@Article{info:doi/10.2196/59688,
author="Chew, Shuxian Eleanor
and Scully, Eugenia Aileen
and Koh, Shi-Man Samanth
and Woon, Ee-Lin
and Low, Miao-Shi Juanita Krysten
and Kwan, Yu-Heng
and Tan, Wei-Ming John
and Pua, Yong-Hao
and Tan, Ia-Choo Celia
and Haseler, Jonathan Luke",
title="Understanding Patient and Physiotherapist Requirements for a Personalized Automated Smartphone Telemonitored App for Posttotal Knee Arthroplasty Rehabilitation: Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Apr",
day="14",
volume="12",
pages="e59688",
keywords="knee replacement",
keywords="knee arthroplasty",
keywords="mobile",
keywords="application",
keywords="interview",
keywords="telemonitored",
keywords="smartphone rehabilitation",
keywords="mobile phone",
abstract="Background: Total knee arthroplasty (TKA) is a cost-effective surgical intervention for painful knee osteoarthritis in older adults, but postsurgery rehabilitation access is limited. Telerehabilitation offers a solution, but existing models require significant therapist involvement and a costly setup. A personalized smartphone-based automated program could be a cost-effective alternative. Objective: This study aimed to understand the requirements of both patients and physiotherapists in developing an automated telemonitored rehabilitation smartphone app for individuals undergoing TKA. To ensure uptake and long-term sustainability, this study adopted a person-based approach. Methods: A multistakeholder qualitative study of user needs was conducted. Physiotherapists and patients who underwent TKA were recruited via purposive sampling. Individual in-depth, hour-long interviews were conducted via Zoom by an experienced, trained female interviewer with a Master of Arts in Sociology. Data were audio-recorded and transcribed by the same interviewer. Two reviewers (ESC and SSK) independently analyzed the data using thematic analysis, with data triangulation achieved through cross-checking of data sources by 3 reviewers (ESC, SSK, and AES). Interviews were conducted to data saturation. Results: Six patients and 4 physiotherapists participated. For the patient interface, patients emphasized ease of use and specified features like a search function and multilingual options. For the physiotherapist interface, physiotherapists stated ease of accessing patient data and outcome measures for effective monitoring as important. Both patients and physiotherapists highlighted the need for timely, condition-specific information, supplemented by visual aids to support exercises, pain management, and recovery goals. They also stressed the significance of progress tracking, feedback, and the ability to access health care professionals for reassurance. Motivational features, including reminders, prompts, and exercise logs, were recommended to improve adherence. Both groups similarly identified the need for initial training to ensure confident use of the app. Conclusion: This study provided insights into the requirements of potential end users of a smartphone app for automated telemonitored rehabilitation following TKA. This is useful for steering the development of a user-centric smartphone app. ",
doi="10.2196/59688",
url="https://rehab.jmir.org/2025/1/e59688"
}


@Article{info:doi/10.2196/72037,
author="Pessoa, Cheila",
title="Enhancing Self-Management Support Apps for Spinal Cord Injury: The Missing Role of Caregivers",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="14",
volume="13",
pages="e72037",
keywords="mobile phone",
keywords="mHealth",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
keywords="spinal cord injury",
keywords="self-management",
keywords="internet-based intervention",
keywords="World Wide Web",
keywords="systematic review",
keywords="caregiver",
doi="10.2196/72037",
url="https://mhealth.jmir.org/2025/1/e72037"
}


@Article{info:doi/10.2196/67275,
author="Hutchison, G. Michael
and Di Battista, P. Alex
and Pyndiura, L. Kyla",
title="Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="11",
volume="9",
pages="e67275",
keywords="mild traumatic brain injury",
keywords="recovery",
keywords="mHealth",
keywords="app",
keywords="digital health",
keywords="smartphone",
keywords="eHealth",
keywords="digital",
keywords="technology",
keywords="usability",
keywords="concussion rehabilitation",
keywords="brain injury",
keywords="rehabilitation protocols",
keywords="evidence-based exercise",
keywords="single-arm pilot study",
keywords="home-based rehabilitation",
keywords="user-friendly",
keywords="questionnaire",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions. Objective: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions. Methods: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from ``strongly agree'' to ``strongly disagree''. Results: Twenty-six participants consented and were enrolled in the study, with 23 participants (82\%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100\% positive responses, with no single question scoring below 83\% positive responses. In the ``ease of use and satisfaction'' category, 100\% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83\%-96\% (19-22) of users responded positively to the remaining four questions. In the ``system information arrangement'' category, 100\% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87\%-96\% of users approving action acknowledgment, error recovery, and expected functions. Under the ``usefulness'' category, 96\% (n=22) of users found the app beneficial for health and well-being, and 91\% (n=21) users felt it effectively managed their health. For the five custom questions, 100\% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations. Conclusions: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app's potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience. ",
doi="10.2196/67275",
url="https://formative.jmir.org/2025/1/e67275"
}


@Article{info:doi/10.2196/57413,
author="Wiesm{\"u}ller, Fabian
and Haag, David
and Sareban, Mahdi
and Mayr, Karl
and M{\"u}rzl, Norbert
and Porodko, Michael
and Puelacher, Christoph
and Moser, Lisa-Marie
and Philippi, Marco
and Traninger, Heimo
and H{\"o}fer, Stefan
and Niebauer, Josef
and Schreier, G{\"u}nter
and Hayn, Dieter",
title="Clinical, Psychological, Physiological, and Technical Parameters and Their Relationship With Digital Tool Use During Cardiac Rehabilitation: Comparison and Correlation Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="8",
volume="13",
pages="e57413",
keywords="mHealth",
keywords="telehealth",
keywords="cardiac rehabilitation",
keywords="wearable",
keywords="adherence",
keywords="health-related quality of life",
keywords="intrinsic motivation",
keywords="self-efficacy",
keywords="health action process approach",
keywords="cardiac",
keywords="rehabilitation",
keywords="quality of life",
keywords="efficacy",
keywords="psychological",
keywords="physiological",
keywords="digital tools",
keywords="home training",
keywords="monitoring",
keywords="questionnaire",
keywords="cardiac risk",
abstract="Background: Home and telehealth-based interventions are increasingly used in cardiac rehabilitation, a multidisciplinary model of health care. Digital tools such as wearables or digital training diaries are expected to support patients to adhere to recommended lifestyle changes, including physical exercise programs. As previously published, the EPICURE study (effect of digital tools in outpatient cardiac rehabilitation including home training) analyzed the effects of digital tools, that is, a digital training diary, adherence monitoring, and wearables, on exercise capacity during outpatient cardiac rehabilitation phase III (OUT-III) which includes an approximately 12-week home-training phase. The study encompassed 149 Austrian patients, of which 50 used digital tools. Objective: The present paper takes a deeper look into the EPICURE data to better understand the relation between the use of digital tools and various psychological, clinical, and physiological parameters, and the relation between these parameters and the improvement of exercise capacity during cardiac rehabilitation. Methods: For this work, we analyzed questionnaires concerning the patients' cardiac rehabilitation. On all these parameters we performed 2 analyzes: (1) Comparison of the 2 groups with and without digital tools and (2) correlation with the change in the maximum workload as achieved during the exercise stress test. If data pre- and post OUT-III were available, the change in the respective parameter during OUT-III was determined and group analysis and correlation were applied on data pre OUT-III, data post OUT-III, and the change during OUT-III. Results: We found significant improvements in quality of life in both groups, with no discernible differences between patients with or without digital tools (P=.53). Patients with digital tools perceived significantly higher competence during cardiac rehabilitation (P=.05), and they anticipated higher cardiac risks if nonadherent to physical activity (P=.03). Although, the overall subjectively reported adherence was not significantly different in the 2 groups (P=.50), specific items differed. Patients with digital tools were significantly more likely to do their exercises even when they were tired (P=.01) and less likely to forget their exercises (P=.01). Concerning reasons for (non-) adherence, patients with digital tools reported significantly more often to do their exercises because they enjoyed them (P=.01), whereas they were significantly less likely to stop exercising when muscular pain was worse (P=.01) and to continue doing their exercises when muscular pain improved (P=.02). Finally, patients who reported a high level of concrete planning achieved significantly higher improvements in exercise capacity (r=0.14, P=.04). Conclusions: This comprehensive analysis provides valuable insights into the multifaceted impact of digital tools on outpatient cardiac rehabilitation including home training, shedding light on the importance of digital tools for increased competence and a higher risk perception during cardiac rehabilitation. In addition, the impact of digital tools on adherence and their influence on patient outcomes were assessed in the evolving landscape of digital health interventions. Trial Registration: ClincalTrials.gov NCT04458727; https://clinicaltrials.gov/study/NCT04458727 ",
doi="10.2196/57413",
url="https://mhealth.jmir.org/2025/1/e57413"
}


@Article{info:doi/10.2196/63064,
author="Suzuki, Takuya
and Kono, Yuji
and Ogasawara, Takayuki
and Mukaino, Masahiko
and Aoshima, Yasushi
and Furuzawa, Shotaro
and Fujita, Yurie
and Matsuura, Hirotaka
and Yamaguchi, Masumi
and Tsukada, Shingo
and Otaka, Yohei",
title="Moving Standard Deviation of Trunk Acceleration as a Quantification Index for Physical Activities: Validation Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="8",
volume="9",
pages="e63064",
keywords="smart clothing",
keywords="step count",
keywords="moving standard deviation of acceleration",
keywords="MSDA",
keywords="wheelchair",
keywords="activity quantification",
keywords="physical activities",
keywords="validation study",
keywords="accelerometer",
keywords="regular gait patterns",
keywords="older people",
keywords="aging",
keywords="motor impairments",
keywords="step detection",
keywords="stroke",
keywords="hemiparesis",
keywords="measurement system",
keywords="walking",
keywords="mobility",
keywords="rehabilitation",
abstract="Background: Step count is used to quantify activity in individuals using accelerometers. However, challenges such as difficulty in detecting steps during slow or irregular gait patterns and the inability to apply this method to wheelchair (WC) users limit the broader utility of accelerometers. Alternative device-specific measures of physical activity exist, but their specificity limits cross-applicability between different device sensors. Moving standard deviation of acceleration (MSDA), obtained from truncal acceleration measurements, is proposed as another alternative variable to quantify physical activity in patients. Objective: This study aimed to evaluate the validity and feasibility of MSDA for quantifying physical activity in patients with stroke-induced hemiparesis by comparing it with the traditional step count. Methods: We enrolled 197 consecutive patients with stroke hemiparesis admitted to a convalescent rehabilitation ward. Using the hitoe system, a smart clothing--based physical activity measurement system, we measured the MSDA of trunk movement and step count. The correlation between MSDA and step count was examined in all participants. Based on their daily living mobility levels, measured using the Functional Independence Measure (FIM), participants were categorized into 6 subgroups: FIM1-4, FIM5 (WC), FIM5 (walking), FIM6 (WC), FIM6 (walking), and FIM7 (walking). Intersubgroup differences in MSDA were analyzed. Results: A strong correlation was observed between MSDA and step count (r=0.78; P<.001), with a stronger correlation in the walking group (r=0.79; P<.001) compared with the WC group (r=0.55; P<.001). The Shapiro-Wilk test indicated no significant results for MSDA across all subgroups, supporting a normal distribution within these groups. In contrast, the step count data for the WC subgroups showed significant results, indicating a deviation from a normal distribution. Additionally, 10.2\% (20/197) of participants recorded zero steps, demonstrating a floor effect in the step count data. The median MSDA values for the 6 subgroups (FIM1-4, FIM5 WC, FIM5 walking, FIM6 WC, FIM6 walking, and FIM7) were 0.006, 0.007, 0.010, 0.011, 0.011, and 0.014, respectively, reflecting their levels of independence based on the FIM mobility scores. The median step counts for these subgroups were 68, 233, 1386, 367, 2835, and 4462, respectively. FIM5 participants who walked had higher step counts than FIM6 participants using WCs, though the difference was marginally but not statistically significant (P=.07), highlighting the impact of mobility type (walking vs WC). Conclusions: The results suggest the validity of MSDA as a variable for physical activity in patients with stroke, applicable to patients with stroke irrespective of their mobility measures. This finding highlights the potential of MSDA for use in individuals with motor impairments, including WC users, underscoring its broad utility in rehabilitation clinical practice. ",
doi="10.2196/63064",
url="https://formative.jmir.org/2025/1/e63064"
}


@Article{info:doi/10.2196/59228,
author="Yu, Kaitao
and Yin, Baobing
and Zhu, Ying
and Meng, Hongdao
and Zhu, Wenwei
and Lu, Lu
and Wang, Junqiao
and Chen, Shugeng
and Ni, Jun
and Lin, Yifang
and Jia, Jie",
title="Efficacy of a Digital Postoperative Rehabilitation Intervention in Patients With Primary Liver Cancer: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="7",
volume="13",
pages="e59228",
keywords="digital health",
keywords="surgery",
keywords="exercise rehabilitation",
keywords="randomized controlled trial",
keywords="primary liver cancer",
abstract="Background: Rehabilitation is considered a fundamental component of cancer treatment, especially for patients undergoing cancer surgery. In contrast to conventional rehabilitation education, digital rehabilitation has the potential to improve patients' access to postoperative rehabilitation programs. While digital health has rapidly emerged to aid patients with various diseases, their clinical efficacy in the recovery of patients with primary liver cancer (PLC) undergoing hepatectomy remains inadequately investigated. Objective: This study aims to evaluate whether a digital postoperative rehabilitation intervention is efficient in improving physical fitness, enhancing exercise adherence, and alleviating fatigue among patients with PLC after hepatectomy. Methods: A randomized controlled trial was undertaken across 2 university-affiliated hospitals in Eastern China. A total of 100 participants were enrolled in this study and were allocated randomly to either the digital health (intervention group, n=50) or the rehabilitation manual-based group (control group, n=50) at a 1:1 ratio. Patients were unblinded and prospectively followed for the intervention of 3 weeks. Outcome measures included physical fitness, exercise adherence, and status of fatigue. Results: Overall, 91 out of 100 patients completed the research and were evaluated after 3 weeks of intervention. The digital health group showed better cardiopulmonary endurance than the control group. The mean difference in the change of 6-minute walk test distance from baseline between the groups was 70.21 (95\% CI 0.730-82.869) m (P=.05). No statistically significant effects were found for grip strength, 5-repetition-sit-to-stand test time, and fatigue. The exercise adherence in the digital health group was higher than that in the control group ($\chi$22=15.871, P<.001). Conclusions: The findings suggested that the implementation of digital health had a positive impact on recovery in exercise capacity after hepatectomy. In addition, rehabilitation exercise mode based on digital health has the potential to improve the exercise adherence of patients with PLC compared to conventional manual-based rehabilitation guidance. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052911; https://www.chictr.org.cn/showproj.html?proj=135351 ",
doi="10.2196/59228",
url="https://mhealth.jmir.org/2025/1/e59228"
}


@Article{info:doi/10.2196/64742,
author="Chen, Yuyin
and Zhang, Yuanyuan
and Long, Xiuhong
and Tu, Huiqiong
and Chen, Jibing",
title="Effectiveness of Virtual Reality--Complemented Pulmonary Rehabilitation on Lung Function, Exercise Capacity, Dyspnea, and Health Status in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="7",
volume="27",
pages="e64742",
keywords="virtual reality",
keywords="video games",
keywords="exergaming",
keywords="pulmonary rehabilitation",
keywords="chronic obstructive pulmonary disease",
keywords="lung function",
keywords="exercise capacity",
keywords="dyspnea",
keywords="health status",
keywords="randomized controlled trial",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by persistent airflow obstruction. Pulmonary rehabilitation (PR) is a cornerstone of COPD management but remains underutilized due to barriers such as low motivation and accessibility issues. Virtual reality (VR)--complemented PR offers a novel approach to overcoming these barriers by enhancing patient engagement and rehabilitation outcomes. Objective: This review aims to evaluate the effect of VR-complemented PR compared with comparators on lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD. Additionally, the study aimed to identify which comparator type (active exercise vs nonactive exercise control group) and intervention duration would result in the greatest improvements in rehabilitation outcomes. The study also assessed patient-reported experience measures, including acceptability and engagement. Methods: A comprehensive search of 11 international and Chinese databases identified randomized controlled trials (RCTs) published up to November 2024. Data were analyzed using RevMan 5.4, with pooled effect sizes reported as mean differences (MDs) and 95\% CIs. Results: A total of 16 RCTs involving 1052 participants were included. VR-complemented PR significantly improved lung function (forced expiratory volume in 1 second [FEV1] [L], MD 0.25, P<.001; FEV1/forced vital capacity [FVC], MD 6.12, P<.001; FVC, MD 0.28, P<.001) compared with comparators. Exercise capacity, assessed by the 6MWD, significantly improved (MD 23.49, P<.001) compared with comparators; however, it did not reach the minimally clinically important difference of 26 m, indicating limited clinical significance despite statistical significance. VR-complemented PR also significantly reduced dyspnea measured by the modified British Medical Research Council scale (MD --0.28, P<.001), improved health status measured by the COPD Assessment Test (MD --2.95, P<.001), and enhanced oxygenation status measured by SpO2 (MD 1.35, P=.04) compared with comparators. Subgroup analyses revealed that VR-complemented PR had a significantly greater effect on FEV1 (L) (MD 0.32, P=.005) and 6MWD (MD 40.93, P<.001) compared with the nonactive exercise control group. Additionally, VR-complemented PR showed a greater improvement in FEV1/FVC (MD 6.15, P<.001) compared with the active exercise control group. Intervention duration influenced outcomes, with 5-12-week programs showing the greatest improvement in 6MWD (MD 38.96, P<.001). VR-complemented PR was well-accepted, with higher adherence and engagement rates than comparators. Conclusions: VR-complemented PR significantly improves lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD compared with comparators, while enhancing adherence and engagement. Subgroup analyses showed greater effects on FEV1 (L) and 6MWD compared with the nonactive exercise control group, and a larger improvement in FEV1/FVC compared with the active exercise control group. Interventions (5-12 weeks) yielded the most significant benefits in exercise capacity. These findings highlight VR as a promising adjunct to traditional PR, with future research focusing on long-term outcomes and standardized protocols. ",
doi="10.2196/64742",
url="https://www.jmir.org/2025/1/e64742"
}


@Article{info:doi/10.2196/68242,
author="Pereira, P. Ana
and Janela, Dora
and Areias, C. Anabela
and Molinos, Maria
and Tong, Xin
and Bento, Virg{\'i}lio
and Yanamadala, Vijay
and Atherton, Jennesa
and Dias Correia, Fernando
and Costa, Fab{\'i}ola",
title="Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="2",
volume="13",
pages="e68242",
keywords="women's health",
keywords="pelvic floor muscle training",
keywords="physical therapy",
keywords="menopause",
keywords="digital therapeutics",
keywords="biofeedback",
keywords="mobile phone",
abstract="Background: The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ?40\%?50\% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models. Objective: This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs. Methods: This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire--short form 7, Urinary Impact Questionnaire--short form 7, Colorectal-Anal Impact Questionnaire--short form 7, and Pelvic Organ Prolapse Impact Questionnaire--short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis. Results: The digital pelvic program had a high completion rate of 77.6\% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69\%). The overall impact of pelvic floor symptoms in participants' daily lives decreased significantly (?19.55 points, 95\% CI ?22.22 to ?16.88; P<.001; response rate of 59.5\%, 95\% CI 54.9\%-63.9\%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (?18.09, 95\% CI ?19.99 to ?16.20 and ?15.08, 95\% CI ?17.52 to ?12.64, respectively; P<.001). Mental health also improved, with 76.1\% (95\% CI 60.7\%-84.9\%; unadjusted: 97/149, 65.1\%) and 54.1\% (95\% CI 39\%-68.5\%; unadjusted: 70/155, 45.2\%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms' burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery. Conclusions: This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life. Trial Registration: ClinicalTrials.gov NCT05513417; https://clinicaltrials.gov/study/NCT05513417 ",
doi="10.2196/68242",
url="https://mhealth.jmir.org/2025/1/e68242"
}


@Article{info:doi/10.2196/64729,
author="Sheehy, Lisa
and Taillon-Hobson, Anne
and Sveistrup, Heidi
and Bilodeau, Martin
and Yang, Christine
and Welch, Vivian
and Finestone, Hillel",
title="Home-Based Nonimmersive Virtual Reality Training After Discharge From Inpatient or Outpatient Stroke Rehabilitation: Parallel  Feasibility Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Mar",
day="28",
volume="12",
pages="e64729",
keywords="virtual reality",
keywords="telerehabilitation",
keywords="stroke",
keywords="home",
keywords="exercises",
keywords="physical activity",
keywords="physiotherapy",
keywords="exergames",
keywords="rehabilitation intensity",
keywords="randomized controlled feasibility trial",
keywords="motor",
keywords="movement",
keywords="patient care",
keywords="patient engagement",
keywords="health intervention",
keywords="stroke rehabilitation",
keywords="interactive games",
keywords="game therapy",
keywords="interactive therapy",
keywords="rehabilitation",
abstract="Background: Nonimmersive virtual reality training (NIVRT) can be used to continue rehabilitative exercise for stroke recovery at home after discharge from inpatient or outpatient therapy. Objective: The objectives of this randomized controlled feasibility trial were to assess home-based NIVRT as telerehabilitation with patients living with stroke, and its potential to improve standing function and gait. Methods: Patients approaching discharge from inpatient or outpatient stroke rehabilitation were randomly allocated to NIVRT or iPad interventions. NIVRT provided interactive games and exercises designed to improve balance, stepping, and aerobic capacity. iPad apps addressed cognition and fine motor skills. Participants were visited in their homes by a physiotherapist, taught to use the program, and asked to do 30 minutes of exercise 5 days a week for 6 weeks, asynchronously. Feasibility was assessed by measuring recruitment, adherence, ability to set up and learn NIVRT, enjoyment, intent to continue, perception of impact, and safety. Participants completed assessments of standing balance, gait, and general function, before and after the intervention, by a blinded assessor. Results: NIVRT participants (n=11; 10 male participants; mean age 64, SD 12 years) did an average of 26 sessions (total 700 minutes), while iPad participants (n=9; 6 male participants; mean age 61, SD 20 years) did an average of 33 sessions (total 1241 minutes). Space was tight in 5 homes. All but 1 participant learned NIVRT and progressed. Most enjoyed it and felt that it improved their recovery. There were no serious adverse events. Most assessments showed improvement over time for both groups. Conclusions: Home-based NIVRT is safe and feasible to continue rehabilitative exercise after discharge. More research on efficacy and effectiveness in this population is required. Trial Registration: ClinicalTrials.gov NCT03261713; https://clinicaltrials.gov/study/NCT03261713 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3438-9  ",
doi="10.2196/64729",
url="https://rehab.jmir.org/2025/1/e64729"
}


@Article{info:doi/10.2196/58393,
author="Mbada, E. Chidozie
and Awosika, Akintunji Henry
and Sonuga, Ademola Oluwatobi
and Akande, Micheal
and Gebrye, Tadesse
and Woolf, Richard
and Fatoye, Francis",
title="Effect of Clinic-Based and Asynchronous Video-Based Exercise on Clinic and Psychosocial Outcomes in Patients With Knee Osteoarthritis: Quasi-Experimental Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="26",
volume="27",
pages="e58393",
keywords="knee osteoarthritis",
keywords="video",
keywords="physiotherapy",
keywords="exercise",
keywords="mobile phone",
keywords="telehealth",
keywords="telemedicine",
keywords="randomized",
keywords="controlled trial",
keywords="asynchronous",
keywords="rehabilitation",
keywords="knees",
keywords="joints",
keywords="osteoarthritis",
keywords="musculoskeletal",
keywords="rheumatology",
keywords="physical therapy",
abstract="Background: Telerehabilitation is promising for improving knee osteoarthritis, but the effect of different telerehabilitation strategies on knee osteoarthritis is unclear. Objective: This study aimed to examine the effect of a clinic-based strengthening exercise (CbSE) and asynchronous video-based strengthening exercise (AVbSE) on pain, range of motion, muscle strength, quality of life, and physical function among patients with knee osteoarthritis. Methods: A total of 52 consenting patients participated in this 8-week experimental study; they were assigned to the CbSE or AVbSE group at 2 different study sites. CbSE is a circuit exercise module comprising knee flexion and extension warm-up in sitting, quadriceps isometric setting, quadriceps strengthening exercise, hamstring clenches, wall squat, and a cooldown of knee flexion and extension. The AVbSE is an asynchronous video-based version of the CbSE. Results: This study spanned from March 31, 2021, to November 26, 2021. Eight out of 62 participants discontinued participation. Data collection and analysis have been completed. Significant differences were only observed in the mental health (t50=--3, P=.004), pain (t39.4=--3.6, P<.001), social support (t50=--2.7, P=.009), and social activities (t50=2.2, P=.03) domains of the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire with higher scores in the AVbSE group at the end of week 4. At the end of week 8, significant differences were observed in mental health (t50=--2.1, P=.04) and pain (t37.3=--2.8, P=.008) measures with higher scores in AVbSE; however, a significantly higher score was observed in the CbSE group for the Quadruple Visual Analog Scale. No significant main effect of time was observed in this study, except in the muscle strength (F2100=1.5, P=.24), social support (F2100=2.5, P=.09), and social activity (F2100=0.7, P=.48) domains of the OAKHQoL questionnaire and activity limitation (F2100=0.1, P=.90), and performance restriction (F2100=1.3, P=.27) domains of the Ibadan Knee and Hip Osteoarthritis Outcome Measure (IKHOAM) questionnaire. There was no significant difference between groups in all OAKHQoL domains except social activities (mean 17.6, SD 1.2 vs 22.8, SD 1.2; P=.003) and average pain (2.8, SD 1.6 vs 2.3, SD 1.6; P=.03) with higher AVbSE mean scores. However, a higher score was observed for the CbSE group in the Quadruple Visual Analog Scale's least pain domain (1.2, SD 0.2 vs 0.7, SD 0.2; P=.04). Also, interaction effects showed that AVbSE scores were significantly higher for the OAKHQoL questionnaire's physical activity and mental health domains at all time points. However, the CbSE score was higher for the physical performance domain of the IKHOAM questionnaire in the eighth week. Conclusions: CbSE circuit training and its AVbSE variant effectively improve treatment outcomes and increase the quality of life of patients. While AVbSE was associated with higher improvement in most health-related quality of life domains, CbSE led to higher improvement in average pain. Trial Registration: Pan African Clinical Trial Registry PACTR202208515182119, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23943 ",
doi="10.2196/58393",
url="https://www.jmir.org/2025/1/e58393"
}


