Efficacy of supervised home-based, real time, videoconferencing telerehabilitation in patients with type 2 diabetes: a single-blind randomized controlled trial

Which intervention is optimal to control blood glucose and improve physical performance in the elderly living with type 2 diabetes mellitus? A network meta-analysis

BACKGROUND AND OBJECTIVES

This study aimed to find the optimal intervention available to both control blood glucose and improve physical function in the geriatric population with T2DM.

METHODS AND STUDY DESIGN

A systemic review and network meta-analysis (NMA) was conducted to assess and rank the comparative efficacy of different interventions on glycosylated hemoglobin A1c (HbAc1), fasting blood glucose (FBG), muscle mass, grip strength, gait speed, lower body muscle strength, and dynamic balance. A total of eight databases were searched for eligible randomized controlled trials (RCTs) that the elderly aged more than 60 years or with mean age ≥ 55 years, the minimal duration of the RCT intervention was 6 weeks, and those lacking data about glycemic level and at least one indicator of physical performance were excluded. The Cochrane risk of bias tool was used to assess the bias of each study included. Bayesian NMA was performed as the main results, the Bayesian meta regression and the frequentist NMA as sensitivity analysis.

RESULTS

Of the 2266 literature retrieved, 27 RCTs with a total of 2289 older adults were included. Health management provided by health workers exerts beneficial effects that is superior to other interventions at achieving glycemic control, but less marked improvement in physical performance. Exercise combined with cognitive training showed more pronounced improvement in muscle strength, gait speed, and dynamic balance, but ranked behind in decreasing the HbAc1 and FBG.

CONCLUSIONS

Personalized health management combined with physical and cognitive training might be the optimal intervention to both accomplish glycemic control and improvement of physical performance. Further RCTs are needed to validate and assess the confidence of our results from this NMA.

The Role of Tele-Exercise for People with Type 2 Diabetes: A Scoping Review

BACKGROUND

Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution.

OBJECTIVE

This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes.

RESULTS

Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise.

CONCLUSIONS

Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.

The Effect of Resistance Exercises Using an Elastic Band on Balance and Fear of Falling in Older Adults With Diabetic Peripheral Neuropathy: A 16-week Randomized Controlled Trial

OBJECTIVE

The current study aimed to investigate the effect of resistance training using an elastic band on balance and fear of falling in older adults with diabetic peripheral neuropathy.

DESIGN

The study was a clinical controlled trial with a repeated measure design.

SETTING

Iranian Diabetes Foundation of Mashhad.

PARTICIPANTS

The participants were 51 older adults with diabetic peripheral neuropathy and balance impairment (N=51).

INTERVENTIONS

Participants were randomly assigned to 2 groups; 1 group received balance training using an elastic band and the other group just received balance training.

MAIN OUTCOME MEASURES

The main outcomes were balance and fear of falling that were measured using Berg Balance Scale and a short version of the Fall Efficiency Scale-International, respectively.

RESULTS

The results showed that balance resistance training with and without using an elastic band significantly enhances balance and reduces fear of falling in diabetic older adults suffering from balance issues. However, balance resistance training using an elastic band had a significantly better effect on the balance and fear of falling in the participants. The best results were obtained after week 12 (48 sessions of balance training).

CONCLUSION

Balance rehabilitation programs may include an elastic band in balance resistance training for 12 weeks (3-4 sessions a week) for enhancing balance in diabetic older adults suffering from balance impairment.

Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends

Rehabilitation is an important and necessary part of local and global healthcare services along with treatment and palliative care, prevention of disease, and promotion of good health. The rehabilitation process helps older and young adults even children to become as independent as possible in activities of daily life and enables participation in useful living activities, recreation, work, and education. The technology of Artificial Intelligence (AI) has evolved significantly in recent years. Many activities related to rehabilitation have been getting benefits from using AI techniques. The objective of this review study is to explore the advantages of AI for rehabilitation and how AI is impacting the rehabilitation process. This study aims at the most critical aspects of the rehabilitation process that could potentially take advantage of AI techniques including personalized rehabilitation apps, rehabilitation through assistance, rehabilitation for neurological disorders, rehabilitation for developmental disorders, virtual reality rehabilitation, rehabilitation of neurodegenerative diseases and Telerehabilitation of Cardiovascular. We presented a survey on the newest empirical studies available in the literature including the AI-based technology helpful in the Rehabilitation process. The novelty feature included but was not limited to an overview of the technological solutions useful in rehabilitation. Seven different categories were identified. Illustrative examples of practical applications were detailed. Implications of the findings for both research and practice were critically discussed. Most of the AI applications in these rehabilitation types are in their infancy and continue to grow while exploring new opportunities. Therefore, we investigate the role of AI technology in rehabilitation processes. In addition, we do statistical analysis of the selected studies to highlight the significance of this review work. In the end, we also present a discussion on some challenges, and future research directions.

Technology-assisted cardiac rehabilitation for coronary heart disease patients with central obesity: a randomized controlled trial

BACKGROUND

Limited empirical evidence is available regarding the effect of technology-assisted cardiac rehabilitation (TACR) among coronary heart disease (CHD) patients with central obesity.

AIM

To determine the effects of 12-week TACR on health outcomes of patients with CHD.

DESIGN

Two-arm randomized controlled trial.

SETTING

Cardiovascular department of a regional hospital.

POPULATION

Coronary heart disease patients with central obesity.

METHODS

The study randomized 78 hospitalized CHD patients to receive either the 12-week TACR intervention or usual care. Guided by social cognitive theory, the intervention began with an in-person assessment and orientation session to assess and identify individual risks and familiarize with the e-platform/device before discharge. After discharge, patients were encouraged to visit the interactive CR website for knowledge and skills acquisition, data uploading, use the pedometer for daily step tracking, and interact with peers and professionals via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2).

RESULTS

Participants in the intervention group showed significant improvement in daily steps at six weeks but not 12 weeks (T1: β=2713.48, P=0.03; T2:β=2450.70, P=0.08), weekly sitting minutes (T1: β=-665.17, P=0.002; T2: β=-722.29, P=0.02), and total (vigorous, moderate, and walking) exercise at 12-week (β=-2445.99, P=0.008). Improvement in health-promoting lifestyle profile (T1: β=24.9, P<0.001; T2: β=15.50, P<0.001), smoking cessation (T2: β=-2.28, P<0.04), self-efficacy (T2: β=0.63, P=0.02), body mass index (T1:β =-0.97, P=0.03; T2: β=-0.73, P=0.04) and waist circumferences (T1: β =-1.97, P=0.003; T2: β =-3.14, P=0.002) were identified.

CONCLUSIONS

Results indicated the effectiveness of the TACR intervention in improving healthy behaviors and anthropometric parameters for CHD patients with central obesity. Individual assessment, collaborative action planning, and ongoing obesity management support should be highlighted in TACR programs for CHD patients.

CLINICAL REHABILITATION IMPACT

Central obesity should be assessed and highlighted in TACR intervention as an independent risk factor that requires corresponding behavior change and body fat management.

Validity and reliability of automated treadmill six-minute walk test in patients entering exercise-based cardiac rehabilitation

Introduction: The six-minute walk test (6MWT) is a well-established tool for assessing submaximal functional capacity for cardiac patients, but space limitations challenge its implementation. Treadmill-based (TR) 6MWT is a promising alternative, but it requires patients to complete a familiarization test to adapt treadmill speed regulation. With the advancement of sensors, it is possible to automatically control speed for individual patients and thus overcome the space limitation or the speed control difficulty on the treadmill for each patient.Methods: This study investigated the validity and interchangeability of automated speed TR6MWT and standard hallway (HL) 6MWT. Eighteen patients were assessed at baseline of the 12-week cardiac rehabilitation program. Fourteen of them were assessed after rehabilitation. All patients performed three TR6MWTs and three HL6MWTs at baseline and one of each test after the program.Results: Patients well tolerated the TR6MWT. There was a strong correlation between both test methods (r = 0.79). However, patients performed significantly better in HL6MWT (514.8m ± 59.7m) than in TR6MWT (447.2 ± 79.1m) with 95% CI, 40.4-94.6m, p < 0.05. Both tests showed high test-retest reliability (intraclass correlation coefficient of 0.86). The TR6MWT showed a valuable comparison of the effect of the cardiac rehabilitation program (20% increase, effect size 1.1) even though it is not interchangeable with the HL6MWT.Conclusion: The automated speed TR6MWT appears to be an acceptable tool with adequate validity, reliability, and responsiveness for assessing functional capacity in patients utilizing cardiac rehabilitation programs.

