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Janela D, Areias AC, Molinos M, Moulder RG, Magalhães I, Bento V, Cardeano M, Yanamadala V, Correia FD, Atherton J, Costa F. Digital Care Program for Urinary Incontinence in Females: A Large-Scale, Prospective, Cohort Study. Healthcare (Basel) 2024; 12:141. [PMID: 38255031 PMCID: PMC10815799 DOI: 10.3390/healthcare12020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
Female urinary incontinence (UI) is highly prevalent in the US (>60%). Pelvic floor muscle training (PFMT) represents first-line care for UI; however, access and adherence challenges urge new care delivery models. This prospective cohort study investigates the feasibility and safety of a remote digital care program (DCP) combining education and PFMT with real-time biofeedback with an average duration of 10 weeks. The primary outcome was the change in the Urinary Impact Questionnaire-short form (UIQ-7) from baseline to program-end, calculated through latent growth curve analysis (LGCA). Secondary outcomes included the impact of pelvic conditions (PFIQ-7), depression (PHQ-9), anxiety (GAD-7), productivity impairment (WPAI), intention to seek additional healthcare, engagement, and satisfaction. Of the 326 participants who started the program, 264 (81.0%) completed the intervention. Significant improvement on UIQ-7 (8.8, 95%CI 4.7; 12.9, p < 0.001) was observed, corresponding to a response rate of 57.3%, together with improvements in all other outcomes and high satisfaction (8.9/10, SD 1.8). This study shows the feasibility and safety of a completely remote DCP with biofeedback managed asynchronously by a physical therapist to reduce UI-related symptoms in a real-world setting. Together, these findings may advocate for the exploration of this care delivery option to escalate access to proper and timely UI care.
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Affiliation(s)
- Dora Janela
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Anabela C. Areias
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Maria Molinos
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Robert G. Moulder
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
- Institute for Cognitive Science, University of Colorado, Boulder, CO 80309, USA
| | - Ivo Magalhães
- Bloom, Sword Health Inc., Draper, UT 84020, USA; (I.M.); (M.C.); (J.A.)
| | - Virgílio Bento
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Marta Cardeano
- Bloom, Sword Health Inc., Draper, UT 84020, USA; (I.M.); (M.C.); (J.A.)
| | - Vijay Yanamadala
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
- Department of Surgery, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT 06473, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT 06103, USA
| | - Fernando Dias Correia
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
- Neurology Department, Centro Hospitalar e Universitário do Porto, 4099-001 Porto, Portugal
| | - Jennesa Atherton
- Bloom, Sword Health Inc., Draper, UT 84020, USA; (I.M.); (M.C.); (J.A.)
| | - Fabíola Costa
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
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Areias AC, Molinos M, Moulder RG, Janela D, Scheer JK, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management. NPJ Digit Med 2023; 6:188. [PMID: 37816899 PMCID: PMC10564877 DOI: 10.1038/s41746-023-00936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from -2.0 95%CI -2.1, -1.9 to -2.1 95%CI -2.3, -1.9, p < 0.001) without intergroup differences in mean changes or responder rates (from 59.9% (420/701) to 66.6% (780/1172), p = 0.067), alongside reduction in analgesic consumption. We observed significant improvements in mental health and productivity across all categories, with productivity and non-work-related functional recovery being greater within the most deprived group. Engagement was high but varied slightly across categories. Together these findings highlight the importance of a patient-centered digital care program as a tool to address health inequities in musculoskeletal pain management. The idea of investigating social deprivation within a digital program provides a foundation for future work in this field to identify areas of improvement.
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Affiliation(s)
| | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | | | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Steven P Cohen
- Department of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Pak SS, Janela D, Freitas N, Costa F, Moulder R, Molinos M, Areias AC, Bento V, Cohen SP, Yanamadala V, Souza RB, Correia FD. Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial. J Med Internet Res 2023; 25:e49236. [PMID: 37490337 PMCID: PMC10474513 DOI: 10.2196/49236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. OBJECTIVE The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. METHODS We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. RESULTS A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (-1.8, 95% CI -13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. CONCLUSIONS This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528.
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Affiliation(s)
- Sang S Pak
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | | | - Nina Freitas
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | | | - Robert Moulder
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | | | | | - Steven P Cohen
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | | | - Richard B Souza
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | - Fernando Dias Correia
- Sword Health Inc, Draper, UT, United States
- Department of Neurology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Areias AC, Janela D, Molinos M, Moulder RG, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study. JMIR Rehabil Assist Technol 2023; 10:e49673. [PMID: 37465960 PMCID: PMC10466151 DOI: 10.2196/49673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). OBJECTIVE This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. METHODS We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ≤44 years old (young adults), 45-64 years old (middle-aged adults), and ≥65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30%), analgesic usage, mental health, work productivity, and non-work-related activity impairment. RESULTS Of 16,229 patients, 12,082 started the program: 38.3% (n=4629) were young adults, 55.7% (n=6726) were middle-aged adults, and 6% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95% CI 1.45-2.06; P<.001 and OR 2.40, 95% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95% CI 1.03-1.45; P=.03 and OR 1.38, 95% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6%; middle-aged adults: 1848/2834, 65.2%; and older adults: 241/387, 62.3%; P=.17). CONCLUSIONS Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population.
