1
|
Langerak AJ, Regterschot GRH, Selles RW, Meskers CGM, Evers M, Ribbers GM, van Beijnum BJF, Bussmann JBJ. Requirements for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients: a user-centred approach. Disabil Rehabil Assist Technol 2024; 19:1392-1404. [PMID: 36905631 PMCID: PMC11073044 DOI: 10.1080/17483107.2023.2183993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Telerehabilitation systems have the potential to enable therapists to monitor and assist stroke patients in achieving high-intensity upper extremity exercise in the home environment. We adopted an iterative user-centred approach, including multiple data sources and meetings with end-users and stakeholders to define the user requirements for home-based upper extremity rehabilitation using wearable motion sensors for subacute stroke patients. METHODS We performed a requirement analysis consisting of the following steps: 1) context & groundwork; 2) eliciting requirements; 3) modelling & analysis; 4) agreeing requirements. During these steps, a pragmatic literature search, interviews and focus groups with stroke patients, physiotherapists and occupational therapists were performed. The results were systematically analysed and prioritised into "must-haves", "should-haves", and "could-haves". RESULTS We formulated 33 functional requirements: eighteen must-have requirements related to blended care (2), exercise principles (7), exercise delivery (3), exercise evaluation (4), and usability (2); ten should-haves; and five could-haves. Six movement components, including twelve exercises and five combination exercises, are required. For each exercise, appropriate exercise measures were defined. CONCLUSION This study provides an overview of functional requirements, required exercises, and required exercise measures for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients, which can be used to develop home-based upper extremity rehabilitation interventions. Moreover, the comprehensive and systematic requirement analysis used in this study can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context.
Collapse
Affiliation(s)
- A. J. Langerak
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G. R. H. Regterschot
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - R. W. Selles
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C. G. M. Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - M. Evers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - G. M. Ribbers
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B. J. F. van Beijnum
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - J. B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Seo NJ, Coupland K, Finetto C, Scronce G. Wearable Sensor to Monitor Quality of Upper Limb Task Practice for Stroke Survivors at Home. SENSORS (BASEL, SWITZERLAND) 2024; 24:554. [PMID: 38257646 PMCID: PMC10821060 DOI: 10.3390/s24020554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Many stroke survivors experience persistent upper extremity impairment that limits performance in activities of daily living. Upper limb recovery requires high repetitions of task-specific practice. Stroke survivors are often prescribed task practices at home to supplement rehabilitation therapy. A poor quality of task practices, such as the use of compensatory movement patterns, results in maladaptive neuroplasticity and suboptimal motor recovery. There currently lacks a tool for the remote monitoring of movement quality of stroke survivors' task practices at home. The objective of this study was to evaluate the feasibility of classifying movement quality at home using a wearable IMU. Nineteen stroke survivors wore an IMU sensor on the paretic wrist and performed four functional upper limb tasks in the lab and later at home while videorecording themselves. The lab data served as reference data to classify home movement quality using dynamic time warping. Incorrect and correct movement quality was labeled by a therapist. The home task practice movement quality was classified with an accuracy of 92% and F1 score of 0.95 for all tasks combined. Movement types contributing to misclassification were further investigated. The results support the feasibility of a home movement quality monitoring system to assist with upper limb rehabilitation post stroke.
Collapse
Affiliation(s)
- Na Jin Seo
- Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Kristen Coupland
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Christian Finetto
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Gabrielle Scronce
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| |
Collapse
|
3
|
Mayrhuber L, Lestoille M, Andres SD, Held JPO, Luft AR, Ryser F, Gassert R, Easthope CA, Lambercy O. Movement Reminders to Encourage Arm Use During Daily Life in Stroke Patients. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941203 DOI: 10.1109/icorr58425.2023.10304727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Stroke is a leading cause of long-term disability, such as loss of upper limb function. Active arm movement and frequent practice are essential to regain such function. Wearable sensors that trigger individualized movement reminders can promote awareness of the affected limb during periods of inactivity. This study investigated the immediate effect of vibrotactile reminders based on activity counts on affected arm use, the evolution of the effect throughout a 6-week intervention at home, and whether the time of the day influences the response to the reminder. Thirteen participants who experienced a unilateral ischemic stroke were included in the analysis. Activity counts were found to increase significantly after receiving a reminder. The immediate effect of receiving a reminder was maintained throughout the day as well as during the study duration of 6 weeks. In conclusion, wearable activity trackers with a feature to trigger individualized vibrotactile reminders could be a promising rehabilitation tool to increase arm activity of the affected side in stroke patients in their home environment.
