Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial

Social robots counselling in community pharmacies - Helping or harming? A qualitative study of pharmacists' views

Background

Welfare technological solutions such as social robots attempt to meet the growing needs of the healthcare sector. Social robots may be able to respond to the shortage of pharmaceutical personnel at community pharmacies. However, there is a lack of previous studies regarding the use of social robots for medication counselling purposes in a pharmacy setting.

Objectives

The objective of this qualitative study was to explore pharmacists' views on the potential role of social robots in medication counselling.

Methods

Pharmacists, purposively sampled based on having recent experience of counselling customers in community pharmacies in Finland, first acted as customers interacting with the social robot in a simulated setting, before taking part in a focus group where their perspectives were explored. The focus group discussions were conducted in October and November 2022. The qualitative data was transcribed and analysed using reflexive thematic analysis.

Results

The number of participants was eight in total. A main theme of how the robot may either help or harm concerning medication safety within a pharmacy setting was identified. The six sub-themes found, according to pharmacists' views on robot counselling in community pharmacies, are context, digital competence, customer integrity, interaction, pharmacists' professional role and human skills.

Conclusions

According to the study findings, pharmacists experience that the social robot can offer a potential complement to a human pharmacist. The robot is seen as beneficial with respect to certain customer groups and in the light of personnel shortages, and may in the future add to trust, equality, freedom of choice and multilingualism, among other things, in the customer service situation at community pharmacies, thus improving medication safety.

The Role of a Smart Health Ecosystem in Transforming the Management of Chronic Health Conditions

The effective management of chronic conditions requires an approach that promotes a shift in care from the clinic to the home, improves the efficiency of health care systems, and benefits all users irrespective of their needs and preferences. Digital health can provide a solution to this challenge, and in this paper, we provide our vision for a smart health ecosystem. A smart health ecosystem leverages the interoperability of digital health technologies and advancements in big data and artificial intelligence for data collection and analysis and the provision of support. We envisage that this approach will allow a comprehensive picture of health, personalization, and tailoring of behavioral and clinical support; drive theoretical advancements; and empower people to manage their own health with support from health care professionals. We illustrate the concept with 2 use cases and discuss topics for further consideration and research, concluding with a message to encourage people with chronic conditions, their caregivers, health care professionals, policy and decision makers, and technology experts to join their efforts and work toward adopting a smart health ecosystem.

Increasing efficiency and well-being? a systematic review of the empirical claims of the double-benefit argument in socially assistive devices

BACKGROUND

Socially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side.

METHODS

Electronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed.

RESULTS

The data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices.

DISCUSSION

We suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument.

[Interventions to reduce hospital readmission rates in patients with COPD: a systematic review]

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) have a high risk of hospital and intensive care unit readmission. Readmissions are a severe burden on patients, families, and the health care system. The aim of this study is to identify pedagogical-counseling interventions to reduce readmissions and other parameters in COPD patients.

METHODS

A systematic literature search was performed in March 2022 in the databases Medline, Cochrane Library, CINAHL, and LIVIVO. German‑, English‑, Arabic-, and French-language (cluster-) randomized, controlled studies were included.

RESULTS

In all, 21 studies with a total of 3894 COPD patients were included. The quality of included studies was moderate to good. Interventions were self-management programs, telemedical, and educational interventions. Five out of seven studies found a significant reduction in readmissions for self-management programs (p = 0.02-0.49). A positive effect of telemedicine interventions on outcome parameters was only reported in two studies (p < 0.05) and no significant effect in four studies. Educational interventions were examined in six studies: four found no difference between the study groups and two found a significant difference in favor of the intervention group (p = 0.01). Special care programs also showed a significant effect in two studies.

CONCLUSION

The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review

BACKGROUND

eHealth is increasingly considered an important tool for supporting pharmacotherapy management.

OBJECTIVE

We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management.

METHODS

We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends.

RESULTS

Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ≥3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes.

CONCLUSIONS

There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains.

Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended.

AIM

To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development.

METHODS

A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically.

RESULTS

A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided.

CONCLUSION

Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences.

TRIAL REGISTRATION

The review was registered in PROSPERO with registration number CRD42022339523.

Clinical Impact of Electronic Monitoring Devices of Inhalers in Adults with Asthma or COPD: A Systematic Review and Meta-Analysis

We conducted a systematic review and meta-analysis to gain insight into the characteristics and clinical impact of electronic monitoring devices of inhalers (EMDs) and their clinical interventions in adult patients with asthma or COPD. The search included PubMed, Web of Science, Cochrane, Scopus and Embase databases, as well as official EMDs websites. We found eight observational studies and ten clinical trials, assessing a wide range of clinical outcomes. Results from the meta-analysis on adherence to inhalers in a period over three months were favourable in the EMD group (fixed effects model: SMD: 0.36 [0.25–0.48]; random effects model SMD: 0.41 [0.22–0.60]). An exploratory meta-analysis found an improvement in ACT score (fixed effect model SMD: 0.25 [0.11–0.39]; random effects model: SMD: 0.47 [−0.14–1.08]). Other clinical outcomes showed mixed results in the descriptive analyses. The findings of this review highlight the benefits of EMDs in the optimization of adherence to inhaled therapy as well as the potential interest in other clinical outcomes.

