Physiotherapy," "Telerehabilitation," "Telecommunication*," "Senior*," and "Elderly" in accordance with PRISMA-ScR guideline. Results: Fourteen articles were selected according to inclusion criteria. Telerehabilitation was offered in seven different ways (video call, applications smartphones, website, etc.). Assessments included were mainly quality of life questionnaires, perceived effort after exercises, field surveys on the tool experience, and physical tests to assess motor functions. Conclusion: This review highlights the importance and relevance of evaluating the contributions and limits of new health technologies to improve patient monitoring and thus enable better remote clinical care.
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Affiliation(s)
- Nawel Ouendi
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
- Pôle SSR - Maison Sport Santé - Institut Jean Stablinski, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Eugénie Avril
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
| | - Benjamin Dervaux
- Pôle SSR - Maison Sport Santé - Institut Jean Stablinski, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Philippe Pudlo
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
| | - Laura Wallard
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
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Wanitschek A, Seebacher B, Muehlbacher A, Brenneis C, Ehling R. Comparison of patient-reported outcomes of physical activity and accelerometry in people with multiple sclerosis and ambulatory impairment: A cross-sectional study. Mult Scler Relat Disord 2024; 85:105532. [PMID: 38452648 DOI: 10.1016/j.msard.2024.105532] [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: 07/21/2023] [Revised: 12/29/2023] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Accelerometers and patient-reported outcomes (PRO) are used to assess physical activity (PA) in people with multiple sclerosis (pwMS). So far it is unknown, however, whether these assessments represent mobility limitations in pwMS with mild and moderate to severe disability alike. The primary aim of the study was to assess the correlation between accelerometry and International Physical Activity Questionnaire (IPAQ) scores in pwMS with different degrees of ambulatory impairment. Taken its frequent use into account, the Godin Leisure Time Exercise Questionnaire (GLTEQ) was investigated as additional PRO. METHODS In a prospective cohort of pwMS, correlational analyses were performed between the number of daily steps, time spent in light, moderate to vigorous PA (MVPA) and time spent sitting as assessed using accelerometry (ActiGraph®-GT3X), and the respective IPAQ and GLTEQ scores. Additionally, associations of PA with disease-specific characteristics, aerobic capacity (VO2peak), walking assessments (Timed 25-Foot Walk, T25FW; 2-Minute Walk Test, 2MWT) and walking perception (Multiple Sclerosis Walking Scale-12; MSWS-12) were explored. Patient subgroups with mild (Expanded Disability Status Scale; EDSS score <4.0) and moderate to severe disability (EDSS ≥4.0) were analysed for the impact of ambulatory impairment on PA. Multiple linear regression was used to determine predictors of PA. RESULTS A total of 56 pwMS completed the study, with a mean (standard deviation, SD) age of 48.4 (10.3) years, disease duration of 14.8 (9.6) years and median (interquartile range) EDSS score of 3.5 (2.0 - 4.4). Moderate to weak correlations were found between daily step count and IPAQ total metabolic equivalent (MET) minutes/week (p < 0.001; r = 0.506), MVPA MET-minutes/week (p < 0.01; r = 0.479) and walking MET-minutes/week (p < 0.05; r = 0.372) in the total cohort. Time spent sitting was inversely correlated with total MET-minutes/week and MVPA MET-minutes/week (p < 0.05; r = -0.358 and r = -0.365). Subgroup analysis revealed, that daily step count was significantly correlated with total MET-minutes/week, MVPA MET-minutes/week and walking MET-minutes/week (p < 0.01, r = 0.569; p < 0.01, r = 0.531 and p < 0.05, r = 0.480, respectively) in the "mild disability" subgroup only, whereas time spent sitting was inversely correlated with total MET-minutes/week (p < 0.05; r = -0.582) in the "moderate to severe disability" subgroup. There was no association between objectively assessed PA and GLTEQ scores in any group. In the total cohort, moderate to weak correlations were found between daily step count and walking assessments (T25FW: p < 0.01, ρ = -0.508; 2MWT: p < 0.01, ρ=0.463) and MSWS-12 (p < 0.001; ρ = -0.609). Moderate to weak correlations were also observed between VO2peak and walking assessments (T25FW: p < 0.01; ρ = -0.516; 2MWT: p < 0.01, ρ=0.480). Multiple linear regression analysis identified disability and VO2peak as predictors of PA (p = 0.045; β=0.25 and p < 0.001; β=0.49). CONCLUSION Significant associations of objective PA measurements using accelerometry with IPAQ were found only in pwMS with "mild disability". In pwMS with "moderate to severe disability", IPAQ did not reflect the objectively assessed amount of PA. In our cohort, GLTEQ showed no association with objectively assessed PA. Thus, an MS-specific self-reported questionnaire for assessing PA is warranted.
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Affiliation(s)
- Andreas Wanitschek
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Barbara Seebacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria; Department of Rehabilitation Science, Clinic for Rehabilitation Muenster, Muenster, Austria
| | - Andreas Muehlbacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria.
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Michaud M, Guérin A, Dejean de La Bâtie M, Bancel L, Oudre L, Tricot A. The Analytical Validity of Stride Detection and Gait Parameters Reconstruction Using the Ankle-Mounted Inertial Measurement Unit Syde ®. SENSORS (BASEL, SWITZERLAND) 2024; 24:2413. [PMID: 38676029 PMCID: PMC11054238 DOI: 10.3390/s24082413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/04/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024]
Abstract
The increasing use of inertial measurement units (IMU) in biomedical sciences brings new possibilities for clinical research. The aim of this paper is to demonstrate the accuracy of the IMU-based wearable Syde® device, which allows day-long and remote continuous gait recording in comparison to a reference motion capture system. Twelve healthy subjects (age: 23.17 ± 2.04, height: 174.17 ± 6.46 cm) participated in a controlled environment data collection and performed a series of gait tasks with both systems attached to each ankle. A total of 2820 strides were analyzed. The results show a median absolute stride length error of 1.86 cm between the IMU-based wearable device reconstruction and the motion capture ground truth, with the 75th percentile at 3.24 cm. The median absolute stride horizontal velocity error was 1.56 cm/s, with the 75th percentile at 2.63 cm/s. With a measurement error to the reference system of less than 3 cm, we conclude that there is a valid physical recovery of stride length and horizontal velocity from data collected with the IMU-based wearable Syde® device.
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Affiliation(s)
- Mona Michaud
- Sysnav, 27200 Vernon, France; (M.M.); (A.G.); (L.B.)
- Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, CNRS, SSA, INSERM, Centre Borelli, 91190 Gif-sur-Yvette, France
| | - Alexandre Guérin
- Sysnav, 27200 Vernon, France; (M.M.); (A.G.); (L.B.)
- DataShape, Inria Saclay Ile-de-France, 91120 Palaiseau, France
- Laboratoire de Mathématiques d’Orsay, Université Paris-Saclay, CNRS, 91405 Orsay, France
| | | | | | - Laurent Oudre
- Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, CNRS, SSA, INSERM, Centre Borelli, 91190 Gif-sur-Yvette, France
| | - Alexis Tricot
- Sysnav, 27200 Vernon, France; (M.M.); (A.G.); (L.B.)
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Dai PY, Wu YC, Sheu RK, Wu CL, Liu SF, Lin PY, Cheng WL, Lin GY, Chung HC, Chen LC. An automated ICU agitation monitoring system for video streaming using deep learning classification. BMC Med Inform Decis Mak 2024; 24:77. [PMID: 38500135 PMCID: PMC10946151 DOI: 10.1186/s12911-024-02479-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To address the challenge of assessing sedation status in critically ill patients in the intensive care unit (ICU), we aimed to develop a non-contact automatic classifier of agitation using artificial intelligence and deep learning. METHODS We collected the video recordings of ICU patients and cut them into 30-second (30-s) and 2-second (2-s) segments. All of the segments were annotated with the status of agitation as "Attention" and "Non-attention". After transforming the video segments into movement quantification, we constructed the models of agitation classifiers with Threshold, Random Forest, and LSTM and evaluated their performances. RESULTS The video recording segmentation yielded 427 30-s and 6405 2-s segments from 61 patients for model construction. The LSTM model achieved remarkable accuracy (ACC 0.92, AUC 0.91), outperforming other methods. CONCLUSION Our study proposes an advanced monitoring system combining LSTM and image processing to ensure mild patient sedation in ICU care. LSTM proves to be the optimal choice for accurate monitoring. Future efforts should prioritize expanding data collection and enhancing system integration for practical application.
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Affiliation(s)
- Pei-Yu Dai
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Yu-Cheng Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ruey-Kai Sheu
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
- Department of post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Shu-Fang Liu
- Supervisor of Nursing Department, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pei-Yi Lin
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Lin Cheng
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Guan-Yin Lin
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Huang-Chien Chung
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Lun-Chi Chen
- College of Engineering, Tunghai University, Taichung, Taiwan
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Reoli R, Therrien A, Millar J, Hill N, Varghese R, Roemmich R, Whitall J, Bastian A, Keller J. The Scale for Assessment and Rating of Ataxia Is Reliable and Valid in the Telehealth Setting for Patients With Cerebellar Ataxia. Phys Ther 2024; 104:pzad166. [PMID: 38051602 PMCID: PMC10921830 DOI: 10.1093/ptj/pzad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/03/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Health care has increasingly expanded into a hybrid in-person/telehealth model. Patients with a variety of health conditions, including cerebellar ataxia, have received virtual health evaluations; however, it remains unknown whether some outcome measures that clinicians utilize in the telehealth setting are reliable and valid. The goal of this project is to evaluate the psychometric properties of the Scale for Assessment and Rating of Ataxia (SARA) for patients with cerebellar ataxia in the telehealth setting. METHODS Nineteen individuals with cerebellar impairments were recruited on a voluntary basis. Participants completed 2 30-minute testing sessions during which a clinical examination and the SARA were performed. One session was performed in person, and the other session was assessed remotely. Outcome measure performance was video recorded in both environments and independently scored by 4 additional raters with varying levels of clinical experience (ranging from 6 months to 29 years). Concurrent validity was assessed with the Spearman rank order correlation coefficient (α < .05), comparing the virtual SARA scores to their gold standard in-person scores. Interrater reliability was evaluated with the intraclass correlation coefficient (ICC) (2,4) (α < .05). RESULTS Fourteen of the 19 participants completed both in-person and telehealth SARA evaluations. We found that the in-person SARA and the telehealth SARA have large concurrent validity (Spearman rho significant at the 2-tailed α of .01 = 0.90; n = 14). Additionally, raters of varying years of experience had excellent interrater reliability for both the in-person SARA (ICC [2,4] = 0.97; n = 19) and the telehealth SARA (ICC [2,4] = 0.98; n = 14). CONCLUSION Our results show that the telehealth SARA is comparable to the in-person SARA. Additionally, raters of varying years of clinical experience were found to have excellent interrater reliability scores for both remote and in-person SARA evaluations. IMPACT Our study shows that the SARA can be used in the telehealth setting for patients with ataxia.