Collapse
|
4
|
Langerak AJ, Regterschot GRH, Evers M, van Beijnum BJF, Meskers CGM, Selles RW, Ribbers GM, Bussmann JBJ. A Sensor-Based Feedback Device Stimulating Daily Life Upper Extremity Activity in Stroke Patients: A Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:5868. [PMID: 37447718 DOI: 10.3390/s23135868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
This study aims to evaluate the feasibility and explore the efficacy of the Arm Activity Tracker (AAT). The AAT is a device based on wrist-worn accelerometers that provides visual and tactile feedback to stimulate daily life upper extremity (UE) activity in stroke patients. METHODS A randomised, crossover within-subject study was conducted in sub-acute stroke patients admitted to a rehabilitation centre. Feasibility encompassed (1) adherence: the dropout rate and the number of participants with insufficient AAT data collection; (2) acceptance: the technology acceptance model (range: 7-112) and (3) usability: the system usability scale (range: 0-100). A two-way ANOVA was used to estimate the difference between the baseline, intervention and control conditions for (1) paretic UE activity and (2) UE activity ratio. RESULTS Seventeen stroke patients were included. A 29% dropout rate was observed, and two participants had insufficient data collection. Participants who adhered to the study reported good acceptance (median (IQR): 94 (77-111)) and usability (median (IQR): 77.5 (75-78.5)-). We found small to medium effect sizes favouring the intervention condition for paretic UE activity (η2G = 0.07, p = 0.04) and ratio (η2G = 0.11, p = 0.22). CONCLUSION Participants who adhered to the study showed good acceptance and usability of the AAT and increased paretic UE activity. Dropouts should be further evaluated, and a sufficiently powered trial should be performed to analyse efficacy.
Collapse
Affiliation(s)
- Anthonia J Langerak
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | | | - Marc Evers
- Rijndam Rehabilitation, 3015 LJ Rotterdam, The Netherlands
| | - Bert-Jan F van Beijnum
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
5
|
Whole-Body Movements Increase Arm Use Outcomes of Wrist-Worn Accelerometers in Stroke Patients. SENSORS 2021; 21:s21134353. [PMID: 34202142 PMCID: PMC8271846 DOI: 10.3390/s21134353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022]
Abstract
Wrist-worn accelerometers are often applied to measure arm use after stroke. They measure arm movements during all activities, including whole-body movements, such as walking. Whole-body movements may influence clinimetric properties of arm use measurements—however, this has not yet been examined. This study investigates to what extent arm use measurements with wrist-worn accelerometers are affected by whole-body movements. Assuming that arm movements during whole-body movements are non-functional, we quantify the effect of whole-body movements by comparing two methods: Arm use measured with wrist-worn accelerometers during all whole-body postures and movements (P&M method), and during sitting/standing only (sit/stand method). We have performed a longitudinal observational cohort study with measurements in 33 stroke patients during weeks 3, 12, and 26 poststroke. The P&M method shows higher daily paretic arm use outcomes than the sit/stand method (p < 0.001), the mean difference increased from 31% at week three to 41% at week 26 (p < 0.001). Differences in daily paretic arm use between methods are strongly related to daily walking time (r = 0.83–0.92). Changes in the difference between methods are strongly related to changes in daily walking time (r = 0.89). We show that not correcting arm use measurements for whole-body movements substantially increases arm use outcomes, thereby threatening the validity of arm use outcomes and measured arm use changes.
Collapse
|
6
|
Signal NEJ, McLaren R, Rashid U, Vandal A, King M, Almesfer F, Henderson J, Taylor D. Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study. JMIR Mhealth Uhealth 2020; 8:e17036. [PMID: 32723718 PMCID: PMC7424469 DOI: 10.2196/17036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/15/2020] [Accepted: 05/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND As many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. OBJECTIVE This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. METHODS A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a "Planned Nudge" to the odds of affected limb movement during the observation period following "No Nudge." RESULTS The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95% CI 0.99-1.29, P=.07). CONCLUSIONS Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687&isReview=true.