@Article{info:doi/10.2196/56978,
author="Shen, Danlin
and Jiao, Jianping
and Zhang, Liqun
and Liu, Yanru
and Liu, Xiang
and Li, Yuanhui
and Zhang, Tianjiao
and Li, Dai
and Hao, Wei",
title="Gamified Adaptive Approach Bias Modification in Individuals With Methamphetamine Use History From Communities in Sichuan: Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2025",
month="Mar",
day="10",
volume="13",
pages="e56978",
keywords="digital therapeutics",
keywords="substance use disorder",
keywords="game",
keywords="pilot RCT",
keywords="randomized controlled trial",
keywords="methamphetamine",
keywords="psychiatric",
keywords="gamified design",
keywords="engagement",
keywords="effectiveness",
keywords="smartphone app",
keywords="cognitive bias modification",
abstract="Background: Cognitive bias modification (CBM) programs have shown promise in treating psychiatric conditions, but they can be perceived as boring and repetitive. Incorporating gamified designs and adaptive algorithms in CBM training may address this issue and enhance engagement and effectiveness. Objectives: This study aims to gather preliminary data and assess the preliminary efficacy of an adaptive approach bias modification (A-ApBM) paradigm in reducing cue-induced craving in individuals with methamphetamine use history. Methods: A randomized controlled trial with 3 arms was conducted. Individuals aged 18?60 years with methamphetamine dependence and at least 1 year of methamphetamine use were recruited from 12 community-based rehabilitation centers in Sichuan, China. Individuals with the inability to fluently operate a smartphone and the presence of mental health conditions other than methamphetamine use disorder were excluded. The A-ApBM group engaged in ApBM training using a smartphone app for 4 weeks. The A-ApBM used an adaptive algorithm to dynamically adjust the difficulty level based on individual performance. Cue-induced craving scores and relapses were assessed using a visual analogue scale at baseline, postintervention, and at week-16 follow-up. Results: A total of 136 participants were recruited and randomized: 48 were randomized to the A-ApBM group, 48 were randomized to the static approach bias modification (S-ApBM) group, and 40 were randomized to the no-intervention control group. The A-ApBM group showed a significant reduction in cue-induced craving scores at postintervention compared with baseline (Cohen d=0.34; P<.01; 95\% CI 0.03-0.54). The reduction remained significant at the week-16 follow-up (Cohen d=0.40; P=.01; 95\% CI 0.18-0.57). No significant changes were observed in the S-ApBM and control groups. Conclusions: The A-ApBM paradigm with gamified designs and dynamic difficulty adjustments may be an effective intervention for reducing cue-induced craving in individuals with methamphetamine use history. This approach improves engagement and personalization, potentially enhancing the effectiveness of CBM programs. Further research is needed to validate these findings and explore the application of A-ApBM in other psychiatric conditions. Trial Registration: ClinicalTrials.gov NCT05794438; https://clinicaltrials.gov/study/NCT05794438 ",
doi="10.2196/56978",
url="https://games.jmir.org/2025/1/e56978"
}


@Article{info:doi/10.2196/60685,
author="Jansen, Marjolein
and van Iperen, D. Ingrid
and Kroner, Anke
and Hemler, Raphael
and Dekker-Holverda, Esther
and Spronk, E. Peter",
title="Kangaroo Stimulation Game in Tracheostomized Intensive Care--Related Dysphagia: Interventional Feasibility Study",
journal="JMIR Serious Games",
year="2025",
month="Mar",
day="5",
volume="13",
pages="e60685",
keywords="dysphagia",
keywords="swallowing",
keywords="intensive care",
keywords="ICU",
keywords="swallowing disturbance",
keywords="kangaroo stimulation",
keywords="game",
keywords="feasibility study",
keywords="surface electromyography",
keywords="training",
keywords="exercise",
keywords="Rephagia biofeedback",
keywords="muscle strength",
keywords="stamina",
keywords="timing",
keywords="tracheostomy",
keywords="clinical",
keywords="feasibility",
abstract="Background: Dysphagia is common in intensive care unit (ICU) patients. Using surface electromyography (sEMG) signals as biofeedback training exercises might offer a promising path to improving swallowing function. The Rephagia biofeedback system uses sEMG to assess muscle strength, stamina, and timing of the swallowing action. Objectives: The aim of this study was to evaluate the feasibility of the Rephagia system in ICU patients with dysphagia. Methods: This feasibility study included patients admitted to a 14-bed mixed medical-surgical ICU. All patients underwent a new tracheostomy placement during ICU stay due to persistent aspiration and ICU-acquired weakness, accompanied by verified dysphagia. Following Rephagia training, patients completed a questionnaire assessing comprehension, satisfaction, and motivation. Swallowing characteristics were assessed via mean sEMG peak values during exercise. Results: Twenty patients with a mean age of 69.4 (SD 8.2) years were included. The means of sEMG values at the beginning of a measurement were not significantly different at baseline versus everyone's last measurement (52 {\textmu}V [23 {\textmu}V] vs 57 {\textmu}V [22 {\textmu}V]; P=.50). The means of sEMG values obtained at the end of a measurement were not significantly different at baseline versus everyone's last measurement (56 {\textmu}V [18 {\textmu}V] vs 59 {\textmu}V [23 {\textmu}V]; P=.62). However, dysphagia improved in all patients. Patients understood the importance of the game in relation to their swallowing problems (16/80, 89\%), which kept them motivated to participate in the training sessions (9/18, 50\%). Conclusions: The Rephagia biofeedback system for stimulating swallowing actions in tracheotomized ICU patients with dysphagia is feasible. No relation was found between clinical improvement in swallowing function and sEMG signals. ",
doi="10.2196/60685",
url="https://games.jmir.org/2025/1/e60685"
}


@Article{info:doi/10.2196/57957,
author="Rampioni, Margherita
and Leonzi, Sara
and Antognoli, Luca
and Mura, Anna
and Stara, Vera",
title="Poststroke eHealth Technologies--Based Rehabilitation for Upper Limb Recovery: Systematic Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e57957",
keywords="stroke",
keywords="rehabilitation",
keywords="technology-based interventions",
keywords="upper limb",
keywords="technologies-based rehabilitation",
keywords="limb",
keywords="systematic review",
keywords="cerebral vascular diseases",
keywords="patient",
keywords="effectiveness",
keywords="database",
keywords="therapy",
keywords="conventional therapy",
keywords="mobile phone",
abstract="Background: Stroke is one of the most common cerebral vascular diseases, usually affecting people aged 60 years and older. It leads to a variety of disabilities requiring motor and cognitive rehabilitation. Poststroke rehabilitation is critical for recovery, particularly for upper limb impairments, which affect approximately 80\% of stroke survivors. Conventional rehabilitation often faces barriers such as cost, accessibility, and patient adherence. In contrast, eHealth technologies offer a promising alternative by providing accessible, cost-effective, and engaging rehabilitation solutions. Objective: While numerous systematic reviews have explored various aspects of technology-based rehabilitation for poststroke upper limb recovery, there is a notable lack of comprehensive synthesis of these findings. This gap presents challenges, primarily due to the focus on specific technologies, which complicates understanding the overall effectiveness of these interventions. Consequently, clinicians and researchers may find it difficult to assess the field holistically, potentially hindering informed decision-making in clinical practice. This review synthesizes evidence from systematic reviews evaluating the effectiveness of eHealth technology--based interventions for upper limb recovery in poststroke individuals. Two main questions are examined: (1) Are eHealth technology--based therapies more or equally effective than conventional therapies for stroke rehabilitation? (2) What are the main clinical considerations for low-cost eHealth technology--based rehabilitation? Methods: Comprehensive literature searches were conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar using predefined inclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework. Systematic reviews published in English without date restrictions were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart guided study selection. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) criteria. Results: A total of 1792 records were screened, resulting in 7 systematic reviews published between 2019 and 2023 being included. These reviews encompassed 95 studies involving 2995 participants with a mean age of 58.8 years across acute, subacute, and chronic stroke phases. Interventions included telerehabilitation, mobile health (mHealth) apps, augmented reality (AR), virtual reality (VR), wearable devices, and exergames. While AR and VR demonstrated potential benefits when combined with conventional therapies (eg, AR showing significant improvements in upper limb function with a standardized mean difference 0.657; P<.001), evidence for stand-alone effectiveness remained inconclusive due to heterogeneity in study designs, intervention protocols, and outcome measures. Most reviews were rated as critically low quality due to methodological limitations. Conclusions: eHealth technologies hold promise for enhancing upper limb rehabilitation post stroke by addressing barriers such as cost and accessibility while providing engaging interventions. However, the field remains fragmented with insufficient evidence to establish clear efficacy. Future research should focus on standardizing protocols, optimizing neurorehabilitation principles such as dosage and task specificity, and improving methodological rigor to evaluate these interventions' long-term impact better. ",
doi="10.2196/57957",
url="https://www.jmir.org/2025/1/e57957",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053744"
}


@Article{info:doi/10.2196/58841,
author="Cyuzuzo, Callixte
and Dukuzimana, Josee Marie
and Muhire, Clement
and Sheldon Ames, Mathew
and Ngwakongnwi, Emmanuel",
title="Challenges to Rehabilitation Services in Sub-Saharan Africa From a User, Health System, and Service Provider Perspective: Scoping Review",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="28",
volume="12",
pages="e58841",
keywords="challenges",
keywords="users",
keywords="health system",
keywords="service providers",
keywords="Sub-Saharan Africa",
keywords="scoping review",
keywords="rehabilitation service",
abstract="Background: Rehabilitation aims to restore and optimize the functioning of impaired systems for people with disabilities. It is an integral part of universal health coverage, and access to it is a human right. Objective: We aimed to identify the key challenges to rehabilitation services in Sub-Saharan Africa from a user, health system, and service provider perspective. Methods: This scoping review was conducted in accordance with the 5-stage framework proposed by Arksey and O'Malley. A comprehensive electronic search was run to identify published articles on rehabilitation services in Sub-Saharan Africa. Of the 131 articles retrieved, 83 articles were assessed for eligibility and 15 papers that met the inclusion criteria were considered. Results: The results show that people with disabilities in Sub-Saharan Africa face multifactorial challenges to access rehabilitation services. Poor access to rehabilitation services is associated with less attention given to rehabilitation by governments, which leads to less funding, negative cultural and social beliefs, fewer rehabilitation centers, poorly equipped rehabilitation units, failure of health systems, lack of training to rehabilitation practitioners, and logistical and financial constraints. This review also reveals that digital rehabilitation reduces costs and improves access to services in hard-to-reach geographical areas. However, digital rehabilitation faces challenges as well, including connectivity issues, inaccessibility to technology, a lack of technical knowledge, a lack of privacy, and ethical concerns. Conclusions: People with disabilities face multifactorial challenges to access rehabilitation services in Sub-Saharan Africa. It is therefore critical to address these challenges to optimize patients' health outcomes and offer better rehabilitation services. ",
doi="10.2196/58841",
url="https://humanfactors.jmir.org/2025/1/e58841"
}


@Article{info:doi/10.2196/60115,
author="Li, Guangqi
and Zhou, Xueyan
and Deng, Junyue
and Wang, Jiao
and Ai, Ping
and Zeng, Jingyuan
and Ma, Xuelei
and Liao, Hu",
title="Digital Therapeutics--Based Cardio-Oncology Rehabilitation for Lung Cancer Survivors: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="25",
volume="13",
pages="e60115",
keywords="cardio-oncology rehabilitation",
keywords="digital therapeutics",
keywords="telerehabilitation",
keywords="non-small cell lung cancer",
keywords="exercise prescription",
keywords="cardiology",
keywords="oncology",
keywords="rehabilitation",
keywords="cardiorespiratory fitness",
keywords="cardiopulmonary",
keywords="cancer",
keywords="physical activity",
keywords="digital health",
keywords="digital technology",
keywords="randomized controlled trial",
keywords="wearable",
keywords="app",
keywords="quality of life",
keywords="survivor",
abstract="Background: Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice. Objective: The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL). Methods: Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence--driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band--based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients' HR reached the target zone (HRresting + [HRmax -- HRresting] {\texttimes} [?40\%-60\%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL. Results: A total of 40 (85\%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2\%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (--0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (--8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (--0.31, SD 0.44 vs --0.05, SD 0.29; P=.048), and daytime dysfunction (--0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period. Conclusions: The 5-month, digital therapeutics--based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594 ",
doi="10.2196/60115",
url="https://mhealth.jmir.org/2025/1/e60115"
}


@Article{info:doi/10.2196/59032,
author="Rujeedawa, Tanzil
and Karimi, Zahabiya
and Wood, Helen
and Sangeorzan, Irina
and Smith, Roy
and Sadler, Iwan
and Martin-Moore, Esther
and Gardner, Adrian
and K Demetriades, Andreas
and Sinha, Rohitashwa
and Grahovac, Gordan
and Bateman, Antony
and Deakin, Naomi
and Davies, Benjamin",
title="Evaluation of Financial Support Workshops for Patients Under State Pension Age With Degenerative Cervical Myelopathy: Survey Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="24",
volume="9",
pages="e59032",
keywords="myelopathy",
keywords="degenerative",
keywords="spine",
keywords="spinal",
keywords="benefits",
keywords="aid",
keywords="financial",
keywords="money",
keywords="income",
keywords="poverty",
keywords="disability",
keywords="disabled",
keywords="finance",
keywords="workshop",
keywords="education",
keywords="service",
keywords="access",
keywords="accessibility",
keywords="navigate",
keywords="confidence",
keywords="government",
abstract="Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels of disability and dependence, and may reduce quality of life. Myelopathy.org is the first global scientific and clinical charity for DCM, providing an accessible platform freely disseminating information relevant to the DCM diagnosis and its treatment. Significant transient and long-term change to earnings do occur and can thrust individuals into poverty. People with DCM face many challenges accessing state financial assistance. This can have a cumulative negative financial effect due to the association between DCM and low socioeconomic index. Financial support available to patients under pension age include Universal Credit (UC), a payment that helps with living costs, and Personal Independence Payment (PIP), which helps with extra living costs if someone has both a long-term health condition or disability and difficulty doing certain everyday tasks. Objective: This study aimed to assess if delivering workshops centered around access to financial support could assist people with DCM living in the United Kingdom. Methods: A series of 2 internet-based workshops was targeted at accessing financial support for English patients under the state pension age, with an anonymized survey delivered to participants after each session. The first session was on UC and the second on PIP. The survey consisted of a mixture of Likert scales, free text and yes or no answers. Survey responses were analyzed using descriptive statistics and free text answers underwent inductive thematic analysis. Results: The average rating on the use of UC was 9.00/10. Presession self-rated confidence levels were 5.11/10 rising to 8.00/10. The mean score of wanting further similar sessions was 8.67/10 with 56\% (5/9) of participants wanting one-to-one sessions. For PIP, the average session use rating was 10/10. Presession self-rated confidence levels were 4.43/10 rising to 9.57/10. The mean score of wanting further similar sessions was 8.71/10, with 43\% (3/7) of participants wanting one-to-one sessions . Following inductive thematic analysis, themes regarding the usefulness of such sessions and the challenges to accessing financial support emerged. One participant gave negative feedback, which included the length of the session and perceived problems around confidentiality and data protection. Conclusions: The pilot series was largely perceived as a success, with participants finding them useful and increasing their self-rated confidence in navigating the UK financial support system. Given the small sample size, it is hard to predict the success of future sessions. Finally, given that the hurdles in accessing financial support extend beyond DCM, such workshops may be relevant to other organizations. ",
doi="10.2196/59032",
url="https://formative.jmir.org/2025/1/e59032"
}


@Article{info:doi/10.2196/57826,
author="Griefahn, Annika
and Avermann, Florian
and Zalpour, Christoff
and Marshall, Percy Robert
and Cordon Morillas, In{\'e}s
and Luedtke, Kerstin",
title="Exploring the Effect of an 8-Week AI-Composed Exercise Program on Pain Intensity and Well-Being in Patients With Spinal Pain: Retrospective Cohort Analysis",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="18",
volume="9",
pages="e57826",
keywords="exercise",
keywords="mHealth",
keywords="app engagement",
keywords="spinal pain",
keywords="artificial intelligence",
keywords="AI",
keywords="intensity",
keywords="well-being",
keywords="mobile health",
keywords="apps",
keywords="applications",
keywords="retrospective analysis",
keywords="physical activity",
keywords="adults",
keywords="questionnaire",
abstract="Background: Spinal pain, one of the most common musculoskeletal disorders (MSDs), significantly impacts the quality of life due to chronic pain and disability. Physical activity has shown promise in managing spinal pain, although optimizing adherence to exercise remains a challenge. The digital development of artificial intelligence (AI)-driven applications offers a possibility for guiding and supporting patients with MSDs in their daily lives. Objective: The trial aimed to investigate the effect of an 8-week AI-composed exercise program on pain intensity and well-being in patients with spinal pain. It also examined the relationship between exercise frequency, pain intensity, and well-being. In addition, app usage frequency was examined as a proxy for app engagement. Methods: Data from users who met the inclusion criteria were collected retrospectively from the medicalmotion app between January 1, 2020, and June 30, 2023. The intervention involved the use of the medicalmotion app, which provides 3?5 personalized exercises for each session based on individual user data. The primary outcomes assessed pain intensity and well-being using the numeric rating scale (NRS) and the Likert scale. Data were collected at baseline (t0), 4 weeks (t1), and 8 weeks (t2). The correlation between exercise frequency, pain intensity, and well-being was analyzed as a secondary outcome. In addition, average session length and frequency were measured to determine app engagement. Statistical analysis included ANOVA and Spearman correlation analysis. Results: The study included 379 participants with a mean age of 50.96 (SD 12.22) years. At t2, there was a significant reduction of 1.78 points on the NRS (P<.001). The score on the Likert scale for well-being improved by 3.11 points after 8 weeks. Pain intensity showed a negative correlation with the number of daily exercises performed at t1 and t2. Well-being had a small negative correlation with the average number of exercises performed per day. The average number of exercises performed per day was 3.58. The average session length was approximately 10 minutes, and the average interaction with the app was 49.2\% (n=27.6 days) of the 56 available days. Conclusions: Overall, the study demonstrates that an app-based intervention program can substantially reduce pain intensity and increase well-being in patients with spinal pain. This retrospective study showed that an app that digitizes multidisciplinary rehabilitation for the self-management of spinal pain significantly reduced user-reported pain intensity in a preselected population of app users. Trial Registration: OSF Registries osf.io/kjhef; https://osf.io/kjhef ",
doi="10.2196/57826",
url="https://formative.jmir.org/2025/1/e57826"
}


@Article{info:doi/10.2196/55298,
author="Faqar Uz Zaman, Fatima Sara
and Sliwinski, Svenja
and Mohr-Wetzel, Lisa
and Dreilich, Julia
and Filmann, Natalie
and Detemble, Charlotte
and Zmuc, Dora
and Chun, Felix
and Derwich, Wojciech
and Schreiner, Waldemar
and Bechstein, Wolf
and Fleckenstein, Johannes
and Schnitzbauer, A. Andreas",
title="Validity, Accuracy, and Safety Assessment of an Aerobic Interval Training Using an App-Based Prehabilitation Program (PROTEGO MAXIMA Trial) Before Major Surgery: Prospective, Interventional Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="10",
volume="13",
pages="e55298",
keywords="digital health",
keywords="prehab",
keywords="major surgery",
keywords="surgical oncology",
keywords="smartwatches",
keywords="safety and quality",
keywords="surgery",
keywords="surgical",
keywords="oncology",
keywords="validity",
keywords="accuracy",
keywords="safety management",
keywords="management",
keywords="aerobic",
keywords="aerobic training",
keywords="app",
keywords="prehabilitation",
keywords="pilot study",
keywords="quality of life",
keywords="medical device",
keywords="wearable",
keywords="wearables",
keywords="heart rate",
abstract="Background: Major surgery is associated with significant morbidity and a reduced quality of life, particularly among older adults and individuals with frailty and impaired functional capacity. Multimodal prehabilitation can enhance functional recovery after surgery and reduce postoperative complications. Digital prehabilitation has the potential to be a resource-sparing and patient-empowering tool that improves patients' preoperative status; however, little remains known regarding their safety and accuracy as medical devices. Objective: This study aims to test the accuracy and validity of a new software in comparison to the gold-standard electrocardiogram (ECG)-based heart rate measurement. Methods: The PROTEGO MAXIMA trial was a prospective interventional pilot trial assessing the validity, accuracy, and safety of an app-based exercise program. The Prehab App calculates a personalized, risk-stratified aerobic interval training plan based on individual risk factors and utilizes wearables to monitor heart rate. Healthy students and patients undergoing major surgery were enrolled. A structured risk assessment was conducted, followed by a 6-minute walking test and a 37-minute supervised interval session. During the exercise, patients wore app-linked wearables for heart rate and distance measurements, which were compared with standard ECG and treadmill measurements. Safety, accuracy, and usability assessments included testing alarm signals, while the occurrence of adverse events served as the primary and secondary outcome measures. Results: A total of 75 participants were included. The mean heart rate differences between wearables and standard ECG were ?5 bpm (beats per minute) with a mean absolute percentage error of ?5\%. Regression analysis revealed a significant impact of the BMI (odds ratio 0.90, 95\% CI 0.82-0.98, P=.02) and Timed Up and Go Test score (odds ratio 0.12, 95\% CI 0.03-0.55, P=.006) on the accuracy of heart rate measurement; 29 (39\%) patients experienced adverse events: pain (5/12, 42\%), ECG electrode--related skin irritations (2/42, 17\%), dizziness (2/42, 17\%), shortness of breath (2/42, 17\%), and fatigue (1/42, 8\%). No cardiovascular or serious adverse events were reported, and no serious device deficiency was detected. There were no indications of clinically meaningful overexertion based on laboratory values measured before and after the 6-minute walking test and exercise. The differences in means and ranges were as follows: lactate (mmol/l), mean 0.04 (range --3 to 6; P=.47); creatinine kinase (U/l), mean 12 (range --7 to 43; P<.001); and sodium (mmol/l), mean --2 (range --11 to 12; P<.001). Conclusions: The interventional trial demonstrated the high safety of the exercise program and the accuracy of heart rate measurements using commercial wearables in patients before major surgery, paving the way for potential remote implementation in the future. Trial Registration: German Clinical Trials Register DRKS00026985; https://drks.de/search/en/trial/DRKS00026985 and European Database on Medical Devices (EUDAMED) CIV-21-07-0307311. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069394 ",
doi="10.2196/55298",
url="https://mhealth.jmir.org/2025/1/e55298"
}


@Article{info:doi/10.2196/46047,
author="Lonner, H. Jess
and Naidu-Helm, Ashwini
and Van Andel, David
and Anderson, B. Mike
and Ditto, Richard
and Redfern, E. Roberta
and Foran, Jared",
title="Smartphone-Based Care Platform Versus Traditional Care in Primary Knee Arthroplasty in the United States: Cost Analysis",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="3",
volume="13",
pages="e46047",
keywords="telerehabilitation",
keywords="telehealth",
keywords="telemedicine",
keywords="rehabilitation",
keywords="physiotherapy",
keywords="mobile health",
keywords="knee arthroplasty",
abstract="Trial registration: ClinicalTrials.gov NCT03737149; https://clinicaltrials.gov/study/NCT03737149 ",
doi="10.2196/46047",
url="https://mhealth.jmir.org/2025/1/e46047"
}


@Article{info:doi/10.2196/54790,
author="Oh, Sejun
and Lee, SangHeon",
title="Rehabilomics Strategies Enabled by Cloud-Based Rehabilitation: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="28",
volume="27",
pages="e54790",
keywords="cloud-based",
keywords="health",
keywords="rehabilitation",
keywords="rehabilomics",
keywords="strategies",
abstract="Background: Rehabilomics, or the integration of rehabilitation with genomics, proteomics, metabolomics, and other ``-omics'' fields, aims to promote personalized approaches to rehabilitation care. Cloud-based rehabilitation offers streamlined patient data management and sharing and could potentially play a significant role in advancing rehabilomics research. This study explored the current status and potential benefits of implementing rehabilomics strategies through cloud-based rehabilitation. Objective: This scoping review aimed to investigate the implementation of rehabilomics strategies through cloud-based rehabilitation and summarize the current state of knowledge within the research domain. This analysis aims to understand the impact of cloud platforms on the field of rehabilomics and provide insights into future research directions. Methods: In this scoping review, we systematically searched major academic databases, including CINAHL, Embase, Google Scholar, PubMed, MEDLINE, ScienceDirect, Scopus, and Web of Science to identify relevant studies and apply predefined inclusion criteria to select appropriate studies. Subsequently, we analyzed 28 selected papers to identify trends and insights regarding cloud-based rehabilitation and rehabilomics within this study's landscape. Results: This study reports the various applications and outcomes of implementing rehabilomics strategies through cloud-based rehabilitation. In particular, a comprehensive analysis was conducted on 28 studies, including 16 (57\%) focused on personalized rehabilitation and 12 (43\%) on data security and privacy. The distribution of articles among the 28 studies based on specific keywords included 3 (11\%) on the cloud, 4 (14\%) on platforms, 4 (14\%) on hospitals and rehabilitation centers, 5 (18\%) on telehealth, 5 (18\%) on home and community, and 7 (25\%) on disease and disability. Cloud platforms offer new possibilities for data sharing and collaboration in rehabilomics research, underpinning a patient-centered approach and enhancing the development of personalized therapeutic strategies. Conclusions: This scoping review highlights the potential significance of cloud-based rehabilomics strategies in the field of rehabilitation. The use of cloud platforms is expected to strengthen patient-centered data management and collaboration, contributing to the advancement of innovative strategies and therapeutic developments in rehabilomics. ",
doi="10.2196/54790",
url="https://www.jmir.org/2025/1/e54790"
}


@Article{info:doi/10.2196/62809,
author="R{\'i}os Rinc{\'o}n, M. Adriana
and Guptill, Christine
and Liubaoerjijin, Yilina
and Figeys, Mathieu
and Koubasi, Farnaz
and Gregson, Geoffrey
and Miguel Cruz, Antonio",
title="Effectiveness of a New Device for Hand, Wrist, and Forearm Rehabilitation: Feasibility Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Jan",
day="27",
volume="12",
pages="e62809",
keywords="hand",
keywords="upper limb",
keywords="motion",
keywords="movement",
keywords="wrist",
keywords="therapeutics",
keywords="rehabilitation",
keywords="musculoskeletal",
keywords="musculoskeletal diseases",
keywords="stroke",
keywords="wrist fractures",
keywords="feasibility studies",
keywords="randomized controlled trial",
keywords="digital health",
keywords="physiotherapy",
keywords="physical therapy",
keywords="occupational therapy",
abstract="Background: Forearm, wrist, and hand impairments affect many individuals and impose a significant economic burden on health care systems. The FEPSim (flexion, extension, pronation, and supination) is designed for hand and wrist rehabilitation. It could become part of the standard care for upper extremity rehabilitation, aiming to improve range of motion, dexterity, and strength during therapeutic activities. However, the FEPSim has not yet been tested in a health care setting, highlighting the need for a trial to assess its effectiveness in upper extremity rehabilitation. Objective: We aim to assess the feasibility of conducting a definitive trial investigating the effectiveness of adding a new device for hand therapy exercises, the FEPSim, to standard care for patients with impairments of the hand, wrist, and forearm. Methods: Thirty-eight patients with impairments of distal upper extremities were randomly assigned either to the intervention group (FEPSim and standard care, n=19) or to the control group (standard care, n=19). Therapeutic activities to increase strength, range of motion, resistance, and dexterity were delivered by treating hand therapists using the FEPSim device for the intervention group. Outcome measures included wrist passive and active range of motion, grip strength, pinch grip force, and the Patient-Rated Wrist Evaluation. Results: The trial retention rate (36/38, 95\%) and compliance (control group: 100\%; intervention group: 89\%) were high. The comparisons of the change-from-baseline between groups revealed that in 63.2\% (12/19) of the outcome variables, the change was in favor of the FEPSim, with statistically significant improvements in passive wrist flexion (t34=?0.335, P=.008) and grip strength (t34=?1.841, P=.04). Conclusions: The FEPSim was accepted as part of standard care by therapists and patients at 2 hospitals. The trial design was feasible for hand intervention using the FEPSim device. The FEPSim positively affected grip strength, an objective measure of hand functioning. Trial Registration: ISRCTN Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 ",
doi="10.2196/62809",
url="https://rehab.jmir.org/2025/1/e62809"
}