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Affiliation(s)
| | - Dora Janela
- Sword Health, Inc, Draper, UT, United States
| | | | - Robert G Moulder
- Sword Health, Inc, Draper, UT, United States
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Molinos M, Fiordalisi MF, Caldeira J, Almeida CR, Barbosa MA, Gonçalves RM. Alterations of bovine nucleus pulposus cells with aging. Aging Cell 2023; 22:e13873. [PMID: 37254638 PMCID: PMC10410011 DOI: 10.1111/acel.13873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 06/01/2023] Open
Abstract
Aging is one of the major etiological factors driving intervertebral disc (IVD) degeneration, the main cause of low back pain. The nucleus pulposus (NP) includes a heterogeneous cell population, which is still poorly characterized. Here, we aimed to uncover main alterations in NP cells with aging. For that, bovine coccygeal discs from young (12 months) and old (10-16 years old) animals were dissected and primary NP cells were isolated. Gene expression and proteomics of fresh NP cells were performed. NP cells were labelled with propidium iodide and analysed by flow cytometry for the expression of CD29, CD44, CD45, CD146, GD2, Tie2, CD34 and Stro-1. Morphological cell features were also dissected by imaging flow cytometry. Elder NP cells (up-regulated bIL-6 and bMMP1 gene expression) presented lower percentages of CD29+, CD44+, CD45+ and Tie2+ cells compared with young NP cells (upregulated bIL-8, bCOL2A1 and bACAN gene expression), while GD2, CD146, Stro-1 and CD34 expression were maintained with age. NP cellulome showed an upregulation of proteins related to endoplasmic reticulum (ER) and melanosome independently of age, whereas proteins upregulated in elder NP cells were also associated with glycosylation and disulfide bonds. Flow cytometry analysis of NP cells disclosed the existence of 4 subpopulations with distinct auto-fluorescence and size with different dynamics along aging. Regarding cell morphology, aging increases NP cell area, diameter and vesicles. These results contribute to a better understanding of NP cells aging and highlighting potential anti-aging targets that can help to mitigate age-related disc disease.
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Affiliation(s)
- Maria Molinos
- i3S – Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB – Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
- ICBAS – Instituto de Ciências Biomédicas Abel SalazarUniversidade do PortoPortoPortugal
| | - Morena F. Fiordalisi
- i3S – Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB – Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
- ICBAS – Instituto de Ciências Biomédicas Abel SalazarUniversidade do PortoPortoPortugal
| | - Joana Caldeira
- i3S – Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB – Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
| | - Catarina R. Almeida
- i3S – Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB – Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
- iBiMED – Institute of Biomedicine, Department of Medical SciencesUniversity of AveiroAveiroPortugal
| | - Mário A. Barbosa
- i3S – Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB – Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
- ICBAS – Instituto de Ciências Biomédicas Abel SalazarUniversidade do PortoPortoPortugal
| | - Raquel M. Gonçalves
- i3S – Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB – Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
- ICBAS – Instituto de Ciências Biomédicas Abel SalazarUniversidade do PortoPortoPortugal
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Cui D, Janela D, Costa F, Molinos M, Areias AC, Moulder RG, Scheer JK, Bento V, Cohen SP, Yanamadala V, Correia FD. Randomized-controlled trial assessing a digital care program versus conventional physiotherapy for chronic low back pain. NPJ Digit Med 2023; 6:121. [PMID: 37420107 DOI: 10.1038/s41746-023-00870-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
Low back pain (LBP) is the world's leading cause of years lived with disability. Digital exercise-based interventions have shown great potential in the management of musculoskeletal conditions, promoting access and easing the economic burden. However, evidence of their effectiveness for chronic LBP (CLBP) management compared to in-person physiotherapy has yet to be unequivocally established. This randomized controlled trial (RCT) aims to compare the clinical outcomes of patients with CLBP following a digital intervention versus evidence-based in-person physiotherapy. Our results demonstrate that patient satisfaction and adherence were high and similar between groups, although a significantly lower dropout rate is observed in the digital group (11/70, 15.7% versus 24/70, 34.3% in the conventional group; P = 0.019). Both groups experience significant improvements in disability (primary outcome), with no differences between groups in change from baseline (median difference: -0.55, 95% CI: -2.42 to 5.81, P = 0.412) or program-end scores (-1.05, 95% CI: -4.14 to 6.37; P = 0.671). Likewise, no significant differences between groups are found for secondary outcomes (namely pain, anxiety, depression, and overall productivity impairment). This RCT demonstrates that a remote digital intervention for CLBP can promote the same levels of recovery as evidence-based in-person physiotherapy, being a potential avenue to ease the burden of CLBP.