Collapse
Affiliation(s)
| | - Ruth McLaren
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Alain Vandal
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Marcus King
- Callaghan Innovation, Christchurch, New Zealand
| | | | - Jeanette Henderson
- Assessment, Treatment and Rehabilitation Department, Waitakere Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
7
|
Louie DR, Bird ML, Menon C, Eng JJ. Perspectives on the prospective development of stroke-specific lower extremity wearable monitoring technology: a qualitative focus group study with physical therapists and individuals with stroke. J Neuroeng Rehabil 2020; 17:31. [PMID: 32098628 PMCID: PMC7041185 DOI: 10.1186/s12984-020-00666-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/14/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Wearable activity monitors that track step count can increase the wearer's physical activity and motivation but are infrequently designed for the slower gait speed and compensatory patterns after stroke. New and available technology may allow for the design of stroke-specific wearable monitoring devices, capable of detecting more than just step counts, which may enhance how rehabilitation is delivered. The objective of this study was to identify important considerations in the development of stroke-specific lower extremity wearable monitoring technology for rehabilitation, from the perspective of physical therapists and individuals with stroke. METHODS A qualitative research design with focus groups was used to collect data. Five focus groups were conducted, audio recorded, and transcribed verbatim. Data were analyzed using content analysis to generate overarching categories representing the stakeholder considerations for the development of stroke-specific wearable monitor technology for the lower extremity. RESULTS A total of 17 physical therapists took part in four focus group discussions and three individuals with stroke participated in the fifth focus group. Our analysis identified four main categories for consideration: 1) 'Variability' described the heterogeneity of patient presentation, therapy approaches, and therapeutic goals that are taken into account for stroke rehabilitation; 2) 'Context of use' described the different settings and purposes for which stakeholders could foresee employing stroke-specific wearable technology; 3) 'Crucial design features' identified the measures, functions, and device characteristics that should be considered for incorporation into prospective technology to enhance uptake; and 4) 'Barriers to adopting technology' highlighted challenges, including personal attitudes and design flaws, that may limit the integration of current and future wearable monitoring technology into clinical practice. CONCLUSIONS The findings from this qualitative study suggest that the development of stroke-specific lower extremity wearable monitoring technology is viewed positively by physical therapists and individuals with stroke. While a single, specific device or function may not accommodate all the variable needs of therapists and their clients, it was agreed that wearable monitoring technology could enhance how physical therapists assess and treat their clients. Future wearable devices should be developed in consideration of the highlighted design features and potential barriers for uptake.
Collapse
Affiliation(s)
- Dennis R Louie
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada
| | - Marie-Louise Bird
- Rehabilitation Research Program, GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Launceston, TAS 7250, Australia
| | - Carlo Menon
- Menrva lab, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Metro Vancouver, BC, V5A 1S6, Canada
| | - Janice J Eng
- Rehabilitation Research Program, GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada.
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| |
Collapse
|
8
|
Laver KE, Adey‐Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev 2020; 1:CD010255. [PMID: 32002991 PMCID: PMC6992923 DOI: 10.1002/14651858.cd010255.pub3] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Telerehabilitation offers an alternate way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face or when added to usual care. OBJECTIVES To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation or usual care. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self-care and domestic life and improved mobility, balance, health-related quality of life, depression, upper limb function, cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation. Additionally, we aimed to report on the presence of adverse events, cost-effectiveness, feasibility and levels of user satisfaction associated with telerehabilitation interventions. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (June 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library, Issue 6, 2019), MEDLINE (Ovid, 1946 to June 2019), Embase (1974 to June 2019), and eight additional databases. We searched trial registries and reference lists. SELECTION CRITERIA Randomised controlled trials (RCTs) of telerehabilitation in stroke. We included studies that compared telerehabilitation with in-person rehabilitation or no rehabilitation. In addition, we synthesised and described the results of RCTs that compared two different methods of delivering telerehabilitation services without an alternative group. We included rehabilitation programmes that used a combination of telerehabilitation and in-person rehabilitation provided that the greater proportion of intervention was provided via telerehabilitation. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials on the basis of prespecified inclusion criteria, extracted data and assessed risk of bias. A third review author moderated any disagreements. The review authors contacted investigators to ask for missing information. We used GRADE to assess the quality of the evidence and interpret findings. MAIN RESULTS We included 22 trials in the review involving a total of 1937 participants. The studies ranged in size from the inclusion of 10 participants to 536 participants, and reporting quality was often inadequate, particularly in relation to random sequence generation and allocation concealment. Selective outcome reporting and incomplete outcome data were apparent in several studies. Study interventions and comparisons varied, meaning that, in many cases, it was inappropriate to pool studies. Intervention approaches included post-hospital discharge support programs, upper limb training, lower limb and mobility retraining and communication therapy for people with post-stroke language disorders. Studies were either conducted upon discharge from hospital or with people in the subacute or chronic phases following stroke. PRIMARY OUTCOME we found moderate-quality evidence that there was no difference in activities of daily living between people who received a post-hospital discharge telerehabilitation intervention and those who received usual care (based on 2 studies with 661 participants (standardised mean difference (SMD) -0.00, 95% confidence interval (CI) -0.15 to 0.15)). We found low-quality evidence of no difference in effects on activities of daily living between telerehabilitation and in-person physical therapy programmes (based on 2 studies with 75 participants: SMD 0.03, 95% CI -0.43 to 0.48). SECONDARY OUTCOMES we found a low quality of evidence that there was no difference between telerehabilitation and in-person rehabilitation for balance outcomes (based on 3 studies with 106 participants: SMD 0.08, 95%CI -0.30 to 0.46). Pooling of three studies with 569 participants showed moderate-quality evidence that there was no difference between those who received post-discharge support interventions and those who received usual care on health-related quality of life (SMD 0.03, 95% CI -0.14 to 0.20). Similarly, pooling of six studies (with 1145 participants) found moderate-quality evidence that there was no difference in depressive symptoms when comparing post-discharge tele-support programs with usual care (SMD -0.04, 95% CI -0.19 to 0.11). We found no difference between groups for upper limb function (based on 3 studies with 170 participants: mean difference (MD) 1.23, 95% CI -2.17 to 4.64, low-quality evidence) when a computer program was used to remotely retrain upper limb function in comparison to in-person therapy. Evidence was insufficient to draw conclusions on the effects of telerehabilitation on mobility or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation; however, five of the studies reported health service utilisation outcomes or costs of the interventions provided within the study. Two studies reported on adverse events, although no serious trial-related adverse events were reported. AUTHORS' CONCLUSIONS While there is now an increasing number of RCTs testing the efficacy of telerehabilitation, it is hard to draw conclusions about the effects as interventions and comparators varied greatly across studies. In addition, there were few adequately powered studies and several studies included in this review were at risk of bias. At this point, there is only low or moderate-level evidence testing whether telerehabilitation is a more effective or similarly effective way to provide rehabilitation. Short-term post-hospital discharge telerehabilitation programmes have not been shown to reduce depressive symptoms, improve quality of life, or improve independence in activities of daily living when compared with usual care. Studies comparing telerehabilitation and in-person therapy have also not found significantly different outcomes between groups, suggesting that telerehabilitation is not inferior. Some studies reported that telerehabilitation was less expensive to provide but information was lacking about cost-effectiveness. Only two trials reported on whether or not any adverse events had occurred; these trials found no serious adverse events were related to telerehabilitation. The field is still emerging and more studies are needed to draw more definitive conclusions. In addition, while this review examined the efficacy of telerehabilitation when tested in randomised trials, studies that use mixed methods to evaluate the acceptability and feasibility of telehealth interventions are incredibly valuable in measuring outcomes.
Collapse
Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareFlinders DriveAdelaideSouth AustraliaAustralia5041
| | - Zoe Adey‐Wakeling
- Southern Adelaide Local Health NetworkDivision Rehabilitation, Aged Care and Palliative CareAdelaideAustralia
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareFlinders DriveAdelaideSouth AustraliaAustralia5041
| | - Natasha A Lannin
- Monash UniversityDepartment of Neuroscience, Central Clinical SchoolMelbourneAustralia
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareFlinders DriveAdelaideSouth AustraliaAustralia5041
| | - Catherine Sherrington
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | | |
Collapse
|
9
|
Janssen MMHP, Lobo-Prat J, Bergsma A, Vroom E. 2nd Workshop on upper-extremity assistive technology for people with Duchenne: Effectiveness and usability of arm supports Irvine, USA, 22nd-23rd January 2018. Neuromuscul Disord 2019; 29:651-656. [PMID: 31443952 DOI: 10.1016/j.nmd.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/18/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Mariska M H P Janssen
- Department of Rehabilitation, Radboud University Medical Center, Donders Centre for Neuroscience, Reinier Postlaan 4, Postbox 9101, 6500 HB Nijmegen, the Netherlands; Flextension Foundation, the Netherlands.