@Article{info:doi/10.2196/55455,
author="Pereira, Polin Amanda
and Machado Neto, Jose Olibario
and Elui, Carril Valeria Meirelles
and Pimentel, Campos Maria da Graca",
title="Wearable Smartphone-Based Multisensory Feedback System for Torso Posture Correction: Iterative Design and Within-Subjects Study",
journal="JMIR Aging",
year="2025",
month="Jan",
day="22",
volume="8",
pages="e55455",
keywords="stroke rehabilitation",
keywords="posture",
keywords="postural balance",
keywords="wearable technology",
keywords="multisensory feedback",
keywords="smartphone",
keywords="stroke",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="gerontology",
abstract="Background: The prevalence of stroke is high in both males and females, and it rises with age. Stroke often leads to sensor and motor issues, such as hemiparesis affecting one side of the body. Poststroke patients require torso stabilization exercises, but maintaining proper posture can be challenging due to their condition. Objective: Our goal was to develop the Postural SmartVest, an affordable wearable technology that leverages a smartphone's built-in accelerometer to monitor sagittal and frontal plane changes while providing visual, tactile, and auditory feedback to guide patients in achieving their best-at-the-time posture during rehabilitation. Methods: To design the Postural SmartVest, we conducted brainstorming sessions, therapist interviews, gathered requirements, and developed the first prototype. We used this initial prototype in a feasibility study with individuals without hemiparesis (n=40, average age 28.4). They used the prototype during 1-hour seated sessions. Their feedback led to a second prototype, which we used in a pilot study with a poststroke patient. After adjustments and a kinematic assessment using the Vicon Gait Plug-in system, the third version became the Postural SmartVest. We assessed the Postural SmartVest in a within-subject experiment with poststroke patients (n=40, average age 57.1) and therapists (n=20, average age 31.3) during rehabilitation sessions. Participants engaged in daily activities, including walking and upper limb exercises, without and with app feedback. Results: The Postural SmartVest comprises a modified off-the-shelf athletic lightweight compression tank top with a transparent pocket designed to hold a smartphone running a customizable Android app securely. This app continuously monitors sagittal and frontal plane changes using the built-in accelerometer sensor, providing multisensory feedback through audio, vibration, and color changes. Patients reported high ratings for weight, comfort, dimensions, effectiveness, ease of use, stability, durability, and ease of adjustment. Therapists noted a positive impact on rehabilitation sessions and expressed their willingness to recommend it. A 2-tailed t-test showed a significant difference (P<.001) between the number of the best-at-the-time posture positions patients could maintain in 2 stages, without feedback (mean 13.1, SD 7.12) and with feedback (mean 4.2, SD 3.97), demonstrating the effectiveness of the solution in improving posture awareness. Conclusions: The Postural SmartVest aids therapists during poststroke rehabilitation sessions and assists patients in improving their posture during these sessions. ",
doi="10.2196/55455",
url="https://aging.jmir.org/2025/1/e55455"
}


@Article{info:doi/10.2196/57423,
author="Kim, Yumi
and Rimmer, H. James
and Lai, Byron
and Oster, Robert
and Cowan, Rachel
and Young, Hui-Ju
and Fisher, Gordon
and Kim, Younguk
and Giannone, John
and Wilroy, D. Jereme",
title="Cardiometabolic Health Intervention Using Music and Exercise (CHIME) Delivered via Telehealth to Wheelchair Users: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="15",
volume="14",
pages="e57423",
keywords="exercise",
keywords="physical activity",
keywords="wheelchair user",
keywords="telehealth",
keywords="disability",
abstract="Background: Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality. Objective: The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos. Methods: This study's design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3{\texttimes}/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded. Results: Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission. Conclusions: The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users. Trial Registration: ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432 International Registered Report Identifier (IRRID): DERR1-10.2196/57423 ",
doi="10.2196/57423",
url="https://www.researchprotocols.org/2025/1/e57423"
}


@Article{info:doi/10.2196/54524,
author="Deka, Pallav
and Salahshurian, Erin
and Ng, Teresa
and Buchholz, W. Susan
and Klompstra, Leonie
and Alonso, Windy",
title="Use of mHealth Technology for Improving Exercise Adherence in Patients With Heart Failure: Systematic Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e54524",
keywords="adherence",
keywords="activity monitors",
keywords="exercise",
keywords="heart failure",
keywords="mHealth",
keywords="mobile health",
keywords="smartphone",
keywords="videoconferencing",
keywords="heart",
keywords="mHealth technology",
keywords="exercise programs",
keywords="age",
keywords="sex",
keywords="race",
keywords="telehealth technology",
keywords="software apps",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: The known and established benefits of exercise in patients with heart failure (HF) are often hampered by low exercise adherence. Mobile health (mHealth) technology provides opportunities to overcome barriers to exercise adherence in this population. Objective: This systematic review builds on prior research to (1) describe study characteristics of mHealth interventions for exercise adherence in HF including details of sample demographics, sample sizes, exercise programs, and theoretical frameworks; (2) summarize types of mHealth technology used to improve exercise adherence in patients with HF; (3) highlight how the term ``adherence'' was defined and how it was measured across mHealth studies and adherence achieved; and (4) highlight the effect of age, sex, race, New York Heart Association (NYHA) functional classification, and HF etiology (systolic vs diastolic) on exercise adherence. Methods: We searched for papers in PubMed, MEDLINE, and CINAHL databases and included studies published between January 1, 2015, and June 30, 2022. The risk of bias was analyzed. Results: In total, 8 studies (4 randomized controlled trials and 4 quasi-experimental trials) met our inclusion and exclusion criteria. A moderate to high risk of bias was noted in the studies. All studies included patients with HF in NYHA classification I-III, with sample sizes ranging from 12 to 81 and study durations lasting 4 to 26 weeks. Six studies had an equal distribution of male and female participants whose ages ranged between 53 and 73 years. Videoconferencing was used in 4 studies, while 4 studies used smartphone apps. Three studies using videoconferencing included an intervention that engaged participants in a group setting. A total of 1 study used a yoga program, 1 study used a walking program, 1 study combined jogging with walking, 1 study used a cycle ergometer, 2 studies combined walking with cycle ergometry, and 1 study used a stepper. Two studies incorporated resistance exercises in their program. Exercise programs varied, ranging between 3 and 5 days of exercise per week, with exercise sessions ranging from 30 to 60 minutes. The Borg rating of perceived exertion scale was mostly used to regulate exercise intensity, with 3 studies using heart rate monitoring using a Fitbit. Only 1 study implicitly mentions developing their intervention using a theoretical framework. Adherence was reported to the investigator-developed exercise programs. All studies were mostly feasibility or pilot studies, and the?effect of age, sex, race, and NYHA classification on exercise adherence with the use of mHealth was not reported. Conclusions: The results show some preliminary evidence of the feasibility of using mHealth technology for building exercise adherence in patients with HF; however, theoretically sound and fully powered studies, including studies on minoritized communities, are lacking. In addition, the sustainability of adherence beyond the intervention period is unknown. ",
doi="10.2196/54524",
url="https://www.jmir.org/2025/1/e54524"
}


@Article{info:doi/10.2196/60374,
author="Pearce, Nettleton Louise Michelle
and Pryor, Julie
and Redhead, Jason
and Sherrington, Catherine
and Hassett, Leanne",
title="Advanced Technology in a Real-World Rehabilitation Setting: Longitudinal Observational Study on Clinician Adoption and Implementation",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="30",
volume="26",
pages="e60374",
keywords="rehabilitation",
keywords="technology",
keywords="digital health",
keywords="virtual reality",
keywords="robotics",
keywords="exoskeleton device",
keywords="implementation science",
keywords="physiotherapy",
keywords="physical therapy",
keywords="occupational therapy",
keywords="mobile phone",
abstract="Background: Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. Objective: This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. Methods: This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Results: Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65\%), occupational therapists (1396/4208, 33\%), and allied health assistants (96/4208, 2\%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70\%). Devices were typically used to target impairment and activity limitation--related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94\%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47\%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51\%, vs outpatient services, 963/2335, 41\%) ($\chi$21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51\%, vs all other conditions, between 24\%-31\%; $\chi$25=16.8, P=.005). Conclusions: The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use. ",
doi="10.2196/60374",
url="https://www.jmir.org/2024/1/e60374"
}


@Article{info:doi/10.2196/58734,
author="Funao, Hiroki
and Momosaki, Ryo
and Tsujikawa, Mayumi
and Kawamoto, Eiji
and Esumi, Ryo
and Shimaoka, Motomu",
title="Virtual Reality--Applied Home-Visit Rehabilitation for Patients With Chronic Pain: Protocol for Single-Arm Pre-Post Comparison Study",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="30",
volume="13",
pages="e58734",
keywords="chronic pain",
keywords="homebound patient",
keywords="home-visit rehabilitation",
keywords="virtual reality",
keywords="protocol",
keywords="feasibility study",
keywords="VR",
keywords="pain",
keywords="recurrent pain",
keywords="home visit",
keywords="rehabilitation",
keywords="home rehabilitation",
keywords="in-home",
keywords="effective",
keywords="screening",
keywords="VR intervention",
keywords="feasibility",
keywords="alleviate pain",
abstract="Background: Pain inhibits rehabilitation. In rehabilitation at medical institutions, the usefulness of virtual reality (VR) has been reported in many cases to alleviate pain. In recent years, the demand for home rehabilitation has increased. Unlike in medical situations, the patients targeted for in-home rehabilitation often have chronic pain due to physical and psychosocial factors, and the environment is not specialized for rehabilitation. However, VR might be effective for in-home rehabilitation settings. Objective: This study aims to evaluate the feasibility of applying VR to home-visit rehabilitation for homebound patients with chronic pain. Methods: This study will test the feasibility of VR applied to home-visit rehabilitation for patients with chronic pain. A single-arm pre-post comparison will be conducted to evaluate its feasibility. Screening will be conducted on patients who have given consent to participate in the study, and those who have pain that persists or recurs for more than 3 months and receive home-visit rehabilitation will be enrolled in the study. Baseline measurements will be conducted on study participants before the start of the VR intervention. VR-applied home-visit rehabilitation will be conducted once a week for a total of 10 VR interventions. The primary endpoint is the change in pain from the baseline to the tenth intervention. Pain is a subjective symptom of the study participants and will be subjectively assessed by the Numerical Rating Scale of 11 levels from 0 to 10. Pain as the primary endpoint will be measured at 3-time points per rehabilitation session: before, during, and after the rehabilitation so that changes between time points can be evaluated. Secondary endpoints are heart rate variability, range of motion of the area in the musculoskeletal system where the pain occurs, motivation for rehabilitation, catastrophic thoughts of pain, mood state, quality of life, and interviews. Assessments will be conducted at the baseline, first, fifth, and tenth interventions. After completing the clinical study (10 VR interventions), patients will continue their regular home-visit rehabilitation as usual. Results: Recruitment of participants began on February 22, 2022, and data collection is ongoing as of November 2024. The research results will be published in international peer-reviewed journals and through presentations at national and international conferences. Conclusions: This study will contribute to the development of novel rehabilitation-based solutions for homebound patients who have had difficulty obtaining adequate relief from chronic pain. Future studies will consider conducting randomized controlled trials as clinical trials to validate the efficacy of VR during home-visit rehabilitation for patients with chronic pain. International Registered Report Identifier (IRRID): DERR1-10.2196/58734 ",
doi="10.2196/58734",
url="https://www.researchprotocols.org/2024/1/e58734"
}


@Article{info:doi/10.2196/64905,
author="Normann, J. Amber
and Mo, C. Clifton
and Wilson, L. Rebekah
and Perez, Michelle
and Cutler, Corey
and Uno, Hajime
and Thompson, V. LaDora
and Skinner, L. Tina
and Richardson, G. Paul
and Marinac, R. Catherine
and Dieli-Conwright, M. Christina",
title="Prehabilitation Exercise Training to Target Improved Muscle Strength in Pretransplant Patients Diagnosed With Multiple Myeloma: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="19",
volume="13",
pages="e64905",
keywords="multiple myeloma",
keywords="stem cell transplantation",
keywords="exercise training",
keywords="aerobic exercise",
keywords="resistance exercise",
keywords="preoperative exercise",
keywords="muscle strength",
keywords="physical fitness",
abstract="Background: Muscle mass and strength are severely compromised in patients diagnosed with multiple myeloma, such that the risk of poor overall survival increases as the prevalence of low muscle mass, also known as sarcopenia, increases. Additionally, at the time of autologous stem cell transplant (ASCT), 51\% of patients experience low muscle mass and strength, which can prolong hospitalization and lead to increased risk of obesity, insulin resistance, lowered physical function, and poor quality of life. Objective: The PROTECT (Prehabilitation Exercise Training in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation) trial will examine the preliminary effects of digitally supervised prehabilitative aerobic and resistance exercise on muscle strength in patients with multiple myeloma scheduled for ASCT. Methods: This prospective, 2-armed single-center randomized controlled trial will recruit 30 patients with multiple myeloma, aged 18 years and older, planning to receive ASCT. Individuals will be assigned to either the exercise or the waitlist control group. The 8-week exercise intervention is home-based and digitally supervised by a clinical exercise trainer. The frequency of the exercise intervention is 3 times per week consisting of aerobic exercise on a cycle ergometer and resistance exercises, which are individually tailored based on patient health status. The waitlist control group maintains normal daily activities of living and is offered the intervention within 6 months from ASCT. The primary outcome is lower limb muscle strength, measured using the 10-repetition maximum leg press or extensor strength. Additional outcomes include physical and cardiorespiratory function, patient-reported outcomes, cardiometabolic health outcomes, and clinical outcomes. Results: The trial was funded in the fall of 2022 and recruitment began in June 2023. As of August 2024, a total of 3 participants have consented and been randomized (n=1, exercise group; n=2, waitlist control group). Trial completion and start of data analysis is expected in July 2025 with expected results to be published in early winter of 2026. Conclusions: We expect exercise to improve lower limb muscle strength and overall health outcomes compared to the waitlist control group. Results will contribute foundational knowledge needed to conduct larger-phase clinical trials testing the clinical benefits of prehabilitation exercise in this patient population. This study will provide insight into a prehabilitative exercise intervention designed to support patient prognosis. Trial Registration: ClinicalTrials.gov NCT05706766; https://clinicaltrials.gov/study/NCT05706766 International Registered Report Identifier (IRRID): DERR1-10.2196/64905 ",
doi="10.2196/64905",
url="https://www.researchprotocols.org/2024/1/e64905"
}


@Article{info:doi/10.2196/53677,
author="Bernard, M. Renaldo
and Seijas, Vanessa
and Davis, Micheal
and Volkova, Anel
and Diviani, Nicola
and L{\"u}scher, Janina
and Sabariego, Carla",
title="Self-Management Support Apps for Spinal Cord Injury: Results of a Systematic Search in App Stores and Mobile App Rating Scale Evaluation",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Dec",
day="19",
volume="12",
pages="e53677",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
keywords="spinal cord injury",
keywords="self-management",
keywords="internet-based intervention",
keywords="world wide web",
keywords="systematic review",
keywords="review",
abstract="Background: The use of mobile technology to meet health needs, widely referred to as mobile health (mHealth), has played a critical role in providing self-management support for chronic health conditions. However, despite its potential benefits, mHealth technologies such as self-management support apps for spinal cord injury (SCI) have received little research attention, and an understanding of their public availability is lacking. Therefore, an overview of these apps is needed to complement findings from the literature for a complete understanding of mHealth self-management support tools for SCI to support the selection and improvement of existing apps and the development of new ones. Objective: This study aimed to identify and describe quantity, quality, focus, strengths, and weaknesses of self-management support apps for SCI available on major mobile app digital distribution platforms. Methods: A systematic search of the Google Play Store and Apple App Store was conducted to identify and summarize apps for SCI that have been updated since 2017. A supplementary systematic literature review was conducted across 11 bibliographic databases to identify publications that provided more detailed descriptions of the identified apps than what is typically available in app stores. The data synthesis was guided by self-management tasks and skills taxonomies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines informed the reporting. Results: The 13 apps included in the final synthesis were launched between 2013 and 2021, mostly originating in the United States, with availability in 72 countries and support for 14 languages. Most apps used the Android operating system (10/13, 77\%), while 31\% (4/13) used iOS. The identified apps mainly focused on activities of daily living, physical activity promotion, health literacy, and therapeutic exercise. All 3 self-management tasks (medical, role, and emotional management) and most self-management skills and support activities were supported by the apps. The mean Mobile App Rating Scale score was 3.86 (SD 0.54), indicating good overall quality. No publications were found describing these apps. Conclusions: Despite their good overall quality, as measured by the Mobile App Rating Scale assessment, the 13 identified apps, alone or combined, do not appear to offer a comprehensive self-management approach that incorporates theory-based strategies. Besides working to improve comprehensiveness, future research and practice should consider adopting new technologies, such as artificial intelligence, to enhance future self-management support apps for SCI. Furthermore, adopting new app development methods, such as low-code development platforms, could help reduce barriers to development, such as time, cost, and securing scarce expertise. ",
doi="10.2196/53677",
url="https://mhealth.jmir.org/2024/1/e53677"
}


@Article{info:doi/10.2196/55231,
author="Gnadlinger, Florian
and Werminghaus, Maika
and Selmanagi{\'c}, Andr{\'e}
and Filla, Tim
and Richter, G. Jutta
and Kriglstein, Simone
and Klenzner, Thomas",
title="Incorporating an Intelligent Tutoring System Into a Game-Based Auditory Rehabilitation Training for Adult Cochlear Implant Recipients: Algorithm Development and Validation",
journal="JMIR Serious Games",
year="2024",
month="Dec",
day="3",
volume="12",
pages="e55231",
keywords="cochlear implant",
keywords="eHealth",
keywords="evidence-centered design",
keywords="hearing rehabilitation",
keywords="adaptive learning",
keywords="intelligent tutoring system",
keywords="game-based learning",
abstract="Background: Cochlear implants are implanted hearing devices; instead of amplifying sounds like common hearing aids, this technology delivers preprocessed sound information directly to the hearing (ie, auditory) nerves. After surgery and the first cochlear implant activation, patients must practice interpreting the new auditory sensations, especially for language comprehension. This rehabilitation process is accompanied by hearing therapy through face-to-face training with a therapist, self-directed training, and computer-based auditory training. Objective: In general, self-directed, computer-based auditory training tasks have already shown advantages. However, compliance of cochlear implant recipients is still a major factor, especially for self-directed training at home. Hence, we aimed to explore the combination of 2 techniques to enhance learner motivation in this context: adaptive learning (in the form of an intelligent tutoring system) and game-based learning (in the form of a serious game). Methods: Following the suggestions of the evidence-centered design framework, a domain analysis of hearing therapy was conducted, allowing us to partially describe human hearing skill as a probabilistic competence model (Bayesian network). We developed an algorithm that uses such a model to estimate the current competence level of a patient and create training recommendations. For training, our developed task system was based on 7 language comprehension task types that act as a blueprint for generating tasks of diverse difficulty automatically. To achieve this, 1053 audio assets with meta-information labels were created. We embedded the adaptive task system into a graphic novel--like mobile serious game. German-speaking cochlear implant recipients used the system during a feasibility study for 4 weeks. Results: The 23 adult participants (20 women; 3 men) fulfilled 2259 tasks. In total, 2004 (90.5\%) tasks were solved correctly, and 255 (9.5\%) tasks were solved incorrectly. A generalized additive model analysis of these tasks indicated that the system adapted to the estimated competency levels of the cochlear implant recipients more quickly in the beginning than at the end. Compared with a uniform distribution of all task types, the recommended task types differed ($\chi${\texttwosuperior}6=86.713; P<.001), indicating that the system selected specific task types for each patient. This is underlined by the identified categories for the error proportions of the task types. Conclusions: This contribution demonstrates the feasibility of combining an intelligent tutoring system with a serious game in cochlear implant rehabilitation therapies. The findings presented here could lead to further advances in cochlear implant care and aural rehabilitation in general. Trial Registration: German Clinical Trials Register (DRKS) DRKS00022860; https://drks.de/search/en/trial/DRKS00022860 ",
doi="10.2196/55231",
url="https://games.jmir.org/2024/1/e55231"
}


@Article{info:doi/10.2196/59136,
author="Krohn, Maria
and Rintala, Aki
and Immonen, Jaakko
and Sj{\"o}gren, Tuulikki",
title="The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e59136",
keywords="stroke",
keywords="chronic",
keywords="virtual reality",
keywords="physiotherapy",
keywords="therapeutic exercise",
keywords="balance",
keywords="walking",
abstract="Background: Well-targeted balance, walking, and weight-shift training can improve balance capabilities in the chronic phase of stroke. There is an urgent need for a long-term approach to rehabilitation that extends beyond the acute and subacute phases, supporting participation without increasing the demand for health care staff. Objective: This study aims to evaluate the effectiveness of therapeutic exercise interventions with virtual reality (VR) training on balance and walking at the activity and participation levels in individuals with chronic stroke, compared with control groups receiving no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without VR. Methods: Studies were searched across 6 databases. The inclusion criteria were as follows: Adults aged 18 years or older with a stroke diagnosis for at least 6 months (population). Therapeutic exercises within a VR environment, using VR glasses or interactive games (intervention). Control groups without the use of VR (including no treatment, conventional physical therapy, specific training, similar treatment without VR, or identical treatment without the additional use of VR; comparison). We evaluated the Berg Balance Scale score, Functional Reach Test performance, Activities-specific Balance Confidence Scale score, Six-minute Walk Test, Two-minute Walk Test, 10-meter Walk Test results, and cadence (outcome measures). We investigated randomized controlled trials (study design). A meta-analysis and a meta-regression analysis were conducted to evaluate whether the content of VR interventions or control groups, as well as the level of VR immersion used, was related to balance or walking outcomes. Results: A total of 43 randomized controlled trials involving 1136 participants were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (standardized mean difference 0.51, 95\% CI 0.29-0.72; P<.001) and a moderate effect on walking (standardized mean difference 0.31, 95\% CI 0.09-0.53; P=.006) in individuals with chronic stroke, compared with pooled control groups (no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR). According to the meta-regression findings, the content of VR interventions (P=.52), the type of control groups (P=.79), and the level of VR immersion (P=.82) were not significantly related to the pooled balance or walking outcomes. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was moderate for balance and low for walking. Conclusions: Therapeutic exercise training with VR had a positive, albeit moderate, effect on balance and a low impact on walking at the level of activity (capacity), even in the chronic phase of stroke, without serious side effects. The results are applicable to working-aged stroke rehabilitees who are able to walk without assistance. Further research is needed with defined VR methods and outcomes that assess performance at the level of real-life participation. ",
doi="10.2196/59136",
url="https://www.jmir.org/2024/1/e59136",
url="http://www.ncbi.nlm.nih.gov/pubmed/39621381"
}


@Article{info:doi/10.2196/65680,
author="Lancioni, E. Giulio
and Alberti, Gloria
and Filippini, Chiara
and Singh, N. Nirbhay
and O'Reilly, F. Mark
and Sigafoos, Jeff
and Orlando, Isabella
and Desideri, Lorenzo",
title="A Technology System to Help People With Intellectual Disability and Blindness Find Room Destinations During Indoor Traveling: Case Series Study",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Nov",
day="27",
volume="11",
pages="e65680",
keywords="barcode reader",
keywords="barcode",
keywords="blindness",
keywords="intellectual disability",
keywords="indoor traveling",
keywords="indoor travel",
keywords="digital health",
keywords="travel",
keywords="navigation",
keywords="wayfinding",
keywords="patient care",
keywords="patient support",
keywords="mobile health",
keywords="patient assessment",
keywords="health intervention",
keywords="user engagement",
keywords="technology use",
keywords="telerehabilitation",
keywords="rehabilitation",
keywords="disability",
keywords="support tools",
keywords="mobility",
keywords="orientation",
keywords="mobile phone",
abstract="Background: People with severe or profound intellectual disability and visual impairment tend to have serious problems in orientation and mobility and need assistance for their indoor traveling. The use of technology solutions may be critically important to help them curb those problems and achieve a level of independence. Objective: This study aimed to assess a new technology system to help people with severe to profound intellectual disability and blindness find room destinations during indoor traveling. Methods: A total of 7 adults were included in the study. The technology system entailed a barcode reader, a series of barcodes marking the room entrances, a smartphone, and a special app that controlled the presentation of different messages (instructions) for the participants. The messages varied depending on whether the participants were (1) in an area between room entrances, (2) in correspondence with a room entrance to bypass, or (3) in correspondence with a room entrance representing the destination to enter. The intervention with the technology system was implemented according to a nonconcurrent multiple baseline design across participants. Sessions included 7 traveling trials, in each of which the participants were to reach and enter a specific room (1 of the 7 or 9 available) to deliver an object they had carried (transported) during their traveling. Results: The participants' mean frequency of traveling trials completed correctly was between zero and 2 per session during the baseline (without the system). Their mean frequency increased to between about 6 and nearly 7 per session during the intervention (with the system). Conclusions: The findings suggest that the new technology system might be a useful support tool for people with severe to profound intellectual disability and blindness. ",
doi="10.2196/65680",
url="https://rehab.jmir.org/2024/1/e65680",
url="http://www.ncbi.nlm.nih.gov/pubmed/39602792"
}


@Article{info:doi/10.2196/59630,
author="Morrow, L. Emily
and Nelson, A. Lyndsay
and Duff, C. Melissa
and Mayberry, S. Lindsay",
title="An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Nov",
day="26",
volume="11",
pages="e59630",
keywords="chronic traumatic brain injury",
keywords="rehabilitation",
keywords="memory",
keywords="ecological momentary intervention",
keywords="text messaging",
keywords="mobile health",
keywords="mobile application",
keywords="digital health",
keywords="digital intervention",
abstract="Background: Memory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals' behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. Objective: This study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message--based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. Methods: We developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI's usability and acceptability. Results: Participants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98\%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. Conclusions: Testing MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users' preferences and plan to test the efficacy of this tool in a future clinical trial. ",
doi="10.2196/59630",
url="https://rehab.jmir.org/2024/1/e59630"
}


@Article{info:doi/10.2196/64806,
author="C Areias, Anabela
and G Moulder, Robert
and Molinos, Maria
and Janela, Dora
and Bento, Virg{\'i}lio
and Moreira, Carolina
and Yanamadala, Vijay
and P Cohen, Steven
and Dias Correia, Fernando
and Costa, Fab{\'i}ola",
title="Predicting Pain Response to a Remote Musculoskeletal Care Program for Low Back Pain Management: Development of a Prediction Tool",
journal="JMIR Med Inform",
year="2024",
month="Nov",
day="19",
volume="12",
pages="e64806",
keywords="telerehabilitation",
keywords="predictive modeling",
keywords="personalized medicine",
keywords="rehabilitation",
keywords="clinical decision support",
keywords="machine learning",
keywords="artificial intelligence",
abstract="Background: Low back pain (LBP) presents with diverse manifestations, necessitating personalized treatment approaches that recognize various phenotypes within the same diagnosis, which could be achieved through precision medicine. Although prediction strategies have been explored, including those employing artificial intelligence (AI), they still lack scalability and real-time capabilities. Digital care programs (DCPs) facilitate seamless data collection through the Internet of Things and cloud storage, creating an ideal environment for developing and implementing an AI predictive tool to assist clinicians in dynamically optimizing treatment. Objective: This study aims to develop an AI tool that continuously assists physical therapists in predicting an individual's potential for achieving clinically significant pain relief by the end of the program. A secondary aim was to identify predictors of pain nonresponse to guide treatment adjustments. Methods: Data collected actively (eg, demographic and clinical information) and passively in real-time (eg, range of motion, exercise performance, and socioeconomic data from public data sources) from 6125 patients enrolled in a remote digital musculoskeletal intervention program were stored in the cloud. Two machine learning techniques, recurrent neural networks (RNNs) and light gradient boosting machine (LightGBM), continuously analyzed session updates up to session 7 to predict the likelihood of achieving significant pain relief at the program end. Model performance was assessed using the area under the receiver operating characteristic curve (ROC-AUC), precision-recall curves, specificity, and sensitivity. Model explainability was assessed using SHapley Additive exPlanations values. Results: At each session, the model provided a prediction about the potential of being a pain responder, with performance improving over time (P<.001). By session 7, the RNN achieved an ROC-AUC of 0.70 (95\% CI 0.65-0.71), and the LightGBM achieved an ROC-AUC of 0.71 (95\% CI 0.67-0.72). Both models demonstrated high specificity in scenarios prioritizing high precision. The key predictive features were pain-associated domains, exercise performance, motivation, and compliance, informing continuous treatment adjustments to maximize response rates. Conclusions: This study underscores the potential of an AI predictive tool within a DCP to enhance the management of LBP, supporting physical therapists in redirecting care pathways early and throughout the treatment course. This approach is particularly important for addressing the heterogeneous phenotypes observed in LBP. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 and NCT05417685; https://clinicaltrials.gov/ct2/show/NCT05417685 ",
doi="10.2196/64806",
url="https://medinform.jmir.org/2024/1/e64806"
}