Telehealth Use and Healthcare Utilization Among Individuals with Type 2 Diabetes During the COVID-19 Pandemic: Evidence From Louisiana Medicaid Claims

INTRODUCTION

The impact of telehealth use on healthcare utilization is limited, especially among Medicaid beneficiaries with type 2 diabetes. Considering the rapid adoption of telehealth during the COVID-19 pandemic, this study examined associations between telehealth use and healthcare utilization among Medicaid beneficiaries with type 2 diabetes.

METHODS

Using Louisiana Medicaid claims data from March 2019 to August 2021, the associations were examined using a difference-in-difference model with propensity score weighting. Demographic characteristics, baseline comorbidities and healthcare utilization, and zip code level environmental factors were included in the analysis. The monthly frequency of healthcare services, including in-person outpatient visits, inpatient visits, emergency department (ED) visits and hemoglobin A1C (HbA1C) tests, were measured as outcomes. Several sensitivity analyses were conducted across different subgroups.

RESULTS

We included 48,992 beneficiaries with type 2 diabetes in the study of 27,340 beneficiaries in the telehealth group and 21,652 beneficiaries in the non-telehealth group. Of 1000 beneficiaries per month, the telehealth group had significantly more utilization compared to the non-telehealth group, with an increase of 195.049 in-person outpatient visits (95% CI: 166.169 to 223.929, p < 0.001), 3.816 inpatient visits (95% CI: 2.539 to 5.093, p < 0.001), 10.499 ED visits (95% CI: 7.287 to 13.712, p < 0.001) and 14.153 HbA1c tests (95% CI: 11.431 to 16.875, p < 0.001, respectively. Excluding beneficiaries who had ED or inpatient visits in the 30 days prior to receiving telehealth visits, overall ED visits significantly decreased for the telehealth group versus the non-telehealth group over time, by 9.456 visits (95% CI: - 12.356 to - 6.557, p < 0.001) per 1000 beneficiaries per month on average.

CONCLUSION

The study found that telehealth was associated with a significant increase in healthcare utilization in general but has the potential to decrease ED and inpatient utilization for some groups among low-income populations with diabetes.

Test-retest reliability and agreement of remote home-based functional capacity self-administered assessments in community-dwelling, socially isolated older adults

Objectives

To determine the test-retest reliability and agreement of home-based functional capacity self-administered assessments in socially isolated older adults.

Methods

Fourteen community-dwelling older adults (eight females, 67.9 ± 7.7 years) volunteered for this study. Before testing, participants were screened online for eligibility and received instructional videos explaining test set-up and execution. Participants underwent the 30-second sit-to-standing test, gait speed tests at the usual pace, and timed-up-and-go tests administered 4 weeks apart. For the 30-second sit-to-standing protocol, participants were instructed to repeatedly sit and stand from a chair (with a height of ∼ 43 cm and without armrests) for 30 s, with the number of repetitions recorded. In the gait speed test protocol, participants were instructed to walk at their usual and comfortable pace, with the time taken recorded (seconds). In the timed-up-and-go, participants stood up from a chair, walked as fast as possible for 3 m, circled a marked point, and returned to the chair to sit down, completing the test, with the score recorded (seconds). A trained researcher conducted the scoring virtually via synchronous video.

Results

30-second sit-to-standing, gait speed test, and timed-up-and-go showed excellent mean coefficient of variation values (2.0-4.9), small standard error of measurement (0.08-1.27), excellent intraclass coefficient (0.97-0.99), very strong correlations (0.97-0.99) and good agreement between the two days of testing.

Conclusion

Self-administered functional capacity tests performed by older adults at home were reliable with good agreement. Healthcare professionals and older adults should take advantage of simple remote self-administered assessments performed at home to evaluate older adults' health status.