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Affiliation(s)
- Di Cui
- Physical and Rehabilitation Medicine, Emory University, Atlanta, GA, Georgia
| | | | | | | | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Vijay Yanamadala
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
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Scheer J, Areias AC, Molinos M, Janela D, Moulder R, Lains J, Bento V, Yanamadala V, Dias Correia F, Costa F. Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study. JMIR Mhealth Uhealth 2023; 11:e44316. [PMID: 36735933 PMCID: PMC10132051 DOI: 10.2196/44316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. OBJECTIVE The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. METHODS This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain. RESULTS Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1%, rural: 68.3%; P=.30). CONCLUSIONS This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
- Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | | | | | | | - Robert Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Coimbra, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Vijay Yanamadala
- Sword Health Inc, Draper, UT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
| | - Fernando Dias Correia
- Sword Health Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Areias AC, Costa F, Janela D, Molinos M, Moulder RG, Lains J, Scheer JK, Bento V, Yanamadala V, Cohen SP, Correia FD. Impact on productivity impairment of a digital care program for chronic low back pain: A prospective longitudinal cohort study. Musculoskelet Sci Pract 2023; 63:102709. [PMID: 36543719 DOI: 10.1016/j.msksp.2022.102709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability in the United States and the main reason for absenteeism. Successful management of chronic LBP (CLBP) is dependent on multimodal evidence-based interventions. Digital interventions (DI) may ease accessibility to such treatments, increasing adherence, while reducing healthcare-related costs. OBJECTIVES Assess the impact of a completely remote multimodal DI on productivity impairment in a real-work context cohort of patients with CLBP. DESIGN Longitudinal study. METHODS Ad-hoc analysis of an interventional, single-arm study of individuals with CLBP undergoing a DI for 12 weeks. Outcomes included the mean change in work productivity and activity impairment (including overall and non-work related activities), pain, depression, anxiety, fear-avoidance beliefs, analgesic usage, and engagement. Minimal clinically important change (MCIC) was calculated for productivity using anchor- and distribution-based methods. RESULTS From 560 patients at program start, 78.4% completed the DI. A significant improvement in overall productivity (20.21, 95%CI: 16.48-23.94) and in non-work related activities (21.36, 95%CI: 17.49-25.22) was observed, corresponding to a responder rate of 57.1-83.3% and 60.5-79.8%, respectively, and depending on the MCIC method. Significant improvements were reported for pain (2.32 points, 95%CI: 2.02-2.61), anxiety (5.24, 95%CI: 4.18-6.29), depression (6.38, 95%CI: 4.78-7.98) and fear-avoidance beliefs (8.11, 95%CI: 6.20-10.02). Both engagement (sessions per week) and patient satisfaction scores were high, 2.9 (SD 1.0) and 8.8/10 (SD 1.6), respectively. CONCLUSIONS This study demonstrated the utility of a multimodal DI to address productivity impairment. DIs have great potential to ease the burden of CLBP, providing an accessible and cost-effective modality of care. TRIAL REGISTRATION The study was approved by the New England IRB (protocol number 120190313) and prospectively registered in ClinicalTrials.gov, NCT04092946, on September 17th, 2019.
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Affiliation(s)
| | | | | | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, 80309, USA.
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, 3064-908, Tocha, Portugal; Faculty of Medicine, Coimbra University, 3004-504, Coimbra, Portugal.
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA.
| | | | - Vijay Yanamadala
- Sword Health, Inc, UT, 84043, USA; Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, 06473, USA; Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, 06103, USA.
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA; Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, 20814, MD, USA.
| | - Fernando Dias Correia
- Sword Health, Inc, UT, 84043, USA; Neurology Department, Centro Hospitalar e Universitário do Porto, 4099-001, Porto, Portugal.
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Scheer JK, Costa F, Janela D, Molinos M, Areias AC, Moulder RG, Lains J, Bento V, Yanamadala V, Correia FD. Sleep Disturbance in Musculoskeletal Conditions: Impact of a Digital Care Program. J Pain Res 2023; 16:33-46. [PMID: 36636267 PMCID: PMC9830709 DOI: 10.2147/jpr.s394421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Background Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking. Purpose To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions. Patients and Methods This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement. Results At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p<0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment. Conclusion This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.
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Affiliation(s)
- Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | | | | | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA,Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA,Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal,Correspondence: Fernando Dias Correia, Sword Health Inc, 13937 Sprague Lane Ste 100, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email
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Janela D, Costa F, Weiss B, Areias AC, Molinos M, Scheer JK, Lains J, Bento V, Cohen SP, Correia FD, Yanamadala V. Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review. Digit Health 2023; 9:20552076231176696. [PMID: 37325077 PMCID: PMC10262679 DOI: 10.1177/20552076231176696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown. Objective To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated. Results Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group. Conclusions Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.