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Affiliation(s)
- Rachel Reoli
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Rehabilitation Sciences, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Amanda Therrien
- Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, Pennsylvania, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jennifer Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nayo Hill
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rini Varghese
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ryan Roemmich
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jill Whitall
- Department of Rehabilitation Sciences, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Amy Bastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Keller
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Esterov D, Pradhan S, Driver S, Whyte J, Bell KR, Barber J, Temkin N, Bombardier CH. The Temporal Relationship Between Moderate to Vigorous Physical Activity and Secondary Conditions During the First Year After Moderate to Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:506-513. [PMID: 37827487 DOI: 10.1016/j.apmr.2023.10.001] [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: 05/03/2023] [Revised: 09/07/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To determine the cross-sectional and temporal relationships between minutes per week of moderate to vigorous physical activity (MVPA) as measured by a wrist-worn accelerometer and secondary conditions in the first year after moderate to severe traumatic brain injury (TBI). DESIGN Prospective longitudinal cohort study. SETTING Four inpatient rehabilitation centers. PARTICIPANTS Individuals (N = 180) with moderate-severe TBI enrolled in the TBI Model Systems Study. INTERVENTIONS Participants wore a wrist accelerometer for 7 days immediately post discharge, and for 7 consecutive days at 6- and 12-months post injury. MAIN OUTCOME MEASURES Minutes per week of MVPA from daily averages based on wrist worn accelerometer. Secondary conditions included depression (Patient Health Questionnaire-9), fatigue (PROMIS Fatigue), Pain (Numeric Rating Scale), Sleep (Pittsburgh Sleep Quality Index), and cognition (Brief Test of Adult Cognition by Telephone). RESULTS At baseline, 6 and 12 months, 61%, 70% and 79% of the sample achieved at least 150 minutes per week of MVPA. The correlations between minutes of MVPA between baseline, 6 and 12 months were significant (r = 0.53-0.73), as were secondary conditions over these time points. However, no significant correlations were observed between minutes of MVPA and any secondary outcomes cross-sectionally or longitudinally at any time point. CONCLUSIONS Given the robust relationships physical activity has with outcomes in the general population, further research is needed to understand the effect of physical activity in individuals with moderate-severe TBI.
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Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Sujata Pradhan
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA
| | - Simon Driver
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallax, TX
| | - John Whyte
- Department of Physical Medicine and Rehabilitation, Moss Rehabilitation Research Institute, Elkins Park, PA
| | - Kathleen R Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason Barber
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA
| | - Nancy Temkin
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA
| | - Charles H Bombardier
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA.
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McGibbon CA, Sexton A, Gryfe P. Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson's disease by facilitating progressive exercise intensity. Sci Rep 2024; 14:4417. [PMID: 38388571 PMCID: PMC10883950 DOI: 10.1038/s41598-024-54200-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
People with Parkinson's disease (PwPD) can benefit from progressive high-intensity exercise facilitated with a lower-extremity exoskeleton, but the mechanisms explaining these benefits are unknown. We explored the relationship between exercise intensity progression and memory and gait outcomes in PwPD who performed 8 weeks (2 × per week) of progressive exercise with and without a lower-extremity powered exoskeleton, as the planned exploratory endpoint analysis of an open-label, parallel, pilot randomized controlled trial. Adults 50-85 years old with a confirmed diagnosis of PD participated. Twenty-seven participants randomized to exercise with (Exo = 13) or without (Nxo = 14) the exoskeleton were included in this exploratory endpoint analysis. Detailed exercise logs were kept and actigraphy was used to measure activity count*min-1 (ACPM) during all exercise sessions. Only the Exo group were able to progressively increase their ACPM over the entire 8-week intervention, whereas the Nxo group plateaued after 4 weeks. Exercise intensity progression correlated with change in the memory sub-scale of the SCOPA-COG and change in gait endurance from the 6MWT, consistent with the prevailing hypotheses linking high-intensity interval exercise to improved muscle and brain function via angiogenic and neurotrophic mechanisms. Facilitating high-intensity exercise with advanced rehabilitation technology is warranted for improving memory and gait endurance in PwPD.Registration: ClinicalTrials.gov, NCT03583879 (7/10/2018).
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Affiliation(s)
- Chris A McGibbon
- Institute of Biomedical Engineering, University of New Brunswick, 25 Dineen Dr, Fredericton, NB, E3B 5A3, Canada.
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada.
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, 25 Dineen Dr, Fredericton, NB, E3B 5A3, Canada
| | - Pearl Gryfe
- Assistive Technology Clinic, 107 Grenadier Cres, Thornhill, ON, L4J 7V7, Canada
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Arntzen EC, Braaten T, Fikke HK, Normann B. Feasibility of a new intervention addressing group-based balance and high-intensity training, physical activity, and employment in individuals with multiple sclerosis: a pilot randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1258737. [PMID: 38259873 PMCID: PMC10801079 DOI: 10.3389/fresc.2023.1258737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
Background and purpose Impaired sensorimotor function, reduced physical activity and unemployment are common challenges in persons with multiple sclerosis (pwMS), even when disability is low. CoreDISTparticipation is a new, multidisciplinary intervention delivered across healthcare levels systematically addressing these elements. This study primarily aimed to evaluate the feasibility of CoreDISTparticipation in terms of process, resources, management, and scientific outcomes. The secondary aim was to evaluate initial efficacy in terms of possible short-term effects compared with the usual care on barriers to employment, balance, walking, health-related quality of life (HRQoL), and physical activity. Methods This assessor-blinded prospective pilot randomized controlled trial included 29 pwMS [Expanded Disability Status Scale (EDSS): 0-3.5] randomly allocated to the intervention group (CoreDISTparticipation) (n = 15) or usual care (n = 14). CoreDISTparticipation consists of three phases: (1) hospital outpatient clinic: MS nurse work-focused session and physiotherapist exploring balance; (2) municipality: a digital meeting with pwMS, employer, MS nurse, and physiotherapist addressing employment and physical activity, 4 weeks indoor CoreDIST balance training (60 min × 2/week); and (3) 4 weeks outdoor CoreDIST balance training and high-intensity running/walking (60 min × 2/week). Assessments were undertaken at baseline and at weeks 6 and 11. Primary feasibility metric outcomes were the reporting of process, resources, management, and scientific outcomes. Efficacy measures included evaluation of the Multiple Sclerosis Work Difficulties Questionnaire-23 Norwegian Version (MSWDQ-23NV) and 6 Minute Walk-test as well as the Trunk Impairment Scale-modified Norwegian Version, Mini-Balance Evaluation Systems Test (Mini-BESTest), Multiple Sclerosis Walking Scale-12, Multiple Sclerosis Impact Scale-29 Norwegian Version (MSIS-29NV), ActiGraph wGT3x-BT monitors, and AccuGait Optimized force platform. The statistical analyses included repeated-measures mixed models performed in IBM SPSS Version 29. Results The primary feasibility metric outcomes demonstrated the need for minor adjustments in regard to the content of the intervention and increasing the number of staff. In regard to the efficacy measures, one person attended no postintervention assessments and was excluded, leaving 28 participants (mean EDSS: 1.8, SD: 1). The mean percentage employment was 46.3 (SD: 35.6) and 65.4 (SD: 39.3) in the CoreDISTparticipation and usual care group, respectively. No between-group differences were found. MSWDQ-23NV demonstrated a within-group difference of 5.7 points from baseline to Week 11 (P = 0.004; confidence interval: 2.2-9.3). Mini-BESTest and MSIS-29NV demonstrated within-group differences. The study is registered in ClinicalTrials.gov (Identifier: NCT05057338). Discussion The CoreDISTparticipation intervention is feasible to support pwMS when the identified feasibility metric outcomes in regard to process, resource, management, and scientific outcome metrics are adjusted to improve feasibility. Regarding efficacy measures, no between-group differences were detected; however, within-group differences in barriers to employment, balance, and HRQoL were detected for the CoreDISTparticipation group. A larger comparative trial is needed to explore between-group differences and should accurately and precisely define usual care and address the identified limitations of this study.
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Affiliation(s)
- Ellen Christin Arntzen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Kongsgården Physiotherapy, Bodø, Norway
| | - Tonje Braaten
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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Nunes AS, Yildiz Potter İ, Mishra RK, Bonato P, Vaziri A. A deep learning wearable-based solution for continuous at-home monitoring of upper limb goal-directed movements. Front Neurol 2024; 14:1295132. [PMID: 38249724 PMCID: PMC10796739 DOI: 10.3389/fneur.2023.1295132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Monitoring upper limb function is crucial for tracking progress, assessing treatment effectiveness, and identifying potential problems or complications. Hand goal-directed movements (GDMs) are a crucial aspect of daily life, reflecting planned motor commands with hand trajectories towards specific target locations. Previous studies have shown that GDM tasks can detect early changes in upper limb function in neurodegenerative diseases and can be used to track disease progression over time. Methods In this study, we used accelerometer data from stroke survivor participants and controls doing activities of daily living to develop an automated deep learning approach to detect GDMs. The model performance for detecting GDM or non-GDM from windowed data achieved an AUC of 0.9, accuracy 0.83, sensitivity 0.81, specificity 0.84 and F1 0.82. Results We further validated the utility of detecting GDM by extracting features from GDM periods and using these features to classify whether the measurements are collected from a stroke survivor or a control participant, and to predict the Fugl-Meyer assessment score from stroke survivors. Discussion This study presents a promising and reliable tool for monitoring upper limb function in a real-world setting, and assessing biomarkers related to upper limb health in neurological, neuromuscular and muscles disorders.
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Affiliation(s)
| | | | | | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital, Boston, MA, United States
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12
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Nie L, He J, Wang J, Wang R, Huang L, Jia L, Kim YT, Bhawal UK, Fan X, Zille M, Jiang C, Chen X, Wang J. Environmental Enrichment for Stroke and Traumatic Brain Injury: Mechanisms and Translational Implications. Compr Physiol 2023; 14:5291-5323. [PMID: 38158368 DOI: 10.1002/cphy.c230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Acquired brain injuries, such as ischemic stroke, intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), can cause severe neurologic damage and even death. Unfortunately, currently, there are no effective and safe treatments to reduce the high disability and mortality rates associated with these brain injuries. However, environmental enrichment (EE) is an emerging approach to treating and rehabilitating acquired brain injuries by promoting motor, sensory, and social stimulation. Multiple preclinical studies have shown that EE benefits functional recovery, including improved motor and cognitive function and psychological benefits mediated by complex protective signaling pathways. This article provides an overview of the enriched environment protocols used in animal models of ischemic stroke, ICH, and TBI, as well as relevant clinical studies, with a particular focus on ischemic stroke. Additionally, we explored studies of animals with stroke and TBI exposed to EE alone or in combination with multiple drugs and other rehabilitation modalities. Finally, we discuss the potential clinical applications of EE in future brain rehabilitation therapy and the molecular and cellular changes caused by EE in rodents with stroke or TBI. This article aims to advance preclinical and clinical research on EE rehabilitation therapy for acquired brain injury. © 2024 American Physiological Society. Compr Physiol 14:5291-5323, 2024.