Personalised socially assistive robot for cardiac rehabilitation: Critical reflections on long-term interactions in the real world

Lack of motivation and low adherence rates are critical concerns of long-term rehabilitation programmes, such as cardiac rehabilitation. Socially assistive robots are known to be effective in improving motivation in therapy. However, over longer durations, generic and repetitive behaviours by the robot often result in a decrease in motivation and engagement, which can be overcome by personalising the interaction, such as recognising users, addressing them with their name, and providing feedback on their progress and adherence. We carried out a real-world clinical study, lasting 2.5 years with 43 patients to evaluate the effects of using a robot and personalisation in cardiac rehabilitation. Due to dropouts and other factors, 26 patients completed the programme. The results derived from these patients suggest that robots facilitate motivation and adherence, enable prompt detection of critical conditions by clinicians, and improve the cardiovascular functioning of the patients. Personalisation is further beneficial when providing high-intensity training, eliciting and maintaining engagement (as measured through gaze and social interactions) and motivation throughout the programme. However, relying on full autonomy for personalisation in a real-world environment resulted in sensor and user recognition failures, which caused negative user perceptions and lowered the perceived utility of the robot. Nonetheless, personalisation was positively perceived, suggesting that potential drawbacks need to be weighed against various benefits of the personalised interaction.

Socially Assistive Robots for Parkinson's Disease: Needs, Attitudes and Specific Applications as Identified by Healthcare Professionals

To explore how socially assistive robots (SARs) may assist the specific needs of individuals with Parkinson's disease (IwPD), we conducted three focus groups with 12 clinicians who treat IwPD. We present a thematic analysis of their perceptions of the needs of the patients, and their own expectations, perceived advantages, disadvantages and concerns regarding the use of SARs for IwPD. Clinicians were positive towards using SARs for IwPD, if used in the patient's home, for motor, communication, emotional, and cognitive needs, especially for practice and for help with activities of daily living. They were concerned that a SAR might be used to replace clinicians’ work, and stressed it should only augment the clinicians’ work. They thought a SAR may relieve some of the burden experienced by informal caregivers, and identified specific applications for SARs for PD. We asked 18 stakeholders (nine IwPD, nine family members) to rate their level of agreement with the clinicians’ statements. The greatest divergence between their views and those of the clinicians was on the topic of using a SAR as a companion, or as a feeding assistant, to which they objected. This work may be used as a basis for future studies designing SARs for IwPD.

A Socially Assistive Robot for Stroke Patients: Acceptance, Needs, and Concerns of Patients and Informal Caregivers

Stroke patients often contend with long-term physical challenges that require treatment and support from both formal and informal caregivers. Socially Assistive Robots (SARs) can assist patients in their physical rehabilitation process and relieve some of the burden on the informal caregivers, such as spouses and family members. We collected and analyzed information from 23 participants (11 stroke patients and 12 informal caregivers) who participated in a total of six focus-group discussions. The participants responded to questions regarding using a SAR to promote physical exercises during the rehabilitation process: (a) the advantages and disadvantages of doing so; (b) specific needs that they wish a SAR would address; (c) patient-specific adaptations they would propose to include; and (d) concerns they had regarding the use of such technology in stroke rehabilitation. We found that the majority of the participants in both groups were interested in experiencing the use of a SAR for rehabilitation, in the clinic and at home. Both groups noted the advantage of having the constant presence of a motivating entity with whom they can practice their rehabilitative exercises. The patients noted how such a device can assist formal caregivers in managing their workload, while the informal caregivers indicated that such a system could ease their own workload and sense of burden. The main disadvantages that participants noted related to the robot not possessing human abilities, such as the ability to hold a conversation, to physically guide the patient's movements, and to express or understand emotions. We anticipate that the data collected in this study-input from the patients and their family members, including the similarities and differences between their points of view-will aid in improving the development of SARs for rehabilitation, so that they can better suit people who have had a stroke, and meet their individual needs.

Assessing the Topics and Motivating Factors Behind Human-Social Chatbot Interactions: Thematic Analysis of User Experiences

Background

Although social chatbot usage is expected to increase as language models and artificial intelligence improve, very little is known about the dynamics of human-social chatbot interactions. Specifically, there is a paucity of research examining why human-social chatbot interactions are initiated and the topics that are discussed.

Objective

We sought to identify the motivating factors behind initiating contact with Replika, a popular social chatbot, and the topics discussed in these interactions.

Methods

A sample of Replika users completed a survey that included open-ended questions pertaining to the reasons why they initiated contact with Replika and the topics they typically discuss. Thematic analyses were then used to extract themes and subthemes regarding the motivational factors behind Replika use and the types of discussions that take place in conversations with Replika.

Results

Users initiated contact with Replika out of interest, in search of social support, and to cope with mental and physical health conditions. Users engaged in a wide variety of discussion topics with their Replika, including intellectual topics, life and work, recreation, mental health, connection, Replika, current events, and other people.

Conclusions

Given the wide range of motivational factors and discussion topics that were reported, our results imply that multifaceted support can be provided by a single social chatbot. While previous research already established that social chatbots can effectively help address mental and physical health issues, these capabilities have been dispersed across several different social chatbots instead of deriving from a single one. Our results also highlight a motivating factor of human-social chatbot usage that has received less attention than other motivating factors: interest. Users most frequently reported using Replika out of interest and sought to explore its capabilities and learn more about artificial intelligence. Thus, while developers and researchers study human-social chatbot interactions with the efficacy of the social chatbot and its targeted user base in mind, it is equally important to consider how its usage can shape public perceptions and support for social chatbots and artificial agents in general.

Effect of telemonitoring and telerehabilitation on physical activity, exercise capacity, health-related quality of life and healthcare use in patients with chronic lung diseases or COVID-19: A scoping review

BACKGROUND

Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19.

METHODS

A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment.

RESULTS

This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups' exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results.

CONCLUSION

Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.

Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review

BACKGROUND

The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care.

OBJECTIVE

The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation.

METHODS

A scoping review of the literature published since 2015 was conducted using the Arksey and O'Malley's framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool.

RESULTS

A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life.

CONCLUSIONS

The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care.

Robot-enhanced diabetes care for middle-aged and older adults living with diabetes in the community: A small sample size mixed-method evaluation

Purpose

This study assessed robot-enhanced healthcare in practical settings for the purpose of community diabetes care.

