Physiotherapists' and occupational therapists' perspectives on information and communication technology in stroke rehabilitation

Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation

AIM

To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation.

SETTING

The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings.

METHODS, PARTICIPANTS AND ANALYSIS

A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed.

RESULTS

Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting.

CONCLUSION

Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.

Home living older adults' subjective perceptions, evaluation, and interpretations of various welfare technology: A systematic review of qualitative studies

Objectives

This paper aims to map home-living older adults' subjective perceptions, evaluations, and interpretations of various welfare technologies.

Study design

Systematic literature review.

Methods

The study was designed as a systematic literature review of qualitative studies. This systematic literature review was carried out according to the PRISMA statement and was prospectively registered in PROSPERO registration number CRD42020190206. The international electronic bibliographic databases included AMED, Academic, CINAHL, Cochrane Reviews, EMBASE, Google Scholar, MEDLINE via PubMed, Scopus, and Web of Science. The scientific evidence was synthesized using qualitative analysis. All aspects of the study method followed COREQ guidelines.

Results

Following a detailed systematic search and screening of 1405 studies, 10 were included in the systematic review. The study shows that implementing Welfare Technology seems to prolong older adults' independent living in their own homes and was perceived as a complement to face-to-face contact with health care providers.

Conclusions

This study indicated that older adults consider accepting Welfare Technology as it contributes to a sense of security and empowerment in their everyday lives.

Qualitative exploration of physical therapists' experiences providing telehealth physical therapy during COVID-19

BACKGROUND

Physical therapists are trained to provide treatment to patients through a mixture of strategies. The coronavirus (COVID-19) pandemic resulted in social distancing restrictions, and physical therapists, some without previous experience, adopted telehealth physical therapy modalities to treat their patients.

OBJECTIVES

The objective of this study was to explore physical therapists' experiences of providing telehealth physical therapy during the COVID-19 pandemic.

DESIGN AND METHODS

A multisite qualitative semi-structured interview study was conducted. Seventeen physical therapists were interviewed by videoconference or by phone, and the interviews were transcribed and analyzed thematically.

RESULTS

Three main themes emerged from the study. Firstly, physical therapists experienced professional challenges with diagnosing and treating patients hands-off and becoming more verbal. Secondly, telehealth physical therapy was perceived as not feasible or effective for certain patients, attesting to the digital care divide. Lastly, participants' perceptions of patient-therapist communication varied, expressing both communicative advantages and challenges.

CONCLUSIONS

Physical therapists who practiced telehealth physical therapy during the COVID-19 period experienced information and communication technology as professionally challenging. Physical therapists adapted positively to the use of telehealth physical therapy but perceived that not every patient could benefit from it. The study emphasized the need for a better understanding of physical therapists' hands-off skills for practicing telehealth physical therapy and considers the need to establish a patient classification for telehealth physical therapy.

The Effectiveness of Digital Apps Providing Personalized Exercise Videos: Systematic Review With Meta-Analysis

BACKGROUND

Among available digital apps, those providing personalized video exercises may be helpful for individuals undergoing functional rehabilitation.

OBJECTIVE

We aimed to assess the effectiveness of apps providing personalized video exercises to support rehabilitation for people with short- and long-term disabling conditions, on functional capacity, confidence in exercise performance, health care consumption, health-related quality of life, adherence, and adverse events.

METHODS

In this systematic review, we searched MEDLINE, CENTRAL, and Embase databases up to March 2022. All randomized controlled trials evaluating the effect of apps providing personalized video exercises to support rehabilitation for any condition requiring physical rehabilitation were included. Selection, extraction, and risk of bias assessment were performed by 2 independent reviewers. The primary outcome was functional capacity at the end of the intervention. The secondary outcomes included confidence in exercise performance, care consumption, health-related quality of life, adherence, and adverse events. A meta-analysis was performed where possible; the magnitude of the effect was assessed with the standardized mean difference (SMD).