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Affiliation(s)
- Luwei Nie
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinxin He
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
- Key Laboratory for Brain Science Research and Transformation in the Tropical Environment of Hainan Province, Hainan Medical University, Haikou, China
| | - Junmin Wang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ruike Wang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Leo Huang
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Lin Jia
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yun Tai Kim
- Division of Functional Food Research, Korea Food Research Institute, Wanju-gun, Jeollabuk-do, Republic of Korea
- Department of Food Biotechnology, Korea University of Science & Technology, Daejeon, Republic of Korea
| | - Ujjal K Bhawal
- Research Institute of Oral Science, Nihon University School of Dentistry at Matsudo, Chiba, Japan
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Xiaochong Fan
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Marietta Zille
- Department of Pharmaceutical Sciences, Division of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xuemei Chen
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jian Wang
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
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Woelfle T, Pless S, Reyes Ó, Wiencierz A, Kappos L, Granziera C, Lorscheider J. Smartwatch-derived sleep and heart rate measures complement step counts in explaining established metrics of MS severity. Mult Scler Relat Disord 2023; 80:105104. [PMID: 37913676 DOI: 10.1016/j.msard.2023.105104] [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: 06/27/2023] [Revised: 10/01/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Passive remote monitoring of patients with MS (PwMS) with sensor-based wearable technologies promises near-continuous evaluation with high ecological validity. Step counts correlate strongly with traditional measures of MS severity. We hypothesized that remote monitoring of sleep and heart rate will yield complementary information. METHODS We recruited 31 PwMS and 31 age- and sex-matched healthy volunteers (HV) as part of the dreaMS feasibility study (NCT04413032). Fitbit Versa 2 smartwatches were worn for 6 weeks and provided a total of 25 features for activity, heart rate, and sleep. Features were selected based on their pairwise intercorrelation (Pearson |r| < 0.6), test-retest reliability (intraclass correlation coefficient ≥ 0.6 or median coefficient of variation < 0.2) and group comparisons between HV and PwMS with moderate disability (expanded disability status scale (EDSS) ≥ 3.5) (rank-biserial |r| ≥ 0.5). These selected features were correlated with clinical reference tests (EDSS, timed 25-foot walk (T25FW), MS-walking scale (MSWS-12)) in PwMS, and multivariate models adjusted for age, sex, and disease duration were compared. RESULTS We analyzed 28 PwMS (68% female, mean age 44 years, median EDSS 3.0) and 26 HV in our primary analysis. The objectively selected features discriminated well between HV and PwMS with moderate disability with rank-biserial r = 0.83 for Total number of steps, 0.51 for Deep sleep proportion, -0.51 for Median heart rate, 0.85 for Proportion very active, and 0.65 for Total number of floors. In PwMS they correlated strongly with the three clinical reference tests EDSS (strongest Spearman ρ = -0.75 for Proportion very active), T25FW (-0.75 for Total number of floors), and MSWS-12 (-0.72 for Total number of floors). Deep sleep proportion and Median heart rate complemented Total number of steps in explaining the variance of reference tests. CONCLUSIONS Activity, deep sleep and heart rate measures can be derived reliably from smartwatches and contain independent clinically meaningful information about MS severity, highlighting their potential for continuous passive monitoring in both clinical trials and clinical care of PwMS.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland; Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital, University of Basel, Switzerland.
| | - Silvan Pless
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland
| | | | - Andrea Wiencierz
- Department of Clinical Research, University Hospital, University of Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland
| | - Cristina Granziera
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland; Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital, University of Basel, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland
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McCarthy M, Jevotovsky D, Mann D, Veerubhotla A, Muise E, Whiteson J, Rizzo JR. Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice. Rehabil Nurs 2023; 48:209-215. [PMID: 37723623 PMCID: PMC10840984 DOI: 10.1097/rnj.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity. DESIGN AND METHODS This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings. RESULTS The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress. CLINICAL RELEVANCE If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services. CONCLUSION RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.
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Affiliation(s)
- Margaret McCarthy
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Devin Mann
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Jonathan Whiteson
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - John Ross Rizzo
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
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van den Bergh R, Evers LJW, de Vries NM, Silva de Lima AL, Bloem BR, Valenti G, Meinders MJ. Usability and utility of a remote monitoring system to support physiotherapy for people with Parkinson's disease. Front Neurol 2023; 14:1251395. [PMID: 37900610 PMCID: PMC10601712 DOI: 10.3389/fneur.2023.1251395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/07/2023] [Indexed: 10/31/2023] Open
Abstract
Background Physiotherapy for persons with Parkinson's disease (PwPD) could benefit from objective and continuous tracking of physical activity and falls in daily life. Objectives We designed a remote monitoring system for this purpose and describe the experiences of PwPD and physiotherapists who used the system in daily clinical practice. Methods Twenty-one PwPD (15 men) wore a sensor necklace to passively record physical activity and falls for 6 weeks. They also used a smartphone app to self-report daily activities, (near-)falls and medication intake. They discussed those data with their PD-specialized physiotherapist (n = 9) during three regular treatment sessions. User experiences and aspects to be improved were gathered through interviews with PwPD and physiotherapists, resulting in system updates. The system was evaluated in a second pilot with 25 new PwPD (17 men) and eight physiotherapists. Results We applied thematic analysis to the interview data resulting in two main themes: usability and utility. First, the usability of the system was rated positively, with the necklace being easy to use. However, some PwPD with limited digital literacy or cognitive impairments found the app unclear. Second, the perceived utility of the system varied among PwPD. While many PwPD were motivated to increase their activity level, others were not additionally motivated because they perceived their activity level as high. Physiotherapists appreciated the objective recording of physical activity at home and used the monitoring of falls to enlarge awareness of the importance of falls for PwPD. Based on the interview data of all participants, we drafted three user profiles for PwPD regarding the benefits of remote monitoring for physiotherapy: for profile 1, a monitoring system could act as a flagging dashboard to signal the need for renewed treatment; for profile 2, a monitoring system could be a motivational tool to maintain physical activity; for profile 3, a monitoring system could passively track physical activity and falls at home. Finally, for a subgroup of PwPD the burdens of monitoring will outweigh the benefits. Conclusions Overall, both PwPD and physiotherapists underline the potential of a remote monitoring system to support physiotherapy by targeting physical activity and (near-)falls. Our findings emphasize the importance of personalization in remote monitoring technology, as illustrated by our user profiles.
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Affiliation(s)
- Robin van den Bergh
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Luc J. W. Evers
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
- Radboud University, Institute for Computing and Information Sciences, Department of Data Science, Nijmegen, Netherlands
| | - Nienke M. de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Ana L. Silva de Lima
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
| | - Giulio Valenti
- Philips Research, Department of Connected Care and Remote Patient Management, Eindhoven, Netherlands
| | - Marjan J. Meinders
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, Netherlands
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Dorsch EM, Röhling HM, Zocholl D, Hafermann L, Paul F, Schmitz-Hübsch T. Progression events defined by home-based assessment of motor function in multiple sclerosis: protocol of a prospective study. Front Neurol 2023; 14:1258635. [PMID: 37881311 PMCID: PMC10597627 DOI: 10.3389/fneur.2023.1258635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background This study relates to emerging concepts of appropriate trial designs to evaluate effects of intervention on the accumulation of irreversible disability in multiple sclerosis (MS). Major starting points of our study are the known limitations of current definitions of disability progression by rater-based clinical assessment and the high relevance of gait and balance dysfunctions in MS. The study aims to explore a novel definition of disease progression using repeated instrumental assessment of relevant motor functions performed by patients in their home setting. Methods The study is a prospective single-center observational cohort study with the primary outcome acquired by participants themselves, a home-based assessment of motor functions based on an RGB-Depth (RGB-D) camera, a camera that provides both depth (D) and color (RGB) data. Participants are instructed to perform and record a set of simple motor tasks twice a day over a one-week period every 6 months. Assessments are complemented by a set of questionnaires. Annual research grade assessments are acquired at dedicated study visits and include clinical ratings as well as structural imaging (MRI and optical coherence tomography). In addition, clinical data from routine visits is provided semiannually by treating neurologists. The observation period is 24 months for the primary endpoint with an additional clinical assessment at 27 month to confirm progression defined by the Expanded Disability Status Scale (EDSS). Secondary analyses aim to explore the time course of changes in motor parameters and performance of the novel definition against different alternative definitions of progression in MS. The study was registered at Deutsches Register für Klinische Studien (DRKS00027042). Discussion The study design presented here investigates disease progression defined by marker-less home-based assessment of motor functions against 3-month confirmed disease progression (3 m-CDP) defined by the EDSS. The technical approach was chosen due to previous experience in lab-based settings. The observation time per participant of 24, respectively, 27 months is commonly conceived as the lower limit needed to study disability progression. Defining a valid digital motor outcome for disease progression in MS may help to reduce observation times in clinical trials and add confidence to the detection of progression events in MS.
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Affiliation(s)
- Eva-Maria Dorsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Hanna Marie Röhling
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Motognosis GmbH, Berlin, Germany
| | - Dario Zocholl
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lorena Hafermann
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Khantan M, Avery M, Aung PT, Zarin RM, Hammelef E, Shawki N, Serruya MD, Napoli A. The NuroSleeve, a user-centered 3D printed hybrid orthosis for individuals with upper extremity impairment. J Neuroeng Rehabil 2023; 20:103. [PMID: 37542335 PMCID: PMC10403889 DOI: 10.1186/s12984-023-01228-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Active upper extremity (UE) assistive devices have the potential to restore independent functional movement in individuals with UE impairment due to neuromuscular diseases or injury-induced chronic weakness. Academically fabricated UE assistive devices are not usually optimized for activities of daily living (ADLs), whereas commercially available alternatives tend to lack flexibility in control and activation methods. Both options are typically difficult to don and doff and may be uncomfortable for extensive daily use due to their lack of personalization. To overcome these limitations, we have designed, developed, and clinically evaluated the NuroSleeve, an innovative user-centered UE hybrid orthosis. METHODS This study introduces the design, implementation, and clinical evaluation of the NuroSleeve, a user-centered hybrid device that incorporates a lightweight, easy to don and doff 3D-printed motorized UE orthosis and a functional electrical stimulation (FES) component. Our primary goals are to develop a customized hybrid device that individuals with UE neuromuscular impairment can use to perform ADLs and to evaluate the benefits of incorporating the device into occupational therapy sessions. The trial is designed as a prospective, open-label, single-cohort feasibility study of eight-week sessions combined with at-home use of the device and implements an iterative device design process where feedback from participants and therapists informs design improvement cycles. RESULTS All participants learned how to independently don, doff, and use the NuroSleeve in ADLs, both in clinical therapy and in their home environments. All participants showed improvements in their Canadian Occupational Performance Measure (COPM), which was the primary clinical trial outcome measure. Furthermore, participants and therapists provided valuable feedback to guide further development. CONCLUSIONS Our results from non-clinical testing and clinical evaluation demonstrate that the NuroSleeve has met feasibility and safety goals and effectively improved independent voluntary function during ADLs. The study's encouraging preliminary findings indicate that the NuroSleeve has met its technical and clinical objectives while improving upon the limitations of the existing UE orthoses owing to its personalized and flexible approach to hardware and firmware design. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04798378, https://clinicaltrials.gov/ct2/show/NCT04798378 , date of registration: March 15, 2021.
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Affiliation(s)
- Mehdi Khantan
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
- Department of Electrical and Computer Engineering, Temple University, Philadelphia, PA, 19121, USA
| | | | - Phyo Thuta Aung
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Rachel M Zarin
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Emma Hammelef
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Nabila Shawki
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Mijail Demian Serruya
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Alessandro Napoli
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
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Kowahl N, Shin S, Barman P, Rainaldi E, Popham S, Kapur R. Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study. JMIR Hum Factors 2023; 10:e48270. [PMID: 37535417 PMCID: PMC10436116 DOI: 10.2196/48270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Mobility is a meaningful aspect of an individual's health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring. OBJECTIVE Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies. METHODS We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure. RESULTS In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device-based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time. CONCLUSIONS We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions.