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Affiliation(s)
| | | | - Brandon Weiss
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | | | - Justin K. Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Steven P. Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
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11
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Scheer J, Costa F, Molinos M, Areias A, Janela D, Moulder RG, Lains J, Bento V, Yanamadala V, Cohen SP, Correia FD. Racial and Ethnic Differences in Outcomes of a 12-Week Digital Rehabilitation Program for Musculoskeletal Pain: Prospective Longitudinal Cohort Study. J Med Internet Res 2022; 24:e41306. [PMID: 36189963 PMCID: PMC9664333 DOI: 10.2196/41306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/14/2022] [Accepted: 09/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) pain disproportionately affects people from different ethnic backgrounds through higher burden and less access to care. Digital care programs (DCPs) can improve access and help reduce inequities. However, the outcomes of such programs based on race and ethnicity have yet to be studied. OBJECTIVE We aimed to assess the impact of race and ethnicity on engagement and outcomes in a multimodal DCP for MSK pain. METHODS This was an ad hoc analysis of an ongoing decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were stratified by self-reported racial and ethnic group, and their engagement and outcome changes between baseline and 12 weeks were compared using latent growth curve analysis. Outcomes included program engagement (number of sessions), self-reported pain scores, likelihood of surgery, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was calculated for pain, and multivariable logistic regression was performed to evaluate race as an independent predictor of meeting the MCID. RESULTS A total of 6949 patients completed the program: 65.5% (4554/6949) of them were non-Hispanic White, 10.8% (749/6949) were Black, 9.7% (673/6949) were Asian, 9.2% (636/6949) were Hispanic, and 4.8% (337/6949) were of other racial or ethnic backgrounds. The population studied was diverse and followed the proportions of the US population. All groups reported high engagement and satisfaction, with Hispanic and Black patients ranking first among satisfaction despite lower engagement. Black patients had a higher likelihood to drop out (odds ratio [OR] 1.19, 95% CI 1.01-1.40, P=.04) than non-Hispanic White patients. Hispanic and Black patients reported the highest level of pain, surgical intent, work productivity, and impairment in activities of daily living at baseline. All race groups showed a significant improvement in all outcomes, with Black and Hispanic patients reporting the greatest improvements in clinical outcomes. Hispanic patients also had the highest response rate for pain (75.8%) and a higher OR of meeting the pain MCID (OR 1.74, 95% CI 1.24-2.45, P=.001), when compared with non-Hispanic White patients, independent of age, BMI, sex, therapy type, education level, and employment status. No differences in mental health outcomes were found between race and ethnic groups. CONCLUSIONS This study advocates for the utility of a DCP in improving access to MSK care and promoting health equity. Engagement and satisfaction rates were high in all the groups. Black and Hispanic patients had higher MSK burden at baseline and lower engagement but also reported higher improvements, with Hispanic patients presenting a higher likelihood of pain improvement.
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Affiliation(s)
- Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | | | | | | | - Dora Janela
- Sword Health, Inc, Draper, UT, United States
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Jorge Lains
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - Steven P Cohen
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Janela D, Costa F, Molinos M, Moulder RG, Lains J, Scheer JK, Bento V, Yanamadala V, Cohen SP, Correia FD. Fear avoidance beliefs in upper-extremity musculoskeletal pain conditions: secondary analysis of a prospective clinical study on digital care programs. Pain Med 2022; 24:451-460. [PMID: 36200858 PMCID: PMC10069851 DOI: 10.1093/pm/pnac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Fear-avoidance beliefs (FAB) have been associated with poorer prognosis and decreased adherence to exercise-based treatments in musculoskeletal (MSK) pain. However, the impact of high FAB on adherence and outcomes in upper extremity musculoskeletal (UEMSK) pain is poorly explored, particularly through exercise-based digital care programs (DCP). OBJECTIVE Assess the adherence levels, clinical outcomes and satisfaction in patients with UEMSK pain and elevated FAB after a fully remote multimodal DCP. Associations between FABQ-PA and clinical outcomes were conducted. METHODS Secondary analysis of an ongoing clinical trial. Participants with UEMSK pain (shoulder, elbow, and wrist/hand) and elevated FAB - physical activity (FABQ-PA ≥ 15) were included. Adherence (completion rate, sessions/week, total exercise time) and mean change in clinical outcomes - disability (QuickDASH), numerical pain score, FABQ-PA, anxiety (GAD-7) and depression (PHQ-9)- between baseline and end-of-program were assessed. Associations between FABQ-PA and clinical outcomes were conducted. RESULTS 520 participants were included, with mean baseline FAB 18.02 (SD 2.77). Patients performed on average 29.3 exercise sessions (2.8 sessions/week), totalizing 338.2 exercise minutes. Mean satisfaction was 8.5/10 (SD 1.7). Significant improvements were observed in all clinical outcomes. Higher baseline FAB were associated with higher baseline disability (p<.001) and smaller improvements in disability (p<.001) and pain (p=.001). Higher engagement was associated with greater improvements in FABQ-PA (p = 0.043) and pain (p = 0.009). CONCLUSIONS This study provides evidence of the potential benefits of a structured and multimodal home-based DCP in the management of UEMSK pain conditions in patients with elevated FAB in a real-world context. TRIAL REGISTRATION ClinicalTrials.gov, NCT04092946. Registered 17/09/2019; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
| | | | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | | | - Vijay Yanamadala
- SWORD Health, Inc, Utah, USA.,Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, Connecticut, USA.,Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, Connecticut, USA
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Fernando Dias Correia
- SWORD Health, Inc, Utah, USA.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Costa F, Janela D, Molinos M, Moulder RG, Lains J, Bento V, Scheer J, Yanamadala V, Correia FD, Cohen SP. Digital Rehabilitation for Acute Low Back Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:1873-1887. [PMID: 35813029 PMCID: PMC9261956 DOI: 10.2147/jpr.s369926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain (LBP) has a lifetime prevalence of 70–80%. Access to timely and personalized, evidence-based care is key to prevent chronic progression. Digital solutions may ease accessibility to treatment while reducing healthcare-related costs. Purpose We aim to report the results of a fully remote digital care program (DCP) for acute LBP. Patients and Methods This was an interventional, single-arm, cohort study of patients with acute LBP who received a DCP. Primary outcome was the mean change in disability (Oswestry Disability Index – ODI) after 12 weeks. Secondary outcomes included change in pain (NPRS), analgesic consumption, surgery likelihood, depression (PHQ-9), anxiety (GAD-7), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results A total of 406 patients were enrolled in the program and of those, 332 (81.8%) completed the intervention. A significant disability reduction of 55.1% (14.93, 95% CI 13.95; 15.91) was observed, corresponding to a 76.1% responder rate (30% cut-off). Disability reduction was accompanied by significant improvements in pain (61.0%), depression (55.4%), anxiety (59.5%), productivity (65.6%), fear-avoidance beliefs (46.3%), intent to pursue surgery (59.1%), and analgesic consumption (from 35.7% at baseline to 10.8% at program end). DCP-related patient satisfaction score was 8.7/10.0 (SD 1.4). Conclusion This study demonstrated the utility of a multimodal DCP for patients with acute LBP. Very high adherence rates and patient satisfaction were observed, alongside significant reductions in all assessed outcomes, consistent with the growing body of evidence supporting the management of acute LBP with DCPs.