Methods

A mixed method evaluation collected quantitative and qualitative data on diabetes patients over 45 (N = 30) and community pharmacists (N = 10). It took 15–20 min for the diabetes patients to interact with the robot. Before and after the interaction, questionnaires including a diabetes knowledge test, self-efficacy for diabetes, and feasibility of use of the robot was administered. In-depth interviews with both pharmacists and patients were also conducted.

Results

After interacting with the robot, a statistically significant improvement in diabetes knowledge (p < .001) and feasibility of the robot (p = .012) was found, but self-efficacy (p = .171) was not significantly improved. Five themes emerged from interviewing the diabetes patients: Theme 1: meets the needs of self-directed learning for the elderly; Theme 2: reduces alertness and creates comfortable interaction; Theme 3: vividness and richness enhance interaction opportunities; Theme 4: Robots are not without disadvantages, and Theme 5: Every person has unique tastes. Three themes emerged from interviewing pharmacists: Theme 1: Technology must meet the real needs of the patient; Theme 2: creates new services, and Theme 3: The use of robots must conform to real-life situations.

Conclusions

Both the diabetes patients and the pharmacist reported more positive feedback on the robot-enhanced diabetes care than concerns. Self-directed learning, comfortable interaction, and vividness were the most focuses when using robot to enhance self-management for the patients. Pharmacists were most receptive to fit conforming with reality and creating new services.

Investigating the Usability, Efficacy and Accuracy of a Medication Entering Software System for a Healthcare Robot

Purpose: This research aimed to evaluate medication software for a healthcare robot. Study I compared two software versions (RoboGen and RoboGen2) for system usability, speed and accuracy of medication entry; Study II evaluated system usability and community pharmacists’ views of RoboGen2.

Methods: Study I had a within-subjects experimental design and recruited 40 Health Sciences students to enter different, comparable sets of prescriptions into the two systems, in randomized order, within a limit of 15 min. Screen activity was recorded to observe prescription errors. Study II had a cross-sectional observational design and recruited 20 community pharmacists using convenience sampling. Pharmacists entered three prescriptions using RoboGen2. Participants in both studies completed the System Usability Scale (SUS) following each task. Study I participants completed a questionnaire on system preference, and Study II participants a semi-structured interview.

Results: Study I participants preferred Robogen2 (p < 0.001) due to its sleek and modern layout, good flow, ease of use, and intuitive design. SUS scores [t (40) = −3.40, p = 0.002] and speed of medication entry favored Robogen2 (t = 3.65, p < 0.001). No significance was found in accuracy (t = 1.12, p = 0.27). In study 2, pharmacists rated the usability of RoboGen2 below average. Themes from interviews were navigation and streamlining the system, ease of use, and integration with pharmacy software systems.

Conclusion: Adding safety features and better aesthetics can improve the usability and safety of a medication prescription system. Streamlining workflow and pre-populating data can increase speed of prescription entry without compromising patient safety. However, a better approach is integration with pre-existing pharmacy systems to reduce workload while incorporating safety features built into existing dispensing systems.

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients’ autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.

Views on Using Social Robots in Professional Caregiving: Content Analysis of a Scenario Method Workshop

BACKGROUND

Interest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary.

OBJECTIVE

In addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care.

METHODS

In February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis.

RESULTS

The majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients.

CONCLUSIONS

The literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future.

Robots for Elderly Care in the Home: A Landscape Analysis and Co-Design Toolkit

Over the last two decades, several deployments of robots for in-house assistance of older adults have been trialled. However, these solutions are mostly prototypes and remain unused in real-life scenarios. In this work, we review the historical and current landscape of the field, to try and understand why robots have yet to succeed as personal assistants in daily life. Our analysis focuses on two complementary aspects: the capabilities of the physical platform and the logic of the deployment. The former analysis shows regularities in hardware configurations and functionalities, leading to the definition of a set of six application-level capabilities (exploration, identification, remote control, communication, manipulation, and digital situatedness). The latter focuses on the impact of robots on the daily life of users and categorises the deployment of robots for healthcare interventions using three types of services: support, mitigation, and response. Our investigation reveals that the value of healthcare interventions is limited by a stagnation of functionalities and a disconnection between the robotic platform and the design of the intervention. To address this issue, we propose a novel co-design toolkit, which uses an ecological framework for robot interventions in the healthcare domain. Our approach connects robot capabilities with known geriatric factors, to create a holistic view encompassing both the physical platform and the logic of the deployment. As a case study-based validation, we discuss the use of the toolkit in the pre-design of the robotic platform for an pilot intervention, part of the EU large-scale pilot of the EU H2020 GATEKEEPER project.

A robot goes to rehab: a novel gamified system for long-term stroke rehabilitation using a socially assistive robot-methodology and usability testing

Background

Socially assistive robots (SARs) have been proposed as a tool to help individuals who have had a stroke to perform their exercise during their rehabilitation process. Yet, to date, there are no data on the motivating benefit of SARs in a long-term interaction with post-stroke patients.

Methods

Here, we describe a robot-based gamified exercise platform, which we developed for long-term post-stroke rehabilitation. The platform uses the humanoid robot Pepper, and also has a computer-based configuration (with no robot). It includes seven gamified sets of exercises, which are based on functional tasks from the everyday life of the patients. The platform gives the patients instructions, as well as feedback on their performance, and can track their performance over time. We performed a long-term patient-usability study, where 24 post-stroke patients were randomly allocated to exercise with this platform—either with the robot or the computer configuration—over a 5–7 week period, 3 times per week, for a total of 306 sessions.