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Affiliation(s)
- Nathan Kowahl
- Verily Life Sciences, South San Francisco, CA, United States
| | - Sooyoon Shin
- Verily Life Sciences, South San Francisco, CA, United States
| | - Poulami Barman
- Verily Life Sciences, South San Francisco, CA, United States
| | - Erin Rainaldi
- Verily Life Sciences, South San Francisco, CA, United States
| | - Sara Popham
- Verily Life Sciences, South San Francisco, CA, United States
| | - Ritu Kapur
- Verily Life Sciences, South San Francisco, CA, United States
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19
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Judica E, Tropea P, Bouça-Machado R, Marín M, Calarota E, Cozma L, Badea R, Ahmed M, Brach M, Ferreira JJ, Corbo M. Personalized Integrated Care Promoting Quality of Life for Older People: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47916. [PMID: 37486732 PMCID: PMC10407767 DOI: 10.2196/47916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Alzheimer disease (AD) and Parkinson disease (PD) are the 2 most common neurodegenerative diseases affecting millions of people worldwide. The Personalized Integrated Care Promoting Quality of Life for Older People (PC4L) project proposes an integrated, scalable, and interactive care ecosystem that can be easily adapted to the needs of several neurodegenerative and chronic diseases, care institutions, and end user requirements. OBJECTIVE The study protocol developed within the framework of the PC4L project aims to iteratively test the integrated platform and its modules, and focuses primarily on assessing the impact of the proposed solution (ie, the PC4L platform) on patients' quality of life, as well as its usability and feasibility on a large-scale sample size in 3 different scenarios (home, neurorehabilitation, and day care centers). METHODS A prospective multicenter clinical study is conducted in 5 European countries (Germany, Italy, Portugal, Romania, and Spain) at 6 different pilot centers, for 3 months, in patients with PD, Parkinsonism, AD, and other dementias (ODs). Patients were randomized in a ratio of 1:1 to the intervention group (use of the PC4L system) or the control group (no intervention). The PC4L system consists mainly of a wristband for monitoring parameters such as steps and levels of physical activity, and the PC4L app, which includes different engaging functionalities. Both groups are assessed through baseline and end-of-study clinical evaluations, including assessment of quality of life through the EQ-5D-3L scale. RESULTS The study protocol is part of a project approved and funded by the European Commission Horizon 2020 (grant agreement number 875221). The ethics committees of all involved centers reviewed and approved the study protocol. The study began with the recruitment phase in September 2022, and enrollment ended in February 2023. Recruitment is now closed (April 2023). The results of this study are expected to be published in summer 2023. A total of 558 patients, 279 per study group, were recruited. The results will allow to clarify the impact of PC4L on quality of life, will assess the empowerment of patients and the medical resources use, as well as the usability of the final version of the PC4L system. It will also provide information on the support of the system as a tool to facilitate the decision-making process. CONCLUSIONS The PC4L project intends to test a technology-based, integrated, scalable, and interactive care platform on patients with neurodegenerative diseases and proposes a good coordinated care model between all involved actors. Future developments of the PC4L solution may involve caregivers and socio-health professionals in the decision-making process in order to facilitate efficient communication between all stakeholders and ensure reliable and protected access to data within Europe. TRIAL REGISTRATION ClinicalTrials.gov NCT05538455; https://clinicaltrials.gov/study/NCT05538455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47916.
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Affiliation(s)
- Elda Judica
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Peppino Tropea
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | | | | | - Elisa Calarota
- Wohlfahrtswerk für Baden-Wurttemburg, Stuttgart, Germany
| | - Liviu Cozma
- University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Badea
- University and Emergency Hospital of Bucharest, Bucharest, Romania
| | - Mona Ahmed
- Institute of Sport and Exercise Sciences, Münster University, Münster, Germany
| | - Michael Brach
- Institute of Sport and Exercise Sciences, Münster University, Münster, Germany
| | | | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
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20
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Block VJ, Cheng S, Juwono J, Cuneo R, Kirkish G, Alexander AM, Khan M, Akula A, Caverzasi E, Papinutto N, Stern WA, Pletcher MJ, Marcus GM, Olgin JE, Hauser SL, Gelfand JM, Bove R, Cree BAC, Henry RG. Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis. Mult Scler 2023; 29:363-373. [PMID: 36573559 PMCID: PMC9972237 DOI: 10.1177/13524585221143726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown. OBJECTIVE Evaluate the association of structural central nervous system pathology with ambulatory disability. METHODS Fifty adults with progressive or relapsing MS with motor disability who could walk >2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics. RESULTS Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04). CONCLUSION These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.
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Affiliation(s)
- Valerie J Block
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA/Department of Physical Therapy and Rehabilitation
Science, University of California San Francisco, San Francisco, CA,
USA
| | - Shuiting Cheng
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Jeremy Juwono
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Richard Cuneo
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Gina Kirkish
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Amber M Alexander
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Mahir Khan
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Amit Akula
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Eduardo Caverzasi
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA/Department of Brain and Behavioral Sciences, University
of Pavia, Pavia, Italy
| | - Nico Papinutto
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | | | - Mark J Pletcher
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA/Department of
Medicine, University of California San Francisco, San Francisco, CA,
USA
| | - Gregory M Marcus
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Bruce AC Cree
- BAC Cree UCSF Weill Institute for
Neurosciences, Department of Neurology, University of California, 1651 4th St
Suite 252, San Francisco, San Francisco, CA 94158, USA.
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21
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Macdonald E, Buchan D, Cerexhe L, Renfrew L, Sculthorpe N. Accelerometer measured physical activity and sedentary time in individuals with multiple sclerosis versus age matched controls: A systematic review and meta-analysis. Mult Scler Relat Disord 2023; 69:104462. [PMID: 36521386 DOI: 10.1016/j.msard.2022.104462] [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: 08/24/2021] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND People with Multiple Sclerosis (PwMS) find it more difficult to engage in physical activity (PA) than healthy controls. Accelerometers can be used to measure sedentary time and free-living physical activity, understanding the differences between PwMS and controls can help inform changes such as interventions to promote a more active lifestyle. This in turn will help prevent secondary conditions and reduce symptom progression. OBJECTIVE To conduct a systematic review and meta-analysis on accelerometer measured sedentary behavior and physical activity between PwMS and healthy controls. METHODS A systematic search of five databases (PubMed, Web of Science, Ovid, Science Direct and CINAHIL) from inception until 22nd November 2019. Inclusion criteria was (1) included a group of participants with a definite diagnosis of multiple sclerosis of any type; (2) have 3 or more days of PA monitoring using accelerometers during free living conditions; (3) include age matched healthy controls; (4) assess adults over the age of 18; (5) reported data had to have been reported in a manner suitable for quantitative pooling including: percent of time spent sedentary, minutes per day of sedentary, light, moderate, vigorous activity (moderate and vigorous totaled together), steps per day or counts per day. RESULTS Initial search produced 9021 papers, after applying inclusion criteria 21 eligible papers were included in the study. One paper was a longitudinal study from which only baseline data was included. One paper was a reliability and validity study, with data for PwMS versus controls in the validity section. All other papers are cross sectional, with one being a pilot study and another a random control study. One paper used two devices in unison, only one set of data is included in the statistics. Outcome data was available for 1098 participants, 579 PwMS and 519 healthy controls. Significant differences were seen in all categories tested: (1) sedentary time (min/day), standard mean difference -0.286, P = 0.044, n = 4 studies; (2) relative sedentary time (%/day), standard mean difference -0.646, P = 0.000, n = 5 studies; (3) LPA (min/day), standard mean difference 0.337, P = 0.039, n = 5 studies; (4) relative LPA (%/day), standard mean difference 0.211, P = 0.152, n = studies; (5) MVPA (min/day), standard mean difference 0.801, P = 0.000, n = 8 studies; (6) relative MVPA (%/day), mean difference 0.914, P = 0.000, n = 5 studies; (7) step count, standard mean difference 0.894, P = 0.000, n = 8 studies; (8) activity count, standard mean difference 0.693, P = 0.000, n = 13 studies. CONCLUSION PwMS are more sedentary and engage in less LPA, MVPA, steps per day and accelerometer counts per day than healthy controls when measured using accelerometers during free-living conditions.
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Affiliation(s)
- Eilidh Macdonald
- Institute of Clinical Exercise & Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park, South Lanarkshire, Scotland G72 0HL, United Kingdom.
| | - Duncan Buchan
- Institute of Clinical Exercise & Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park, South Lanarkshire, Scotland G72 0HL, United Kingdom
| | - Luke Cerexhe
- Institute of Clinical Exercise & Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park, South Lanarkshire, Scotland G72 0HL, United Kingdom
| | - Linda Renfrew
- Douglas Grant Rehabilitation Unit, Ayrshire Central Hospital, Kilwinning Road, Irvine, Ayrshire, Scotland KA12 8SS, United Kingdom
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise & Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park, South Lanarkshire, Scotland G72 0HL, United Kingdom
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22
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O’Neil J, Barnes K, Morgan Donnelly E, Sheehy L, Sveistrup H. Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review. Digit Health 2023; 9:20552076231183233. [PMID: 37377560 PMCID: PMC10291871 DOI: 10.1177/20552076231183233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Background The clinical adoption of telerehabilitation accelerated rapidly over the last few years, creating opportunities for clinicians and researchers to explore the use of digital technologies and telerehabilitation in the assessment of deficits related to neurological conditions. The objectives of this scoping review were to identify outcome measures used to remotely assess the motor function and participation in people with neurological conditions and report, when available, the psychometric data of these remote outcome measures. Methods MEDLINE (Ovid), CINAHL, PubMed, PsychINFO, EMBASE, and Cochrane databases were searched between December 13, 2020, and January 4, 2021, for studies investigating the use of remote assessments to evaluate motor function and participation in people with neurological conditions. An updated search was completed on May 9, 2022, using the same databases and search terms. Two reviewers independently screened each title and abstract, followed by full-text screening. Data extraction was completed using a pre-piloted data extraction sheet where outcome measures were reported as per the International Classification of Functioning, Disability and Health. Results Fifty studies were included in this review. Eighteen studies targeted outcomes related to body structures and 32 targeted those related to activity limitation and participation restriction. Seventeen studies reported psychometric data; of these, most included reliability and validity data. Conclusion Clinical assessments of motor function of people living with neurological conditions can be completed in a telerehabilitation or remote context using validated and reliable remote assessment measures.