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Affiliation(s)
- Fabíola Costa
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Dora Janela
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Maria Molinos
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Vijay Yanamadala
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Fernando Dias Correia
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Correspondence: Fernando Dias Correia, 65 E Wadsworth Park Dr Ste 230, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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14
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Costa F, Janela D, Molinos M, Moulder R, Bento V, Lains J, Scheer J, Yanamadala V, Cohen S, Dias Correia F. Depression and work productivity: insights from a longitudinal cohort study on digital care programs for Musculoskeletal conditions. J Med Internet Res 2022; 24:e38942. [PMID: 35714099 PMCID: PMC9361146 DOI: 10.2196/38942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity between musculoskeletal (MSK) pain and depression is highly common and associated with greater symptom burden and greater loss of work productivity. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. OBJECTIVE Assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. METHODS The present study is an ad-hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP. Three subgroups with different baseline depression severity levels were created based on the Patient Health Questionnaire (PHQ-9): cluster 1 (<5: minimal depression); cluster 2 (5-10: mild depression) and cluster 3 (≥10: moderate depression). The mean change between baseline and end-of-program (8-12 weeks) on depression, anxiety, fear-avoidance beliefs, work productivity and activity impairment and adherence was assessed across subgroups. Outcome changes were analyzed by latent growth curve analysis. RESULTS From a total of 7785 eligible participants, 6137 (78.8%) were included in Cluster 1, 1158 (14.9%) in cluster 2 and 490 (6.3%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (5 and 10 for clusters 2 and 3, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from -16.82, 95%CI -20.32 to -13.42 in cluster 1 to -20.10, 95%CI -32.64 to -7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). CONCLUSIONS A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. CLINICALTRIAL ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
- Fabíola Costa
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Dora Janela
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Maria Molinos
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Robert Moulder
- Institute for Cognitive Science, University of Colorado, Boulder, US
| | - Vírgilio Bento
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, PT.,Faculty of Medicine, Coimbra University, Coimbra, PT
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, US
| | - Vijay Yanamadala
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, US.,Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, US.,SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Steven Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, US.,Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Maryland, USA, Bethesda, US
| | - Fernando Dias Correia
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, PT
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15
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Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
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Janela D, Costa F, Molinos M, Moulder RG, Lains J, Francisco GE, Bento V, Cohen SP, Correia FD. Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:53-66. [PMID: 35035234 PMCID: PMC8755939 DOI: 10.2147/jpr.s343308] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. Purpose Present the results of a fully remote digital care program (DCP) for chronic SP. Patients and Methods Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.
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Affiliation(s)
- Dora Janela
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Fabíola Costa
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Maria Molinos
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA
| | - Virgílio Bento
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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17
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Costa F, Janela D, Molinos M, Lains J, Francisco GE, Bento V, Dias Correia F. Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study. BMC Musculoskelet Disord 2022; 23:29. [PMID: 34983488 PMCID: PMC8728982 DOI: 10.1186/s12891-021-04891-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Objective Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Methods Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Results Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Strengths and limitations This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. Conclusions We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. Trial registration NCT, NCT04092946. Registered 17/09/2019; Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04891-5.