@Article{info:doi/10.2196/56795,
author="Lu, Taiping
and Deng, Ting
and Long, Yangyang
and Li, Jin
and Hu, Anmei
and Hu, Yufan
and Ouyang, Li
and Wang, Huiping
and Ma, Junliang
and Chen, Shaolin
and Hu, Jiale",
title="Effectiveness and Feasibility of Digital Pulmonary Rehabilitation in Patients Undergoing Lung Cancer Surgery: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="11",
volume="26",
pages="e56795",
keywords="app-based",
keywords="digital rehabilitation",
keywords="internet-based intervention",
keywords="lung cancer",
keywords="perioperative pulmonary rehabilitation",
keywords="systematic review",
keywords="telerehabilitation",
abstract="Background: Pulmonary rehabilitation (PR) has been shown to effectively support postsurgical recovery in patients with lung cancer (LC) at various stages. While digital PR programs offer a potential solution to traditional challenges, such as time and space constraints, their efficacy and feasibility for patients undergoing LC surgery remain unclear. Objective: This systematic review aims to assess the feasibility and effectiveness of digital PR programs for individuals undergoing LC surgery. Methods: A systematic review was conducted, retrieving data from 6 English and 4 Chinese databases from their inception to January 1, 2024. References in related studies were also manually reviewed. The primary outcomes assessed were physical capacity, lung function, and the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were compliance, hospital stay, chest tube duration, anxiety, depression, and quality of life. Where applicable, recruitment and withdrawal rates were also evaluated. Meta-analysis and descriptive analysis were used to assess the outcomes. Results: A total of 5 randomized controlled trials and 6 quasi-experimental studies (n=1063) were included, with 4 studies being included in the meta-analyses. Our meta-analyses revealed that digital PR reduced the decline in 6-minute walk distance (6-MWD) by an average of 15 m compared with routine PR programs from admission to discharge, demonstrating a clinically significant improvement in physical capacity (mean difference --15.00, 95\% CI --25.65 to --4.34, P=.006). Additionally, digital PR was associated with a reduction (26/58, 45\%) in the likelihood of PPCs (risk ratio 0.45, 95\% CI 0.30-0.66, P<.001) and a reduction of 1.53 days in chest tube duration (mean difference --1.53, 95\% CI --2.95 to --0.12, P=.03), without a statistically significant effect on postoperative hospital stay (mean difference --1.42, 95\% CI --3.45 to 0.62, P=.17). Descriptive analyses suggested that digital PR has the potential to improve knowledge, lung function, quality of life, and self-efficacy, while reducing depression and anxiety. Notably, digital PR was found to be a safe, feasible, and acceptable supplementary intervention. Despite challenges with low recruitment, digital PR enhanced exercise compliance, increased patient satisfaction, and lowered dropout rates. Conclusions: This systematic review is the first comprehensive analysis to suggest that digital PR is a safe, feasible, acceptable, and effective intervention for promoting recovery in patients with LC after surgery. Digital PR has the potential to be a valuable supplement, expanding access to traditional PR programs. Future research should prioritize the development of interactive and inclusive digital solutions tailored to diverse age groups and educational backgrounds. Rigorous studies, including large-scale, high-quality randomized controlled trials with detailed protocols and robust methodologies, are needed to assess the short-, medium-, and long-term efficacy of digital PR, ensuring reproducibility in future research. Trial Registration: PROSPERO CRD42023430271; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=430271 ",
doi="10.2196/56795",
url="https://www.jmir.org/2024/1/e56795"
}


@Article{info:doi/10.2196/60673,
author="Scaramozza, Matthew
and Ruet, Aur{\'e}lie
and Chiesa, A. Patrizia
and Ahamada, La{\"i}tissia
and Bartholom{\'e}, Emmanuel
and Carment, Lo{\"i}c
and Charre-Morin, Julie
and Cosne, Gautier
and Diouf, L{\'e}a
and Guo, C. Christine
and Juraver, Adrien
and Kanzler, M. Christoph
and Karatsidis, Angelos
and Mazz{\`a}, Claudia
and Penalver-Andres, Joaquin
and Ruiz, Marta
and Saubusse, Aurore
and Simoneau, Gabrielle
and Scotland, Alf
and Sun, Zhaonan
and Tang, Minao
and van Beek, Johan
and Zajac, Lauren
and Belachew, Shibeshih
and Brochet, Bruno
and Campbell, Nolan",
title="Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e60673",
keywords="multiple sclerosis",
keywords="sensor-derived measure",
keywords="smartphone",
keywords="cognitive function",
keywords="motor function",
keywords="digital biomarkers",
keywords="mobile phone",
abstract="Background: Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective: This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods: The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95\% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results: A total of 16 (34\%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95\% CI 19\%-35\%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |$\rho$|>0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25?|$\rho$|<0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25?|$\rho$|<0.5) or were not correlated (|$\rho$|<0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5<|$\rho$|?0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|$\rho$|>0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions: Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials. ",
doi="10.2196/60673",
url="https://formative.jmir.org/2024/1/e60673"
}


@Article{info:doi/10.2196/56437,
author="Reilly, D. Erin
and Kelly, M. Megan
and Grigorian, L. Hannah
and Waring, E. Molly
and Quigley, S. Karen
and Hogan, P. Timothy
and Heapy, A. Alicia
and Drebing, E. Charles
and Volonte, Matias
and Kathawalla, Ummul-Kiram
and Robins, E. Hannah
and Bernice, Katarina
and Bickmore, Timothy",
title="Virtual Coach--Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e56437",
keywords="chronic pain",
keywords="randomized controlled trial",
keywords="usability",
keywords="acceptance and commitment therapy",
keywords="embodied conversational agent",
keywords="veterans",
abstract="Background: Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47\%-56\%) and a 40\% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. Objective: This study aims to evaluate the virtual coach--guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Methods: Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Results: Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). Conclusions: VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain---chronic pain acceptance---after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132 International Registered Report Identifier (IRRID): RR2-10.2196/45887 ",
doi="10.2196/56437",
url="https://formative.jmir.org/2024/1/e56437"
}


@Article{info:doi/10.2196/51865,
author="Lange-Drenth, Lukas
and Schulz, Holger
and Suck, Isabell
and Bleich, Christiane",
title="Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e51865",
keywords="telerehabilitation",
keywords="rehabilitation",
keywords="eHealth development",
keywords="value specification",
keywords="stakeholder participation",
keywords="occupational injuries",
keywords="vocational rehabilitation",
keywords="aftercare",
keywords="mobile phone",
abstract="Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients' lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. ",
doi="10.2196/51865",
url="https://formative.jmir.org/2024/1/e51865"
}


@Article{info:doi/10.2196/50631,
author="Li, Haodong
and Qian, Chuang
and Yan, Weili
and Fu, Dong
and Zheng, Yiming
and Zhang, Zhiqiang
and Meng, Junrong
and Wang, Dahui",
title="Use of Artificial Intelligence in Cobb Angle Measurement for Scoliosis: Retrospective Reliability and Accuracy Study of a Mobile App",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="1",
volume="26",
pages="e50631",
keywords="scoliosis",
keywords="photogrammetry",
keywords="artificial intelligence",
keywords="deep learning",
abstract="Background: Scoliosis is a spinal deformity in which one or more spinal segments bend to the side or show vertebral rotation. Some artificial intelligence (AI) apps have already been developed for measuring the Cobb angle in patients with scoliosis. These apps still require doctors to perform certain measurements, which can lead to interobserver variability. The AI app (cobbAngle pro) in this study will eliminate the need for doctor measurements, achieving complete automation. Objective: We aimed to evaluate the reliability and accuracy of our new AI app that is based on deep learning to automatically measure the Cobb angle in patients with scoliosis. Methods: A retrospective analysis was conducted on the clinical data of children with scoliosis who were treated at the Pediatric Orthopedics Department of the Children's Hospital affiliated with Fudan University from July 2019 to July 2022. Three measurers used the Picture Archiving and Communication System (PACS) to measure the coronal main curve Cobb angle in 802 full-length anteroposterior and lateral spine X-rays of 601 children with scoliosis, and recorded the results of each measurement. After an interval of 2 weeks, the mobile AI app was used to remeasure the Cobb angle once. The Cobb angle measurements from the PACS were used as the reference standard, and the accuracy of the Cobb angle measurements by the app was analyzed through the Bland-Altman test. The intraclass correlation coefficient (ICC) was used to compare the repeatability within measurers and the consistency between measurers. Results: Among 601 children with scoliosis, 89 were male and 512 were female (age range: 10-17 years), and 802 full-length spinal X-rays were analyzed. Two functionalities of the app (photography and photo upload) were compared with the PACS for measuring the Cobb angle. The consistency was found to be excellent. The average absolute errors of the Cobb angle measured by the photography and upload methods were 2.00 and 2.08, respectively. Using a clinical allowance maximum error of 5{\textdegree}, the 95\% limits of agreement (LoAs) for Cobb angle measurements by the photography and upload methods were --4.7{\textdegree} to 4.9{\textdegree} and --4.9{\textdegree} to 4.9{\textdegree}, respectively. For the photography and upload methods, the 95\% LoAs for measuring Cobb angles were --4.3{\textdegree} to 4.6{\textdegree} and --4.4{\textdegree} to 4.7{\textdegree}, respectively, in mild scoliosis patients; --4.9{\textdegree} to 5.2{\textdegree} and --5.1{\textdegree} to 5.1{\textdegree}, respectively, in moderate scoliosis patients; and --5.2{\textdegree} to 5.0{\textdegree} and --6.0{\textdegree} to 4.8{\textdegree}, respectively, in severe scoliosis patients. The Cobb angle measured by the 3 observers twice before and after using the photography method had good repeatability (P<.001). The consistency between the observers was excellent (P<.001). Conclusions: The new AI platform is accurate and repeatable in the automatic measurement of the Cobb angle of the main curvature in patients with scoliosis. ",
doi="10.2196/50631",
url="https://www.jmir.org/2024/1/e50631"
}


@Article{info:doi/10.2196/57940,
author="Ortiz-Barrios, Miguel
and Cleland, Ian
and Donnelly, Mark
and Gul, Muhammet
and Yucesan, Melih
and Jim{\'e}nez-Delgado, Isabel Genett
and Nugent, Chris
and Madrid-Sierra, Stephany",
title="Integrated Approach Using Intuitionistic Fuzzy Multicriteria Decision-Making to Support Classifier Selection for Technology Adoption in Patients with Parkinson Disease: Algorithm Development and Validation",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Oct",
day="22",
volume="11",
pages="e57940",
keywords="Parkinson disease",
keywords="technology adoption",
keywords="intuitionistic fuzzy analytic hierarchy process",
keywords="intuitionistic fuzzy decision-making trial and evaluation laboratory",
keywords="combined compromise solution",
abstract="Background: Parkinson disease (PD) is reported to be among the most prevalent neurodegenerative diseases globally, presenting ongoing challenges and increasing burden on health care systems. In an effort to support patients with PD, their carers, and the wider health care sector to manage this incurable condition, the focus has begun to shift away from traditional treatments. One of the most contemporary treatments includes prescribing assistive technologies (ATs), which are viewed as a way to promote independent living and deliver remote care. However, the uptake of these ATs is varied, with some users not ready or willing to accept all forms of AT and others only willing to adopt low-technology solutions. Consequently, to manage both the demands on resources and the efficiency with which ATs are deployed, new approaches are needed to automatically assess or predict a user's likelihood to accept and adopt a particular AT before it is prescribed. Classification algorithms can be used to automatically consider the range of factors impacting AT adoption likelihood, thereby potentially supporting more effective AT allocation. From a computational perspective, different classification algorithms and selection criteria offer various opportunities and challenges to address this need. Objective: This paper presents a novel hybrid multicriteria decision-making approach to support classifier selection in technology adoption processes involving patients with PD. Methods: First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) was implemented to calculate the relative priorities of criteria and subcriteria considering experts' knowledge and uncertainty. Second, the intuitionistic fuzzy decision-making trial and evaluation laboratory (IF-DEMATEL) was applied to evaluate the cause-effect relationships among criteria/subcriteria. Finally, the combined compromise solution (CoCoSo) was used to rank the candidate classifiers based on their capability to model the technology adoption. Results: We conducted a study involving a mobile smartphone solution to validate the proposed methodology. Structure (F5) was identified as the factor with the highest relative priority (overall weight=0.214), while adaptability (F4) (D-R=1.234) was found to be the most influencing aspect when selecting classifiers for technology adoption in patients with PD. In this case, the most appropriate algorithm for supporting technology adoption in patients with PD was the A3 - J48 decision tree (M3=2.5592). The results obtained by comparing the CoCoSo method in the proposed approach with 2 alternative methods (simple additive weighting and technique for order of preference by similarity to ideal solution) support the accuracy and applicability of the proposed methodology. It was observed that the final scores of the algorithms in each method were highly correlated (Pearson correlation coefficient >0.8). Conclusions: The IF-AHP-IF-DEMATEL-CoCoSo approach helped to identify classification algorithms that do not just discriminate between good and bad adopters of assistive technologies within the Parkinson population but also consider technology-specific features like design, quality, and compatibility that make these classifiers easily implementable by clinicians in the health care system. ",
doi="10.2196/57940",
url="https://rehab.jmir.org/2024/1/e57940"
}


@Article{info:doi/10.2196/56480,
author="Waranski, Melina
and Garbsch, Ren{\'e}
and Kotewitsch, Mona
and Teschler, Marc
and Schmitz, Boris
and Mooren, C. Frank",
title="A Behavioral Change--Based Mobile Intervention for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance of Patients With Coronary Artery Disease: Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="8",
volume="26",
pages="e56480",
keywords="rehabilitation",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="telemedicine",
keywords="cardiovascular disease",
keywords="behavioral change",
keywords="mobile phone",
abstract="Background: Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, but adoption of a healthy postrehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change--based eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ aims to improve postrehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA). Objective: This study aims to evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care. Methods: A total of 169 patients with CAD who had undergone stent implantation or bypass surgery were recruited after completing center-based phase II rehabilitation. They were then divided, without blinding, into 2 groups using a quasi-experimental approach: a case manager--assisted 24-week eHealth program (RehaPlus+; n=84) and a conventional physician-assisted outpatient program (usual care; n=85). The study was designed as a noninferiority trial. RehaPlus+ participants received motivational messages twice weekly for 6 months, and the usual care group engaged in a 6-month outpatient program (twenty-four 90-minute strength and endurance training sessions). The primary outcomes, evaluated using the self-assessed Bewegungs- und Sportaktivit{\"a}t questionnaire, were regular PA (?150 min/wk) and weekly activities of daily living (ADLs) 6 months after rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (measured by Bewegungs- und Sportaktivit{\"a}t questionnaire), psychological well-being (assessed by the 5-item World Health Organization Well-Being Index), cardiac self-efficacy, health-related quality of life (measured by the 36-Item Short Form Survey), and work ability (using the Work Ability Index). Results: Data of 105 patients (RehaPlus+: n=44, 41.9\%; usual care: n=61, 58.1\%; male patients: n=80, 76.2\%; female patients: n=25, 23.8\%; mean age 56.0, SD 7.3 years) were available at the 6-month follow-up. At 6 months after discharge from phase II cardiac rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per week of PA and the usual care group exhibited 119 (SD 175) minutes per week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 (SD 538) minutes per week compared to the usual care group with 308 (SD 412) minutes per week at the 6-month follow-up, with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined 1-sided noninferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P>.05). Conclusions: RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation. Trial Registration: ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793 ",
doi="10.2196/56480",
url="https://www.jmir.org/2024/1/e56480"
}


@Article{info:doi/10.2196/49449,
author="Hach, Sylvia
and Alder, Gemma
and Stavric, Verna
and Taylor, Denise
and Signal, Nada",
title="Usability Assessment Methods for Mobile Apps for Physical Rehabilitation: Umbrella Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="4",
volume="12",
pages="e49449",
keywords="usability",
keywords="quality evaluation",
keywords="mobile health",
keywords="physical exercise",
keywords="rehabilitation",
keywords="overview",
keywords="umbrella review",
keywords="psychometrics",
abstract="Background: Usability has been touted as one determiner of success of mobile health (mHealth) interventions. Multiple systematic reviews of usability assessment approaches for different mHealth solutions for physical rehabilitation are available. However, there is a lack of synthesis in this portion of the literature, which results in clinicians and developers devoting a significant amount of time and effort in analyzing and summarizing a large body of systematic reviews. Objective: This study aims to summarize systematic reviews examining usability assessment instruments, or measurements tools, in mHealth interventions including physical rehabilitation. Methods: An umbrella review was conducted according to a published registered protocol. A topic-based search of PubMed, Cochrane, IEEE Xplore, Epistemonikos, Web of Science, and CINAHL Complete was conducted from January 2015 to April 2023 for systematic reviews investigating usability assessment instruments in mHealth interventions including physical exercise rehabilitation. Eligibility screening included date, language, participant, and article type. Data extraction and assessment of the methodological quality (AMSTAR 2 [A Measurement Tool to Assess Systematic Reviews 2]) was completed and tabulated for synthesis. Results: A total of 12 systematic reviews were included, of which 3 (25\%) did not refer to any theoretical usability framework and the remaining (n=9, 75\%) most commonly referenced the ISO framework. The sample referenced a total of 32 usability assessment instruments and 66 custom-made, as well as hybrid, instruments. Information on psychometric properties was included for 9 (28\%) instruments with satisfactory internal consistency and structural validity. A lack of reliability, responsiveness, and cross-cultural validity data was found. The methodological quality of the systematic reviews was limited, with 8 (67\%) studies displaying 2 or more critical weaknesses. Conclusions: There is significant diversity in the usability assessment of mHealth for rehabilitation, and a link to theoretical models is often lacking. There is widespread use of custom-made instruments, and preexisting instruments often do not display sufficient psychometric strength. As a result, existing mHealth usability evaluations are difficult to compare. It is proposed that multimethod usability assessment is used and that, in the selection of usability assessment instruments, there is a focus on explicit reference to their theoretical underpinning and acceptable psychometric properties. This could be facilitated by a closer collaboration between researchers, developers, and clinicians throughout the phases of mHealth tool development. Trial Registration: PROSPERO CRD42022338785; https://www.crd.york.ac.uk/prospero/\#recordDetails ",
doi="10.2196/49449",
url="https://mhealth.jmir.org/2024/1/e49449"
}


@Article{info:doi/10.2196/57635,
author="Wang, Qingling
and Lee, Lai-Tong Regina
and Hunter, Sharyn
and Zhu, Aiyong
and Chan, Wai-Chi Sally",
title="Patient Engagement in a Mobile App--Based Rehabilitation Program for Total Hip or Knee Arthroplasty: Secondary Data Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="1",
volume="12",
pages="e57635",
keywords="total hip arthroplasty",
keywords="total knee arthroplasty",
keywords="rehabilitation",
keywords="mobile health",
keywords="social media application",
keywords="patient engagement",
abstract="Background: Health care professionals use mobile apps to support patients' rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients. Objective: This study aimed to investigate patient engagement in a mobile app--based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics. Methods: Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])--based program to support patients' rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants' posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics. Results: The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74\%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88\%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95\% CI 1.98-15.35; $\chi$21=11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95\% CI 0.45-5.48; $\chi$21=5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy. Conclusions: Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the design of mobile arthroplasty rehabilitation programs to enhance patient engagement in such interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000867897; https://tinyurl.com/mtdw25fp ",
doi="10.2196/57635",
url="https://mhealth.jmir.org/2024/1/e57635"
}


@Article{info:doi/10.2196/59098,
author="Bilbrey, Tim
and Martin, Jenny
and Zhou, Wen
and Bai, Changhao
and Vaswani, Nitin
and Shah, Rishab
and Chokshi, Sara
and Chen, Xi
and Bhusri, Satjit
and Niemi, Samantha
and Meng, Hongdao
and Lei, Zhen",
title="A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="1",
volume="12",
pages="e59098",
keywords="cardiac rehabilitation",
keywords="telehealth",
keywords="mHealth",
keywords="digital health",
keywords="exercise",
keywords="quality of life",
keywords="myocardial infarction",
keywords="app",
keywords="application",
keywords="physical fitness",
keywords="self-management",
keywords="disease management",
abstract="Background: Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD. Objective: We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD. Methods: This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ?40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables. Results: In total, 162 met the inclusion criteria and 75 (46.3\%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49\%; White: n=46, 61\%). Heart failure was the most common diagnosis (37/75, 49\%). In total, 62/75 (83\%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79\%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81\%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95\% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95\% CI 1.1-4.3) and 2.2 (SD 9.09) points (95\% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. Conclusions: The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States. Trial Registration: ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500 ",
doi="10.2196/59098",
url="https://mhealth.jmir.org/2024/1/e59098",
url="http://www.ncbi.nlm.nih.gov/pubmed/39150858"
}


@Article{info:doi/10.2196/60955,
author="Eriksson, Gunilla
and Kamwesiga, Tunga Julius
and Fors, Uno
and Oyana, Tonny
and von Koch, Lena
and Ytterberg, Charlotte
and Guidetti, Susanne",
title="Implementing and Evaluating a Mobile Phone--Supported and Family-Centered Rehabilitation Program for People With Stroke in Uganda (F@ce 2.0): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="25",
volume="13",
pages="e60955",
keywords="information and communication technology",
keywords="ICT",
keywords="mobile health",
keywords="mHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="remote rehabilitation",
keywords="activity of daily living",
keywords="ADL",
keywords="East Africa",
keywords="sub-Saharan Africa",
keywords="intervention",
keywords="occupational therapy",
keywords="physiotherapy",
abstract="Background: Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke. Objective: This study aims to implement F@ce 2.0, a mobile phone--supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0. Methods: A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process. Results: Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025. Conclusions: This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/60955 ",
doi="10.2196/60955",
url="https://www.researchprotocols.org/2024/1/e60955"
}


@Article{info:doi/10.2196/57185,
author="Grube, Lara
and Petit, Pascal
and Vuillerme, Nicolas
and Nitschke, Marlies
and Nwosu, Bertrand Obioma
and Knitza, Johannes
and Krusche, Martin
and Seifer, Ann-Kristin
and Eskofier, M. Bjoern
and Schett, Georg
and Morf, Harriet",
title="Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="19",
volume="8",
pages="e57185",
keywords="DTx",
keywords="DHA",
keywords="usability",
keywords="Yoga",
keywords="YogiTherapy",
keywords="ankylosing spondylitis",
keywords="axial spondylarthritis",
keywords="digital health application",
keywords="eHealth",
keywords="self-assessment",
keywords="physical exercise",
keywords="patient acceptance",
keywords="therapy",
keywords="home exercise",
keywords="exercise",
keywords="patients",
keywords="patient",
keywords="spondyloarthritis",
keywords="usability study",
keywords="app",
keywords="apps",
keywords="rheumatic disease",
keywords="chronic",
keywords="spine",
keywords="adjacent joints",
keywords="joints",
keywords="joint",
keywords="correlation analysis",
keywords="digital therapeutics",
abstract="Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. Results: A total of 65 patients with AS (33, 51\% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95\% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43\% (26/65 nonpromoters, 42\% (25/65) indifferent, and 15\% (9/65) promoters. A total of 7\% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is --26\%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95\% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=--0.21, P<.001). Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. ",
doi="10.2196/57185",
url="https://formative.jmir.org/2024/1/e57185"
}


@Article{info:doi/10.2196/51564,
author="Fu, Yan
and Zhang, Yuxin
and Ye, Bing
and Babineau, Jessica
and Zhao, Yan
and Gao, Zhengke
and Mihailidis, Alex",
title="Smartphone-Based Hand Function Assessment: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="16",
volume="26",
pages="e51564",
keywords="hand function assessment",
keywords="smartphone-based sensing",
keywords="rehabilitation",
keywords="digital health",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Hand function assessment heavily relies on specific task scenarios, making it challenging to ensure validity and reliability. In addition, the wide range of assessment tools, limited and expensive data recording, and analysis systems further aggravate the issue. However, smartphones provide a promising opportunity to address these challenges. Thus, the built-in, high-efficiency sensors in smartphones can be used as effective tools for hand function assessment. Objective: This review aims to evaluate existing studies on hand function evaluation using smartphones. Methods: An information specialist searched 8 databases on June 8, 2023. The search criteria included two major concepts: (1) smartphone or mobile phone or mHealth and (2) hand function or function assessment. Searches were limited to human studies in the English language and excluded conference proceedings and trial register records. Two reviewers independently screened all studies, with a third reviewer involved in resolving discrepancies. The included studies were rated according to the Mixed Methods Appraisal Tool. One reviewer extracted data on publication, demographics, hand function types, sensors used for hand function assessment, and statistical or machine learning (ML) methods. Accuracy was checked by another reviewer. The data were synthesized and tabulated based on each of the research questions. Results: In total, 46 studies were included. Overall, 11 types of hand dysfunction--related problems were identified, such as Parkinson disease, wrist injury, stroke, and hand injury, and 6 types of hand dysfunctions were found, namely an abnormal range of motion, tremors, bradykinesia, the decline of fine motor skills, hypokinesia, and nonspecific dysfunction related to hand arthritis. Among all built-in smartphone sensors, the accelerometer was the most used, followed by the smartphone camera. Most studies used statistical methods for data processing, whereas ML algorithms were applied for disease detection, disease severity evaluation, disease prediction, and feature aggregation. Conclusions: This systematic review highlights the potential of smartphone-based hand function assessment. The review suggests that a smartphone is a promising tool for hand function evaluation. ML is a conducive method to classify levels of hand dysfunction. Future research could (1) explore a gold standard for smartphone-based hand function assessment and (2) take advantage of smartphones' multiple built-in sensors to assess hand function comprehensively, focus on developing ML methods for processing collected smartphone data, and focus on real-time assessment during rehabilitation training. The limitations of the research are 2-fold. First, the nascent nature of smartphone-based hand function assessment led to limited relevant literature, affecting the evidence's completeness and comprehensiveness. This can hinder supporting viewpoints and drawing conclusions. Second, literature quality varies due to the exploratory nature of the topic, with potential inconsistencies and a lack of high-quality reference studies and meta-analyses. ",
doi="10.2196/51564",
url="https://www.jmir.org/2024/1/e51564"
}


@Article{info:doi/10.2196/54356,
author="Dieter, Valerie
and Janssen, Pia
and Krauss, Inga",
title="Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="9",
volume="12",
pages="e54356",
keywords="digital app",
keywords="mobile health",
keywords="mHealth",
keywords="knee osteoarthritis",
keywords="exercise",
keywords="knee brace",
abstract="Background: Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. Objective: This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. Methods: This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. Results: A total of 61 participants were included (IG: n=30, 49\%; CG: n=31, 51\%; male: n=31, 51\%; female: n=30, 49\%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5\% (899/972) of all scheduled exercise sessions. Conclusions: Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. Trial Registration: German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269 ",
doi="10.2196/54356",
url="https://mhealth.jmir.org/2024/1/e54356",
url="http://www.ncbi.nlm.nih.gov/pubmed/39250181"
}