RESULTS

From 1641 identified references, 10 papers (n=1050 participants, 93% adults) were included: 7 papers (n=906 participants) concerned musculoskeletal disorders and 3 (n=144 participants) concerned neurological disorders. Two (n=332 participants) were employee based. The apps were mostly commercial (7/10); the videos were mostly elaborated on by a physiotherapist (8/10). The duration of app use was 3-48 weeks. All included studies had a high overall risk of bias. Low-quality evidence suggested that the use of apps providing personalized video exercises led to a significant small to moderate improvement in physical function (SMD 0.35, 95% CI 0.19-0.51; Phet=.86; I2=0%) and confidence in exercise performance (SMD 0.67; 95% CI 0.37-0.96; Phet=.22; I2=33%). Because of the very low quality of the evidence, the effects on quality of life and exercise adherence were uncertain. Apps did not influence the rate of adverse events.

CONCLUSIONS

Apps providing personalized video exercises to support exercise performance significantly improved physical function and confidence in exercise performance. However, the level of evidence was low; more robust studies are needed to confirm these results.

TRIAL REGISTRATION

PROSPERO CRD42022323670; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323670.

Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl-Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains.

Implementation of the Gamut of Physiotherapy Maneuvers in Restoration and Normalization of Functional Potencies in a Patient With a Hemorrhagic Stroke: A Case Report

A stroke is a medical emergency characterized by a sudden onset of focal neurological deficits due to an interruption in the blood flow to the brain tissues, with signs and symptoms persisting for more than 24 hours. Motor, sensory, recognition, language, and perceptual deficiencies are typical signs of the disease, depending on the areas affected, the size of the injury, and the origin of the injury. Patients who have had a stroke frequently have problems like weakness, stiffness, and altered movement patterns in addition to poor balance and mobility issues. Numerous physiotherapeutic strategies concentrate on helping stroke victims recover quickly. Stroke-related mortality rates have decreased over the past few decades due to advancements in stroke therapy and rehabilitation. One approach that can be primarily used to normalization of tone is facilitation by Rood's technique. The present case report is of a 45-year-old female with a history of hypertension presented with complaints of weakness on the right side of the body. The patient had right hemiplegia with more involvement of the right upper extremity. The patient underwent a decompressive craniotomy. On investigation, the magnetic resonance imaging (MRI) report revealed an area of blood density attenuation with multiple air foci in the left gangliocapsular region. Treatment was started after the patient was operated on. An approach-oriented rehabilitation program was planned for the patient. Physiotherapy maneuvers such as the proprioceptive neuromuscular facilitation (PNF) approach and Rood's approach were used to restore and normalize functional potencies and recover the patient's condition. Oral facial facilitation was also used for swallowing frequency control, sensory awareness, and motor control. Posttreatment changes such as changes in muscle tone, strength, and mobility, which are essential for patients with the activity of daily living (ADLs), were observed. Outcome measures used in this patient are the Functional Independence of Measures (FIM) scale, Brunnstrom grading, voluntary control grading, and the National Institute of Health Stroke Scale (NIHSS).

Use of the digital assistant “Vigo” at home environment for stroke recovery: focus group discussion with specialists working in neurorehabilitation (Preprint)

BACKGROUND

There is a lack of resources for the provision of adequate rehabilitation after a stroke, thus creating a challenge to provide the necessary high-quality, patient-centered, and cost-efficient rehabilitation services at a time when they are needed the most. Tablet-based therapeutic programs present an alternative way to access rehabilitation services and show a new paradigm for providing therapeutic interventions following a stroke anytime and anywhere. The digital assistant Vigo is an artificial intelligence-based app that provides an opportunity for a new, more integrative way of carrying out a home-based rehabilitation program. Considering the complexity of the stroke recovery process, factors such as a suitable population, appropriate timing, setting, and the necessary patient-specialist support structure need to be thoroughly researched. There is a lack of qualitative research exploring the perspectives of professionals working in neurorehabilitation of the content and usability of the digital tool for the recovery of patients after a stroke.

OBJECTIVE

The aim of this study is to identify the requirements for a tablet-based home rehabilitation program for stroke recovery from the perspective of a specialist working in stroke rehabilitation.