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Affiliation(s)
| | - Dora Janela
- SWORD Health Technologies, Inc, Draper, UT, USA
| | | | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA
| | | | - Fernando Dias Correia
- SWORD Health Technologies, Inc, Draper, UT, USA. .,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
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18
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Correia FD, Molinos M, Neves C, Janela D, Carvalho D, Luis S, Francisco GE, Lains J, Bento V. Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study. JMIR Rehabil Assist Technol 2021; 8:e31247. [PMID: 34499038 PMCID: PMC8517823 DOI: 10.2196/31247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022
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Affiliation(s)
- Fernando D Correia
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Maria Molinos
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Carlos Neves
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Dora Janela
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Diana Carvalho
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Sara Luis
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States.,TIRR Memorial Hermann, Houston, TX, United States
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Virgilio Bento
- SWORD Health Technologies, Inc, Draper, UT, United States
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19
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Dias Correia F, Nogueira A, Magalhães I, Guimarães J, Moreira M, Barradas I, Molinos M, Teixeira L, Pires J, Seabra R, Lains J, Bento V. Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study. JMIR Rehabil Assist Technol 2019; 6:e14523. [PMID: 31228176 PMCID: PMC6611148 DOI: 10.2196/14523] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care. Objective The aim of this study was to assess the feasibility of a novel artificial intelligence–powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation. Methods This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM). Results A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of −4.79 seconds (95% CI −7.24 to −1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion. Conclusions This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. Trial Registration ClinicalTrials.gov NCT03045549; https://clinicaltrials.gov/ct2/show/NCT03045549
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Affiliation(s)
- Fernando Dias Correia
- Neurology Department, Hospital de Santo António-Centro Hospitalar do Porto, Porto, Portugal
| | | | | | | | | | | | | | - Laetitia Teixeira
- Department of Population Studies, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Joaquim Pires
- Orthopaedics Department, Hospital da Prelada-Domingos Braga da Cruz, Porto, Portugal
| | - Rosmaninho Seabra
- Orthopaedics Department, Hospital da Prelada-Domingos Braga da Cruz, Porto, Portugal
| | - Jorge Lains
- Physical Rehabilitation Medicine Department, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | - Virgílio Bento
- Engineering Department, Instituto Universitário da Maia, Maia, Porto, Portugal
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20
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Correia FD, Nogueira A, Magalhães I, Guimarães J, Moreira M, Barradas I, Molinos M, Teixeira L, Tulha J, Seabra R, Lains J, Bento V. Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study. JMIR Rehabil Assist Technol 2019; 6:e13111. [PMID: 30816849 PMCID: PMC6416534 DOI: 10.2196/13111] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 12/23/2022] Open
Abstract
Background Physical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times. Objective This study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring. Methods The digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion. Results A total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95% CI 1.85-7.47), in favor of the digital intervention group. Conclusions The present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources. Trial Registration ClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252
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Affiliation(s)
- Fernando Dias Correia
- SWORD Health, Porto, Portugal.,Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | | | | | | | | | | | | | - Laetitia Teixeira
- Department of Population Studies, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - José Tulha
- Orthopaedics Department, Hospital da Prelada - Dr. Domingos Braga da Cruz, Porto, Portugal
| | - Rosmaninho Seabra
- Orthopaedics Department, Hospital da Prelada - Dr. Domingos Braga da Cruz, Porto, Portugal
| | - Jorge Lains
- Physical Rehabilitation Medicine Department, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | - Virgílio Bento
- SWORD Health, Porto, Portugal.,Engineering Department, University Institute of Maia - ISMAI, Maia, Portugal
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21
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Cunha C, Almeida CR, Almeida MI, Silva AM, Molinos M, Lamas S, Pereira CL, Teixeira GQ, Monteiro AT, Santos SG, Gonçalves RM, Barbosa MA. Systemic Delivery of Bone Marrow Mesenchymal Stem Cells for In Situ Intervertebral Disc Regeneration. Stem Cells Transl Med 2016; 6:1029-1039. [PMID: 28297581 PMCID: PMC5442789 DOI: 10.5966/sctm.2016-0033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022] Open
Abstract
Cell therapies for intervertebral disc (IVD) regeneration presently rely on transplantation of IVD cells or stem cells directly to the lesion site. Still, the harsh IVD environment, with low irrigation and high mechanical stress, challenges cell administration and survival. In this study, we addressed systemic transplantation of allogeneic bone marrow mesenchymal stem cells (MSCs) intravenously into a rat IVD lesion model, exploring tissue regeneration via cell signaling to the lesion site. MSC transplantation was performed 24 hours after injury, in parallel with dermal fibroblasts as a control; 2 weeks after transplantation, animals were killed. Disc height index and histological grading score indicated less degeneration for the MSC‐transplanted group, with no significant changes in extracellular matrix composition. Remarkably, MSC transplantation resulted in local downregulation of the hypoxia responsive GLUT‐1 and in significantly less herniation, with higher amounts of Pax5+ B lymphocytes and no alterations in CD68+ macrophages within the hernia. The systemic immune response was analyzed in the blood, draining lymph nodes, and spleen by flow cytometry and in the plasma by cytokine array. Results suggest an immunoregulatory effect in the MSC‐transplanted animals compared with control groups, with an increase in MHC class II+ and CD4+ cells, and also upregulation of the cytokines IL‐2, IL‐4, IL‐6, and IL‐10, and downregulation of the cytokines IL‐13 and TNF‐α. Overall, our results indicate a beneficial effect of systemically transplanted MSCs on in situ IVD regeneration and highlight the complex interplay between stromal cells and cells of the immune system in achieving successful tissue regeneration. Stem Cells Translational Medicine2017;6:1029–1039
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Affiliation(s)
- Carla Cunha
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Catarina R. Almeida
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- Department of Medical Sciences and Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Maria Inês Almeida