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Affiliation(s)
- Jennifer O’Neil
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Keely Barnes
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lisa Sheehy
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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23
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Polhemus A, Haag C, Sieber C, Sylvester R, Kool J, Gonzenbach R, von Wyl V. Methodological heterogeneity biases physical activity metrics derived from the Actigraph GT3X in multiple sclerosis: A rapid review and comparative study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:989658. [PMID: 36518351 PMCID: PMC9742246 DOI: 10.3389/fresc.2022.989658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2023]
Abstract
BACKGROUND Physical activity (PA) is reduced in persons with multiple sclerosis (MS), though it is known to aid in symptom and fatigue management. Methods for measuring PA are diverse and the impact of this heterogeneity on study outcomes is unclear. We aimed to clarify this impact by comparing common methods for deriving PA metrics in MS populations. METHODS First, a rapid review of existing literature identified methods for calculating PA in studies which used the Actigraph GT3X in populations with MS. We then compared methods in a prospective study on 42 persons with MS [EDSS 4.5 (3.5-6)] during a voluntary course of inpatient neurorehabilitation. Mixed-effects linear regression identified methodological factors which influenced PA measurements. Non-parametric hypothesis tests, correlations, and agreement statistics assessed overall and pairwise differences between methods. RESULTS In the rapid review, searches identified 421 unique records. Sixty-nine records representing 51 eligible studies exhibited substantial heterogeneity in methodology and reporting practices. In a subsequent comparative study, multiple methods for deriving six PA metrics (step count, activity counts, total time in PA, sedentary time, time in light PA, time in moderate to vigorous PA), were identified and directly compared. All metrics were sensitive to methodological factors such as the selected preprocessing filter, data source (vertical vs. vector magnitude counts), and cutpoint. Additionally, sedentary time was sensitive to wear time definitions. Pairwise correlation and agreement between methods varied from weak (minimum correlation: 0.15, minimum agreement: 0.03) to perfect (maximum correlation: 1.00, maximum agreement: 1.00). Methodological factors biased both point estimates of PA and correlations between PA and clinical assessments. CONCLUSIONS Methodological heterogeneity of existing literature is high, and this heterogeneity may confound studies which use the Actigraph GT3X. Step counts were highly sensitive to the filter used to process raw accelerometer data. Sedentary time was particularly sensitive to methodology, and we recommend using total time in PA instead. Several, though not all, methods for deriving light PA and moderate to vigorous PA yielded nearly identical results. PA metrics based on vertical axis counts tended to outperform those based on vector magnitude counts. Additional research is needed to establish the relative validity of existing methods.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Christina Haag
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Chloé Sieber
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Ramona Sylvester
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Jan Kool
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Roman Gonzenbach
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Viktor von Wyl
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
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24
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Miller A, Collier Z, Reisman DS. Beyond steps per day: other measures of real-world walking after stroke related to cardiovascular risk. J Neuroeng Rehabil 2022; 19:111. [PMID: 36242083 PMCID: PMC9563761 DOI: 10.1186/s12984-022-01091-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background Significant variability exists in how real-world walking has been measured in prior studies in individuals with stroke and it is unknown which measures are most important for cardiovascular risk. It is also unknown whether real-world monitoring is more informative than laboratory-based measures of walking capacity in the context of cardiovascular risk. The purpose of this study was to determine a subset of real-world walking activity measures most strongly associated with systolic blood pressure (SBP), a measure of cardiovascular risk, in people with stroke and if these measures are associated with SBP after accounting for laboratory-based measures of walking capacity. Methods This was a cross-sectional analysis of 276 individuals with chronic (≥ 6 months) stroke. Participants wore an activity monitor for ≥ 3 days. Measures of activity volume, activity frequency, activity intensity, and sedentary behavior were calculated. Best subset selection and lasso regression were used to determine which activity measures were most strongly associated with systolic blood pressure. Sequential linear regression was used to determine if these activity measures were associated with systolic blood pressure after accounting for walking capacity (6-Minute Walk Test). Results Average bout cadence (i.e., the average steps/minute across all bouts of walking) and the number of long (≥ 30 min) sedentary bouts were most strongly associated with systolic blood pressure. After accounting for covariates (ΔR2 = 0.089, p < 0.001) and walking capacity (ΔR2 = 0.002, p = 0.48), these activity measures were significantly associated with systolic blood pressure (ΔR2 = 0.027, p = 0.02). Higher systolic blood pressure was associated with older age (β = 0.219, p < 0.001), male gender (β = − 0.121, p = 0.046), black race (β = 0.165, p = 0.008), and a slower average bout cadence (β = − 0.159, p = 0.022). Conclusions Measures of activity intensity and sedentary behavior may be superior to commonly used measures, such as steps/day, when the outcome of interest is cardiovascular risk. The relationship between walking activity and cardiovascular risk cannot be inferred through laboratory-based assessments of walking capacity.
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Science Program, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Zachary Collier
- Department of Education and Human Development, University of Delaware, Newark, DE, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Science Program, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA. .,Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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25
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Wang N, Buchongo P, Chen J. Rural and urban disparities in potentially preventable hospitalizations among US patients with Alzheimer's Disease and Related Dementias: Evidence of hospital-based telehealth and enabling services. Prev Med 2022; 163:107223. [PMID: 36027993 DOI: 10.1016/j.ypmed.2022.107223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
We examined urban and rural disparities in potentially preventable hospitalizations (PPHs) among US patients with Alzheimer's Disease and Related Dementias (ADRD) and the use of telehealth post-discharge and enabling services as mediators. We merged 2017 100% Medicare Fee-For-Service (FFS) claims with the Medicare Beneficiary Summary File, along with population and hospital-based characteristics. Logistic regression models were employed to examine differences in PPHs by telehealth and enabling services. The rates of PPHs related to acute and chronic conditions for patients with ADRD living in rural and micropolitan areas were significantly higher compared to patients with ADRD in urban areas. Telehealth post-discharge combined with enabling services significantly decreased the odds of PPHs associated with acute (OR: 0.93, 95% CI: 0.89-0.98, P-value <0.01) and chronic conditions (OR: 0.96, 95% CI: 0.92-1.00, P-value = 0.07). In addition, telehealth post-discharge combined with enabling services significantly decreased the odds of PPHs in patients with ADRD in rural (acute PPHs OR: 0.56, 95% CI: 0.41-0.77, P-value <0.01; chronic PPHs OR: 0.73, 95% CI: 0.55-0.97, P-value = 0.03) and micropolitan (acute PPHs OR: 0.65, 95% CI: 0.57-0.73, P-value <0.01; chronic PPHs OR: 0.83, 95% CI: 0.74-0.93, P-value <0.01) areas. Our results suggest that the combinations of telehealth post-discharge and enabling services are important interventions in helping to reduce preventable hospitalizations among patients with ADRD living in rural and micropolitan areas.
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Affiliation(s)
- Nianyang Wang
- Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Dr, College Park, MD 20742, USA
| | - Portia Buchongo
- Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Dr, College Park, MD 20742, USA
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Dr, College Park, MD 20742, USA.
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26
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Pohl J, Ryser A, Veerbeek JM, Verheyden G, Vogt JE, Luft AR, Easthope CA. Accuracy of gait and posture classification using movement sensors in individuals with mobility impairment after stroke. Front Physiol 2022; 13:933987. [PMID: 36225292 PMCID: PMC9549863 DOI: 10.3389/fphys.2022.933987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke leads to motor impairment which reduces physical activity, negatively affects social participation, and increases the risk of secondary cardiovascular events. Continuous monitoring of physical activity with motion sensors is promising to allow the prescription of tailored treatments in a timely manner. Accurate classification of gait activities and body posture is necessary to extract actionable information for outcome measures from unstructured motion data. We here develop and validate a solution for various sensor configurations specifically for a stroke population.Methods: Video and movement sensor data (locations: wrists, ankles, and chest) were collected from fourteen stroke survivors with motor impairment who performed real-life activities in their home environment. Video data were labeled for five classes of gait and body postures and three classes of transitions that served as ground truth. We trained support vector machine (SVM), logistic regression (LR), and k-nearest neighbor (kNN) models to identify gait bouts only or gait and posture. Model performance was assessed by the nested leave-one-subject-out protocol and compared across five different sensor placement configurations.Results: Our method achieved very good performance when predicting real-life gait versus non-gait (Gait classification) with an accuracy between 85% and 93% across sensor configurations, using SVM and LR modeling. On the much more challenging task of discriminating between the body postures lying, sitting, and standing as well as walking, and stair ascent/descent (Gait and postures classification), our method achieves accuracies between 80% and 86% with at least one ankle and wrist sensor attached unilaterally. The Gait and postures classification performance between SVM and LR was equivalent but superior to kNN.Conclusion: This work presents a comparison of performance when classifying Gait and body postures in post-stroke individuals with different sensor configurations, which provide options for subsequent outcome evaluation. We achieved accurate classification of gait and postures performed in a real-life setting by individuals with a wide range of motor impairments due to stroke. This validated classifier will hopefully prove a useful resource to researchers and clinicians in the increasingly important field of digital health in the form of remote movement monitoring using motion sensors.
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Affiliation(s)
- Johannes Pohl
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- *Correspondence: Johannes Pohl,
| | - Alain Ryser
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | | | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | | | - Andreas Rüdiger Luft
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
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Sasaki JE, Bertochi GFA, Meneguci J, Motl RW. Pedometers and Accelerometers in Multiple Sclerosis: Current and New Applications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11839. [PMID: 36142112 PMCID: PMC9517119 DOI: 10.3390/ijerph191811839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Pedometers and accelerometers have become commonplace for the assessment of physical behaviors (e.g., physical activity and sedentary behavior) in multiple sclerosis (MS) research. Current common applications include the measurement of steps taken and the classification of physical activity intensity, as well as sedentary behavior, using cut-points methods. The existing knowledge and applications, coupled with technological advances, have spawned new opportunities for using those motion sensors in persons with MS, and these include the utilization of the data as biomarkers of disease severity and progression, perhaps in clinical practice. Herein, we discuss the current state of knowledge on the validity and applications of pedometers and accelerometers in MS, as well as new opportunities and strategies for the improved assessment of physical behaviors and disease progression, and consequently, personalized care.
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Affiliation(s)
- Jeffer Eidi Sasaki
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro, Uberaba 38025-180, MG, Brazil
| | | | - Joilson Meneguci
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro, Uberaba 38025-180, MG, Brazil
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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Jirasakulsuk N, Saengpromma P, Khruakhorn S. Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis. JMIR Rehabil Assist Technol 2022; 9:e36028. [PMID: 36048520 PMCID: PMC9478822 DOI: 10.2196/36028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Real-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers. OBJECTIVE We aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness. METHODS A literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane's risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR's effectiveness based on different treatments, controls, and outcome measures. RESULTS The search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95% CI 0.36-0.9; I2=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I2=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I2=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I2=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI -0.16 to 0.66; I2=0%) had no effect on improving balance and was comparable to conventional treatment. CONCLUSIONS We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care. TRIAL REGISTRATION PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289.
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Affiliation(s)
- Nathaphon Jirasakulsuk
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Pattaridaporn Saengpromma
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
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Block VJ, Bove R, Nourbakhsh B. The Role of Remote Monitoring in Evaluating Fatigue in Multiple Sclerosis: A Review. Front Neurol 2022; 13:878313. [PMID: 35832181 PMCID: PMC9272225 DOI: 10.3389/fneur.2022.878313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
Abstract
Fatigue is one of the most common multiple sclerosis (MS) symptoms. Despite this, monitoring and measuring fatigue (subjective lack of energy)- and fatigability (objectively measurable and quantifiable performance decline)- in people with MS have remained challenging. Traditionally, administration of self-report questionnaires during in-person visits has been used to measure fatigue. However, remote measurement and monitoring of fatigue and fatigability have become feasible in the past decade. Traditional questionnaires can be administered through the web in any setting. The ubiquitous availability of smartphones allows for momentary and frequent measurement of MS fatigue in the ecological home-setting. This approach reduces the recall bias inherent in many traditional questionnaires and demonstrates the fluctuation of fatigue that cannot be captured by standard measures. Wearable devices can assess patients' fatigability and activity levels, often influenced by the severity of subjective fatigue. Remote monitoring of fatigue, fatigability, and activity in real-world situations can facilitate quantifying symptom-severity in clinical and research settings. Combining remote measures of fatigue as well as objective fatigability in a single construct, composite score, may provide a more comprehensive outcome. The more granular data obtained through remote monitoring techniques may also help with the development of interventions aimed at improving fatigue and lowering the burden of this disabling symptom.