@Article{info:doi/10.2196/56580,
author="Shi, Weihong
and Zhang, Yuhang
and Bian, Yanyan
and Chen, Lixia
and Yuan, Wangshu
and Zhang, Houqiang
and Feng, Qiyang
and Zhang, Huiling
and Liu, Diana
and Lin, Ye",
title="The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="6",
volume="12",
pages="e56580",
keywords="nonspecific low back pain",
keywords="telerehabilitation",
keywords="physical therapy",
keywords="low back pain",
keywords="back pain",
keywords="psychological",
keywords="exercise",
keywords="randomized controlled trial",
keywords="efficacy",
keywords="medical infrastructure",
keywords="pain intensity",
keywords="quality of life",
keywords="health survey",
keywords="therapeutic",
keywords="mobile phone",
abstract="Background: Physical therapy has demonstrated efficacy in managing nonspecific low back pain (NLBP) among patients. Nevertheless, the prevalence of NLBP poses a challenge, as the existing medical infrastructure may be insufficient to care for the large patient population, particularly in geographically remote regions. Telerehabilitation emerges as a promising method to address this concern by offering a method to deliver superior medical care to a greater number of patients with NLBP. Objective: The purpose of this study is to demonstrate the physical and psychological effectiveness of a user-centered telerehabilitation program, consisting of a smartphone app and integrated sensors, for patients with NLBP. Methods: This was a single-center, prospective, randomized controlled trial for individuals with NLBP for a duration exceeding 3 months. All participants were assigned randomly to either the telerehabilitation-based exercise group (TBEG) or the outpatient-based exercise group (OBEG). All participants completed a 30-minute regimen of strength and stretching exercises 3 times per week, for a total of 8 weeks, and were required to complete assessment questionnaires at 0, 2, 4, and 8 weeks. The TBEG completed home-based exercises and questionnaires using a telerehabilitation program, while the OBEG completed them in outpatient rehabilitation. The Oswestry Disability Index (ODI) served as the primary outcome measure, assessing physical disability. Secondary outcomes included the Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire, and 36-item Short-Form Health Survey. Results: In total, 54 of 129 eligible patients were enrolled and randomly assigned to the study. The completion of all the interventions and assessments in the TBEG and OBEG was 89\% (24/27) and 81\% (22/27). The findings indicate that no statistical significance was found in the difference of ODI scores between the TBEG and the OBEG at 2 weeks (mean difference ?0.91; odds ratio [OR] 0.78, 95\% CI ?5.96 to 4.14; P=.72), 4 weeks (mean difference ?3.80; OR 1.33, 95\% CI ?9.86 to ?2.25; P=.21), and 8 weeks (mean difference ?3.24; OR 0.92, 95\% CI ?8.65 to 2.17; P=.24). The improvement of the ODI in the TBEG (mean ?16.42, SD 7.30) and OBEG (mean ?13.18, SD 8.48) was higher than 10 after an 8-week intervention. No statistically significant differences were observed between the 2 groups at the 8-week mark regarding the Fear-Avoidance Beliefs Questionnaire (mean difference 8.88; OR 1.04, 95\% CI ?2.29 to 20.06; P=.12) and Numeric Pain Rating Scale (mean difference ?0.39; OR 0.44, 95\% CI ?2.10 to 1.31; P=.64). In the subgroup analysis, there was no statistically significant difference in outcomes between the 2 groups. Conclusions: Telerehabilitation interventions demonstrate comparable therapeutic efficacy for individuals with NLBP when compared to conventional outpatient-based physical therapy, yielding comparable outcomes in pain reduction and improvement in functional limitations. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300068984; https://www.chictr.org.cn/showproj.html?proj=189852 ",
doi="10.2196/56580",
url="https://mhealth.jmir.org/2024/1/e56580"
}


@Article{info:doi/10.2196/59013,
author="Goeldner, Moritz
and Gehder, Sara",
title="Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="29",
volume="26",
pages="e59013",
keywords="digital health application",
keywords="DiGA",
keywords="data-driven analysis",
keywords="clinical evidence",
keywords="health economics",
keywords="positive care effect",
keywords="medical benefit",
keywords="patient-relevant structural and procedural improvements",
keywords="pSVV",
keywords="digital health care act",
abstract="Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut f{\"u}r Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately {\texteuro}200 to {\texteuro}700 ({\texteuro}1=US \$1.07), averaging at a median of {\texteuro}514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50\% reduction, settling at a median of {\texteuro}221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82\% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. ",
doi="10.2196/59013",
url="https://www.jmir.org/2024/1/e59013"
}


@Article{info:doi/10.2196/54193,
author="Bressler, Michael
and Merk, Joachim
and Gohlke, Tanja
and Kayali, Fares
and Daigeler, Adrien
and Kolbenschlag, Jonas
and Prahm, Cosima",
title="A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study",
journal="JMIR Serious Games",
year="2024",
month="Aug",
day="27",
volume="12",
pages="e54193",
keywords="video games",
keywords="virtual reality",
keywords="exercise therapy",
keywords="physical therapy",
keywords="hand rehabilitation",
keywords="finger rehabilitation",
abstract="Background: Restoring hand and finger function after a traumatic hand injury necessitates a regimen of consistent and conscientious exercise. However, motivation frequently wanes due to unchallenging repetitive tasks or discomfort, causing exercises to be performed carelessly or avoided completely. Introducing gamification to these repetitive tasks can make them more appealing to patients, ultimately increasing their motivation to exercise consistently. Objective: This study aims to iteratively develop a serious virtual reality game for hand and finger rehabilitation within an appealing and engaging digital environment, encouraging patient motivation for at least 2 weeks of continuous therapy. Methods: The development process comprised 3 distinct stages, each of which was subject to evaluation. Initially, a prototype was created to encompass the game's core functionalities, which was assessed by 18 healthy participants and 7 patients with impaired hand function. Subsequently, version 1 of the game was developed and evaluated with 20 patients who were divided into an investigation group and a control group. On the basis of these findings, version 2 was developed and evaluated with 20 patients who were divided into an investigation group and a control group. Motivation was assessed using the Intrinsic Motivation Inventory (IMI), while the application's quality was rated using the Mobile Application Rating Scale and the System Usability Scale. User feedback was gathered using semistructured interviews. Results: The prototype evaluation confirmed the acceptance and feasibility of the game design. Version 1 significantly increased motivation in 2 IMI subscales, effort (P<.001) and usefulness (P=.02). In version 2, a significant increase in daily performed exercises was achieved (P=.008) compared to version 1, with significantly higher motivation in the IMI subscale effort (P=.02). High Mobile Application Rating Scale scores were obtained for both versions 1 and 2, with version 2 scoring 86.9 on the System Usability Scale, indicating excellent acceptability. User feedback provided by the semistructured interviews was instrumental in the iterative development regarding improvements and the expansion of the playable content. Conclusions: This study presented a virtual reality serious game designed for hand and finger rehabilitation. The game was well received and provided an environment that effectively motivated the users. The iterative development process incorporated user feedback, confirming the game's ease of use and feasibility even for patients with severely limited hand function. ",
doi="10.2196/54193",
url="https://games.jmir.org/2024/1/e54193",
url="http://www.ncbi.nlm.nih.gov/pubmed/39190432"
}


@Article{info:doi/10.2196/54511,
author="Niyomyart, Atsadaporn
and Ruksakulpiwat, Suebsarn
and Benjasirisan, Chitchanok
and Phianhasin, Lalipat
and Nigussie, Kabtamu
and Thorngthip, Sutthinee
and Shamita, Gazi
and Thampakkul, Jai
and Begashaw, Lidya",
title="Current Status of Barriers to mHealth Access Among Patients With Stroke and Steps Toward the Digital Health Era: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="22",
volume="12",
pages="e54511",
keywords="digital health",
keywords="mHealth",
keywords="barrier",
keywords="stroke",
keywords="systematic review",
keywords="mobile phones",
abstract="Background: Mobile health (mHealth) offers significant benefits for patients with stroke, facilitating remote monitoring and personalized health care solutions beyond traditional settings. However, there is a dearth of comprehensive data, particularly qualitative insights, on the barriers to mHealth access. Understanding these barriers is crucial for devising strategies to enhance mHealth use among patients with stroke. Objective: This study aims to examine the recent literature focusing on barriers to mHealth access among patients with stroke. Methods: A systematic search of PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text was conducted for literature published between 2017 and 2023. Abstracts and full texts were independently screened based on predetermined inclusion and exclusion criteria. Data synthesis was performed using the convergent integrated analysis framework recommended by the Joanna Briggs Institute. Results: A total of 12 studies met the inclusion criteria. The majority were qualitative studies (about 42\%), followed by mixed methods (25\%), pilot studies (about 17\%), nonrandomized controlled trials (about 8\%), and observational studies (about 8\%). Participants included patients with stroke, caregivers, and various health care professionals. The most common mHealth practices were home-based telerehabilitation (30\%) and poststroke mHealth and telecare services (20\%). Identified barriers were categorized into two primary themes: (1) at the patient level and (2) at the health provider-patient-device interaction level. The first theme includes 2 subthemes: health-related issues and patient acceptability. The second theme encompassed 3 subthemes: infrastructure challenges (including software, networking, and hardware), support system deficiencies, and time constraints. Conclusions: This systematic review underscores significant barriers to mHealth adoption among patients with stroke. Addressing these barriers in future research is imperative to ensure that mHealth solutions effectively meet patients' needs. ",
doi="10.2196/54511",
url="https://mhealth.jmir.org/2024/1/e54511"
}


@Article{info:doi/10.2196/56969,
author="Goncalves Leite Rocco, Patricia
and Reategui-Rivera, Mahony C.
and Finkelstein, Joseph",
title="Telemedicine Applications for Cancer Rehabilitation: Scoping Review",
journal="JMIR Cancer",
year="2024",
month="Aug",
day="21",
volume="10",
pages="e56969",
keywords="telerehabilitation",
keywords="telemedicine",
keywords="rehabilitation",
keywords="cancer",
keywords="exercise",
keywords="physical therapy",
keywords="telehealth",
keywords="remote care",
keywords="digital medicine",
keywords="oncology",
keywords="oncologist",
keywords="metastases",
keywords="exercising",
keywords="scoping review",
keywords="scoping reviews",
keywords="PubMed",
abstract="Background: Cancer is a significant public health issue worldwide. Treatments such as surgery, chemotherapy, and radiation therapy often cause psychological and physiological side effects, affecting patients' ability to function and their quality of life (QoL). Physical activity is crucial to cancer rehabilitation, improving physical function and QoL and reducing cancer-related fatigue. However, many patients face barriers to accessing cancer rehabilitation due to socioeconomic factors, transportation issues, and time constraints. Telerehabilitation can potentially overcome these barriers by delivering rehabilitation remotely. Objective: The aim of the study is to identify how telemedicine is used for the rehabilitation of patients with cancer. Methods: This scoping review followed recognized frameworks. We conducted an electronic literature search on PubMed for studies published between January 2015 and May 2023. Inclusion criteria were studies reporting physical therapy telerehabilitation interventions for patients with cancer, including randomized and nonrandomized controlled trials, feasibility studies, and usability studies. In total, 21 studies met the criteria and were included in the final review. Results: Our search yielded 37 papers, with 21 included in the final review. Randomized controlled trials comprised 47\% (n=10) of the studies, with feasibility studies at 33\% (n=7) and usability studies at 19\% (n=4). Sample sizes were typically 50 or fewer participants in 57\% (n=12) of the reports. Participants were generally aged 65 years or younger (n=17, 81\%), with a balanced gender distribution. Organ-specific cancers were the focus of 66\% (n=14) of the papers, while 28\% (n=6) included patients who were in the posttreatment period. Web-based systems were the most used technology (n=13, 61\%), followed by phone call or SMS text messaging--based systems (n=9, 42\%) and mobile apps (n=5, 23\%). Exercise programs were mainly home based (n=19, 90\%) and included aerobic (n=19, 90\%), resistance (n=13, 61\%), and flexibility training (n=7, 33\%). Outcomes included improvements in functional capacity, cognitive functioning, and QoL (n=10, 47\%); reductions in pain and hospital length of stay; and enhancements in fatigue, physical and emotional well-being, and anxiety. Positive effects on feasibility (n=3, 14\%), acceptability (n=8, 38\%), and cost-effectiveness (n=2, 9\%) were also noted. Functional outcomes were frequently assessed (n=19, 71\%) with tools like the 6-minute walk test and grip strength tests. Conclusions: Telerehabilitation for patients with cancer is beneficial and feasible, with diverse approaches in study design, technologies, exercises, and outcomes. Future research should focus on developing standardized methodologies, incorporating objective measures, and exploring emerging technologies like virtual reality, wearable or noncontact sensors, and artificial intelligence to optimize telerehabilitation interventions. Addressing these areas can enhance clinical practice and improve outcomes for remote rehabilitation with patients. ",
doi="10.2196/56969",
url="https://cancer.jmir.org/2024/1/e56969",
url="http://www.ncbi.nlm.nih.gov/pubmed/39079103"
}


@Article{info:doi/10.2196/59755,
author="Widhalm, Klaus
and Maul, Lukas
and Durstberger, Sebastian
and Putz, Peter
and Leder-Berg, Sebastian
and Kainz, Hans
and Augat, Peter",
title="Efficacy of Real-Time Feedback Exercise Therapy in Patients Following Total Hip Arthroplasty: Protocol for a Pilot Cluster-Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="20",
volume="13",
pages="e59755",
keywords="hip replacement",
keywords="exercise therapy",
keywords="real-time feedback",
keywords="movement analysis",
abstract="Background: Osteoarthritis of the hip joint is an increasing functional and health-related problem. The most common surgical treatment is hip replacement to reduce pain and improve function. Rehabilitation after total hip arthroplasty (THA) is not regulated in Austria and mostly depends on the patient's own initiative and possibilities. Functional deficits, such as valgus thrust of the leg, functional Trendelenburg gait, or Duchenne limp, are characteristic symptoms before and, due to the performance learning effect prior to surgery, also after the operation. Addressing these deficits is possible through neuromuscular-focused exercise therapy. The efficacy of such therapy relies significantly on the quality of performance, the frequency of exercise, and the duration of engagement. Enhancing sustainability is achievable through increased motivation and real-time feedback (RTF) on exercise execution facilitated by digital feedback systems. Objective: This study will be performed to quantify the medium-term effectiveness of digital home exercise feedback systems on functional performance following THA. Methods: A clinical trial with a cluster-randomized, 2-arm, parallel-group design with an 8-week intervention phase and subsequent follow-ups at 3 and 6 months postsurgery will be conducted. Feedback during exercising will be provided through a blended-care program, combining a supervised group exercise program with a self-developed digital feedback system for home exercise. In total, 70 patients will be recruited for baseline. The primary outcome parameters will be the frontal knee range of motion, pelvic obliquity, and lateral trunk lean. Secondary outcomes will be the sum scores of patient-reported outcomes and relevant kinematic, kinetic, and spatiotemporal parameters. Results: The trial started in January 2024, and the first results are anticipated to be published by June 2025. RTF-supported home exercise is expected to improve exercise execution quality and therapeutic adherence compared to using paper instructions for excise guidance. Conclusions: The anticipated findings of this study aim to offer new insights into the effect of a blended-care program incorporating digital RTF on exercise therapy after unilateral THA, in addition to knowledge on the functional status 3 and 6 months postsurgery, for further improvement in the development of rehabilitation guidelines following THA. Trial Registration: ClinicalTrials.gov: NCT06161194; https://clinicaltrials.gov/study/NCT06161194 International Registered Report Identifier (IRRID): PRR1-10.2196/59755 ",
doi="10.2196/59755",
url="https://www.researchprotocols.org/2024/1/e59755"
}


@Article{info:doi/10.2196/51898,
author="Wolf, Anton Milan
and Sauerwald, Leon
and Kosmalla, Felix
and Daiber, Florian
and Kr{\"u}ger, Antonio
and Landgraeber, Stefan",
title="Implementation and Evaluation of a Gait Training Assistant for the Use of Crutches: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="16",
volume="11",
pages="e51898",
keywords="telerehabilitation",
keywords="orthopedics",
keywords="digital gait trainer",
keywords="orthopedic",
keywords="gait",
keywords="movement",
keywords="walk",
keywords="walking",
keywords="crutch",
keywords="crutches",
keywords="sensor",
keywords="sensors",
keywords="rehabilitation",
keywords="usability",
keywords="digital health",
keywords="physiotherapy",
keywords="physical therapy",
keywords="telehealth",
keywords="telemedicine",
keywords="eHealth",
keywords="virtual",
keywords="locomotor",
keywords="locomotion",
abstract="Background: Surgical procedures on the lower extremities often require weight-bearing on crutches as part of the rehabilitation process. Orthopedic elective procedures enable patients to learn the correct use of crutches in a controlled preoperative setting. Digital assistance systems can safely circumvent a shortage of skilled staff and any contact restrictions that may be necessary. Objective: The usability of a newly developed gait training assistant (GTA) for the use of crutches will be evaluated. An intervention group trained to use crutches by the digital trainer will be compared with a control group trained to use crutches conventionally by a physiotherapist. Methods: As part of the development and implementation of a novel GTA, 14 patients learned to walk with crutches by completing specific exercises while receiving live feedback. Their movements were detected by a depth sensor and evaluated in real time. Specific parameters (step length, synchronous movement, crutch angle, and crutch distance to the feet) were compared with a control group (n=14) trained to use crutches by physiotherapists. The intervention group was also assessed by a physiotherapist. At the end of the study, the patients completed questionnaires to evaluate the usability of the system (Brooke's System Usability Scale score) and patient satisfaction. Results: All patients trained by the novel GTA were able to use crutches correctly. The intervention group showed significantly better values for crutch angle (mean --6.3{\textdegree}, SD 3.5{\textdegree} vs mean --12.4{\textdegree}, SD 4.5{\textdegree}; P<.001) and crutch position (mean 3.3, SD 5.1 cm vs mean --8.5, SD 4.9 cm; P=.02). Both groups reported that they felt confident in the use of crutches, were able to follow the instructions, and enjoyed the training. Even though the majority (12/14, 86\%) preferred physical therapy over a purely digital approach, most participants enjoyed using the system (13/14, 93\%) and were interested in trying out other digital assistants (11/14, 79\%). The usability of the GTA was rated above average by the majority (9/14, 64\%) of the patients. Conclusions: The newly designed GTA is a safe method of teaching the use of crutches and is statistically superior to training by a physiotherapist. Even if patients prefer interaction with a physiotherapist over a purely digital approach, digital devices provide a safe and motivating opportunity to learn the essential locomotor skills for rehabilitation. ",
doi="10.2196/51898",
url="https://humanfactors.jmir.org/2024/1/e51898"
}


@Article{info:doi/10.2196/56189,
author="Barcheus, Ida-Maria
and Ranner, Maria
and M{\aa}nsson Lexell, Eva
and Jacobsson, Lars
and Larsson-Lund, Maria",
title="The Internet-Based Intervention Strategies for Empowering Activities in Everyday Life: Qualitative Study of Experiences of Clients With Stroke",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="15",
volume="8",
pages="e56189",
keywords="internet-based rehabilitation",
keywords="occupational therapy intervention",
keywords="rehabilitation",
keywords="self-management",
keywords="stroke",
keywords="active everyday life",
keywords="activity-based intervention",
abstract="Background: There is a need to enhance access to and support for self-management of activities in everyday life after a stroke. Internet-based solutions have the potential to contribute to this development. Consequently, an internet-based intervention called Strategies for Empowering Activities in Everyday Life (SEE) was developed. The intervention aims to assist clients in developing management strategies that promote a healthy distribution and balanced engagement in various activities performed in different places and with other people.?To further support the development and feasibility of this intervention, more knowledge is needed about clients' experiences during the intervention process. Objective: This study aims to explore and describe how clients with stroke experienced the SEE intervention process and whether participation in SEE influenced their experience of everyday life. Methods: Overall, 9 clients with stroke who received SEE participated in the study---4 (44\%) women and 5 (56\%) men aged 37 to 73 years. Qualitative interviews about experiences with SEE were conducted twice during the intervention process with each participant. The data were analyzed using the constant comparative method of grounded theory. Results: The participants' experiences with the intervention process of SEE formed the core category, conceptualized as The relevance of and readiness for entering a change process in activities of everyday life differ among clients, constituting of two main categories: (1) an eye-opener providing agency for a change process and (2) never beginning a change process in activities in everyday life. The results showed that the relevance of and readiness for SEE differed between the participants. The experiences of 78\% (7/9) of the participants reflected that the intervention process provided them with an agency to drive their own change process for activities in everyday life to promote health. Overall, 22\% (2/9) of the participants refrained from entering a change process during SEE as they did not recognize any need for changes in their activities. When SEE was relevant and adopted as expected, the participants described it as an eye-opener for how they can alter their health based on how they distribute and spend their time on various activities. Conclusions: SEE has the potential to support clients' development of self-management and to take an active role in influencing their engagement in activities in everyday life and health. This study identified necessary improvements in the educational program for professionals to enhance delivery and strengthen the therapeutic mechanisms of SEE for future research. To effectively implement internet-based interventions such as SEE, it is crucial to identify clients who express a need for self-management in activities and are ready to invest the effort required to adopt a change process. Furthermore, it is indicated that participants'?self-analysis?of their everyday activities empowers them to adopt new?self-management strategies, which can also benefit other interventions. ",
doi="10.2196/56189",
url="https://formative.jmir.org/2024/1/e56189"
}


@Article{info:doi/10.2196/52310,
author="Angonese, Giulia
and Buhl, Mareike
and Kuhlmann, Inka
and Kollmeier, Birger
and Hildebrandt, Andrea",
title="Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="12",
volume="11",
pages="e52310",
keywords="hearing loss",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="help seeking",
keywords="mobile study",
keywords="machine learning",
keywords="supervised classification",
keywords="feature importance",
keywords="profiling",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3\% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, na{\"i}ve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9\% (122/185) to 70.3\% (130/185) of cases, reaching 74.8\% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. ",
doi="10.2196/52310",
url="https://humanfactors.jmir.org/2024/1/e52310",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133539"
}


@Article{info:doi/10.2196/51878,
author="Wasilewski, B. Marina
and Vijayakumar, Abirami
and Szigeti, Zara
and Mayo, Amanda
and Desveaux, Laura
and Shaw, James
and Hitzig, L. Sander
and Simpson, Robert",
title="Patient and Provider Experiences With Compassionate Care in Virtual Physiatry: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="6",
volume="26",
pages="e51878",
keywords="compassionate care",
keywords="rehabilitation",
keywords="physiatry",
keywords="telemedicine",
keywords="burnout",
keywords="care",
keywords="qualitative study",
keywords="patient experience",
keywords="compassion",
keywords="compassionate",
keywords="patient centered",
keywords="virtual care",
keywords="communication",
keywords="health care delivery",
keywords="patient engagement",
keywords="physiatrist",
keywords="physiatrists",
keywords="Canada",
keywords="social media",
keywords="physical medicine",
keywords="technology",
keywords="communication technology",
keywords="ICT",
keywords="experience",
abstract="Background: Telemedicine in the realm of rehabilitation includes the remote delivery of rehabilitation services using communication technologies (eg, telephone, emails, and video). The widespread application of virtual care grants a suitable time to explore the intersection of compassion and telemedicine, especially due to the impact of COVID-19 and how it greatly influenced the delivery of health care universally. Objective: The purpose of this study was to explore how compassionate care is understood and experienced by physiatrists and patients engaged in telemedicine. Methods: We used a qualitative descriptive approach to conduct interviews with patients and physiatrists between June 2021 and March 2022. Patients were recruited across Canada from social media and from a single hospital network in Toronto, Ontario. Physiatrists were recruited across Canada through social media and the Canadian Association for Physical Medicine and Rehabilitation (CAPM\&R) email listserve. Interviews were recorded and transcribed. Data were analyzed thematically. Results: A total of 19 participants were interviewed---8 physiatrists and 11 patients. Two themes capturing physiatrists' and patients' experiences with delivering and receiving compassionate care, especially in the context of virtual care were identified: (1) compassionate care is inherently rooted in health care providers' inner intentions and are, therefore, expressed as caring behaviors and (2) virtual elements impact the delivery and receipt of compassionate care. Conclusions: Compassionate care stemmed from physiatrists' caring attitudes which then manifest as caring behaviors. In turn, these caring attitudes and behaviors enable individualized care and the establishment of a safe space for patients. Moreover, the virtual care modality both positively and negatively influenced how compassion is enacted by physiatrists and received by patients. Notably, there was large ambiguity around the norms and etiquette surrounding virtual care. Nonetheless, the flexibility and person-centeredness of virtual care cause it to be useful in health care settings. ",
doi="10.2196/51878",
url="https://www.jmir.org/2024/1/e51878",
url="http://www.ncbi.nlm.nih.gov/pubmed/39106094"
}


@Article{info:doi/10.2196/54599,
author="Johnson, K. Joshua
and Longhurst, K. Jason
and Gevertzman, Michael
and Jefferson, Corey
and Linder, M. Susan
and Bethoux, Francois
and Stilphen, Mary",
title="The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="31",
volume="8",
pages="e54599",
keywords="rehabilitation",
keywords="physical therapy",
keywords="PT",
keywords="physiotherapy",
keywords="telehealth",
keywords="Parkinson disease",
keywords="tele-rehabilitation",
keywords="telerehabilitation",
keywords="TR",
keywords="exercise",
keywords="physical activity",
keywords="exercise therapy",
keywords="tele-health",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="digital health",
keywords="smartphone",
keywords="smartphones",
keywords="Parkinson's disease",
keywords="Parkinson",
keywords="Parkinsons",
keywords="Parkinsonism",
keywords="PD",
abstract="Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5\%) met eligibility criteria, and 20 (29.4\% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non--study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as ``good'' or ``very good'' across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 ",
doi="10.2196/54599",
url="https://formative.jmir.org/2024/1/e54599"
}


@Article{info:doi/10.2196/56715,
author="Lowe, Cabella
and Sephton, Ruth
and Marsh, William
and Morrissey, Dylan",
title="Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="30",
volume="8",
pages="e56715",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="digital technology",
keywords="digital triage",
keywords="musculoskeletal",
keywords="triage",
keywords="physiotherapy triage",
keywords="validation",
keywords="acceptability",
keywords="physiotherapy",
keywords="primary care",
keywords="randomized controlled trial",
keywords="usability",
keywords="assess",
keywords="assessment",
keywords="triaging",
keywords="referrals",
keywords="crossover",
abstract="Background: Musculoskeletal conditions account for 16\% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation. Such innovations are rarely rigorously tested in clinical trials---considered the gold standard for evaluating safety and efficacy. This pilot study is a precursor to a trial assessing DART performance with a physiotherapist-led triage assessment. Objective: The study aims to evaluate trial design, assess procedures, and collect exploratory data to establish the feasibility of delivering an adequately powered, definitive randomized trial, assessing DART safety and efficacy in an NHS primary care setting. Methods: A crossover, noninferiority pilot trial using an integrated knowledge translation approach within a National Health Service England primary care setting. Participants were patients seeking assessment for a musculoskeletal condition, completing a DART assessment and the history-taking element of a face-to-face physiotherapist-led triage in a randomized order. The primary outcome was agreement between DART and physiotherapist triage recommendation. Data allowed analysis of participant recruitment and retention, randomization, blinding, study burden, and potential barriers to intervention delivery. Participant satisfaction was measured using the System Usability Scale. Results: Over 8 weeks, 129 patients were invited to participate. Of these, 92\% (119/129) proceeded to eligibility assessment, with 60\% (78/129) meeting the inclusion criteria and being randomized into each intervention arm (39/39). There were no dropouts and data were analyzed for all 78 participants. Agreement between physiotherapist and DART across all participants and all primary triage outcomes was 41\% (32/78; 95\% CI 22-45), intraclass correlation coefficient 0.37 (95\% CI 0.16-0.55), indicating that the reliability of DART was poor to moderate. Feedback from the clinical service team led to an adjusted analysis yielding of 78\% (61/78; 95\% CI 47-78) and an intraclass correlation coefficient of 0.57 (95\% CI 0.40-0.70). Participant satisfaction was measured quantitively using amalgamated System Usability Scale scores (n=78; mean score 84.0; 90\% CI +2.94 to --2.94), equating to an ``excellent'' system. There were no study incidents, and the trial burden was acceptable. Conclusions: Physiotherapist-DART agreement of 78\%, with no adverse triage decisions and high patient satisfaction, was sufficient to conclude DART had the potential to improve the musculoskeletal pathway. Study validity was enhanced by the recruitment of real-world patients and using an integrated knowledge translation approach. Completion of a context-specific consensus process is recommended to provide definitive definitions of safety criteria, range of appropriateness, noninferiority margin, and sample size. This pilot demonstrated an adequately powered definitive trial is feasible, which would provide evidence of DART safety and efficacy, ultimately informing potential for DART implementation. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): RR2-10.2196/31541 ",
doi="10.2196/56715",
url="https://formative.jmir.org/2024/1/e56715",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078682"
}