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Andreia M. Silva
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- ICBAS‐Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Maria Molinos
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- ICBAS‐Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Sofia Lamas
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC‐Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Catarina L. Pereira
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- ICBAS‐Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Graciosa Q. Teixeira
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- ICBAS‐Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - António T. Monteiro
- Research Centre on Biodiversity and Genetic Resources, CIBIO‐InBIO Associate Laboratory, Vairão, Portugal
| | - Susana G. Santos
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Raquel M. Gonçalves
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Mário A. Barbosa
- i3S‐Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB‐Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- ICBAS‐Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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22
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Schröder P, Helmreich B, Škrbić B, Carballa M, Papa M, Pastore C, Emre Z, Oehmen A, Langenhoff A, Molinos M, Dvarioniene J, Huber C, Tsagarakis KP, Martinez-Lopez E, Pagano SM, Vogelsang C, Mascolo G. Status of hormones and painkillers in wastewater effluents across several European states-considerations for the EU watch list concerning estradiols and diclofenac. Environ Sci Pollut Res Int 2016; 23:12835-66. [PMID: 27023823 PMCID: PMC4912981 DOI: 10.1007/s11356-016-6503-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 02/28/2016] [Indexed: 05/05/2023]
Abstract
Present technologies for wastewater treatment do not sufficiently address the increasing pollution situation of receiving water bodies, especially with the growing use of personal care products and pharmaceuticals (PPCP) in the private household and health sector. The relevance of addressing this problem of organic pollutants was taken into account by the Directive 2013/39/EU that introduced (i) the quality evaluation of aquatic compartments, (ii) the polluter pays principle, (iii) the need for innovative and affordable wastewater treatment technologies, and (iv) the identification of pollution causes including a list of principal compounds to be monitored. In addition, a watch list of 10 other substances was recently defined by Decision 2015/495 on March 20, 2015. This list contains, among several recalcitrant chemicals, the painkiller diclofenac and the hormones 17β-estradiol and 17α-ethinylestradiol. Although some modern approaches for their removal exist, such as advanced oxidation processes (AOPs), retrofitting most wastewater treatment plants with AOPs will not be acceptable as consistent investment at reasonable operational cost. Additionally, by-product and transformation product formation has to be considered. The same is true for membrane-based technologies (nanofiltration, reversed osmosis) despite of the incredible progress that has been made during recent years, because these systems lead to higher operation costs (mainly due to higher energy consumption) so that the majority of communities will not easily accept them. Advanced technologies in wastewater treatment like membrane bioreactors (MBR) that integrate biological degradation of organic matter with membrane filtration have proven a more complete elimination of emerging pollutants in a rather cost- and labor-intensive technology. Still, most of the presently applied methods are incapable of removing critical compounds completely. In this opinion paper, the state of the art of European WWTPs is reflected, and capacities of single methods are described. Furthermore, the need for analytical standards, risk assessment, and economic planning is stressed. The survey results in the conclusion that combinations of different conventional and advanced technologies including biological and plant-based strategies seem to be most promising to solve the burning problem of polluting our environment with hazardous emerging xenobiotics.
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Affiliation(s)
- P Schröder
- Research Unit Microbe-Plant Interactions (EGEN), German Research Center for Health and Environment GmbH, Helmholtz Zentrum Muenchen, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - B Helmreich
- Chair of Urban Water Systems Engineering, Technische Universität München, Munich, Germany
| | - B Škrbić
- Faculty of Technology, University of Novi Sad, Novi Sad, Serbia
| | - M Carballa
- Department of Chemical Engineering, School of Engineering, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M Papa
- Department of Civil Environmental Architectural Engineering & Mathematics, University of Brescia, Brescia, Italy
| | - C Pastore
- CNR-Istituto di Ricerca Sulle Acque, Bari, Italy
| | - Z Emre
- Turkish Atomic Energy Authority, Ankara, Turkey
| | - A Oehmen
- Departamento de Química, Faculdade de Ciências e Tecnologia (FCT), Universidade Nova de Lisboa (UNL), Caparica, Portugal
| | - A Langenhoff
- Sub-department of Environmental Technology, Wageningen University of Agrotechnology & Food Sciences, Wageningen, The Netherlands
| | - M Molinos
- University of Valencia, Valencia, Spain
| | | | - C Huber
- Research Unit Microbe-Plant Interactions (EGEN), German Research Center for Health and Environment GmbH, Helmholtz Zentrum Muenchen, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - K P Tsagarakis
- Business and Environmental Economics Technology Lab (BETECO), Department of Environmental Engineering, Democritus University of Thrace, Xanthi, Greece
| | | | | | - C Vogelsang
- Norwegian Institute for Water Research (NIVA), Oslo, Norway
| | - G Mascolo
- CNR-Istituto di Ricerca Sulle Acque, Bari, Italy
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23
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Molinos M, Almeida CR, Caldeira J, Cunha C, Gonçalves RM, Barbosa MA. Inflammation in intervertebral disc degeneration and regeneration. J R Soc Interface 2015; 12:20141191. [PMID: 25673296 DOI: 10.1098/rsif.2014.1191] [Citation(s) in RCA: 218] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is one of the major causes of low back pain, a problem with a heavy economic burden, which has been increasing in prevalence as populations age. Deeper knowledge of the complex spatial and temporal orchestration of cellular interactions and extracellular matrix remodelling is critical to improve current IVD therapies, which have so far proved unsatisfactory. Inflammation has been correlated with degenerative disc disease but its role in discogenic pain and hernia regression remains controversial. The inflammatory response may be involved in the onset of disease, but it is also crucial in maintaining tissue homeostasis. Furthermore, if properly balanced it may contribute to tissue repair/regeneration as has already been demonstrated in other tissues. In this review, we focus on how inflammation has been associated with IVD degeneration by describing observational and in vitro studies as well as in vivo animal models. Finally, we provide an overview of IVD regenerative therapies that target key inflammatory players.