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Affiliation(s)
- Valerie J. Block
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Valerie J. Block
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
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Vilendrer S, Lestoquoy A, Artandi M, Barman L, Cannon K, Garvert DW, Halket D, Holdsworth LM, Singer S, Vaughan L, Winget M. A 360 degree mixed-methods evaluation of a specialized COVID-19 outpatient clinic and remote patient monitoring program. BMC PRIMARY CARE 2022; 23:151. [PMID: 35698064 PMCID: PMC9189794 DOI: 10.1186/s12875-022-01734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Our goals are to quantify the impact on acute care utilization of a specialized COVID-19 clinic with an integrated remote patient monitoring program in an academic medical center and further examine these data with stakeholder perceptions of clinic effectiveness and acceptability. METHODS A retrospective cohort was drawn from enrolled and unenrolled ambulatory patients who tested positive in May through September 2020 matched on age, presence of comorbidities and other factors. Qualitative semi-structured interviews with patients, frontline clinician, and administrators were analyzed in an inductive-deductive approach to identify key themes. RESULTS Enrolled patients were more likely to be hospitalized than unenrolled patients (N = 11/137 in enrolled vs 2/126 unenrolled, p = .02), reflecting a higher admittance rate following emergency department (ED) events among the enrolled vs unenrolled, though this was not a significant difference (46% vs 25%, respectively, p = .32). Thirty-eight qualitative interviews conducted June to October 2020 revealed broad stakeholder belief in the clinic's support of appropriate care escalation. Contrary to beliefs the clinic reduced inappropriate care utilization, no difference was seen between enrolled and unenrolled patients who presented to the ED and were not admitted (N = 10/137 in enrolled vs 8/126 unenrolled, p = .76). Administrators and providers described the clinic's integral role in allowing health services to resume in other areas of the health system following an initial lockdown. CONCLUSIONS Acute care utilization and multi-stakeholder interviews suggest heightened outpatient observation through a specialized COVID-19 clinic and remote patient monitoring program may have contributed to an increase in appropriate acute care utilization. The clinic's role securing safe reopening of health services systemwide was endorsed as a primary, if unmeasured, benefit.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA.
| | - Anna Lestoquoy
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Maja Artandi
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Linda Barman
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Kendell Cannon
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Donn W Garvert
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Douglas Halket
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Laura M Holdsworth
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Sara Singer
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Laura Vaughan
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Marcy Winget
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
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Direct Mobile Coaching as a Paradigm for the Creation of Mobile Feedback Systems. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In sports feedback systems, digital systems perform tasks such as capturing, analysing and representing data. These systems not only aim to provide athletes and coaches with insights into performances but also help athletes learn new tasks and control movements, for example, to prevent injuries. However, designing mobile feedback systems requires a high level of expertise from researchers and practitioners in many areas. As a solution to this problem, we present Direct Mobile Coaching (DMC) as a design paradigm and model for mobile feedback systems. Besides components for feedback provisioning, the model consists of components for data recording, storage and management. For the evaluation of the model, its features are compared against state-of-the-art frameworks. Furthermore, the capabilities are benchmarked using a review of the literature. We conclude that DMC is capable of modelling all 39 identified systems while other identified frameworks (MobileCoach, Garmin Connect IQ SDK, RADAR) could (at best) only model parts of them. The presented design paradigm/model is applicable for a wide range of mobile feedback systems and equips researchers and practitioners with a valuable tool.
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Torriani-Pasin C, Domingues VL, de Freitas TB, Silva TAD, Caldeira MF, Júnior RPA, Lara ARF, Antonio BDA, Palma GCDS, Makhoul MP, Mochizuki L. Adherence rate, barriers to attend, safety and overall experience of a physical exercise program via telemonitoring during COVID-19 pandemic for individuals with Parkinson's disease: A feasibility study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1959. [PMID: 35633094 PMCID: PMC9348085 DOI: 10.1002/pri.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/30/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Background Telemonitoring can maintain daily exercise routine during the COVID‐19 pandemic of individuals with Parkinson's disease (PD). However, there are barriers to adherence and attendance with remote physical rehabilitation. The main objective of this study was to evaluate adherence rate, barriers to attendance, and safety of a telemonitoring program for individuals with PD; and secondarily to evaluate the individual and their family members perceived overall experience when performing the telemonitoring physical exercise program. Methods This was a phase 1 of a clinical trial, engaging 19 individuals with idiopathic PD of an in‐person community rehabilitation program. For 24 weeks an asynchronous telemonitoring physical exercise program delivered two sessions per week by video including warm‐up, balance, aerobic and resistance exercises, and cool‐down. During the remote program were verified: adherence rate at entrance, attendance rate, barriers to attend, safety, and overall experience of the program. Results and conclusion Only one participant did not perform any session and 18 participants completed between 2 and 34 sessions. Participants with a caregiver showed higher attendance rates. The most frequently cited barriers to attend the program were: pain; lack of motor skills; and reduced physical fitness. In relation to safety of the program, the most frequently reported was fear of falling. Although participants reported the telemonitoring program induced health benefits and they had positive experiences for themselves and for their families, most of participants prefer an in‐person program. In this sense, the asynchronous telemonitoring physical exercise program was safe, showed moderate adherence, with attendance rate depending on the presence of a companion.
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Affiliation(s)
- Camila Torriani-Pasin
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Vitoria Leite Domingues
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Tatiana Beline de Freitas
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Marina Portugal Makhoul
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
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Applications and Outcomes of Internet of Things for Patients with Alzheimer’s Disease/Dementia: A Scoping Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6274185. [PMID: 35342749 PMCID: PMC8948545 DOI: 10.1155/2022/6274185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives We aimed to identify and classify the Internet of Things (IoT) technologies used for Alzheimer's disease (AD)/dementia as well as the healthcare aspects addressed by these technologies and the outcomes of the IoT interventions. Methodology. We searched PubMed/MEDLINE, IEEE Explore, Web of Science, OVID, Scopus, Embase, Cochrane, and Google Scholar. In total, 13,005 papers were reviewed, 36 of which were finally selected. All the reviews were independently carried out by two researchers. In the case of any disagreement, the problem was resolved by holding a meeting and exchanging views. Due to the diversity of the reviewed studies, narrative analysis was performed. Results Among the technologies used for the patients including radio frequency identification (RFID), near field communication (NFC), ZigBee, Bluetooth, global positioning system (GPS), sensors, and cameras, the sensors were employed in 36 studies, most of which were switch and vital sign monitoring sensors. The most common aspects of AD/dementia care monitored using these technologies were activities of daily living (ADLs) in 27 studies, followed by sleep patterns and disease diagnosis in 19 and 14 studies, respectively. Sleeping, medication, vital signs, agitation, memory, social interaction, apathy, movement, tracking, and fall were other aspects monitored by IoT. Then, their outcomes were reported. Conclusion Using IoT for AD/dementia provides many opportunities for considering various aspects of this disease. Moreover, the ability to use various technologies for gathering patient-related data provides a comprehensive application for almost all aspects of the patients' care with high accuracy.
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Gopal A, Hsu WY, Allen DD, Bove R. Remote Assessments of Hand Function in Neurological Disorders: Systematic Review. JMIR Rehabil Assist Technol 2022; 9:e33157. [PMID: 35262502 PMCID: PMC8943610 DOI: 10.2196/33157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be regularly assessed to monitor loss of fine motor skills in people with central nervous system disorders; however, there are challenges to in-clinic assessments. Remotely assessing hand function could facilitate monitoring and supporting of early diagnosis and intervention when warranted. OBJECTIVE Remote assessments can facilitate the tracking of limitations, aiding in early diagnosis and intervention. This study aims to systematically review existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction. METHODS PubMed and MEDLINE, CINAHL, Web of Science, and Embase were searched for studies that reported remote assessment of hand function (ie, outside of traditional in-person clinical settings) in adults with chronic central nervous system disorders. We excluded studies that included participants with orthopedic upper limb dysfunction or used tools for intervention and treatment. We extracted data on the evaluated hand function domains, validity and reliability, feasibility, and stage of development. RESULTS In total, 74 studies met the inclusion criteria for Parkinson disease (n=57, 77% studies), stroke (n=9, 12%), multiple sclerosis (n=6, 8%), spinal cord injury (n=1, 1%), and amyotrophic lateral sclerosis (n=1, 1%). Three assessment modalities were identified: external device (eg, wrist-worn accelerometer), smartphone or tablet, and telerehabilitation. The feasibility and overall participant acceptability were high. The most common hand function domains assessed included finger tapping speed (fine motor control and rigidity), hand tremor (pharmacological and rehabilitation efficacy), and finger dexterity (manipulation of small objects required for daily tasks) and handwriting (coordination). Although validity and reliability data were heterogeneous across studies, statistically significant correlations with traditional in-clinic metrics were most commonly reported for telerehabilitation and smartphone or tablet apps. The most readily implementable assessments were smartphone or tablet-based. CONCLUSIONS The findings show that remote assessment of hand function is feasible in neurological disorders. Although varied, the assessments allow clinicians to objectively record performance in multiple hand function domains, improving the reliability of traditional in-clinic assessments. Remote assessments, particularly via telerehabilitation and smartphone- or tablet-based apps that align with in-clinic metrics, facilitate clinic to home transitions, have few barriers to implementation, and prompt remote identification and treatment of hand function impairments.
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Affiliation(s)
- Arpita Gopal
- Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Wan-Yu Hsu
- Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Diane D Allen
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco/San Francisco State University, San Francisco, CA, United States
| | - Riley Bove
- Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA, United States
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Knox L, McDermott C, Hobson E. Telehealth in long-term neurological conditions: the potential, the challenges and the key recommendations. J Med Eng Technol 2022; 46:506-517. [PMID: 35212580 DOI: 10.1080/03091902.2022.2040625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Long-term neurological conditions (LTNCs) cause physical and psychological symptoms that have a significant impact on activities of daily living and quality of life. Multidisciplinary teams are effective at providing treatment for people with LTNCs; however, access to such services by people with disabilities can be difficult and as a result, good quality care is not universal. One potential solution is telehealth. This review describes the potential of telehealth to support people with LTNCs, the challenges of designing and implementing these systems, and the key recommendations for those involved in telehealth to facilitate connected services that can benefit patients, carers and healthcare professionals. These recommendations include understanding the problems posed by LTNCs and the needs of the end-user through a person-centred approach. We discuss how to work collaboratively and use shared learning, and consider how to effectively evaluate the intervention at every stage of the development process.
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Affiliation(s)
- Liam Knox
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Christopher McDermott
- Department of Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neuroscience, Sheffield Teaching Hospitals, Sheffield, UK
| | - Esther Hobson
- Department of Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neuroscience, Sheffield Teaching Hospitals, Sheffield, UK
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Miller LM, Solomon DN, Whitlatch CJ, Hiatt SO, Wu CY, Reynolds C, Au-Yeung WTM, Kaye J, Steele JS. The Remote Assessment and Dynamic Response Program: Development of an In-Home Dementia-Related Care Needs Assessment to Improve Well-Being. Innov Aging 2022; 6:igac006. [PMID: 35402736 PMCID: PMC8985764 DOI: 10.1093/geroni/igac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Objectives The Remote Assessment and Dynamic Response (READyR) Program was developed in order to address the current lack of early-stage dementia care planning programs that assess the care needs of persons with dementia. The goal was to create a program informed by care values and ongoing ecologically valid data. The objectives of this study are to describe the development and design process of the READyR Program, and to evaluate the utility of the READyR Program for identifying dementia-related care needs. Research Design and Methods A prototype of the web-based READyR Program tool was first created using digital activity data that were collected by previous studies using a platform of multimodal sensors installed in the homes of older adult couples with and without dementia. Digital activity data were then mapped onto potential care values (e.g., safety & autonomy) to create a values-based needs assessment that is tailored to the individual care dyad. Next, evaluation of the READyR Program by 11 professional dementia care coordinators and case managers (across 3 semistructured focus groups) was used to explore the utility of READyR for assessing dementia-related needs. Qualitative description using conventional content analysis was used to iteratively code focus group data and to describe prevalent themes. Results Prevalent focus groups themes included barriers to (e.g., family relationship strain) and facilitators of (e.g., tailored assessments) the optimal process for assessing dementia-related care needs by care coordinators, as well as advantages to (e.g., providing new objective insights into function, and routines) and disadvantages of (e.g., bringing up new questions about care) incorporating the remote monitoring data into a values-based needs assessment. Discussion and Implications READyR has the potential to help family members, as well as care coordinators and providers, gain insight into the values-based care needs of persons with early-stage dementia. Clinical Trials Registration Number: NCT04542109.