Results

The participants in both groups reported that this rehabilitation platform addressed their arm rehabilitation needs, and they expressed their desire to continue training with it even after the study ended. We found a trend for higher acceptance of the system by the participants in the robot group on all parameters; however, this difference was not significant. We found that system failures did not affect the long-term trust that users felt towards the system.

Conclusions

We demonstrated the usability of using this platform for a long-term rehabilitation with post-stroke patients in a clinical setting. We found high levels of acceptance of both platform configurations by patients following this interaction, with higher ratings given to the SAR configuration. We show that it is not the mere use of technology that increases the motivation of the person to practice, but rather it is the appreciation of the technology’s effectiveness and its perceived contribution to the rehabilitation process. In addition, we provide a list of guidelines that can be used when designing and implementing other technological tools for rehabilitation.

Trial registration: This trial is registered in the NIH ClinicalTrials.gov database. Registration number NCT03651063, registration date 21.08.2018. https://clinicaltrials.gov/ct2/show/NCT03651063.

Effectiveness of eHealth Interventions in Improving Medication Adherence for Patients With Chronic Obstructive Pulmonary Disease or Asthma: Systematic Review

Background

Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth.

Objective

This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma.

Methods

A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed.

Results

In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects.

Conclusions

The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.

Older adults' experiences and perceptions of living with Bomy, an assistive dailycare robot: a qualitative study

An aging global population and preference for aging-in-place pose the opportunity for home-based robots to assist older adults with their daily routines. However, there is limited research into the experiences of older adults using robots in their own homes. In this descriptive qualitative feasibility study, older self-supporting and community-dwelling adults with various age-related health needs used Bomy, a dailycare robot in their homes for up to one week. The study explored the usefulness of the robot and participants' perceptions and experiences of using it. Bomy reminded them of daily activities and delivered cognitive stimulation games. Semi-structured in-person interviews were conducted, and data were analyzed thematically. Findings revealed an acceptance toward robots and the value of assistive dailycare robots. Participants perceived Bomy as a companion and made suggestions for improvement, including resolving technical issues associated with long-term use. Future functions should be personalizable, to accommodate each user's health needs and could also include smoke detection and reading aloud functions. Dailycare robots show promising potential in elderly care, especially in providing reminders for medication, health and wellbeing. This study highlights the importance of co-design and testing robotics in the environments for which they have been developed. Widespread implementation of Bomy might be feasible in the future, with some further adjustments.

Telemedicine Services in Chronic Obstructive Pulmonary Disease: A Systematic Review of Patients' Adherence

BACKGROUND

The current systematic review aimed to determine the effect of telemedicine services on adherence in patients with chronic obstructive pulmonary disease (COPD) and to describe the type of adherence and applied devices and modules.

MATERIALS AND METHODS

We reviewed PubMed, Scopus, Web of Science, and Embase databases to identify relevant studies from the time of inception of these databases to March 10, 2019, using three groups of keywords. The first group comprised words describing COPD, the second group included words describing types of telemedicine interventions, and the third group contained words describing adherence. The reference list of identified articles was also hand-searched to retrieve possibly relevant articles.

RESULTS

In total 21 articles were included, in which 13 reported a positive effect for telemedicine on patients' adherence. Adherence to treatment was classified under six categories. The highest frequency belongs to the adherence to performing exercises and participation in training sessions, using the system, using devices, measuring (like blood pressure, oxygen saturation, heart rate, weight, temperature, sputum volume) and reporting symptoms and the results of measurements, completing tasks, and medication.

CONCLUSION

This study demonstrated the effectiveness of telemedicine services on adherence to treatment plans in patients with COPD. The following factors contribute to the effectiveness of telemedicine services: patient support by healthcare professionals and easy access to them, uninterrupted execution of telemedicine programs, follow-up and supervision of providers, creating and maintaining motivation in patients, and provision of different self-management modules.

Perceptions of community pharmacists to implementing technologies in the workplace: an exploratory study

Background The proliferation of different technologies in pharmacies has begun to change the role and work of pharmacists; however, while workplace integration of technologies has been shown to be beneficial, there are still barriers to their implementation. Few studies have investigated pharmacists' perceptions of these technologies. Objective To investigate the views of community pharmacists on the implementation of technologies in pharmacy practice. Setting Community pharmacies in Auckland, New Zealand. Methods Semi-structured interviews were conducted June-September 2018 with a convenience sample of 20 pharmacists. Interviews explored current medication management and technologies used to support this service, experiences with technologies, confidence in learning new technologies, and whether the introduction of technologies could solve any needs in pharmacy practice. Data were analysed using inductive thematic analysis. Main outcome measure Community pharmacists views on pharmacy technologies. Results Four key themes were identified: attitudes to existing medication management technologies, adapting to new technologies, acceptance of technology, and barriers to implementing technology in pharmacies. Pharmacists were accepting of technology to help with medication management and allowing them to provide more patient-centered care. Most pharmacists expressed confidence in using new technologies and viewed technology as a tool to address current limitations in their practice. Barriers to technology were cost, consequences of medication error, fear that technology may replace people, and an over-reliance on technology. Conclusion Community pharmacists made use of several types of technologies to promote medication management, including robotics. While mostly accepting of new technologies to streamline tasks and reduce error, pharmacists highlighted the importance of addressing barriers to technology implementation prior to workplace implementation.

Telerehabilitation for chronic respiratory disease

BACKGROUND

Pulmonary rehabilitation is a proven, effective intervention for people with chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and bronchiectasis. However, relatively few people attend or complete a program, due to factors including a lack of programs, issues associated with travel and transport, and other health issues. Traditionally, pulmonary rehabilitation is delivered in-person on an outpatient basis at a hospital or other healthcare facility (referred to as centre-based pulmonary rehabilitation). Newer, alternative modes of pulmonary rehabilitation delivery include home-based models and the use of telehealth. Telerehabilitation is the delivery of rehabilitation services at a distance, using information and communication technology. To date, there has not been a comprehensive assessment of the clinical efficacy or safety of telerehabilitation, or its ability to improve uptake and access to rehabilitation services, for people with chronic respiratory disease.