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Affiliation(s)
- Maria Molinos
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal Instituto de Ciências Biomédicas Abel Salazar-ICBAS, Universidade do Porto, Porto, Portugal
| | - Catarina R Almeida
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal
| | - Joana Caldeira
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia-IPATIMUP, Universidade do Porto, Porto, Portugal
| | - Carla Cunha
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal
| | - Raquel M Gonçalves
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal
| | - Mário A Barbosa
- Instituto de Engenharia Biomédica-INEB, Universidade do Porto, Porto, Portugal Instituto de Ciências Biomédicas Abel Salazar-ICBAS, Universidade do Porto, Porto, Portugal
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Molinos M, Almeida CR, Gonçalves RM, Barbosa MA. Improvement of Bovine Nucleus Pulposus Cells Isolation Leads to Identification of Three Phenotypically Distinct Cell Subpopulations. Tissue Eng Part A 2015; 21:2216-27. [DOI: 10.1089/ten.tea.2014.0461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Maria Molinos
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Catarina R. Almeida
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - Raquel M. Gonçalves
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - Mário A. Barbosa
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
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Silva AM, Varela-Moreira A, Pereira Gomes C, Molinos M, Leite M, Almeida M, Ribeiro D, Schrader M, Figueiredo C, Barbosa M, Gonçalves R, Almeida C, Pêgo A, Santos SG, Gomez-Lazaro M. Integrated Analysis of Biological Samples by Imaging Flow Cytometry. Microsc Microanal 2015; 21 Suppl 5:95-96. [PMID: 26227728 DOI: 10.1017/s1431927615014282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A M Silva
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - A Varela-Moreira
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - C Pereira Gomes
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - M Molinos
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - M Leite
- 3Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP),Porto,Portugal
| | - M Almeida
- 7Centre for Cell Biology and Department of Biology,University of Aveiro,Aveiro,Portugal
| | - D Ribeiro
- 7Centre for Cell Biology and Department of Biology,University of Aveiro,Aveiro,Portugal
| | - M Schrader
- 8College of Life and Environmental Sciences,Biosciences,University of Exeter,Exeter,Devon,United Kindgom
| | - C Figueiredo
- 3Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP),Porto,Portugal
| | - M Barbosa
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - R Gonçalves
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - C Almeida
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - A Pêgo
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - S G Santos
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
| | - M Gomez-Lazaro
- 1Instituto de Engenharia Biomédica (INEB),University of Porto,Porto,Portugal
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Molinos M, Carvalho V, Silva DM, Gama FM. Development of a Hybrid Dextrin Hydrogel Encapsulating Dextrin Nanogel As Protein Delivery System. Biomacromolecules 2012; 13:517-27. [DOI: 10.1021/bm2015834] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Maria Molinos
- IBB, Institute for Biotechnology and Bioengineering,
Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Vera Carvalho
- IBB, Institute for Biotechnology and Bioengineering,
Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Dina M. Silva
- IBB, Institute for Biotechnology and Bioengineering,
Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Francisco M. Gama
- IBB, Institute for Biotechnology and Bioengineering,
Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
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Antunes JC, Pereira CL, Molinos M, Ferreira-da-Silva F, Dessı̀ M, Gloria A, Ambrosio L, Gonçalves RM, Barbosa MA. Layer-by-Layer Self-Assembly of Chitosan and Poly(γ-glutamic acid) into Polyelectrolyte Complexes. Biomacromolecules 2011; 12:4183-95. [DOI: 10.1021/bm2008235] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | | | - Mariagemiliana Dessı̀
- Institute of Composite and Biomedical Materials, National Research Council,
P.le Tecchio 80, 80125 Naples, Italy
| | - Antonio Gloria
- Institute of Composite and Biomedical Materials, National Research Council,
P.le Tecchio 80, 80125 Naples, Italy
| | - Luigi Ambrosio
- Institute of Composite and Biomedical Materials, National Research Council,
P.le Tecchio 80, 80125 Naples, Italy
| | | | - Mário A. Barbosa
- Institute of Composite and Biomedical Materials, National Research Council,
P.le Tecchio 80, 80125 Naples, Italy
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