@Article{info:doi/10.2196/55421,
author="Cruz-Cobo, Celia
and Bernal-Jim{\'e}nez, {\'A}ngeles Mar{\'i}a
and Calle, Germ{\'a}n
and Gheorghe, Luciana Livia
and Guti{\'e}rrez-Barrios, Alejandro
and Ca{\~n}adas, Dolores
and Tur, A. Josep
and V{\'a}zquez-Garc{\'i}a, Rafael
and Santi-Cano, Jos{\'e} Mar{\'i}a",
title="Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="25",
volume="12",
pages="e55421",
keywords="coronary event",
keywords="coronary heart disease",
keywords="eHealth",
keywords="lifestyle",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Cardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format. Objective: This study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome. Methods: A randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability. Results: The study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0\%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P<.001) and frequency of eating foods (red meat [?1/week]: 141/143, 97.9\% vs 96/141, 68.1\%; industrial pastries [<2/week]: 129/143, 89.6\% vs 80/141, 56.8\%; oily fish [?2/week]: 124/143, 86.1\% vs 64/141, 41.4\%; vegetables [?2/day]: 130/143, 90.3\% vs 78/141, 55.3\%; fruit [?2/day]: 128/143, 88.9\% vs 85/141, 60.2\%; all P<.001); (2) physical activity (mean 2112.66, SD 1196.67 vs 1372.60, SD 944.62 metabolic equivalents/week; P<.001) and sedentary time (mean 8.38, SD 1.88 vs 9.59, SD 2.09 hours; P<.001); (3) exercise capacity (distance: mean 473.49, SD 102.28 vs 447.25, SD 93.68 meters; P=.04); and (4) level of knowledge (mean 117.85, SD 3.83 vs 111.00, SD 7.11 points; P<.001). App satisfaction was high (mean 42.53, SD 6.38 points), and its usability was excellent (mean 95.60, SD 4.03 points). Conclusions: With the eMOTIVA app, favorable results were obtained in the intervention group in terms of adherence to the Mediterranean diet, frequency of eating certain foods, physical activity, sedentary time, exercise capacity, knowledge level, systolic blood pressure, heart rate, and blood sugar level. Furthermore, participants reported high app satisfaction and rated its usability as excellent. Thus, this innovative tool is very promising. Trial Registration: ClinicalTrials.gov NCT05247606; https://clinicaltrials.gov/study/NCT05247606 ",
doi="10.2196/55421",
url="https://mhealth.jmir.org/2024/1/e55421"
}


@Article{info:doi/10.2196/55716,
author="Marcuzzi, Anna
and Klevanger, Elisabeth Nina
and Aasdahl, Lene
and Gismervik, Sigmund
and Bach, Kerstin
and Mork, Jarle Paul
and Nordstoga, Lovise Anne",
title="An Artificial Intelligence--Based App for Self-Management of Low Back and Neck Pain in Specialist Care: Process Evaluation From a Randomized Clinical Trial",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="9",
volume="11",
pages="e55716",
keywords="low back pain",
keywords="neck pain",
keywords="self-management",
keywords="smartphone app",
keywords="process evaluation",
keywords="focus group",
keywords="focus groups",
keywords="musculoskeletal",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="usage",
keywords="interview",
keywords="interviews",
keywords="qualitative",
keywords="engagement",
abstract="Background: Self-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence--based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. Objective: This study is a process evaluation aiming to explore patients' engagement and experiences with the selfBACK app and specialist health care practitioners' views on adopting digital self-management tools in their clinical practice. Methods: App usage analytics in the first 12 weeks were used to explore patients' engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. Results: Nearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. Conclusions: Although the app's uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. Trial Registration: ClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043 ",
doi="10.2196/55716",
url="https://humanfactors.jmir.org/2024/1/e55716",
url="http://www.ncbi.nlm.nih.gov/pubmed/38980710"
}


@Article{info:doi/10.2196/58491,
author="Lu, Linken
and Lu, Tangsheng
and Tian, Chunyu
and Zhang, Xiujun",
title="AI: Bridging Ancient Wisdom and Modern Innovation in Traditional Chinese Medicine",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="28",
volume="12",
pages="e58491",
keywords="traditional Chinese medicine",
keywords="TCM",
keywords="artificial intelligence",
keywords="AI",
keywords="diagnosis",
doi="10.2196/58491",
url="https://medinform.jmir.org/2024/1/e58491",
url="http://www.ncbi.nlm.nih.gov/pubmed/38941141"
}


@Article{info:doi/10.2196/57404,
author="Bass, Alec
and G{\'e}phine, Sarah
and Martin, Micka{\"e}l
and Belley, Marianne
and Robic, Manon
and Fabre, Claudine
and Grosbois, Jean-Marie
and Dion, Genevi{\`e}ve
and Saey, Didier
and Chambellan, Arnaud
and Maltais, Fran{\c{c}}ois",
title="Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="28",
volume="13",
pages="e57404",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="exercise capacity test",
keywords="interstitial lung diseases",
keywords="physiotherapy",
keywords="rehabilitation",
keywords="telerehabilitation",
keywords="validation study",
keywords="stepper test",
abstract="Background: Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases. Unfortunately, access to timely and appropriate rehabilitation remains limited. To help close this inaccessibility gap, telerehabilitation has been proposed. However, exercise testing is necessary for effective and safe exercise prescription. Current gold-standard tests, such as maximal cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT), are poorly adapted to home-based or telerehabilitation settings. This was an obstacle to the continuity of services during the COVID-19 pandemic. It is essential to validate tests adapted to these new realities, such as the 6-minute stepper test (6MST). This test, strongly inspired by 6MWT, consists of taking as many steps as possible on a ``stepper'' for 6 minutes. Objective: This study aims to evaluate the metrological qualities of 6MST by (1) establishing concurrent validity and agreement between the 6MST and CPET, as well as with the 6MWT; (2) determining test-retest reliability in a home-based setting with direct and remote (videoconferencing) monitoring; and (3) documenting adverse events and participant perspectives when performing the 6MST in home-based settings. Methods: Three centers (Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Qu{\'e}bec in Qu{\'e}bec, Groupement des H{\^o}pitaux de l'Institut Catholique de Lille in France, and FormAction Sant{\'e} in France) will be involved in this multinational project, which is divided into 2 studies. For study 1 (objective 1), 30 participants (Qu{\'e}bec, n=15; France, n=15) will be recruited. Two laboratory visits will be performed to assess anthropometric data, pulmonary function, and the 3 exercise tolerance tests (CPET, 6MWT, and 6MST). Concurrent validity (paired sample t tests and Pearson correlations) and agreement (Bland-Altman plots with 95\% agreement limits) will be evaluated. For study 2 (objectives 2 and 3), 52 participants (Qu{\'e}bec, n=26; France, n=26) will be recruited. Following a familiarization trial (trial 1), the 6MST will be conducted on 2 separate occasions (trials 2 and 3), once under direct supervision and once under remote supervision, in a randomized order. Paired sample t test, Bland-Altman plots, and intraclass correlations will be used to compare trials 2 and 3. A semistructured interview will be conducted after the third trial to collect participants' perspectives. Results: Ethical approval was received for this project (October 12, 2023, in Qu{\'e}bec and September 25, 2023, in France) and the first participant was recruited in February 2024. Conclusions: This study innovates by validating a new clinical test necessary for the development and implementation of new models of rehabilitation adapted to home and telerehabilitation contexts. This study also aligns with the United Nations Sustainable Development Goals by contributing to augmenting health care service delivery (goal 3) and reducing health care access inequalities (goal 11). Trial Registration: ClinicalTrials.gov NCT06447831; https://clinicaltrials.gov/study/NCT06447831 International Registered Report Identifier (IRRID): DERR1-10.2196/57404 ",
doi="10.2196/57404",
url="https://www.researchprotocols.org/2024/1/e57404",
url="http://www.ncbi.nlm.nih.gov/pubmed/38941132"
}


@Article{info:doi/10.2196/49482,
author="Pliannuom, Suphawita
and Pinyopornpanish, Kanokporn
and Buawangpong, Nida
and Wiwatkunupakarn, Nutchar
and Mallinson, Carson Poppy Alice
and Jiraporncharoen, Wichuda
and Angkurawaranon, Chaisiri",
title="Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="12",
volume="26",
pages="e49482",
keywords="home-based intervention",
keywords="digital health interventions",
keywords="postoperative care",
keywords="older adults",
keywords="hip fracture",
abstract="Background: Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. Objective: This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. Methods: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95\% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results: Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=--7.89; 95\% CI --10.34 to --5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95\% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95\% CI 5.73-10.24; P<.001). Conclusions: Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population. ",
doi="10.2196/49482",
url="https://www.jmir.org/2024/1/e49482",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865706"
}


@Article{info:doi/10.2196/52726,
author="Berrigan, T. Margaret
and Beaulieu-Jones, R. Brendin
and Baines, Rachel
and Berkowitz, Seth
and Evans, Heather
and Brat, A. Gabriel",
title="Barriers to Postdischarge Smartphone App Use Among Patients With Traumatic Rib Fractures",
journal="JMIR Form Res",
year="2024",
month="May",
day="31",
volume="8",
pages="e52726",
keywords="mobile health",
keywords="smartphone app",
keywords="electronic health record",
keywords="postdischarge monitoring",
keywords="implementation science",
keywords="mHealth",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="digital health",
keywords="smartphone",
keywords="smartphones",
keywords="mobile phone",
doi="10.2196/52726",
url="https://formative.jmir.org/2024/1/e52726",
url="http://www.ncbi.nlm.nih.gov/pubmed/38820574"
}


@Article{info:doi/10.2196/52309,
author="Dalko, Katharina
and Elsuson, Andri Hlynur
and Kalter, Ivonne
and Zilezinski, Max
and Hofstetter, Sebastian
and Stoevesandt, Dietrich
and Paulicke, Denny
and Jahn, Patrick",
title="Virtual Reality Applications for the Implementation of Domestic Respiratory Rehabilitation Programs for Patients With Long COVID and Post-COVID Condition: Scoping Review",
journal="JMIR Serious Games",
year="2024",
month="May",
day="31",
volume="12",
pages="e52309",
keywords="long COVID",
keywords="post-COVID",
keywords="rehabilitation",
keywords="virtual reality",
keywords="implementation",
keywords="respiratory",
keywords="respiratory rehabilitation",
keywords="scoping review",
keywords="development",
keywords="accessibility",
keywords="support",
keywords="physical",
keywords="psychological",
keywords="motivation",
keywords="compliance",
keywords="usability",
keywords="COVID-19",
keywords="COVID",
abstract="Background: Due to a high number of patients affected by long COVID or post-COVID condition, an essential step to address the long-term effects of COVID-19 lies in the development and implementation of flexible and accessible rehabilitation programs. Virtual reality (VR) technologies offer the potential to support traditional therapies with individualized at-home programs. Objective: This study aims to provide an overview of existing scientific evidence on the development and implementation of VR-assisted respiratory rehabilitation programs for patients with long COVID and post-COVID condition and to synthesize the results. Methods: We conducted a scoping review of studies from 6 databases. PubMed, CINAHL, Cochrane, ScienceDirect, Web of Science Social Sciences Citation Index, and PEDro were searched using an exploratory search strategy. The search, which was last updated in February 2024, included peer-reviewed studies on immersive VR applications providing respiratory rehabilitation programs for patients with chronic obstructive pulmonary disease and long COVID or post-COVID condition. Exclusion criteria were studies in clinical or inpatient settings, telemedicine, nonimmersive VR applications, and gray literature. Nine publications were included in this review. Findings were extracted and summarized from the studies according to the JBI (Joanna Briggs Institute) method and thematically categorized. Topics covered were study characteristics, physiotherapeutic concept, clinical parameters, as well as usability and acceptability. Results: The 9 publications included in the qualitative analysis were published in 2019-2023. Eight empirical studies were included: 4 followed a mixed methods design, 3 were qualitative studies, and 1 followed a quantitative method. One scoping review was included in the data analyses. Four of the included studies were on patients with chronic obstructive pulmonary disease. The 9 studies demonstrated that VR-supported respiratory rehabilitation programs result in positive initial outcomes in terms of physical as well as psychological parameters. Particularly noteworthy was the increased motivation and compliance of patients. However, adverse effects and lack of usability are the barriers to the implementation of this innovative approach. Conclusions: Overall, VR is a promising technology for the implementation of individualized and flexible respiratory rehabilitation programs for patients with long COVID and post-COVID condition. Nevertheless, corresponding approaches are still under development and need to be more closely adapted to the needs of users. Further, the evidence was limited to pilot studies or a small number of patients, and no randomized controlled trials or long-term studies were part of the study selection. The included studies were performed by 4 groups of researchers: 3 from Europe and 1 from the United States. ",
doi="10.2196/52309",
url="https://games.jmir.org/2024/1/e52309",
url="http://www.ncbi.nlm.nih.gov/pubmed/38819890"
}


@Article{info:doi/10.2196/46067,
author="Evans, Stuart",
title="Sacroiliac Joint Dysfunction in Endurance Runners Using Wearable Technology as a Clinical Monitoring Tool: Systematic Review",
journal="JMIR Biomed Eng",
year="2024",
month="May",
day="20",
volume="9",
pages="e46067",
keywords="sacroiliac",
keywords="sacroiliac dysfunction",
keywords="sacroiliac wearables",
keywords="sensors",
keywords="injury management",
abstract="Background: In recent years, researchers have delved into the relationship between the anatomy and biomechanics of sacroiliac joint (SIJ) pain and dysfunction in endurance runners to elucidate the connection between lower back pain and the SIJ. However, the majority of SIJ pain and dysfunction cases are diagnosed and managed through a traditional athlete-clinician arrangement, where the athlete must attend regular in-person clinical appointments with various allied health professionals. Wearable sensors (wearables) are increasingly serving as a clinical diagnostic tool to monitor an athlete's day-to-day activities remotely, thus eliminating the necessity for in-person appointments. Nevertheless, the extent to which wearables are used in a remote setting to manage SIJ dysfunction in endurance runners remains uncertain. Objective: This study aims to conduct a systematic review of the literature to enhance our understanding regarding the use of wearables in both in-person and remote settings for biomechanical-based rehabilitation in SIJ dysfunction among endurance runners. In addressing this issue, the overarching goal was to explore how wearables can contribute to the clinical diagnosis (before, during, and after) of SIJ dysfunction. Methods: Three online databases, including PubMed, Scopus, and Google Scholar, were searched using various combinations of keywords. Initially, a total of 4097 articles were identified. After removing duplicates and screening articles based on inclusion and exclusion criteria, 45 articles were analyzed. Subsequently, 21 articles were included in this study. The quality of the investigation was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) evidence-based minimum set of items for reporting in systematic reviews. Results: Among the 21 studies included in this review, more than half of the investigations were literature reviews focusing on wearable sensors in the diagnosis and treatment of SIJ pain, wearable movement sensors for rehabilitation, or a combination of both for SIJ gait analysis in an intelligent health care setting. As many as 4 (19\%) studies were case reports, and only 1 study could be classified as fully experimental. One paper was classified as being at the ``pre'' stage of SIJ dysfunction, while 6 (29\%) were identified as being at the ``at'' stage of classification. Significantly fewer studies attempted to capture or classify actual SIJ injuries, and no study directly addressed the injury recovery stage. Conclusions: SIJ dysfunction remains underdiagnosed and undertreated in endurance runners. Moreover, there is a lack of clear diagnostic or treatment pathways using wearables remotely, despite the availability of validated technology. Further research of higher quality is recommended to investigate SIJ dysfunction in endurance runners and explore the use of wearables for rehabilitation in remote settings. ",
doi="10.2196/46067",
url="https://biomedeng.jmir.org/2024/1/e46067",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875697"
}


@Article{info:doi/10.2196/50430,
author="Papadopoulos, Petros
and Soflano, Mario
and Connolly, Thomas",
title="A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="14",
volume="11",
pages="e50430",
keywords="mobile health",
keywords="mHealth",
keywords="digital health intervention",
keywords="total knee replacement",
keywords="TKR",
keywords="total hip replacement",
keywords="THR",
keywords="dynamic hip screw",
keywords="DHS",
keywords="rehabilitation",
keywords="usability",
keywords="mobile phone",
abstract="Background: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. Objective: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. Methods: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. Results: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range ?3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. Conclusions: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw. ",
doi="10.2196/50430",
url="https://humanfactors.jmir.org/2024/1/e50430",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743479"
}


@Article{info:doi/10.2196/44948,
author="Wolff, Christian
and Steinheimer, Patrick
and Warmerdam, Elke
and Dahmen, Tim
and Slusallek, Philipp
and Schlinkmann, Christian
and Chen, Fei
and Orth, Marcel
and Pohlemann, Tim
and Ganse, Bergita",
title="Characteristic Changes of the Stance-Phase Plantar Pressure Curve When Walking Uphill and Downhill: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="8",
volume="26",
pages="e44948",
keywords="podiatry",
keywords="podiatric medicine",
keywords="movement analysis",
keywords="ground reaction forces",
keywords="wearables",
keywords="slope",
keywords="gait analysis",
keywords="monitoring",
keywords="gait",
keywords="rehabilitation",
keywords="treatment",
keywords="sensor",
keywords="injury",
keywords="postoperative treatment",
keywords="sensors",
keywords="personalized medicine",
keywords="movement",
keywords="digital health",
keywords="pedography",
keywords="baropedography",
abstract="Background: Monitoring of gait patterns by insoles is popular to study behavior and activity in the daily life of people and throughout the rehabilitation process of patients. Live data analyses may improve personalized prevention and treatment regimens, as well as rehabilitation. The M-shaped plantar pressure curve during the stance phase is mainly defined by the loading and unloading slope, 2 maxima, 1 minimum, as well as the force during defined periods. When monitoring gait continuously, walking uphill or downhill could affect this curve in characteristic ways. Objective: For walking on a slope, typical changes in the stance phase curve measured by insoles were hypothesized. Methods: In total, 40 healthy participants of both sexes were fitted with individually calibrated insoles with 16 pressure sensors each and a recording frequency of 100 Hz. Participants walked on a treadmill at 4 km/h for 1 minute in each of the following slopes: ?20\%, ?15\%, ?10\%, ?5\%, 0\%, 5\%, 10\%, 15\%, and 20\%. Raw data were exported for analyses. A custom-developed data platform was used for data processing and parameter calculation, including step detection, data transformation, and normalization for time by natural cubic spline interpolation and force (proportion of body weight). To identify the time-axis positions of the desired maxima and minimum among the available extremum candidates in each step, a Gaussian filter was applied ($\sigma$=3, kernel size 7). Inconclusive extremum candidates were further processed by screening for time plausibility, maximum or minimum pool filtering, and monotony. Several parameters that describe the curve trajectory were computed for each step. The normal distribution of data was tested by the Kolmogorov-Smirnov and Shapiro-Wilk tests. Results: Data were normally distributed. An analysis of variance with the gait parameters as dependent and slope as independent variables revealed significant changes related to the slope for the following parameters of the stance phase curve: the mean force during loading and unloading, the 2 maxima and the minimum, as well as the loading and unloading slope (all P<.001). A simultaneous increase in the loading slope, the first maximum and the mean loading force combined with a decrease in the mean unloading force, the second maximum, and the unloading slope is characteristic for downhill walking. The opposite represents uphill walking. The minimum had its peak at horizontal walking and values dropped when walking uphill and downhill alike. It is therefore not a suitable parameter to distinguish between uphill and downhill walking. Conclusions: While patient-related factors, such as anthropometrics, injury, or disease shape the stance phase curve on a longer-term scale, walking on slopes leads to temporary and characteristic short-term changes in the curve trajectory. ",
doi="10.2196/44948",
url="https://www.jmir.org/2024/1/e44948",
url="http://www.ncbi.nlm.nih.gov/pubmed/38718385"
}


@Article{info:doi/10.2196/52312,
author="Danielsson, Lyng Marius
and Vergeer, Melanie
and Plasqui, Guy
and Baumgart, Kathrin Julia",
title="Accuracy of the Apple Watch Series 4 and Fitbit Versa for Assessing Energy Expenditure and Heart Rate of Wheelchair Users During Treadmill Wheelchair Propulsion: Cross-sectional Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="7",
volume="8",
pages="e52312",
keywords="agreement",
keywords="validity",
keywords="accuracy",
keywords="cross sectional",
keywords="physiology",
keywords="disability",
keywords="disabled",
keywords="upper-body exercise",
keywords="upper body",
keywords="exercise",
keywords="physical activity",
keywords="ergospirometer",
keywords="fitness",
keywords="vital",
keywords="vitals",
keywords="energy",
keywords="expenditure",
keywords="mHealth",
keywords="wearable",
keywords="wearables",
keywords="mobile health",
keywords="smartwatch",
keywords="smartwatches",
keywords="apple watch",
keywords="fitbit",
keywords="digital health",
keywords="energy expenditure",
keywords="heart rate",
keywords="wheelchair",
keywords="wheelchairs",
keywords="fitness trackers",
keywords="tracker",
keywords="trackers",
abstract="Background: The Apple Watch (AW) Series 1 provides energy expenditure (EE) for wheelchair users but was found to be inaccurate with an error of approximately 30\%, and the corresponding error for heart rate (HR) provided by the Fitbit Charge 2 was approximately 10\% to 20\%. Improved accuracy of estimated EE and HR is expected with newer editions of these smart watches (SWs). Objective: This study aims to assess the accuracy of the AW Series 4 (wheelchair-specific setting) and the Fitbit Versa (treadmill running mode) for estimating EE and HR during wheelchair propulsion at different intensities. Methods: Data from 20 manual wheelchair users (male: n=11, female: n=9; body mass: mean 75, SD 19 kg) and 20 people without a disability (male: n=11, female: n=9; body mass: mean 75, SD 11 kg) were included. Three 4-minute wheelchair propulsion stages at increasing speed were performed on 3 separate test days (0.5\%, 2.5\%, or 5\% incline), while EE and HR were collected by criterion devices and the AW or Fitbit. The mean absolute percentage error (MAPE) was used to indicate the absolute agreement between the criterion device and SWs for EE and HR. Additionally, linear mixed model analyses assessed the effect of exercise intensity, sex, and group on the SW error. Interclass correlation coefficients were used to assess relative agreement between criterion devices and SWs. Results: The AW underestimated EE with MAPEs of 29.2\% (SD 22\%) in wheelchair users and 30\% (SD 12\%) in people without a disability. The Fitbit overestimated EE with MAPEs of 73.9\% (SD 7\%) in wheelchair users and 44.7\% (SD 38\%) in people without a disability. Both SWs underestimated HR. The device error for EE and HR increased with intensity for both SWs (all comparisons: P<.001), and the only significant difference between groups was found for HR in the AW (--5.27 beats/min for wheelchair users; P=.02). There was a significant effect of sex on the estimation error in EE, with worse accuracy for the AW (--0.69 kcal/min; P<.001) and better accuracy for the Fitbit (--2.08 kcal/min; P<.001) in female participants. For HR, sex differences were found only for the AW, with a smaller error in female participants (5.23 beats/min; P=.02). Interclass correlation coefficients showed poor to moderate relative agreement for both SWs apart from 2 stage-incline combinations (AW: 0.12-0.57 for EE and 0.11-0.86 for HR; Fitbit: 0.06-0.85 for EE and 0.03-0.29 for HR). Conclusions: Neither the AW nor Fitbit were sufficiently accurate for estimating EE or HR during wheelchair propulsion. The AW underestimated EE and the Fitbit overestimated EE, and both SWs underestimated HR. Caution is hence required when using SWs as a tool for training intensity regulation and energy balance or imbalance in wheelchair users. ",
doi="10.2196/52312",
url="https://formative.jmir.org/2024/1/e52312",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713497"
}


@Article{info:doi/10.2196/55452,
author="de Graaf, Debbie
and de Vries, M. Nienke
and van de Zande, Tessa
and Schimmel, P. Janneke J.
and Shin, Sooyoon
and Kowahl, Nathan
and Barman, Poulami
and Kapur, Ritu
and Marks Jr, J. William
and van 't Hul, Alex
and Bloem, R. Bastiaan",
title="Measuring Physical Functioning Using Wearable Sensors in Parkinson Disease and Chronic Obstructive Pulmonary Disease (the Accuracy of Digital Assessment of Performance Trial Study): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="7",
volume="13",
pages="e55452",
keywords="Parkinson disease",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="physical activity",
keywords="physical capacity",
keywords="wearable devices",
keywords="walking",
keywords="exercise",
keywords="locomotion",
keywords="home-based",
keywords="wearable",
keywords="wearables",
keywords="wearable sensor",
keywords="dementia",
keywords="smartwatch",
keywords="StepWatch",
keywords="treatment",
abstract="Background: Physical capacity and physical activity are important aspects of physical functioning and quality of life in people with a chronic disease such as Parkinson disease (PD) or chronic obstructive pulmonary disease (COPD). Both physical capacity and physical activity are currently measured in the clinic using standardized questionnaires and tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go test (TUG). However, relying only on in-clinic tests is suboptimal since they offer limited information on how a person functions in daily life and how functioning fluctuates throughout the day. Wearable sensor technology may offer a solution that enables us to better understand true physical functioning in daily life. Objective: We aim to study whether device-assisted versions of 6MWT and TUG, such that the tests can be performed independently at home using a smartwatch, is a valid and reliable way to measure the performance compared to a supervised, in-clinic test. Methods: This is a decentralized, prospective, observational study including 100 people with PD and 100 with COPD. The inclusion criteria are broad: age ?18 years, able to walk independently, and no co-occurrence of PD and COPD. Participants are followed for 15 weeks with 4 in-clinic visits, once every 5 weeks. Outcomes include several walking tests, cognitive tests, and disease-specific questionnaires accompanied by data collection using wearable devices (the Verily Study Watch and Modus StepWatch). Additionally, during the last 10 weeks of this study, participants will follow an aerobic exercise training program aiming to increase physical capacity, creating the opportunity to study the responsiveness of the remote 6MWT. Results: In total, 89 people with PD and 65 people with COPD were included in this study. Data analysis will start in April 2024. Conclusions: The results of this study will provide information on the measurement properties of the device-assisted 6MWT and TUG in the clinic and at home. When reliable and valid, this can contribute to a better understanding of a person's physical capacity in real life, which makes it possible to personalize treatment options. Trial Registration: ClinicalTrials.gov NCT05756075; https://clinicaltrials.gov/study/NCT05756075 International Registered Report Identifier (IRRID): DERR1-10.2196/55452 ",
doi="10.2196/55452",
url="https://www.researchprotocols.org/2024/1/e55452",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713508"
}