OBJECTIVES

To determine the effectiveness and safety of telerehabilitation for people with chronic respiratory disease.

SEARCH METHODS

We searched the Cochrane Airways Trials Register, and the Cochrane Central Register of Controlled Trials; six databases including MEDLINE and Embase; and three trials registries, up to 30 November 2020. We checked reference lists of all included studies for additional references, and handsearched relevant respiratory journals and meeting abstracts.

SELECTION CRITERIA

All randomised controlled trials and controlled clinical trials of telerehabilitation for the delivery of pulmonary rehabilitation were eligible for inclusion. The telerehabilitation intervention was required to include exercise training, with at least 50% of the rehabilitation intervention being delivered by telerehabilitation.

DATA COLLECTION AND ANALYSIS

We used standard methods recommended by Cochrane. We assessed the risk of bias for all studies, and used the ROBINS-I tool to assess bias in non-randomised controlled clinical trials. We assessed the certainty of evidence with GRADE. Comparisons were telerehabilitation compared to traditional in-person (centre-based) pulmonary rehabilitation, and telerehabilitation compared to no rehabilitation. We analysed studies of telerehabilitation for maintenance rehabilitation separately from trials of telerehabilitation for initial primary pulmonary rehabilitation.

MAIN RESULTS

We included a total of 15 studies (32 reports) with 1904 participants, using five different models of telerehabilitation. Almost all (99%) participants had chronic obstructive pulmonary disease (COPD). Three studies were controlled clinical trials. For primary pulmonary rehabilitation, there was probably little or no difference between telerehabilitation and in-person pulmonary rehabilitation for exercise capacity measured as 6-Minute Walking Distance (6MWD) (mean difference (MD) 0.06 metres (m), 95% confidence interval (CI) -10.82 m to 10.94 m; 556 participants; four studies; moderate-certainty evidence). There may also be little or no difference for quality of life measured with the St George's Respiratory Questionnaire (SGRQ) total score (MD -1.26, 95% CI -3.97 to 1.45; 274 participants; two studies; low-certainty evidence), or for breathlessness on the Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score (MD 0.13, 95% CI -0.13 to 0.40; 426 participants; three studies; low-certainty evidence). Participants were more likely to complete a program of telerehabilitation, with a 93% completion rate (95% CI 90% to 96%), compared to a 70% completion rate for in-person rehabilitation. When compared to no rehabilitation control, trials of primary telerehabilitation may increase exercise capacity on 6MWD (MD 22.17 m, 95% CI -38.89 m to 83.23 m; 94 participants; two studies; low-certainty evidence) and may also increase 6MWD when delivered as maintenance rehabilitation (MD 78.1 m, 95% CI 49.6 m to 106.6 m; 209 participants; two studies; low-certainty evidence). No adverse effects of telerehabilitation were noted over and above any reported for in-person rehabilitation or no rehabilitation.

AUTHORS' CONCLUSIONS

This review suggests that primary pulmonary rehabilitation, or maintenance rehabilitation, delivered via telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre-based pulmonary rehabilitation, with no safety issues identified. However, the certainty of the evidence provided by this review is limited by the small number of studies, of varying telerehabilitation models, with relatively few participants. Future research should consider the clinical effect of telerehabilitation for individuals with chronic respiratory diseases other than COPD, the duration of benefit of telerehabilitation beyond the period of the intervention, and the economic cost of telerehabilitation.

Quality of Care Perceived by Older Patients and Caregivers in Integrated Care Pathways With Interviewing Assistance From a Social Robot: Noninferiority Randomized Controlled Trial

Background

Society is facing a global shortage of 17 million health care workers, along with increasing health care demands from a growing number of older adults. Social robots are being considered as solutions to part of this problem.

Objective

Our objective is to evaluate the quality of care perceived by patients and caregivers for an integrated care pathway in an outpatient clinic using a social robot for patient-reported outcome measure (PROM) interviews versus the currently used professional interviews.

Methods

A multicenter, two-parallel-group, nonblinded, randomized controlled trial was used to test for noninferiority of the quality of care delivered through robot-assisted care. The randomization was performed using a computer-generated table. The setting consisted of two outpatient clinics, and the study took place from July to December 2019. Of 419 patients who visited the participating outpatient clinics, 110 older patients met the criteria for recruitment. Inclusion criteria were the ability to speak and read Dutch and being assisted by a participating health care professional. Exclusion criteria were serious hearing or vision problems, serious cognitive problems, and paranoia or similar psychiatric problems. The intervention consisted of a social robot conducting a 36-item PROM. As the main outcome measure, the customized Consumer Quality Index (CQI) was used, as reported by patients and caregivers for the outpatient pathway of care.

Results

In total, 75 intermediately frail older patients were included in the study, randomly assigned to the intervention and control groups, and processed: 36 female (48%) and 39 male (52%); mean age 77.4 years (SD 7.3), range 60-91 years. There was no significant difference in the total patient CQI scores between the patients included in the robot-assisted care pathway (mean 9.27, SD 0.65, n=37) and those in the control group (mean 9.00, SD 0.70, n=38): P=.08, 95% CI –0.04 to 0.58. There was no significant difference in the total CQI scores between caregivers in the intervention group (mean 9.21, SD 0.76, n=30) and those in the control group (mean 9.09, SD 0.60, n=35): P=.47, 95% CI –0.21 to 0.46. No harm or unintended effects occurred.

Conclusions

Geriatric patients and their informal caregivers valued robot-assisted and nonrobot-assisted care pathways equally.