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Affiliation(s)
- Lyndsey M Miller
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health and Science University, Portland, Oregon, USA
| | - Diane N Solomon
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Shirin O Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health and Science University, Portland, Oregon, USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Christina Reynolds
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health and Science University, Portland, Oregon, USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Wan-Tai Michael Au-Yeung
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health and Science University, Portland, Oregon, USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Jeffrey Kaye
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health and Science University, Portland, Oregon, USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Joel S Steele
- Department of Psychology, Portland State University, Portland, Oregon, USA
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Abasıyanık Z, Kurt M, Kahraman T. COVID-19 and Physical Activity Behaviour in People with Neurological Diseases: A Systematic Review. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 34:987-1012. [PMID: 35125854 PMCID: PMC8803459 DOI: 10.1007/s10882-022-09836-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 05/02/2023]
Abstract
The COVID-19 pandemic has led to a radical lifestyle change, which may unintendedly change physical activity levels. We aimed to perform a systematic review to investigate the physical activity changes in people with neurological diseases, and to examine the relationship between physical activity and disease symptoms, and psychosocial factors. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of the literature across five databases (PubMed, CINAHL, Web of Science, SCOPUS, and Cochrane Library) was carried out using the keywords relating to COVID-19, physical activity, sedentary behaviour, exercise, and the name of the neurological diseases. The systematic search was updated on 4 February 2021 with the same keywords. Fourteen studies (n = 7662 persons with neurological diseases, n = 1663 healthy controls) were eligible for this review. The study populations were Parkinson disease (n = 7), dementia (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 1), hereditary spastic paraplegia (n = 1), neuromuscular diseases (n = 1), Charcot-Marie-Tooth neuropathy (n = 1), and epilepsy (n = 1). Thirteen studies reported a decreased physical activity level, one study reported a high interruption rate of physiotherapy/rehabilitation. Furthermore, the physical activity reduction was associated with worse disease symptoms, depression, perceived health, and mental and physical components of quality of life. The COVID-19 pandemic has a negative impact on the physical activity levels of people with neurological diseases, and this change was related to the worsening of disease symptoms and psychosocial factors. Registration number A protocol of the review was registered with the PROSPERO database (CRD42020207676). Supplementary Information The online version contains supplementary material available at 10.1007/s10882-022-09836-x.
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Affiliation(s)
- Zuhal Abasıyanık
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Merve Kurt
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
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Abstract
Internet-connected devices, including personal computers, smartphones, smartwatches, and voice assistants, have evolved into powerful multisensor technologies that billions of people interact with daily to connect with friends and colleagues, access and share information, purchase goods, play games, and navigate their environment. Digital phenotyping taps into the data streams captured by these devices to characterize and understand health and disease. The purpose of this article is to summarize opportunities for digital phenotyping in neurology, review studies using everyday technologies to obtain motor and cognitive information, and provide a perspective on how neurologists can embrace and accelerate progress in this emerging field.
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Affiliation(s)
- Anoopum S. Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Domingues VL, Pompeu JE, de Freitas TB, Polese J, Torriani-Pasin C. Physical activity level is associated with gait performance and five times sit-to-stand in Parkinson's disease individuals. Acta Neurol Belg 2022; 122:191-196. [PMID: 34689319 DOI: 10.1007/s13760-021-01824-w] [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: 05/12/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Physical activity (PA) level is decreased in individuals with Parkinson´s disease (PD). To increase the PA level improves both motor and non-motor symptoms of this population. It is known that gait performance and five times sit-to-stand (FTSTS) are associated with PA level; therefore, it is of great relevance for rehabilitation purposes to understand whether these variables may predict PA level of individuals with PD. OBJECTIVE To investigate whether gait performance and FTSTS are predictors of PA level. METHODS Cross-sectional study with individuals with idiopathic PD modified Hoehn and Yahr staging scale between 1.0 and 3.0. The gait performance was measured by Functional Gait Assessment (FGA) and PA level was measured by an accelerometer for one week, during day and night through their time spend in locomotion (locomotion time-LT). Multiple linear regression was conducted with gait performance and FTSTS as independent variables and PA level (LT) as dependent variable. RESULTS Twenty-two participants were included, mean age 64.82 (8.39) and the mean storage of accelerometer time was 9.866 min (0.33). Both gait performance and FTSTS have moderate significant correlation with PA level (r = - 0.538 p < 0.01 and r = 0.625 p < 0.001, respectively). The linear regression model with FGA and FTSTS was significant (p < 0.05) and predicted 41% of LT. CONCLUSION Gait performance and FTSTS have important interaction with PA level measured by LT in individuals with PD, and it provides insights on the importance of these variables in predicting the PA level of its population.
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Affiliation(s)
- Vitória Leite Domingues
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil.
| | - José Eduardo Pompeu
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Tatiana Beline de Freitas
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Janaine Polese
- Department of Physical Therapy, Medical Sciences College of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Camila Torriani-Pasin
- Laboratory of Motor Behavior, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
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Zhou H, Yu T. Effect of Comprehensive Rehabilitation Training Program in Orthopedic Nursing of Patients with Residual Limb Injury Caused by Crush. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6769572. [PMID: 35126938 PMCID: PMC8808221 DOI: 10.1155/2022/6769572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
This study was developed to explore the role and application value of a comprehensive rehabilitation training (CRT) program based on the remote monitoring system of limb rehabilitation training (LRT-RM system) in the rehabilitation nursing of patients with residual limb injuries caused by crush. The LRT-RM system was constructed based on the characteristics of limb movement and using the time-domain analysis method and support vector machine (SVM). The 84 crush injury patients were selected as the research objects and divided into a control group (Con group, received conventional rehabilitation therapy) and a CRT group (received conventional rehabilitation therapy + functional training) according to different therapies, with 42 people in each group. The incidence of compound injuries and the incidence of residual limb injuries were counted and compared for patients in two groups. The differences in renal function, blood electrolytes, and biochemical indicators before and after treatment were analyzed. The MOS 36-item short-form health survey (SF-36) scale was selected to evaluate the improvement of physical and mental health of the patients before treatment and 1 month (time point (TP1)), 3 months (TP2), 6 months (TP3), and 12 months (TP4) after the treatment. It was found that, after the intervention, the values of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), K+, P3+, and white blood cells (WBC) of patients in CRT group were obviously lower than those of Con group (P < 0.05), and the values of carbon dioxide combining power (CO2CP), Ca2+, hemoglobin (Hb), red blood cell (RBC), total protein (TP), and albumin (ALB) were obviously higher than the values in Con group (P < 0.05). In the CRT group, the residual limb injury rate was lower in elbow, wrist, shoulder joint, ankle joint, and toe (P < 0.05) and extremely lower in knee joint in contrast to that in the Con group (P < 0.001). The score of SF-36 was dramatically higher than that in the Con group (P < 0.05). It suggested that the CRT program based on the LRT-RM system was helpful for the rehabilitation of patients with crush injuries, and it can reduce the incidence of residual limb injuries in patients. Results of this study could provide a reference basis for the treatment of residual limb injuries caused by crush.
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Affiliation(s)
- Haihong Zhou
- Department of Hand and Foot Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang 317500, China
| | - Tongyao Yu
- Department of Orthopedic Trauma, The First People's Hospital of Wenling, Wenling, Zhejiang 317500, China
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Factors Influencing Habitual Physical Activity in Parkinson’s Disease: Considering the Psychosocial State and Wellbeing of People with Parkinson’s and Their Carers. SENSORS 2022; 22:s22030871. [PMID: 35161617 PMCID: PMC8837970 DOI: 10.3390/s22030871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023]
Abstract
Participating in habitual physical activity (HPA) may slow onset of dependency and disability for people with Parkinson’s disease (PwP). While cognitive and physical determinants of HPA are well understood, psychosocial influences are not. This pilot study aimed to identify psychosocial factors associated with HPA to guide future intervention development. Sixty-four PwP participated in this study; forty had carer informants. PwP participants wore a tri-axial accelerometer on the lower back continuously for seven days at two timepoints (18 months apart), measuring volume, pattern and variability of HPA. Linear mixed effects analysis identified relationships between demographic, clinical and psychosocial data and HPA from baseline to 18 months. Key results in PwP with carers indicated that carer anxiety and depression were associated with increased HPA volume (p < 0.01), while poorer carer self-care was associated with reduced volume of HPA over 18 months (p < 0.01). Greater carer strain was associated with taking longer walking bouts after 18 months (p < 0.01). Greater carer depression was associated with lower variability of HPA cross-sectionally (p = 0.009). This pilot study provides preliminary novel evidence that psychosocial outcomes from PwP’s carers may impact HPA in Parkinson’s disease. Interventions to improve HPA could target both PwP and carers and consider approaches that also support psychosocial wellbeing.
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Sakamaki T, Furusawa Y, Hayashi A, Otsuka M, Fernandez J. Remote Patient Monitoring for Neuropsychiatric Disorders: A Scoping Review of Current Trends and Future Perspectives from Recent Publications and Upcoming Clinical Trials. Telemed J E Health 2022; 28:1235-1250. [PMID: 35073206 PMCID: PMC9508442 DOI: 10.1089/tmj.2021.0489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Telemedicine and remote patient monitoring are rapidly growing fields. This scoping review provides an update on remote patient monitoring for neuropsychiatric disorders from recent publications and upcoming clinical trials. Methods: Publications (PubMed and ICHUSHI; published January 2010 to February 2021) and trials (ClinicalTrials.gov and Japanese registries; active or recruiting by March 2021) that assessed wearable devices for remote management and/or monitoring of patients with neuropsychiatric disorders were searched. The review focuses on disorders with ≥3 publications. Results: We identified 44 publications and 51 active or recruiting trials, mostly from 2019 or 2020. Research on digital devices was most common for Parkinson's disease (11 publications and 19 trials), primarily for monitoring motor symptoms and/or preventing falls. Other disorders (3–5 publications each) included epilepsy (electroencephalogram [EEG] and seizure prediction), sleep disorder (sleep outcomes and behavioral therapies), multiple sclerosis (physical activity and symptoms), depression (physical activity, symptoms, and behavioral therapies), and amyotrophic lateral sclerosis (symptoms). Very few studies focused on newly emerging technologies (e.g., in-ear EEG and portable oximeters), and few studies integrated remote symptom monitoring with telemedicine. Discussion: Currently, development of digital devices for daily symptom monitoring is focused on Parkinson's disease. For the diseases reviewed, studies mostly focused on physical activity rather than psychiatric or nonmotor symptoms. Although the validity and usefulness of many devices are established, models for implementing remote patient monitoring in telehealth settings have not been established. Conclusions: Verification of the clinical effectiveness of digital devices combined with telemedicine is needed to further advance remote patient care for neuropsychiatric disorders.
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Affiliation(s)
- Tetsuo Sakamaki
- Medical Informatics and Decision Sciences, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshihiko Furusawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ayako Hayashi
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Masaru Otsuka
- Enterprise Digital Lead, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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Montes J, Eichinger KJ, Pasternak A, Yochai C, Krosschell KJ. A post pandemic roadmap toward remote assessment for neuromuscular disorders: limitations and opportunities. Orphanet J Rare Dis 2022; 17:5. [PMID: 34983609 PMCID: PMC8726521 DOI: 10.1186/s13023-021-02165-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/19/2021] [Indexed: 12/14/2022] Open
Abstract
Recent advances in technology and expanding therapeutic opportunities in neuromuscular disorders has resulted in greater interest in and development of remote assessments. Over the past year, the rapid and abrupt COVID-19 shutdowns and stay-at-home orders imposed challenges to routine clinical management and clinical trials. As in-person services were severely limited, clinicians turned to remote assessments through telehealth to allow for continued care. Typically, disease-specific clinical outcome assessments (COAs) for neuromuscular disorders (NMD) are developed over many years through rigorous and iterative processes to fully understand their psychometric properties. While efforts were underway towards developing remote assessments for NMD before the pandemic, few if any were fully developed or validated. These included assessments of strength, respiratory function and patient-reported outcomes, as well as wearable technology and other devices to quantify physical activity and function. Without many choices, clinicians modified COAs for a virtual environment recognizing it was not yet known how they compared to standard in-person administration. Despite being able to quickly adapt to the demands of the COVID-19 pandemic, these experiences with remote assessments uncovered limitations and opportunities. It became clear that existing COAs required modifications for use in a virtual environment limiting the interpretation of the information gathered. Still, the opportunity for real-world evaluation and reduced patient burden were clear benefits to remote assessment and may provide a more robust understanding and characterization of disease impact in NMD. Hence, we propose a roadmap navigating an informed post-pandemic path toward development and implementation of safe and successful use of remote assessments for patients with NMD.