@Article{info:doi/10.2196/53186,
author="Ren, Sicong
and McDonald, C. Catherine
and Corwin, J. Daniel
and Wiebe, J. Douglas
and Master, L. Christina
and Arbogast, B. Kristy",
title="Response Rate Patterns in Adolescents With Concussion Using Mobile Health and Remote Patient Monitoring: Observational Study",
journal="JMIR Pediatr Parent",
year="2024",
month="May",
day="6",
volume="7",
pages="e53186",
keywords="concussion",
keywords="mHealth",
keywords="response rate",
keywords="adolescents",
keywords="reporting behavior",
keywords="remote monitoring",
keywords="engagement",
keywords="monitoring",
keywords="adolescent",
keywords="teen",
keywords="youth",
keywords="remote patient monitoring",
keywords="mobile health",
keywords="injury",
keywords="neurobiological",
keywords="neurobiological development",
keywords="quality of life",
keywords="academic",
keywords="academic performance",
keywords="mHealth engagement",
keywords="tertiary care",
abstract="Background: A concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been shown to be promising in health maintenance. However, there is limited evidence about mHealth engagement in adolescents with a concussion during their recovery course. Objective: This study aims to determine the response rate and response rate patterns in concussed adolescents reporting their daily symptoms through mHealth technology. It will also examine the effect of time-, demographic-, and injury-related characteristics on response rate patterns. Methods: Participants aged between 11-18 years (median days since injury at enrollment: 11 days) were recruited from the concussion program of a tertiary care academic medical center and a suburban school's athletic teams. They were asked to report their daily symptoms using a mobile app. Participants were prompted to complete the Post-Concussion Symptom Inventory (PCSI) 3 times (ie, morning, afternoon, and evening) per day for 4 weeks following enrollment. The primary outcome was the response rate pattern over time (by day since initial app use and the day since injury). Time-, demographic-, and injury-related differences in reporting behaviors were compared using Mann Whitney U tests. Results: A total of 56 participants were enrolled (mean age 15.3, SD 1.9 years; n=32, 57\% female). The median response rate across all days of app use in the evening was 37.0\% (IQR 27.2\%-46.4\%), which was significantly higher than the morning (21.2\%, IQR 15.6\%-30.5\%) or afternoon (26.4\%, IQR 21.1\%-31.5\%; P<.001). The median daily response was significantly different by sex (female: 53.8\%, IQR 46.2\%-64.2\% vs male: 42.0\%, IQR 28.6\%-51.1\%; P=.003), days since injury to app use (participants starting to use the app >7 days since injury: 54.1\%, IQR 47.4\%-62.2\% vs starting to use the app ?7 days since injury: 38.0\%, IQR 26.0\%-53.3\%; P=.002), and concussion history (participants with a history of at least one prior concussion: 57.4\%, IQR 44.5\%-70.5\% vs participants without concussion history: 42.3\%, IQR 36.8\%-53.5\%; P=.03). There were no significant differences by age. Differences by injury mechanism (sports- and recreation-related injury: 39.6\%, IQR 36.1\%-50.4\% vs non--sports- or recreation-related injury: 30.6\%, IQR 20.0\%-42.9\%; P=.04) and initial symptom burden (PCSI scores greater than the median score of 47: 40.9\%, IQR 35.2\%-53.8\% vs PCSI scores less than or equal to the median score: 31.9\%, IQR 24.6\%-40.6\%; P=.04) were evident in the evening response rates; however, daily rates were not statistically different. Conclusions: Evening may be the optimal time to prompt for daily concussion symptom assessment among concussed adolescents compared with morning or afternoon. Multiple demographic- and injury-related characteristics were associated with higher daily response rates, including for female participants, those with more than 1 week from injury to beginning mHealth monitoring, and those with a history of at least one previous concussion. Future studies may consider incentive strategies or adaptive digital concussion assessments to increase response rates in populations with low engagement. ",
doi="10.2196/53186",
url="https://pediatrics.jmir.org/2024/1/e53186"
}


@Article{info:doi/10.2196/53798,
author="Zhu, Dian
and Zhao, Jianan
and Wang, Mingxuan
and Cao, Bochen
and Zhang, Wenhui
and Li, Yunlong
and Zhang, Chenqi
and Han, Ting",
title="Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="May",
day="2",
volume="12",
pages="e53798",
keywords="knee osteoarthritis",
keywords="digital application",
keywords="behavioral therapy",
keywords="behavior change therapy",
keywords="cognitive behavioral therapy",
abstract="Background: The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA. Objective: This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications. Methods: A systematic literature search was conducted using the keywords ``Knee Osteoarthritis,'' ``Behavior Therapy,'' and ``Digitization'' in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data. Results: A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study. Conclusions: The results demonstrate that ``goals and planning'' and ``repetition and substitution'' are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting. ",
doi="10.2196/53798",
url="https://mhealth.jmir.org/2024/1/e53798",
url="http://www.ncbi.nlm.nih.gov/pubmed/38696250"
}


@Article{info:doi/10.2196/51508,
author="Webster, Amy
and Poyade, Matthieu
and Coulter, Elaine
and Forrest, Lisa
and Paul, Lorna",
title="Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study",
journal="JMIR Serious Games",
year="2024",
month="Apr",
day="26",
volume="12",
pages="e51508",
keywords="virtual reality",
keywords="multiple sclerosis",
keywords="upper limb rehabilitation",
keywords="coproduction",
keywords="activities of daily living",
keywords="exercise games",
keywords="upper limb impairment",
abstract="Background: Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. Objective: This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. Methods: Separate focus groups were conducted with people with MS, recruited through the MS Society UK's research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. Results: People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. Conclusions: VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS. ",
doi="10.2196/51508",
url="https://games.jmir.org/2024/1/e51508",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669680"
}


@Article{info:doi/10.2196/57329,
author="Maikos, T. Jason
and Chomack, M. John
and Herlihy, V. David
and Paglia, N. David
and Wetterstrand, Charlene
and O'Connor, Patrick J.
and Hyre, J. Michael
and Loan, Peter J.
and D'Andrea, E. Susan",
title="Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="26",
volume="13",
pages="e57329",
keywords="biplanar fluoroscopy",
keywords="dynamic stereo x-ray",
keywords="lower limb loss",
keywords="transtibial limb loss",
keywords="prosthetic sockets",
keywords="amputation",
keywords="lower extremity",
abstract="Background: Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. Objective: This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. Methods: A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10\% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. Results: This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. Conclusions: The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. International Registered Report Identifier (IRRID): DERR1-10.2196/57329 ",
doi="10.2196/57329",
url="https://www.researchprotocols.org/2024/1/e57329",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669065"
}


@Article{info:doi/10.2196/56417,
author="Kim, Yuyoung
and Kim, Minjung
and Kim, Jinwoo
and Song, Tae-Jin",
title="Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="25",
volume="26",
pages="e56417",
keywords="dysarthria",
keywords="stroke",
keywords="smartphone",
keywords="speech therapy",
keywords="app",
keywords="acute and early subacute",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: Dysarthria is a common poststroke speech disorder affecting communication and psychological well-being. Traditional speech therapy is effective but often poses challenges in terms of accessibility and patient adherence. Emerging smartphone-based therapies may offer promising alternatives for the treatment of poststroke dysarthria. Objective: This study aimed to assess the efficacy and feasibility of smartphone-based speech therapy for improving speech intelligibility in patients with acute and early subacute poststroke dysarthria. This study also explored the impact of the intervention on psychological well-being, user experience, and overall feasibility in a clinical setting. Methods: Participants were divided into 2 groups for this randomized, evaluator-blinded trial. The intervention group used a smartphone-based speech therapy app for 1 hour per day, 5 days per week, for 4 weeks, with guideline-based standard stroke care. The control group received standard guideline-based stroke care and rehabilitation. Speech intelligibility, psychological well-being, quality of life, and user acceptance were assessed using repeated measures ANOVA. Results: In this study, 40 patients with poststroke dysarthria were enrolled, 32 of whom completed the trial (16 in each group). The intervention group showed significant improvements in speech intelligibility compared with the control group. This was evidenced by improvements from baseline (F1,30=34.35; P<.001), between-group differences (F1,30=6.18; P=.02), and notable time-by-group interactions (F1,30=6.91; P=.01). Regarding secondary outcomes, the intervention led to improvements in the percentage of correct consonants over time (F1,30=5.57; P=.03). In addition, significant reductions were noted in the severity of dysarthria in the intervention group over time (F1,30=21.18; P<.001), with a pronounced group effect (F1,30=5.52; P=.03) and time-by-group interaction (F1,30=5.29; P=.03). Regarding quality of life, significant improvements were observed as measured by the EQ-5D-3L questionnaire (F1,30=13.25; P<.001) and EQ-VAS (F1,30=7.74; P=.009) over time. The adherence rate to the smartphone-based app was 64\%, with over half of the participants completing all the sessions. The usability of the app was rated high (system usability score 80.78). In addition, the intervention group reported increased self-efficacy in using the app compared with the control group (F1,30=10.81; P=.003). Conclusions: The smartphone-based speech therapy app significantly improved speech intelligibility, articulation, and quality of life in patients with poststroke dysarthria. These findings indicate that smartphone-based speech therapy can be a useful assistant device in the management of poststroke dysarthria, particularly in the acute and early subacute stroke stages. Trial Registration: ClinicalTrials.gov NCT05146765; https://clinicaltrials.gov/ct2/show/NCT05146765 ",
doi="10.2196/56417",
url="https://www.jmir.org/2024/1/e56417",
url="http://www.ncbi.nlm.nih.gov/pubmed/38509662"
}


@Article{info:doi/10.2196/48725,
author="Gooch, J. Helen
and Jarvis, A. Kathryn
and Stockley, C. Rachel",
title="Behavior Change Approaches in Digital Technology--Based Physical Rehabilitation Interventions Following Stroke: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="24",
volume="26",
pages="e48725",
keywords="behavior change",
keywords="behavior therapy",
keywords="digital health technology",
keywords="digital health",
keywords="digital technology",
keywords="health behavior",
keywords="physical and rehabilitation medicine",
keywords="scoping review",
keywords="stroke rehabilitation",
abstract="Background: Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions. Objective: This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT. Methods: Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1). Results: From a total of 1973 identified sources, 103 (5\%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67\%). Almost half (45/103, 44\%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56\%), and almost two-thirds (65/103, 63\%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17\%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85\%), reward and threat (56/103, 54\%), goals and planning (33/103, 32\%), and shaping knowledge (33/103, 32\%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality. Conclusions: Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation. ",
doi="10.2196/48725",
url="https://www.jmir.org/2024/1/e48725"
}


@Article{info:doi/10.2196/44025,
author="Wu, Shih-Chung
and Chuang, Chia-Wen
and Liao, Wen-Chun
and Li, Chung-Fang
and Shih, Hsin-Hsin",
title="Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study",
journal="JMIR Serious Games",
year="2024",
month="Apr",
day="16",
volume="12",
pages="e44025",
keywords="breast cancer",
keywords="rehabilitation",
keywords="virtual reality",
keywords="VR",
keywords="virtual reality design process",
keywords="VR design process",
keywords="feasibility",
keywords="accessibility",
abstract="Background: Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. Objective: This study explored patients' attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. Methods: A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Results: Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. Conclusions: The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation. ",
doi="10.2196/44025",
url="https://games.jmir.org/2024/1/e44025"
}


@Article{info:doi/10.2196/51428,
author="Kim, KunJung
and Hwang, Hyunchan
and Bae, Sujin
and Kim, Mi Sun
and Han, Hyun Doug",
title="The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="12",
volume="26",
pages="e51428",
keywords="digital app",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="functional near-infrared spectroscopy",
keywords="hemodynamic",
keywords="hemodynamics",
keywords="panic disorder",
keywords="anxiety",
keywords="panic",
keywords="mental",
keywords="fear",
keywords="spectroscopy",
keywords="digital therapy",
keywords="fNIRS",
keywords="brain",
keywords="imaging",
keywords="neurology",
keywords="neuroscience",
keywords="cortex",
keywords="cortices",
abstract="Background: Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed. Objective: We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS). Methods: Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants. Results: The number of participants with improved panic symptoms in the app use group (20/25, 80\%) was greater than that in the control group (6/21, 29\%; $\chi$21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5\% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6\% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group. Conclusions: Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state. Trial Registration: Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448 ",
doi="10.2196/51428",
url="https://www.jmir.org/2024/1/e51428",
url="http://www.ncbi.nlm.nih.gov/pubmed/38608270"
}


@Article{info:doi/10.2196/47012,
author="Wang, Ying
and Chen, Yanling
and Song, Yuqing
and Chen, Hong
and Guo, Xin
and Ma, Ling
and Liu, Huan",
title="The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Apr",
day="11",
volume="12",
pages="e47012",
keywords="mHealth",
keywords="continuous care",
keywords="gout",
keywords="treat-to-target",
keywords="uric acid",
keywords="Chinese",
keywords="awareness",
keywords="management",
keywords="intervention",
keywords="disease management",
keywords="compliance",
keywords="mobile health",
abstract="Background: In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues. Objective: This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels. Methods: This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention. Results: Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50\%) and control (n=60, 50\%) groups. Of the 120 participants, 93 (77.5\%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time ($\beta$=0.617, 95\% CI 0.104-1.129; P=.02 and $\beta$=1.300, 95\% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week ($\beta$=1.667, 95\% CI ?3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week ($\beta$=6.287, 95\% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43). Conclusions: Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout. Trial Registration: Chinese Clinical Trials Registry ChiCTR2100042712; https://www.chictr.org.cn/showproj.html?proj=121002 ",
doi="10.2196/47012",
url="https://mhealth.jmir.org/2024/1/e47012"
}


@Article{info:doi/10.2196/57226,
author="Ledoux, Andr{\'e}e-Anne
and Zemek, Roger
and Cairncross, Molly
and Silverberg, Noah
and Sicard, Veronik
and Barrowman, Nicholas
and Goldfield, Gary
and Gray, Clare
and Harris, D. Ashley
and Jaworska, Natalia
and Reed, Nick
and Saab, J. Bechara
and Smith, Andra
and Walker, Lisa",
title="Smartphone App--Delivered Mindfulness-Based Intervention for Mild Traumatic Brain Injury in Adolescents: Protocol for a Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="11",
volume="13",
pages="e57226",
keywords="pediatric",
keywords="concussion",
keywords="persisting symptoms after concussion",
keywords="mindfulness",
keywords="randomized controlled trial",
keywords="feasibility RCT",
keywords="psychological intervention",
keywords="youth",
keywords="digital therapeutics",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Concussion in children and adolescents is a significant public health concern, with 30\% to 35\% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child's quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms. Objective: The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group. Methods: This study is a double-blind Health Canada--regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion. Results: The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted. Conclusions: This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications. Trial Registration: ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802 International Registered Report Identifier (IRRID): DERR1-10.2196/57226 ",
doi="10.2196/57226",
url="https://www.researchprotocols.org/2024/1/e57226",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602770"
}


@Article{info:doi/10.2196/51849,
author="Morrow, M. Melissa
and Hughes, C. Lynne
and Collins, M. Diane
and Vos-Draper, L. Tamara",
title="Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="10",
volume="13",
pages="e51849",
keywords="wheelchair user",
keywords="seating and mobility",
keywords="weight shift behavior",
keywords="pressure injury",
keywords="mobile phone",
abstract="Background: Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. Objective: This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. Methods: For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. Results: Currently, 6 participants have been recruited for our aim-1 qualitative study. Conclusions: This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. International Registered Report Identifier (IRRID): DERR1-10.2196/51849 ",
doi="10.2196/51849",
url="https://www.researchprotocols.org/2024/1/e51849",
url="http://www.ncbi.nlm.nih.gov/pubmed/38598267"
}


@Article{info:doi/10.2196/49501,
author="Paul, Lorna
and Thomson, Katie
and Asibey, Osei Shadrack
and Brady, Marian
and van Wijck, Frederike
and Antwi, Derrick
and Opoku, Nkansah Eric
and Sarfo, Stephen Fred",
title="Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="27",
volume="12",
pages="e49501",
keywords="telerehabilitation",
keywords="low- to middle-income country",
keywords="LMIC",
keywords="service user",
keywords="health care professional",
keywords="qualitative study",
keywords="caregiver",
keywords="neurorehabilitation",
keywords="barriers",
keywords="facilitators",
keywords="eHealth",
keywords="focus group",
keywords="thematic analysis",
abstract="Background: Up to 50\% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. Objective: This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Methods: Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Results: Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Conclusions: Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required. ",
doi="10.2196/49501",
url="https://mhealth.jmir.org/2024/1/e49501",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536218"
}


@Article{info:doi/10.2196/55178,
author="Yamamoto, Akiko
and Yamada, Eriku
and Ibara, Takuya
and Nihey, Fumiyuki
and Inai, Takuma
and Tsukamoto, Kazuya
and Waki, Tomohiko
and Yoshii, Toshitaka
and Kobayashi, Yoshiyuki
and Nakahara, Kentaro
and Fujita, Koji",
title="Using In-Shoe Inertial Measurement Unit Sensors to Understand Daily-Life Gait Characteristics in Patients With Distal Radius Fractures During 6 Months of Recovery: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="20",
volume="12",
pages="e55178",
keywords="distal radius fracture",
keywords="gait analysis",
keywords="daily life",
keywords="long-term results",
keywords="gait",
keywords="sensor",
keywords="sensors",
keywords="walk",
keywords="walking",
keywords="fracture",
keywords="fractures",
keywords="wearable",
keywords="wearables",
keywords="recover",
keywords="rehabilitation",
keywords="spatiotemporal",
keywords="inertial measurement",
keywords="fragility",
keywords="postmenopausal",
keywords="menopause",
keywords="grip",
keywords="surgery",
keywords="surgical",
keywords="orthopedic",
keywords="postoperative",
keywords="orthopedics",
keywords="fall",
keywords="falls",
keywords="bone",
keywords="bones",
keywords="wrist",
keywords="radius",
keywords="radial",
abstract="Background: A distal radius fracture (DRF) is a common initial fragility fracture among women in their early postmenopausal period, which is associated with an increased risk of subsequent fractures. Gait assessments are valuable for evaluating fracture risk; inertial measurement units (IMUs) have been widely used to assess gait under free-living conditions. However, little is known about long-term changes in patients with DRF, especially concerning daily-life gait. We hypothesized that, in the long term, the daily-life gait parameters in patients with DRF could enable us to reveal future risk factors for falls and fractures. Objective: This study assessed the spatiotemporal characteristics of patients with DRF at 4 weeks and 6 months of recovery. Methods: We recruited 16 women in their postmenopausal period with DRF as their first fragility fracture (mean age 62.3, SD 7.0 years) and 28 matched healthy controls (mean age 65.6, SD 8.0 years). Daily-life gait assessments and physical assessments, such as hand grip strength (HGS), were performed using an in-shoe IMU sensor. Participants' results were compared with those of the control group, and their recovery was assessed for 6 months after the fracture. Results: In the fracture group, at 4 weeks after DRF, lower foot height in the swing phase (P=.049) and higher variability of stride length (P=.03) were observed, which improved gradually. However, the dorsiflexion angle in the fracture group tended to be lower consistently during 6 months (at 4 weeks: P=.06; during 6 months: P=.07). As for the physical assessments, the fracture group showed lower HGS at all time points (at 4 weeks: P<.001; during 6 months: P=.04), despite significant improvement at 6 months (P<.001). Conclusions: With an in-shoe IMU sensor, we discovered the recovery of spatiotemporal gait characteristics 6 months after DRF surgery without the participants' awareness. The consistently unchanged dorsiflexion angle in the swing phase and lower HGS could be associated with fracture risk, implying the high clinical importance of appropriate interventions for patients with DRF to prevent future fractures. These results could be applied to a screening tool for evaluating the risk of falls and fractures, which may contribute to constructing a new health care system using wearable devices in the near future. ",
doi="10.2196/55178",
url="https://mhealth.jmir.org/2024/1/e55178",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506913"
}


@Article{info:doi/10.2196/50200,
author="B{\"u}hne, David
and Elling, Mathis Jan
and Hetzel, Christian
and Alles, Torsten",
title="Promoting Return to Work After Vocational Rehabilitation Using a Work-Related Fitness App: Protocol for a Cluster-Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="18",
volume="13",
pages="e50200",
keywords="digital health",
keywords="eHealth",
keywords="physical activity",
keywords="profile comparison",
keywords="vocational rehabilitation",
abstract="Background: Retraining programs in vocational rehabilitation are often characterized by a low level of physical activity, even when targeting jobs with primarily physical demands. They might therefore be accompanied by a decline in functional capacity if the lack of physical activity is not compensated by increased activity during leisure time. The implementation of a work-related exercise app might be a promising approach to promoting a return to work in vocational rehabilitation. We developed the ``WORKout-app'' which provides exercise plans based on a comparison of the physical demands of the retraining profession and the current functional capacity. Objective: The aim of this study is to examine the effects of app-based exercise during vocational rehabilitation on perceived work ability (primary outcome), occupational self-efficacy, days of sick leave, and return to work (secondary outcomes). Methods: We conducted a cluster-randomized controlled trial with 2 arms (intervention: WORKout-app vs control: treatment as usual) in 4 cohorts of 5 vocational rehabilitation centers in Germany. Participants are nested within retraining classes per vocational rehabilitation center and per cohort assigned to either the intervention condition or the control condition. The target sample size at the participant level is 598. Measurement time points include baseline, the end of rehabilitation, 3 months after the end of rehabilitation, and 6 months after the end of rehabilitation. Linear and generalized linear mixed-effects models are performed to test for treatment differences in outcomes. Results: This study is funded by the German Federal Pension Insurance. The trial is registered with the German Clinical Trials Register (DRKS00030775) and approved by the Ethics Committee of the German Sport University Cologne (145/2022). Conclusions: The findings of the study will inform researchers and practitioners about the effectiveness of an exercise app developed to counteract the effects of physical inactivity during vocational rehabilitation. International Registered Report Identifier (IRRID): DERR1-10.2196/50200 ",
doi="10.2196/50200",
url="https://www.researchprotocols.org/2024/1/e50200",
url="http://www.ncbi.nlm.nih.gov/pubmed/38498051"
}


@Article{info:doi/10.2196/49808,
author="Veneman, Tim
and Koopman, Sophia Fieke
and Oorschot, Sander
and Koomen, G. Pien
and Nollet, Frans
and Voorn, L. Eric",
title="A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="15",
volume="11",
pages="e49808",
keywords="neuromuscular disorders",
keywords="endurance training",
keywords="home-based exercise",
keywords="eHealth",
keywords="tele-rehabilitation",
keywords="app",
keywords="exercise",
keywords="aerobic exercise",
keywords="mhealth",
keywords="mobile app",
keywords="neuromuscular disease",
keywords="usability",
abstract="Background: Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). Objective: We aimed to determine the usability of the ReVi app. Methods: Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. Results: Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55\%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81\%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70\%) and physiotherapists (n=6, 60\%) were satisfied with the use of the app. The median attendance rate was 88\% (IQR 63\%-98\%), with 76\% (IQR 69\%-82\%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. Conclusions: The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice. ",
doi="10.2196/49808",
url="https://humanfactors.jmir.org/2024/1/e49808",
url="http://www.ncbi.nlm.nih.gov/pubmed/38488838"
}


@Article{info:doi/10.2196/54823,
author="Park, G. Linda
and Chi, Serena
and Pitsenbarger, Susan
and Johnson, K. Julene
and Shah, J. Amit
and Elnaggar, Abdelaziz
and von Oppenfeld, Julia
and Cho, Evan
and Harzand, Arash
and Whooley, A. Mary",
title="Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study",
journal="JMIR Cardio",
year="2024",
month="Mar",
day="14",
volume="8",
pages="e54823",
keywords="cardiac rehabilitation",
keywords="cardiac rehab",
keywords="COVID-19",
keywords="digital health",
keywords="digital technology",
keywords="physical activity",
keywords="physical activity maintenance",
keywords="social media",
keywords="older adults",
keywords="pandemic",
keywords="social distancing",
keywords="technology",
keywords="wearables",
keywords="CR",
keywords="exercise",
keywords="cardiovascular disease",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="hospital",
keywords="medical facility",
keywords="California",
keywords="interview",
keywords="thematic analysis",
keywords="anxiety",
abstract="Background: Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. Objective: This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. Methods: We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. Results: In total, 22 participants (n=9, 41\% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants' feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. Conclusions: Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR. ",
doi="10.2196/54823",
url="https://cardio.jmir.org/2024/1/e54823",
url="http://www.ncbi.nlm.nih.gov/pubmed/38483450"
}


@Article{info:doi/10.2196/51150,
author="Chien, Shih-Ying
and Wong, May-Kuen Alice
and Tseng, Winston
and Hu, Han-Chung
and Cho, Hsiu-Ying",
title="Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="7",
volume="11",
pages="e51150",
keywords="chronic lung diseases",
keywords="home-based pulmonary rehabilitation",
keywords="telehealth",
keywords="remote health care",
abstract="Background: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Objective: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. Methods: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. Results: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. Conclusions: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design. ",
doi="10.2196/51150",
url="https://humanfactors.jmir.org/2024/1/e51150",
url="http://www.ncbi.nlm.nih.gov/pubmed/38452366"
}


@Article{info:doi/10.2196/55003,
author="Merolli, Mark
and Francis, J. Jill
and Vallance, Patrick
and Bennell, L. Kim
and Malliaras, Peter
and Hinman, S. Rana",
title="Evaluation of Patient-Facing Mobile Apps to Support Physiotherapy Care: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="4",
volume="12",
pages="e55003",
keywords="physiotherapy",
keywords="physical therapy",
keywords="digital health intervention",
keywords="mobile app",
keywords="behavior change technique",
keywords="behavior change",
keywords="exercise",
keywords="systematic review",
keywords="quality",
keywords="rehabilitation",
keywords="BCT",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="physical activity",
keywords="fitness",
keywords="synthesis",
keywords="syntheses",
keywords="review methods",
keywords="review methodology",
keywords="search",
keywords="searches",
keywords="searching",
keywords="systematic",
keywords="mobile phone",
abstract="Background: Mobile health interventions delivered through mobile apps are increasingly used in physiotherapy care. This may be because of the potential of apps to facilitate changes in behavior, which is central to the aims of care delivered by physiotherapists. A benefit of using apps is their ability to incorporate behavior change techniques (BCTs) that can optimize the effectiveness of physiotherapeutic interventions. Research continues to suggest that despite their importance, behavior change strategies are often missing in patient management. Evaluating mobile apps that physiotherapists can use to drive behavior change may inform clinical practice and potentially improve patient outcomes. Examining the quality of apps and exploring their key features that can support behavior change and physiotherapy care are important aspects of such an evaluation. Objective: The primary aim of this study was to describe the range of mobile apps in app stores that are intended for use by patients to support physiotherapy care. The secondary aims were to assess app quality, BCTs, and their behavior change potential. Methods: A systematic review of mobile apps in app stores was undertaken. The Apple App Store and Google Play were searched using a 2-step search strategy, using terms relevant to the physiotherapy discipline. Strict inclusion and exclusion criteria were applied: apps had to be intended for use by patients and be self-contained (or stand-alone) without the requirement to be used in conjunction with a partner wearable device or another plugin. Included apps were coded for BCTs using the Behavior Change Technique Taxonomy version 1. App quality was assessed using the Mobile App Rating Scale, and the App Behavior Change Scale was used to assess the app's potential to change behavior. Results: In total, 1240 apps were screened, and 35 were included. Of these 35 apps, 22 (63\%) were available on both the Apple App Store and Google Play platforms. In total, 24 (69\%) were general in their focus (eg, not condition-specific), with the remaining 11 (31\%) being more specific (eg, knee rehabilitation and pelvic floor training). The mean app quality score (Mobile App Rating Scale) was 3.7 (SD 0.4) of 5 (range 2.8-4.5). The mean number of BCTs identified per app was 8.5 (SD 3.6). BCTs most frequently included in the apps were instruction on how to perform a behavior (n=32), action planning (n=30), and self-monitoring of behavior (n=28). The mean behavior change potential score (App Behavior Change Scale) was 8.5 (SD 3.1) of 21 (range 3-15). Conclusions: Mobile apps available to support patient care received from a physiotherapist are of variable quality. Although they contain some BCTs, the potential for behavior change varied widely across apps. International Registered Report Identifier (IRRID): RR2-10.2196/29047 ",
doi="10.2196/55003",
url="https://mhealth.jmir.org/2024/1/e55003",
url="http://www.ncbi.nlm.nih.gov/pubmed/38437018"
}