Trial Registration

ClinicalTrials.gov NCT03857789; https://clinicaltrials.gov/ct2/show/NCT03857789

Telemedicine in COPD: An Overview by Topics

COPD is a major cause of morbidity and mortality worldwide and carries a huge and growing economic and social burden. Telemedicine might allow the care of patients with limited access to health services and improve their self-management. During the COVID-19 pandemic, patient's safety represents one of the main reasons why we might use these tools to manage our patients. The authors conducted a literature search in MEDLINE database. The retrieval form of the Medical Subject Headings (Mesh) was ((Telemedicine OR Tele-rehabilitation OR Telemonitoring OR mHealth OR Ehealth OR Telehealth) AND COPD). We only included systematic reviews, reviews, meta-analysis, clinical trials and randomized-control trials, in the English language, with the selected search items in title or abstract, and published from January 1st 2015 to 31st May 2020 (n = 56). There was a positive tendency toward benefits in tele-rehabilitation, health-education and self-management, early detection of COPD exacerbations, psychosocial support and smoking cessation, but the heterogeneity of clinical trials and reviews limits the extent to which this value can be understood. Telemonitoring interventions and cost-effectiveness had contradictory results. The literature on teleconsultation was scarce during this period. The non-inferiority tendency of telemedicine programmes comparing to conventional COPD management seems an opportunity to deliver quality healthcare to COPD patients, with a guarantee of patient's safety, especially during the COVID-19 outbreak.

Coaching Through Technology: A Systematic Review into Efficacy and Effectiveness for the Ageing Population

Background: Despite the evidence on the positive role of self-management, the adoption of health coaching strategies for older people is still limited. To address these gaps, recent efforts have been made in the ICT sector in order to develop systems for delivering coaching and overcoming barriers relating to scarcity of resources. The aim of this review is to examine the efficacy of personal health coaching systems for older adults using digital virtual agents. Methods: A systematic review of the literature was conducted in December 2019 analyzing manuscripts from four databases over the last 10 years. Nine papers were included. Results: Despite the low number of studies, there was evidence that technology-integrated interventions can deliver benefits for health over usual care. However, the review raises important questions about how to maintain benefits and permanence of behavior change produced by short-term interventions. Conclusion: These systems offer a potential tool to reduce costs, minimize therapist burden and training, and expand the range of clients who can benefit from them. It is desirable that in the future the number of studies will grow, considering other aspects such as the role of the virtual coaches’ characteristics, social-presence, empathy, usability, and health literacy.

A Virtual Reality-Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study

BACKGROUND

The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely.

OBJECTIVE

This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs.

METHODS

This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale.

RESULTS

In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures.

CONCLUSIONS

Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale.

Technologically-enhanced psychological interventions for older adults: a scoping review

Background

The world population is getting older. As life expectancy increases, traditional health care systems are facing different challenges in terms of cost reduction and high-quality service delivery capability. New ways to improve older adults’ quality of life have been explored, taking advantage of new technological solutions. Our focus is on the integration of technology in clinical treatments to facilitate or deliver psychological interventions meant to improve well-being in older adults. Our aims were to describe the main technology-based interventions supporting seniors’ quality of life or psychological well-being and to provide greater clarity to what is described in the current literature as their effects on seniors’ cognitive and psychological outcomes and healthcare policies.

Methods

We reviewed the scientific literature looking for studies that investigated how technology can be implemented into clinical psychology treatments for older adults. Our search was conducted using the following databases: PubMed, PsycINFO, Scopus, ISI Web of Science, and CINAHL. The search provided 350 articles, mostly (≈90%) dated after 2002. Abstract analysis narrowed the selection to 150 papers, according to their relevance and actuality as judged by a restricted group of independent researchers.

Results

Through a thematic analysis, we found that virtual reality (VR), robots, telemedicine, software, video games, and smartphone applications could potentially support older adults’ psychological treatment with a positive impact on healthcare systems.

Conclusion

Findings from the literature are encouraging, although most of these results are only preliminary.

Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications

BACKGROUND

Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications.

OBJECTIVES

To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications.

SEARCH METHODS

We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included.

DATA COLLECTION AND ANALYSIS

Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality.

MAIN RESULTS

We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes.

AUTHORS' CONCLUSIONS

Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.

Evaluating an Intervention Program Using WeChat for Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Background

The application of telemedicine in home pulmonary rehabilitation interventions for the management of patients with chronic obstructive pulmonary disease (COPD) has achieved promising results.

Objective

This study aimed to develop a WeChat official account (Pulmonary Internet Explorer Rehabilitation [PeR]) based on social media. It further evaluated the effect of PeR on the quality of life, symptoms, and exercise self-efficacy of patients with COPD.

Methods

The functional modules of PeR were developed by a multidisciplinary team according to the electronic health–enhanced chronic care model (eCCM) components. A total of 106 patients were randomly selected (53 in the PeR group and 53 in the outpatient face-to-face group [FtF]). Pulmonary rehabilitation intervention was conducted for 3 months, and the outcome was observed for 3 months. The primary outcome was patient quality of life measured with the COPD assessment test (CAT). The secondary outcomes were evaluated using the modified Medical Research Council scale (mMRC), exercise self-regulatory efficacy scale (Ex-SRES), and St George’s Respiratory Questionnaire (SGRQ).

Results

The intention-to-treat analysis was used in the study. A total of 94 participants completed the 6-month pulmonary rehabilitation program. No statistically significant differences were observed in CAT (F_1,3=7.78, P=.001), Ex-SRES (F_1,3=21.91, P<.001), and mMRC scores (F_1,3=29.64, P<.001) between the two groups with the variation in time tendency. The Ex-SRES score had a significant effect on the CAT score (P=.03). The partial regression coefficient of Ex-SRES to CAT was 0.81, and Exp (B) was 2.24.