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Affiliation(s)
- Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, Room 347, New York, NY, 10002, USA.
| | - Katy J Eichinger
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Amy Pasternak
- Departments of Physical Therapy and Occupational Therapy Services and Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Cara Yochai
- Department of Neurology, Columbia University Irving Medical Center, New York City, NY, USA
| | - Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Perenc L, Perenc A, Bartosik-Psujek H. Selected factors determining the failure to undertake physical activity in patients with multiple sclerosis in Poland. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:2. [PMID: 35342441 PMCID: PMC8943561 DOI: 10.4103/jrms.jrms_170_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/03/2020] [Accepted: 07/28/2021] [Indexed: 11/04/2022]
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Cubo E, Garcia-Bustillo A, Arnaiz-Gonzalez A, Ramirez-Sanz JM, Garrido-Labrador JL, Valiñas F, Allende M, Gonzalez-Bernal JJ, Gonzalez-Santos J, Diez-Pastor JF, Jahouh M, Arribas J, Trejo J. Adopting a multidisciplinary telemedicine intervention for fall prevention in Parkinson's disease. Protocol for a longitudinal, randomized clinical trial. PLoS One 2021; 16:e0260889. [PMID: 34932580 PMCID: PMC8691608 DOI: 10.1371/journal.pone.0260889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Esther Cubo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
- * E-mail:
| | - Alvaro Garcia-Bustillo
- Hospital Universitario Burgos, Burgos, Spain
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | | | | | | | | | | | | | | | - Maha Jahouh
- Facultad Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - Jose Trejo
- Hospital Universitario Burgos, Burgos, Spain
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Zischke C, Simas V, Hing W, Milne N, Spittle A, Pope R. The utility of physiotherapy assessments delivered by telehealth: A systematic review. J Glob Health 2021; 11:04072. [PMID: 34956637 PMCID: PMC8684795 DOI: 10.7189/jogh.11.04072] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Telehealth use is increasing due to its ability to overcome service access barriers and provide continued care when disease transmission is of concern. However, little is known of the validity, reliability and utility of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. The aim of this systematic review was to determine the current clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all areas of physiotherapy practice. METHODS A comprehensive search of databases (PubMed/MEDLINE, The Cochrane Library, Embase and EBSCO) was undertaken to identify studies investigating the clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. Following selection, a quality appraisal was conducted using the Brink and Louw or Mixed Methods Appraisal Tool. Evidence regarding validity, reliability and utility of synchronous telehealth physiotherapy assessments was extracted and synthesised using a critical narrative approach. RESULTS Thirty-nine studies conducted in a variety of simulated (n = 15) or real-world telehealth environments (n = 24), were included. The quality of the validity, reliability and utility studies varied. Assessments including range of movement, muscle strength, endurance, pain, special orthopaedic tests (shoulder/elbow), Berg Balance Scale, timed up and go, timed stance test, six-minute walk test, steps in 360-degree turn, Movement Assessment Battery for Children (2nd Edition), step test, ABILHAND assessment, active straight leg raise, and circumferential measures of the upper limb were reported as valid/reliable in limited populations and settings (many with small sample sizes). Participants appeared to embrace telehealth technology use, with most studies reporting high levels of participant satisfaction. If given a choice, many reported a preference for in-person physiotherapy assessments. Some inconsistencies in visual/auditory quality and challenges with verbal/non-verbal communication methods were reported. Telehealth was considered relatively cost-effective once services were established. CONCLUSIONS Performing physiotherapy assessments using synchronous forms of telehealth appears valid and reliable for specific assessment types in limited populations. Further research is needed in all areas of physiotherapy practice, to strengthen the evidence surrounding its clinometric value. Clinicians contemplating using this assessment mode should consider the client/family preferences, assessment requirements, cultural needs, environment, cost considerations, access and confidence using technology. PROTOCOL REGISTRATION PROSPERO: CRD42018108166.
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Affiliation(s)
- Cherie Zischke
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Vinicius Simas
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Alicia Spittle
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
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O'Neil J, Barnes K, Morgan Donnelly E, Sheehy L, Sveistrup H. Identification and Description of Balance, Mobility, and Gait Assessments Conducted via Telerehabilitation for Individuals With Neurological Conditions: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e27186. [PMID: 34889765 PMCID: PMC8704120 DOI: 10.2196/27186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The COVID-19 global pandemic pushed many rehabilitation practitioners to pivot their in-person practice to adopt telerehabilitation as their main method of delivery. In addition to documenting information on interventions used with clients, it is best practice for therapists to use reliable and validated outcome measures to inform their interventions. OBJECTIVE Through this scoping review, we aim to identify (1) which outcomes are being used remotely to assess balance, mobility, and gait in patients with neurological conditions, and (2) what psychometric data (validity, reliability, etc.) for remotely administered outcomes are available. METHODS Three main concepts will be included in our search: (1) neurological conditions; (2) administration by telerehabilitation; and (3) outcome measures for balance, mobility, and gait. Studies reporting remote assessment of neurological conditions published since 1990 will be included. The database search will be completed in MEDLINE (Ovid), CINAHL, PubMed, PsycINFO, EMBASE, and Cochrane. Gray literature including dissertations, conference papers, and protocol papers will also be sourced. Two reviewers will independently screen each title and abstract using pre-established inclusion and exclusion criteria. Manuscripts that appear to meet the criteria will be subject to further review, and full-text extraction using a pre-piloted extraction sheet if all criteria are met. The data will be categorized by assessment types describing impairments (such as balance, strength, and mobility) or activity limitations or participation restriction (such as functional mobility, ambulatory functions, and activities of daily living). RESULTS This scoping review will document outcome measures currently used in the remote assessment of neurological conditions. To date, 235 titles and abstracts were screened. We are in the process of finalizing the full text screening for the inclusion of articles. We expect the full screening to be completed in November 2021 and data analysis in January 2022. Our results are expected to be published in early 2022. CONCLUSIONS The optimal use of telerehabilitation as a mode to deliver rehabilitation intervention should be coupled with the completion of validated outcome measures. Therefore, it is crucial to further our knowledge on remote outcome measures and therapeutic assessments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/27186.
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Affiliation(s)
- Jennifer O'Neil
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Keely Barnes
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Lisa Sheehy
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
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Dillenseger A, Weidemann ML, Trentzsch K, Inojosa H, Haase R, Schriefer D, Voigt I, Scholz M, Akgün K, Ziemssen T. Digital Biomarkers in Multiple Sclerosis. Brain Sci 2021; 11:brainsci11111519. [PMID: 34827518 PMCID: PMC8615428 DOI: 10.3390/brainsci11111519] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
For incurable diseases, such as multiple sclerosis (MS), the prevention of progression and the preservation of quality of life play a crucial role over the entire therapy period. In MS, patients tend to become ill at a younger age and are so variable in terms of their disease course that there is no standard therapy. Therefore, it is necessary to enable a therapy that is as personalized as possible and to respond promptly to any changes, whether with noticeable symptoms or symptomless. Here, measurable parameters of biological processes can be used, which provide good information with regard to prognostic and diagnostic aspects, disease activity and response to therapy, so-called biomarkers Increasing digitalization and the availability of easy-to-use devices and technology also enable healthcare professionals to use a new class of digital biomarkers-digital health technologies-to explain, influence and/or predict health-related outcomes. The technology and devices from which these digital biomarkers stem are quite broad, and range from wearables that collect patients' activity during digitalized functional tests (e.g., the Multiple Sclerosis Performance Test, dual-tasking performance and speech) to digitalized diagnostic procedures (e.g., optical coherence tomography) and software-supported magnetic resonance imaging evaluation. These technologies offer a timesaving way to collect valuable data on a regular basis over a long period of time, not only once or twice a year during patients' routine visit at the clinic. Therefore, they lead to real-life data acquisition, closer patient monitoring and thus a patient dataset useful for precision medicine. Despite the great benefit of such increasing digitalization, for now, the path to implementing digital biomarkers is widely unknown or inconsistent. Challenges around validation, infrastructure, evidence generation, consistent data collection and analysis still persist. In this narrative review, we explore existing and future opportunities to capture clinical digital biomarkers in the care of people with MS, which may lead to a digital twin of the patient. To do this, we searched published papers for existing opportunities to capture clinical digital biomarkers for different functional systems in the context of MS, and also gathered perspectives on digital biomarkers under development or already existing as a research approach.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tjalf Ziemssen
- Correspondence: ; Tel.: +49-351-458-5934; Fax: +49-351-458-5717
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Cancer A, Sarti D, De Salvatore M, Granocchio E, Chieffo DPR, Antonietti A. Dyslexia Telerehabilitation during the COVID-19 Pandemic: Results of a Rhythm-Based Intervention for Reading. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1011. [PMID: 34828724 PMCID: PMC8624373 DOI: 10.3390/children8111011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 12/19/2022]
Abstract
The COVID-19 outbreak necessitated a reorganization of the rehabilitation practices for Learning Disorders (LDs). During the lockdown phase, telerehabilitation offered the possibility to continue training interventions while enabling social distancing. Given such an advantage of telerehabilitation methods for LDs, clinical research is still needed to test the effectiveness of diverse teletraining approaches by comparing their outcomes with those of face-to-face interventions. To compare the effectiveness of telerehabilitation vs. in-presence rehabilitation of dyslexia, a rhythm-based intervention for reading, called Rhythmic Reading Training (RRT), was tested in a small-scale clinical trial during the lockdown phase of the COVID-19 pandemic. Thirty children aged 8-13 with a diagnosis of developmental dyslexia were assigned to either a telerehabilitation or an in-presence rehabilitation setting and received RRT for 10 biweekly sessions of 45 min, supervised by a trained practitioner. The results showed that both telerehabilitation and in-presence rehabilitation were effective in improving reading and rapid automatized naming in children with dyslexia and that the effects were comparable between settings. Therefore, RRT was found to be effective in spite of the administration method (remote or in-presence). These results confirm the potential of telemedicine for the rehabilitation of LDs. Clinical Trial ID: NCT04995471.
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Affiliation(s)
- Alice Cancer
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
| | - Daniela Sarti
- Developmental Neurology Unit—Language and Learning Disorders Service, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (D.S.); (M.D.S.); (E.G.)
| | - Marinella De Salvatore
- Developmental Neurology Unit—Language and Learning Disorders Service, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (D.S.); (M.D.S.); (E.G.)
| | - Elisa Granocchio
- Developmental Neurology Unit—Language and Learning Disorders Service, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (D.S.); (M.D.S.); (E.G.)
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Normann B, Arntzen EC. What are the relationships between trunk control, balance and walking in individuals with multiple sclerosis with minor to moderate disability? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1772870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Physiotherapy Department, Nordland Hospital Trust, Bodø, Norway
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