| | - Joan Lobo-Prat
- Department of Mechanical and Aerospace Engineering, University of California Irvine, USA; Flextension Foundation, the Netherlands
| | - Arjen Bergsma
- Department of Biomechanical Engineering, University of Twente, the Netherlands; Flextension Foundation, the Netherlands
| | - Elizabeth Vroom
- Duchenne Parent Project, the Netherlands; World Duchenne Organization, the Netherlands
| | | |
Collapse
|
10
|
Lee SI, Liu X, Rajan S, Ramasarma N, Choe EK, Bonato P. A novel upper-limb function measure derived from finger-worn sensor data collected in a free-living setting. PLoS One 2019; 14:e0212484. [PMID: 30893308 PMCID: PMC6426183 DOI: 10.1371/journal.pone.0212484] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/03/2019] [Indexed: 12/30/2022] Open
Abstract
The use of wrist-worn accelerometers has recently gained tremendous interest among researchers and clinicians as an objective tool to quantify real-world use of the upper limbs during the performance of activities of daily living (ADLs). However, wrist-worn accelerometers have shown a number of limitations that hinder their adoption in the clinic. Among others, the inability of wrist-worn accelerometers to capture hand and finger movements is particularly relevant to monitoring the performance of ADLs. This study investigates the use of finger-worn accelerometers to capture both gross arm and fine hand movements for the assessment of real-world upper-limb use. A system of finger-worn accelerometers was utilized to monitor eighteen neurologically intact young adults while performing nine motor tasks in a laboratory setting. The system was also used to monitor eighteen subjects during the day time of a day in a free-living setting. A novel measure of real-world upper-limb function—comparing the duration of activities of the two limbs—was derived to identify which upper limb subjects predominantly used to perform ADLs. Two validated handedness self-reports, namely the Waterloo Handedness Questionnaire and the Fazio Laterality Inventory, were collected to assess convergent validity. The analysis of the data recorded in the laboratory showed that the proposed measure of upper-limb function is suitable to accurately detect unilateral vs. bilateral use of the upper limbs, including both gross arm movements and fine hand movements. When applied to recordings collected in a free-living setting, the proposed measure showed high correlation with self-reported handedness indices (i.e., ρ = 0.78 with the Waterloo Handedness Questionnaire scores and ρ = 0.77 with the Fazio Laterality Inventory scores). The results herein presented establish face and convergent validity of the proposed measure of real-world upper-limb function derived using data collected by means of finger-worn accelerometers.
Collapse
Affiliation(s)
- Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
- * E-mail:
| | - Xin Liu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
| | - Smita Rajan
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
| | | | - Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, United States of America
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States of America
| |
Collapse
|
11
|
Da-Silva RH, Moore SA, Rodgers H, Shaw L, Sutcliffe L, van Wijck F, Price CI. Wristband Accelerometers to motiVate arm Exercises after Stroke (WAVES): a pilot randomized controlled trial. Clin Rehabil 2019; 33:1391-1403. [PMID: 30845829 DOI: 10.1177/0269215519834720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a multicentre, observer-blind, pilot randomized controlled trial (RCT) of a wristband accelerometer with activity-dependent vibration alerts to prompt impaired arm use after stroke. DESIGN Parallel-group pilot RCT. SETTING Four English stroke services. PARTICIPANTS Patients 0-3 months post stroke with a new arm deficit. INTERVENTION Participants were randomized to wear a prompting or 'sham' wristband during a four-week self-directed therapy programme with twice-weekly therapy review. MAIN OUTCOMES Recruitment, retention and adherence rates, safety and completion of assessments were reported. Arm recovery was measured by Action Research Arm Test (ARAT) and Motor Activity Log (MAL) without statistical comparison. RESULTS In total, 33 patients were recruited (0.6 per month/site; median time post stroke: 26 days (interquartile range (IQR):15.5-45)). Baseline, four-week and eight-week median (IQR) ARAT for the control group (n = 19) were 15 (2-35), 35 (15-26) and 31 (21-55) and those for the intervention group (n = 14) were 37 (16-45), 57 (29-57) and 57 (37-57), respectively; for MAL Amount of Use, the corresponding values in the control group were 0.2 (0.0-1.2), 1.1 (0.3-2.9) and 1.2 (0.7-2.9) and in the intervention group were 1.4 (0.5-2.6), 3.8 (1.9-4.5) and 3.7 (2.1-4.3). Four participants withdrew from the study. Wristbands were worn for 79% of the recommended time. The intervention and control group participants received a median of 6.0 (IQR: 4.3-8.0) and 7.5 (IQR: 6.8-8.0) therapy reviews. A median of 8 (IQR: 6-10) prompts were delivered per intervention participant/day. Research assessments were completed for 28/29 and 25/28 patients at four and eight weeks. Eight serious adverse events were reported, all unrelated to the intervention. CONCLUSION A multicentre RCT of wristband accelerometers to prompt arm activity early after stroke is feasible. A total sample of 108 participants would be required.
Collapse
Affiliation(s)
- Ruth H Da-Silva
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah A Moore
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Rodgers
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Shaw
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Sutcliffe
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Frederike van Wijck
- 2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Christopher I Price
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|