Conclusions

The telemedicine technology was effective using the eCCM combined with a behavioral intervention strategy centering on self-efficacy. Pulmonary rehabilitation at home through PeR and FtF could improve the sense of self-efficacy and quality of life and alleviate symptoms in patients with COPD.

Trial Registration

Chinese Clinical Trial Registry ChiCTR1900022770; https://tinyurl.com/tmmvpq3

User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis

BACKGROUND

Previous research suggests that artificial agents may be a promising source of social support for humans. However, the bulk of this research has been conducted in the context of social support interventions that specifically address stressful situations or health improvements. Little research has examined social support received from artificial agents in everyday contexts.

OBJECTIVE

Considering that social support manifests in not only crises but also everyday situations and that everyday social support forms the basis of support received during more stressful events, we aimed to investigate the types of everyday social support that can be received from artificial agents.

METHODS

In Study 1, we examined publicly available user reviews (N=1854) of Replika, a popular companion chatbot. In Study 2, a sample (n=66) of Replika users provided detailed open-ended responses regarding their experiences of using Replika. We conducted thematic analysis on both datasets to gain insight into the kind of everyday social support that users receive through interactions with Replika.

RESULTS

Replika provides some level of companionship that can help curtail loneliness, provide a "safe space" in which users can discuss any topic without the fear of judgment or retaliation, increase positive affect through uplifting and nurturing messages, and provide helpful information/advice when normal sources of informational support are not available.

CONCLUSIONS

Artificial agents may be a promising source of everyday social support, particularly companionship, emotional, informational, and appraisal support, but not as tangible support. Future studies are needed to determine who might benefit from these types of everyday social support the most and why. These results could potentially be used to help address global health issues or other crises early on in everyday situations before they potentially manifest into larger issues.

Results of Field Trials with a Mobile Service Robot for Older Adults in 16 Private Households

In this article, we present results obtained from field trials with the Hobbit robotic platform, an assistive, social service robot aiming at enabling prolonged independent living of older adults in their own homes. Our main contribution lies within the detailed results on perceived safety, usability, and acceptance from field trials with autonomous robots in real homes of older users. In these field trials, we studied how 16 older adults (75 plus) lived with autonomously interacting service robots over multiple weeks.

Robots have been employed for periods of months previously in home environments for older people, and some have been tested with manipulation abilities, but this is the first time a study has tested a robot in private homes that provided the combination of manipulation abilities, autonomous navigation, and non-scheduled interaction for an extended period of time. This article aims to explore how older adults interact with such a robot in their private homes. Our results show that all users interacted with Hobbit daily, rated most functions as well working, and reported that they believe that Hobbit will be part of future elderly care. We show that Hobbit’s adaptive behavior approach towards the user increasingly eased the interaction between the users and the robot. Our trials reveal the necessity to move into actual users’ homes, as only there, we encounter real-world challenges and demonstrate issues such as misinterpretation of actions during non-scripted human-robot interaction.

Adherence to Therapy in Chronic Obstructive Pulmonary Disease: A Systematic Review

Adherence to therapy plays a key role in treatment optimization and clinical outcome in patients with chronic obstructive pulmonary disease (COPD). The adherence to inhaled medications is poor, ranging from 20% to 60%. In this study we searched Medline and PubMed literature regarding factors that could have an impact on therapy adherence in COPD patients, using the key words "COPD" or "chronic obstructive pulmonary disease" and "adherence". The search was limited to the English language article published between January 2013 and December 2019. Review papers, study protocols, and meta-analyses were excluded. The final material included 25 articles. The evaluation was performed using the Cochrane Review Manager guidelines. The 25 articles represented 29 countries from 5 continents. We assessed adherence to therapy and the impact of selected factors on the adherence in 27,660 COPD patients (60.9% of whom were male, mean age 64 years). The factors affecting adherence were broken down into three categories: sociodemographic, clinical, and psychological. There were two standardized instruments used in the analyzed studies: Test of Adherence to Inhalers (TAI) and self-reported Morisky Medication Adherence Scale (MMAS-8). We found that 46.3% of patients had a moderately good level of adherence to inhaled therapy (TAI range around 50 points), while 41.6% of patients had a high level of adherence to oral therapy. The nature of non-adherence was in most cases inadvertent rather than an erratic or deliberate demeanor (48.5% vs. 38.9% vs. 42.4%, respectively). We conclude that standardized instruments enable the prediction of adherence to therapy and should be used in clinical practice. The assessment of adherence is essential for undertaking interventions to counteract plausible non-adherence. Collaboration between an educator and a psychologist is required to evaluate the patient's motivation and to ensure his comprehension of treatment prescribed.

Increasing the Impact of JMIR Journals in the Attention Economy

The Journal of Medical Internet Research (JMIR) has attained remarkable achievements in the past twenty years. By depth, JMIR has published the most impactful research in medical informatics and is top ranked in the field. By width, JMIR has spun off to about thirty sister journals to cover topics such as serious games, mobile health, public health, surveillance, and other medical areas. With ever-increasing data and research findings, academic publishers need to be competitive to win readers’ attention. While JMIR is well-positioned in the field, the journal will need more creative strategies to increase its attention base and maintain its leading position. Viable strategies include the creation of online collaborative spaces, the engagement of more diverse audience from less traditional channels, and partnerships with other publishers and academic institutes. Doing so could also enable JMIR researchers to turn research insights into practical strategies to improve personal health and medical services.