METHODS

The focus group study method was chosen to explore specialists' attitudes, experience, and expectations related to the use of the digital assistant Vigo as a home-based rehabilitation program for stroke recovery in domains of the app's functionality, compliance, usability, and content.

RESULTS

In total, 3 focus groups were conducted with a participant count of 5-6 per group and the duration of the discussion ranging from 70 to 80 minutes. In total, 17 health care professionals participated in the focus group discussions. The participants represented physiotherapists (n=7, 41.2%), occupational therapists (n=7, 41.2%), speech and language therapists (n=2, 11.8%), and physical medicine and rehabilitation physicians (n=1, 5.9%). Audio and video recordings of each discussion were created for further transcription and analysis. In total, 4 themes were identified: (1) the clinician's views on using Vigo as a home-based rehabilitation system, (2) patient-related circumstances facilitating and limiting the use of Vigo; (3) Vigo's functionality and use process (program creation, individual use, remote support); and (4) complementary and alternative Vigo use perspectives. The last 3 themes were divided further into 10 subthemes, and 2 subthemes had 2 sub-subthemes each.

CONCLUSIONS

Health care professionals expressed a positive attitude toward the usability of the Vigo app. It is important that the content and use of the app be coherent with the aim to avoid (1) misunderstanding its practical use and the need for integration in practice and (2) misusing the app. In all focus groups, the importance of close involvement of rehabilitation specialists in the process of app development and research was highlighted.

Knowledge Structure and Emerging Trends of Telerehabilitation in Recent 20 Years: A Bibliometric Analysis via CiteSpace

Purpose

Telerehabilitation, as an effective means of treatment, is not inferior to traditional rehabilitation, and solves the problem of many patients who do not have access to hospital-based training due to costs and distance. So far, the knowledge structure of the global use of telerehabilitation has not been formed. This study aimed to demonstrate the state of emerging trends and frontiers concerning the studies of telerehabilitation through bibliometric software.

Methods

Literature about telerehabilitation from 2000 to 2021 was retrieved from the Web of Science Core Collection. We used CiteSpace 5.8.R3 to analyze the publication years, journals/cited journals, countries, institutions, authors/cited authors, references, and keywords. Based on the analysis results, we plotted the co-citation map to more intuitively observe the research hotspots and knowledge structure.

Results

A total of 1,986 records were obtained. The number of annual publications gradually increased over the investigated period. The largest increase occurred between 2019 and 2020. J TELEMED TELECARE was the most prolific and the most cited journal. The United States was the most influential country, with the highest number of publications and centrality. The University of Queensland was the most productive institution. The author Tousignant M ranked the highest in the number of publications and Russell TG ranked the first in the cited authors. Respectively, the articles published by Cottrell MA and Russell TG ranked the first in the frequency and centrality of cited references. The four hot topics in telerehabilitation were “care”,“stroke”, “telemedicine” and “exercise”. The keyword “stroke” showed the strongest citation burst. The two frontier keywords were “physical therapy” and “participation”. The keywords were clustered to form 21 labels.

Conclusion

This study uses visualization software CiteSpace to provide the current status and trends in clinical research of telerehabilitation over the past 20 years, which may help researchers identify new perspectives concerning potential collaborators and cooperative institutions, hot topics, and research frontiers in the research field. Bibliometric analysis of telerehabilitation supplements and improves the knowledge field of telemedicine from the concept of rehabilitation medicine and provides new insights into therapists during the COVID-19 pandemic.

Use of Information and Communication Technology by South Korean Occupational Therapists Working in Hospitals: A Cross-Sectional Study

The convergence and development of information and communication technology (ICT) have brought changes to occupational therapy practices, posing novel challenges for occupational therapists (OTs). This study aimed to investigate current practices of ICT use and factors affecting the clinical use of ICT among Korean OTs. An online survey was conducted among 158 domestic OTs working in hospitals. Participants reported that the therapeutic use of ICT positively affected client outcomes, ICT choice, and continued use. Participants highlighted the necessity to assess the ability of clients to use smart devices and ensure familiarity in the OT process. Of respondents, 31% reported the application of ICT-based interventions or recommendations in clinical practice. The use of ICT was predominantly associated with cognitive function, leisure activities, and information access and communication. A significant difference in barriers to ICT use was observed between familiar users and non-users. Familiar users reported a lack of knowledge and training as major barriers, whereas non-users reported expensive products or technology. Ease of use and usefulness were facilitators of ICT use among familiar users. Information and training opportunities are required to promote ICT use by OTs, and the usefulness of ICT must be realized via client-centered, customized approaches.

Telerehabilitation during the COVID-19 pandemic in Sweden: a survey of use and perceptions among physiotherapists treating people with neurological diseases or older adults

Background 

Telerehabilitation, i.e. rehabilitation at a distance using Information and Communication Technology (ICT), is a promising avenue for improving health among people with neurological diseases or older adults who often experience limited access to services. Still, little is known about physiotherapists’ use, perceptions and needs with regards to telerehabilitation services.

Aims

To describe physiotherapists use and perceptions of, as well as needs for, telerehabilitation services for the rehabilitation of people with neurological diseases or older adults in Sweden.

Methods

In this cross-sectional study, an author-created survey was sent out to members of the Swedish Association of Physiotherapists including questions about the use and perceptions of existing telerehabilitation services (e.g. telephone, internet-based applications and mobile applications) as well as needs of future telerehabilitation services. The results were presented descriptively as numbers and percentages.

Results

Three hundred seven physiotherapists were included in this study with 139 (45%) treating people with neurological diseases and 168 (55%) treating older adults. Most respondents did not provide telerehabilitation before (74%) or during (51%) the COVID-19 pandemic. Telephone, which was predominantly used for administrative tasks, was the most frequent utilised ICT used by 68% of the physiotherapist using ICTs several days/week. Few respondents used internet-based applications (12%), mobile applications (3%) or SMS services (8%) and videoconferencing (3%). A majority of the respondents were interested in ICT (78%), felt comfortable using ICT (57%) and were interested in learning how ICT can be used in rehabilitation (92%). Still, few respondents perceived that people with neurological diseases or older adults can use existing ICTs for rehabilitation purposes (18%) and that existing reimbursement system within health care facilitates remote rehabilitation (16%). Important functionality of future ICT perceived by physiotherapists covered patient communication (e.g. chat, SMS and video), assessments (e.g. digital surveys and assessment of physical activity) and treatment (e.g. exercise prescription).

Conclusion

While physiotherapists had an overall positive perception to use and willingness to learn about telerehabilitation, few used telerehabilitation services before nor during the COVID-19 pandemic and they also perceived multilevel barriers for implementation, ranging from patients ability to use ICT to existing reimbursement systems within health care. Our findings emphasize the need to strengthen the expertise regarding remote services among physiotherapists.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07968-6.

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients’ acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists’ constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy.

Wearable Activity Monitoring in Day-to-Day Stroke Care: A Promising Tool but Not Widely Used

Physical activity monitoring with wearable technology has the potential to support stroke rehabilitation. Little is known about how physical therapists use and value the use of wearable activity monitors. This cross-sectional study explores the use, perspectives, and barriers to wearable activity monitoring in day-to-day stroke care routines amongst physical therapists. Over 300 physical therapists in primary and geriatric care and rehabilitation centers in the Netherlands were invited to fill in an online survey that was developed based on previous studies and interviews with experts. In total, 103 complete surveys were analyzed. Out of the 103 surveys, 27% of the respondents were already using activity monitoring. Of the suggested treatment purposes of activity monitoring, 86% were perceived as useful by more than 55% of the therapists. The most recognized barriers to clinical implementation were lack of skills and knowledge of patients (65%) and not knowing what brand and type of monitor to choose (54%). Of the non-users, 79% were willing to use it in the future. In conclusion, although the concept of remote activity monitoring was perceived as useful, it was not widely adopted by physical therapists involved in stroke care. To date, skills, beliefs, and attitudes of individual therapists determine the current use of wearable technology.