Reducing Patient Loneliness With Artificial Agents: Design Insights From Evolutionary Neuropsychiatry

Loneliness is a growing public health issue that substantially increases the risk of morbidity and mortality. Artificial agents, such as robots, embodied conversational agents, and chatbots, present an innovation in care delivery and have been shown to reduce patient loneliness by providing social support. However, similar to doctor and patient relationships, the quality of a patient’s relationship with an artificial agent can impact support effectiveness as well as care engagement. Incorporating mammalian attachment-building behavior in neural network processing as part of an agent’s capabilities may improve relationship quality and engagement between patients and artificial agents. We encourage developers of artificial agents intended to relieve patient loneliness to incorporate design insights from evolutionary neuropsychiatry.

Psychosocial Health Interventions by Social Robots: Systematic Review of Randomized Controlled Trials

Background

Social robots that can communicate and interact with people offer exciting opportunities for improved health care access and outcomes. However, evidence from randomized controlled trials (RCTs) on health or well-being outcomes has not yet been clearly synthesized across all health domains where social robots have been tested.

Objective

This study aimed to undertake a systematic review examining current evidence from RCTs on the effects of psychosocial interventions by social robots on health or well-being.

Methods

Medline, PsycInfo, ScienceDirect, Scopus, and Engineering Village searches across all years in the English language were conducted and supplemented by forward and backward searches. The included papers reported RCTs that assessed changes in health or well-being from interactions with a social robot across at least 2 measurement occasions.

Results

Out of 408 extracted records, 27 trials met the inclusion criteria: 6 in child health or well-being, 9 in children with autism spectrum disorder, and 12 with older adults. No trials on adolescents, young adults, or other problem areas were identified, and no studies had interventions where robots spontaneously modified verbal responses based on speech by participants. Most trials were small (total N=5 to 415; median=34), only 6 (22%) reported any follow-up outcomes (2 to 12 weeks; median=3.5) and a single-blind assessment was reported in 8 (31%). More recent trials tended to have greater methodological quality. All papers reported some positive outcomes from robotic interventions, although most trials had some measures that showed no difference or favored alternate treatments.

Conclusions

Controlled research on social robots is at an early stage, as is the current range of their applications to health care. Research on social robot interventions in clinical and health settings needs to transition from exploratory investigations to include large-scale controlled trials with sophisticated methodology, to increase confidence in their efficacy.

Robot for health data acquisition among older adults: a pilot randomised controlled cross-over trial

Background /Objectives

Healthcare professionals (HCP) are confronted with an increased demand for assessments of important health status measures, such as patient-reported outcome measurements (PROM), and the time this requires. The aim of this study was to investigate the effectiveness and acceptability of using an HCP robot assistant, and to test the hypothesis that a robot can autonomously acquire PROM data from older adults.

Design

A pilot randomised controlled cross-over study where a social robot and a nurse administered three PROM questionnaires with a total of 52 questions.

Setting

A clinical outpatient setting with community-dwelling older adults.

Participants

Forty-two community-dwelling older adults (mean age: 77.1 years, SD: 5.7 years, 45% female).

Measurements

The primary outcome was the task time required for robot–patient and nurse–patient interactions. Secondary outcomes were the similarity of the data and the percentage of robot interactions completed autonomously. The questionnaires resulted in two values (robot and nurse) for three indexes of frailty, well-being and resilience. The data similarity was determined by comparing these index values using Bland-Altman plots, Cohen’s kappa (κ) and intraclass correlation coefficients (ICC). Acceptability was assessed using questionnaires.

Results

The mean robot interview duration was 16.57 min (SD=1.53 min), which was not significantly longer than the nurse interviews (14.92 min, SD=8.47 min; p=0.19). The three Bland-Altman plots showed moderate to substantial agreement between the frailty, well-being and resilience scores (κ=0.61, 0.50 and 0.45, and ICC=0.79, 0.86 and 0.66, respectively). The robot autonomously completed 39 of 42 interviews (92.8%).

Conclusion

Social robots may effectively and acceptably assist HCPs by interviewing older adults.

Robotic Services Acceptance in Smart Environments With Older Adults: User Satisfaction and Acceptability Study

BACKGROUND

In Europe, the population of older people is increasing rapidly. Many older people prefer to remain in their homes but living alone could be a risk for their safety. In this context, robotics and other emerging technologies are increasingly proposed as potential solutions to this societal concern. However, one-third of all assistive technologies are abandoned within one year of use because the end users do not accept them.

OBJECTIVE

The aim of this study is to investigate the acceptance of the Robot-Era system, which provides robotic services to permit older people to remain in their homes.

METHODS

Six robotic services were tested by 35 older users. The experiments were conducted in three different environments: private home, condominium, and outdoor sites. The appearance questionnaire was developed to collect the users' first impressions about the Robot-Era system, whereas the acceptance was evaluated through a questionnaire developed ad hoc for Robot-Era.

RESULTS

A total of 45 older users were recruited. The people were grouped in two samples of 35 participants, according to their availability. Participants had a positive impression of Robot-Era robots, as reflected by the mean score of 73.04 (SD 11.80) for DORO's (domestic robot) appearance, 76.85 (SD 12.01) for CORO (condominium robot), and 75.93 (SD 11.67) for ORO (outdoor robot). Men gave ORO's appearance an overall score higher than women (P=.02). Moreover, participants younger than 75 years understood more readily the functionalities of Robot-Era robots compared to older people (P=.007 for DORO, P=.001 for CORO, and P=.046 for ORO). For the ad hoc questionnaire, the mean overall score was higher than 80 out of 100 points for all Robot-Era services. Older persons with a high educational level gave Robot-Era services a higher score than those with a low level of education (shopping: P=.04; garbage: P=.047; reminding: P=.04; indoor walking support: P=.006; outdoor walking support: P=.03). A higher score was given by male older adults for shopping (P=.02), indoor walking support (P=.02), and outdoor walking support (P=.03).

CONCLUSIONS

Based on the feedback given by the end users, the Robot-Era system has the potential to be developed as a socially acceptable and believable provider of robotic services to facilitate older people to live independently in their homes.