@Article{info:doi/10.2196/54600,
author="van der Horst, Annemieke
and Meijer, Laura
and van Os - Medendorp, Harmieke
and Jukema, S. Jan
and Bohlmeijer, Ernst
and Schreurs, MG Karlein
and Kelders, Saskia",
title="Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="7",
volume="8",
pages="e54600",
keywords="pilot feasibility study",
keywords="spinal surgery",
keywords="digital health intervention",
keywords="positive psychology",
keywords="acceptance and commitment therapy",
keywords="mobile phone",
abstract="Background: Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. Objective: The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). Methods: We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum--Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. Results: A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum--Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80\% (12/15) was completed by patients undergoing spinal fusion and 67\% (6/9) was completed by patients undergoing decompression surgery. A total of 68\% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88\%) in the intervention group would recommend the intervention to future patients. Conclusions: This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted. ",
doi="10.2196/54600",
url="https://formative.jmir.org/2024/1/e54600",
url="http://www.ncbi.nlm.nih.gov/pubmed/38324374"
}


@Article{info:doi/10.2196/53262,
author="Zhou, Tianyu
and Salman, David
and McGregor, Alison",
title="mHealth Apps for the Self-Management of Low Back Pain: Systematic Search in App Stores and Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="1",
volume="12",
pages="e53262",
keywords="smartphone",
keywords="mHealth",
keywords="mobile health",
keywords="low back pain",
keywords="self-management",
keywords="treatment interventions",
keywords="mobile phone",
abstract="Background: With the rapid development of mobile health (mHealth) technology, many health apps have been introduced to the commercial market for people with back pain conditions. However, little is known about their content, quality, approaches to care for low back pain (LBP), and associated risks of use. Objective: The aims of this research were to (1) identify apps for the self-management of LBP currently on the market and (2) assess their quality, intervention content, theoretical approaches, and risk-related approaches. Methods: The UK iTunes and Google Play stores were initially searched for apps related to the self-management of LBP in May 2022. A repeat search in June 2023 was conducted to ensure that any relevant new apps developed in the last year were incorporated into the review. A total of 3 keywords recommended by the Cochrane Back and Neck Group were used to search apps ``low back pain,'' ``back pain,'' and ``lumbago.'' The quality of the apps was assessed by using the 5-point Mobile App Rating Scale (MARS). Results: A total of 69 apps (25 iOS and 44 Android) met the inclusion criteria. These LBP self-management apps mainly provide recommendations on muscle stretching (n=51, 73.9\%), muscle strengthening (n=42, 60.9\%), core stability exercises (n=32, 46.4\%), yoga (n=19, 27.5\%), and information about LBP mechanisms (n=17, 24.6\%). Most interventions (n=14, 78\%) are consistent with the recommendations in the National Institute for Health and Care Excellence (NICE) guidelines. The mean (SD) MARS overall score of included apps was 2.4 (0.44) out of a possible 5 points. The functionality dimension was associated with the highest score (3.0), whereas the engagement and information dimension resulted in the lowest score (2.1). Regarding theoretical and risk-related approaches, 18 (26.1\%) of the 69 apps reported the rate of intervention progression, 11 (15.9\%) reported safety checks, only 1 (1.4\%) reported personalization of care, and none reported the theoretical care model or the age group targeted. Conclusions: mHealth apps are potentially promising alternatives to help people manage their LBP; however, most of the LBP self-management apps were of poor quality and did not report the theoretical approaches to care and their associated risks. Although nearly all apps reviewed included a component of care listed in the NICE guidelines, the model of care delivery or embracement of care principles such as the application of a biopsychosocial model was unclear. ",
doi="10.2196/53262",
url="https://mhealth.jmir.org/2024/1/e53262",
url="http://www.ncbi.nlm.nih.gov/pubmed/38300700"
}


@Article{info:doi/10.2196/47843,
author="Pritwani, Sabhya
and Shrivastava, Purnima
and Pandey, Shruti
and Kumar, Ajit
and Malhotra, Rajesh
and Maddison, Ralph
and Devasenapathy, Niveditha",
title="Mobile and Computer-Based Applications for Rehabilitation Monitoring and Self-Management After Knee Arthroplasty: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="26",
volume="12",
pages="e47843",
keywords="knee arthroplasty",
keywords="telerehabilitation",
keywords="mHealth",
keywords="rehabilitation",
keywords="monitoring",
keywords="self-management",
keywords="knee",
keywords="arthroplasty",
keywords="social support",
keywords="mHealth intervention",
keywords="development",
keywords="scoping review",
keywords="knee replacement",
abstract="Background: Successful post-knee replacement rehabilitation requires adequate access to health information, social support, and periodic monitoring by a health professional. Mobile health (mHealth) and computer-based technologies are used for rehabilitation and remote monitoring. The extent of technology use and its function in post-knee replacement rehabilitation care in low and middle-income settings are unknown. Objective: To inform future mHealth intervention development, we conducted a scoping review to map the features and functionality of existing technologies and determine users' perspectives on telerehabilitation and technology for self-management. Methods: We followed the Joanna Briggs Institute methodology for scoping reviews. We searched the Embase, Medline, PsycINFO via OVID, and Cochrane Central Register of Controlled Trials databases for manuscripts published from 2001 onward. We included original research articles reporting the use of mobile or computer-based technologies by patients, health care providers, researchers, or family members. Studies were divided into the following 3 categories based on the purpose: validation studies, clinical evaluation, and end user feedback. We extracted general information on study design, technology features, proposed function, and perspectives of health care providers and patients. The protocol for this review is accessible in the Open Science Framework. Results: Of the 5960 articles, 158 that reported from high-income settings contributed to the qualitative summary (64 studies on mHealth or telerehabilitation programs, 28 validation studies, 38 studies describing users' perceptions). The highest numbers of studies were from Europe or the United Kingdom and North America regarding the use of a mobile app with or without wearables and reported mainly in the last decade. No studies were from low and middle-income settings. The primary functions of technology for remote rehabilitation were education to aid recovery and enable regular, appropriate exercises; monitoring progress of pain (n=19), activity (n=20), and exercise adherence (n=30); 1 or 2-way communication with health care professionals to facilitate the continuum of care (n=51); and goal setting (n=23). Assessment of range of motion (n=16) and gait analysis (n=10) were the commonly validated technologies developed to incorporate into a future rehabilitation program. Few studies (n=14) reported end user involvement during the development stage. We summarized the reasons for satisfaction and dissatisfaction among users across various technologies. Conclusions: Several existing mobile and computer-based technologies facilitate post-knee replacement rehabilitation care for patients and health care providers. However, they are limited to high-income settings and may not be extrapolated to low-income settings. A systematic needs assessment of patients undergoing knee replacement and health care providers involved in rehabilitation, involving end users at all stages of development and evaluation, with clear reporting of the development and clinical evaluation can make post-knee replacement rehabilitation care in resource-poor settings accessible and cost-effective. ",
doi="10.2196/47843",
url="https://mhealth.jmir.org/2024/1/e47843",
url="http://www.ncbi.nlm.nih.gov/pubmed/38277195"
}


@Article{info:doi/10.2196/50616,
author="Nagel, Johanna
and Wegener, Florian
and Grim, Casper
and Hoppe, Wilhelm Matthias",
title="Effects of Digital Physical Health Exercises on Musculoskeletal Diseases: Systematic Review With Best-Evidence Synthesis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="23",
volume="12",
pages="e50616",
keywords="mobile health",
keywords="mHealth",
keywords="electronic health",
keywords="eHealth",
keywords="digital health applications",
keywords="DiGA",
keywords="musculoskeletal",
keywords="MSK",
keywords="home-based",
keywords="PROM",
keywords="disorder",
keywords="mobile phone",
abstract="Background: Musculoskeletal diseases affect 1.71 billion people worldwide, impose a high biopsychosocial burden on patients, and are associated with high economic costs. The use of digital health interventions is a promising cost-saving approach for the treatment of musculoskeletal diseases. As physical exercise is the best clinical practice in the treatment of musculoskeletal diseases, digital health interventions that provide physical exercises could have a highly positive impact on musculoskeletal diseases, but evidence is lacking. Objective: This systematic review aims to evaluate the impact of digital physical health exercises on patients with musculoskeletal diseases concerning the localization of the musculoskeletal disease, patient-reported outcomes, and medical treatment types. Methods: We performed systematic literature research using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted using the PubMed, BISp, Cochrane Library, and Web of Science databases. The Scottish Intercollegiate Guidelines Network checklist was used to assess the quality of the included original studies. To determine the evidence and direction of the impact of digital physical health exercises, a best-evidence synthesis was conducted, whereby only studies with at least acceptable methodological quality were included for validity purposes. Results: A total of 8988 studies were screened, of which 30 (0.33\%) randomized controlled trials met the inclusion criteria. Of these, 16 studies (53\%) were of acceptable or high quality; they included 1840 patients (1008/1643, 61.35\% female; 3 studies including 197 patients did not report gender distribution) with various musculoskeletal diseases. A total of 3 different intervention types (app-based interventions, internet-based exercises, and telerehabilitation) were used to deliver digital physical health exercises. Strong evidence was found for the positive impact of digital physical health exercises on musculoskeletal diseases located in the back. Moderate evidence was found for diseases located in the shoulder and hip, whereas evidence for the entire body was limited. Conflicting evidence was found for diseases located in the knee and hand. For patient-reported outcomes, strong evidence was found for impairment and quality of life. Conflicting evidence was found for pain and function. Regarding the medical treatment type, conflicting evidence was found for operative and conservative therapies. Conclusions: Strong to moderate evidence was found for a positive impact on musculoskeletal diseases located in the back, shoulder, and hip and on the patient-reported outcomes of impairment and quality of life. Thus, digital physical health exercises could have a positive effect on a variety of symptoms of musculoskeletal diseases. ",
doi="10.2196/50616",
url="https://mhealth.jmir.org/2024/1/e50616",
url="http://www.ncbi.nlm.nih.gov/pubmed/38261356"
}


@Article{info:doi/10.2196/46957,
author="Wang, Zeyu
and He, Kang
and Sui, Xin
and Yi, Jiang
and Yang, Zhaoyun
and Wang, Kai
and Gao, Yan
and Bian, Linfang
and Jiang, Junjie
and Zhao, Lijing",
title="The Effect of Web-Based Telerehabilitation Programs on Children and Adolescents With Brain Injury: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="25",
volume="25",
pages="e46957",
keywords="acquired brain injury",
keywords="web-based",
keywords="telerehabilitation",
keywords="motor function",
keywords="physical activity level",
keywords="lower limb strength",
keywords="children",
keywords="adolescents",
keywords="meta-analysis",
abstract="Background: Acquired brain injury (ABI) in children and adolescents can lead to motor and executive impairments that often require long-term treatment. The implementation of web-based telerehabilitation therapy at home is a method to improve the functional status of patients. Therefore, we performed a systematic review of the effects of web-based telerehabilitation programs on functional outcomes in children and adolescents with brain injury and supplemented the findings with a meta-analysis. Objective: This study evaluated the therapeutic effect of web-based telerehabilitation training on children and adolescents with brain injury to determine whether web-based telerehabilitation therapy improved motor function, executive function, physical activity level, lower limb strength, hand and upper limb function, visual processing skills, and occupational functional performance in children and adolescents with brain injury. Methods: PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials on web-based telerehabilitation programs in children and adolescents with brain injury until December 2022, and the risk of bias was evaluated using the Cochrane Collaboration Tool. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software. Results: Overall, 17 studies involving 848 patients were included. Web-based telerehabilitation therapy improved the motor function (standardized mean difference [SMD] 0.29, 95\% CI 0.01-0.57; P=.04), physical activity level (SMD 0.42, 95\% CI 0.11-0.73; P=.007), lower limb strength (SMD 0.52, 95\% CI 0.13-0.90; P=.009), and visual processing skills (SMD 0.26, 95\% CI 0.02-0.50; P=.04) of children and adolescents with brain injury. It also improved executive function in letter-number sequencing (SMD 1.26, 95\% CI 0.26-2.26; P=.01), attention (SMD 0.38, 95\% CI 0.09-0.66; P=.009), and symbol search (SMD 1.18, 95\% CI 0.43-1.93, P=.002). Conclusions: Web-based telerehabilitation therapy improved motor function, physical activity level, lower limb strength, letter-number sequencing, attention, and symbol search, which improved the quality of life in children and adolescents with brain injury. Web-based telerehabilitation programs provide great convenience for children and adolescents with ABI who need long-term treatment and allow them to exercise at home for rehabilitation training. The widespread implementation of remote interventions also provides children and adolescents in remote areas with better access to rehabilitation services. This review provides evidence for the effectiveness of web-based telerehabilitation therapy, but there was heterogeneity in some of the results because of different disease types and intervention programs. Future studies can expand the sample size according to disease type and increase follow-up time according to different exercise prescriptions to further refine the long-term effects of this intervention on various functions of children and adolescents with ABI. Trial Registration: PROSPERO CRD42023421917; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=421917 ",
doi="10.2196/46957",
url="https://www.jmir.org/2023/1/e46957",
url="http://www.ncbi.nlm.nih.gov/pubmed/38145485"
}


@Article{info:doi/10.2196/50729,
author="Lu, Ziyuan
and Signer, Tabea
and Sylvester, Ramona
and Gonzenbach, Roman
and von Wyl, Viktor
and Haag, Christina",
title="Implementation of Remote Activity Sensing to Support a Rehabilitation Aftercare Program: Observational Mixed Methods Study With Patients and Health Care Professionals",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Dec",
day="8",
volume="11",
pages="e50729",
keywords="physical activity",
keywords="activity sensor",
keywords="normalization process theory",
keywords="rehabilitation",
keywords="chronic disease",
keywords="chronic",
keywords="aftercare",
keywords="sensor",
keywords="sensors",
keywords="exercise",
keywords="neurology",
keywords="neuroscience",
keywords="neurorehabilitation",
keywords="adherence",
keywords="need",
keywords="needs",
keywords="experience",
keywords="experiences",
keywords="questionnaire",
keywords="questionnaires",
keywords="mobile phone",
abstract="Background: Physical activity is central to maintaining the quality of life for patients with complex chronic conditions and is thus at the core of neurorehabilitation. However, maintaining activity improvements in daily life is challenging. The novel Stay With It program aims to promote physical activity after neurorehabilitation by cultivating self-monitoring skills and habits. Objective: We examined the implementation of the Stay With It program at the Valens Rehabilitation Centre in Switzerland using the normalization process theory framework, focusing on 3 research aims. We aimed to examine the challenges and facilitators of program implementation from the perspectives of patients and health care professionals. We aimed to evaluate the potential of activity sensors to support program implementation and patient acceptance. Finally, we aimed to evaluate patients' engagement in physical activity after rehabilitation, patients' self-reported achievement of home activity goals, and factors influencing physical activity. Methods: Patients were enrolled if they had a disease that was either chronic or at risk for chronicity and participated in the Stay With It program. Patients were assessed at baseline, the end of rehabilitation, and a 3-month follow-up. The health care professionals designated to deliver the program were surveyed before and after program implementation. We used a mixed methods approach combining standardized questionnaires, activity-sensing data (patients only), and free-text questions. Results: This study included 23 patients and 13 health care professionals. The diverse needs of patients and organizational hurdles were major challenges to program implementation. Patients' intrinsic motivation and health care professionals' commitment to refining the program emerged as key facilitators. Both groups recognized the value of activity sensors in supporting program implementation and sustainability. Although patients appreciated the sensor's ability to monitor, motivate, and quantify activity, health care professionals saw the sensor as a motivational tool but expressed concerns about technical difficulties and potential inaccuracies. Physical activity levels after patients returned home varied considerably, both within and between individuals. The self-reported achievement of activity goals at home also varied, in part because of vague definitions. Common barriers to maintaining activity at home were declining health and fatigue often resulting from heat and pain. At the 3-month follow-up, 35\% (8/23) of the patients withdrew from the study, with most citing deteriorating physical health as the reason and that monitoring and discussing their low activity would negatively affect their mental health. Conclusions: Integrating aftercare programs like Stay With It into routine care is vital for maintaining physical activity postrehabilitation. Although activity trackers show promise in promoting motivation through monitoring, they may lead to frustration during health declines. Their acceptability may also be influenced by an individual's health status, habits, and technical skills. Our study highlights the importance of considering health care professionals' perspectives when integrating new interventions into routine care. ",
doi="10.2196/50729",
url="https://mhealth.jmir.org/2023/1/e50729",
url="http://www.ncbi.nlm.nih.gov/pubmed/38064263"
}


@Article{info:doi/10.2196/51515,
author="Colonna, Giulia
and Hoye, Jocelyn
and de Laat, Bart
and Stanley, Gelsina
and Ibrahimy, Alaaddin
and Tinaz, Sule
and Morris, D. Evan",
title="Measuring Heart Rate Accurately in Patients With Parkinson Disease During Intense Exercise: Usability Study of Fitbit Charge 4",
journal="JMIR Biomed Eng",
year="2023",
month="Dec",
day="8",
volume="8",
pages="e51515",
keywords="Fitbit",
keywords="heart rate measurements",
keywords="Parkinson disease",
keywords="exercise",
keywords="accuracy",
keywords="intensity",
keywords="heart rate",
keywords="wearable",
keywords="neurodegenerative disease",
keywords="aerobic exercise",
keywords="physical exercise",
keywords="program",
keywords="device",
abstract="Background: Parkinson disease (PD) is the second most common neurodegenerative disease, affecting approximately 1\% of the world's population.Increasing evidence suggests that aerobic physical exercise can be beneficial in mitigating both motor and nonmotor symptoms of the disease.In a recent pilot study of the role of exercise on PD, we sought to confirm exercise intensity by monitoring heart rate (HR). For this purpose, we asked participants to wear a chest strap HR monitor (Polar Electro Oy) and the Fitbit Charge 4 (Fitbit Inc) wrist-worn HR monitor as a potential proxy due to its convenience.Polar H10 has been shown to provide highly accurate R-R interval measurements. Therefore, we treated it as the gold standard in this study. It has been shown that Fitbit Charge 4 has comparable accuracy to Polar H10 in healthy participants. It has yet to be determined if the Fitbit is as accurate as Polar H10 in patients with PD during rest and exercise. Objective: This study aimed to compare Fitbit Charge 4 to Polar H10 for monitoring HR in patients with PD at rest and during an intensive exercise program. Methods: A total of 596 exercise sessions from 11 (6 male and 5 female) participants were collected simultaneously with both devices. Patients with early-stage PD (Hoehn and Yahr ?2) were enrolled in a 6-month exercise program designed for patients with PD. They participated in 3 one-hour exercise sessions per week. They wore both Fitbit and Polar H10 during each session. Sessions included rest, warm-up, intense exercise, and cool-down periods.We calculated the bias in the HR of the Fitbit Charge 4 at rest (5 min) and during intense exercise (20 min) by comparing the mean HR during each of the periods to the respective means measured by Polar H10 (HRFitbit -- HRPolar). We also measured the sensitivity and specificity of Fitbit Charge 4 to detect average HRs that exceed the threshold for intensive exercise, defined as 70\% of an individual's theoretical maximum HR. Different types of correlations between the 2 devices were investigated. Results: The mean bias was 1.68 beats per minute (bpm) at rest and 6.29 bpm during high-intensity exercise, with an overestimation by Fitbit Charge 4 in both conditions. The mean bias of the Fitbit across both rest and intensive exercise periods was 3.98 bpm. The device's sensitivity in identifying high-intensity exercise sessions was 97.14\%. The correlation between the 2 devices was nonlinear, suggesting Fitbit's tendency to saturate at high values of HR. Conclusions: The performance of Fitbit Charge 4 is comparable to Polar H10 for assessing exercise intensity in a cohort of patients with PD (mean bias 3.98 bpm). The device could be considered a reasonable surrogate for more cumbersome chest-worn devices in future studies of clinical cohorts. ",
doi="10.2196/51515",
url="https://biomedeng.jmir.org/2023/1/e51515",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875680"
}


@Article{info:doi/10.2196/46558,
author="Thompson, N. Alexandra
and Dawson, R. Deirdre
and Legasto-Mulvale, Michelle Jean
and Chandran, Nivetha
and Tanchip, Chelsea
and Niemczyk, Veronika
and Rashkovan, Jillian
and Jeyakumar, Saisa
and Wang, H. Rosalie
and Cameron, I. Jill
and Nalder, Emily",
title="Mobile Technology--Based Interventions for Stroke Self-Management Support: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Dec",
day="6",
volume="11",
pages="e46558",
keywords="stroke",
keywords="chronic disease",
keywords="self-management",
keywords="rehabilitation",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="digital health",
keywords="mobile phone",
abstract="Background: There is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, ``self-management support'' is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted. Objective: The objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management. Methods: A scoping review was conducted according to the methodology by Arksey and O'Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis. Results: A total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong. Conclusions: On the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale. ",
doi="10.2196/46558",
url="https://mhealth.jmir.org/2023/1/e46558",
url="http://www.ncbi.nlm.nih.gov/pubmed/38055318"
}


@Article{info:doi/10.2196/45947,
author="Harper, C. Rosie
and Sheppard, Sally
and Stewart, Carly
and Clark, J. Carol",
title="Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Nov",
day="30",
volume="11",
pages="e45947",
keywords="adherence",
keywords="behavior change",
keywords="mHealth",
keywords="mobile apps",
keywords="pelvic floor muscle training",
keywords="women",
abstract="Background: Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. Objective: We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core ``capability, opportunity, and motivation'' (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. Methods: We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. Results: Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT ``prompts and cues.'' Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps. Conclusions: Digital ``prompts and cues'' are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital ``prompts and cues'' on PFMT adherence in women can be conducted. ",
doi="10.2196/45947",
url="https://mhealth.jmir.org/2023/1/e45947",
url="http://www.ncbi.nlm.nih.gov/pubmed/38032694"
}


@Article{info:doi/10.2196/49051,
author="Li, Yufei
and Chen, Weihong
and Liang, Yanjing
and Yang, Ling
and Hou, Lili",
title="Evaluation of Mobile Health Technology Interventions for the Postdischarge Management of Patients With Head and Neck Cancer: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="23",
volume="11",
pages="e49051",
keywords="head and neck cancer",
keywords="mobile health technology",
keywords="postdischarge",
keywords="self-management",
keywords="rehabilitation",
abstract="Background: Patients with head and neck cancer (HNC) often experience various types and degrees of complications and functional impairment following surgery or radiotherapy. Consequently, these patients require extensive postdischarge rehabilitation, either at home or in the community. Numerous studies have shown the advantages of mobile Health (mHealth) technology in assisting patients with cancer with self-management and rehabilitation during the postdischarge period. However, few reviews have focused on the intervention, management, and evaluation of mHealth technology in postdischarge patients with HNC. Objective: This study aimed to conduct a scoping review of mHealth technology apps and interventions currently available to patients discharged from hospitals after receiving treatment for HNC. This study sought to identify and summarize the types and effectiveness of existing mHealth interventions as well as the differences in their outcome assessments. Methods: The PubMed, Embase, Web of Science, and CINAHL databases were used to identify studies with no publication time limits. The keywords ``mobile health technology'' and ``head and neck cancer'' were combined to address the main concepts of the research questions. Results: Of the 1625 papers identified, 13 (0.8\%) met the inclusion and exclusion criteria. Most studies (n=8, 61.5\%) were randomized controlled trials (RCTs) and cohort studies. These studies were conducted in 6 countries. The main aims of the mHealth interventions in these studies are as follows: (1) symptom monitoring and assessment, (2) rehabilitation training, (3) access to medical health information, (4) telehealth advisers, (5) peer communication and support, and (6) follow-up/review reminders. The outcome evaluations of the 13 included studies were grouped into 4 categories: (1) technology usability and patient satisfaction, (2) self-management of symptoms and patient-reported outcome--related indicators, (3) adherence, and (4) health-related quality of life. Conclusions: A limited number of studies have investigated the use of mHealth technology in the postdischarge self-management of patients with HNC. The existing literature suggests that mHealth technology can effectively assist patients with HNC in self-management and postdischarge interventions. It plays an important role in addressing patients' health information needs, reducing both their somatic and psychological burdens, and improving their overall quality of life. Future research should prioritize conducting additional high-quality RCTs to evaluate the usability and analyze the cost-effectiveness of mHealth technology. ",
doi="10.2196/49051",
url="https://mhealth.jmir.org/2023/1/e49051",
url="http://www.ncbi.nlm.nih.gov/pubmed/37870887"
}


@Article{info:doi/10.2196/49813,
author="Vos-Draper, L. Tamara
and Morrow, B. Melissa M.
and Ferguson, E. John
and Mathiowetz, G. Virgil",
title="Effects of Real-Time Pressure Map Feedback on Confidence in Pressure Management in Wheelchair Users With Spinal Cord Injury: Pilot Intervention Study",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="Oct",
day="12",
volume="10",
pages="e49813",
keywords="spinal cord injury",
keywords="wheelchair",
keywords="pressure injury prevention",
keywords="self-efficacy",
keywords="pressure mapping",
keywords="pressure",
keywords="mapping",
keywords="map",
keywords="interface",
keywords="spine",
keywords="spinal cord",
keywords="feedback",
keywords="real time",
keywords="mobile phone",
abstract="Background: Wheelchair users with a spinal cord injury (SCI) are at a high risk for developing pressure injuries (PIs). Performing weight shifts is a primary method of pressure management for PI prevention; however, individuals with SCI may lack confidence in their abilities to perform adequate pressure relief due to their lack of sensation. Real-time seat interface pressure mapping feedback may provide partial substitution for sensory feedback such that an individual's confidence is improved. Objective: We aim to examine how confidence for pressure management by wheelchair users with SCI was impacted by providing access to real-time, on-demand seat interface pressure mapping feedback. Methods: Adults with SCI (N=23) completed self-efficacy questions addressing confidence around 4 factors related to performing weight shifts in this longitudinal, repeated-measures study. We evaluated the impact of providing standard PI prevention education and access to live pressure map feedback on confidence levels for performing weight shifts. Results: Access to live pressure map feedback while learning how to perform weight shifts resulted in significantly higher confidence about moving far enough to relieve pressure at high-risk areas. Confidence for adhering to the recommended weight shift frequency and duration was not significantly impacted by in-clinic education or use of pressure map feedback. Confidence that performing weight shifts reduces PI risk increased most following education, with slight additional increase when pressure map feedback was added. Conclusions: Access to live pressure mapping feedback improves confidence about performing weight shifts that relieve pressure when provided in the clinical setting and demonstrates potential for the same in the home. This preliminary exploration of a smartphone-based pressure mapping intervention highlights the value of access to continuous pressure mapping feedback to improve awareness and confidence for managing pressure. Trial Registration: ClinicalTrials.gov NCT03987243; https://clinicaltrials.gov/study/NCT03987243 ",
doi="10.2196/49813",
url="https://rehab.jmir.org/2023/1/e49813",
url="http://www.ncbi.nlm.nih.gov/pubmed/37824188"
}


@Article{info:doi/10.2196/46911,
author="Jo, Sungmin
and Park, Kyun Moo
and Seo, Jae-Hyun
and Lee, Ki-eun
and Han, Sang Jae
and Lim, Hyung Ji
and Lee, Ho Jun
and Oh, Seung-Ha",
title="Feasibility of a Smartphone-Based Hearing Aid App for Mild-to-Moderate Hearing Loss: Prospective Multicenter Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="5",
volume="11",
pages="e46911",
keywords="hearing aid apps",
keywords="hearing aids",
keywords="hearing loss",
keywords="prospective",
keywords="smartphone",
keywords="hearing rehabilitation",
abstract="Background: Hearing loss is a growing health concern worldwide. Hearing aids (HAs) are the treatment of choice for hearing rehabilitation in most cases of mild-to-moderate hearing loss. However, many patients with hearing loss do not use HAs due to their high cost, stigma, and inaccessibility. Since smartphones are widely used, many apps that mimic the amplification function of HAs have been introduced. Smartphone-based HA apps (SHAAs) are affordable and easy to access. However, the audiological benefit of SHAAs has not been determined. Objective: We compared the audiological performance between an SHAA and a conventional HA in a prospective, multicenter randomized controlled trial. Methods: Patients with mild-to-moderate hearing loss were prospectively enrolled from 2 tertiary hospitals and randomly assigned to either an SHAA (Petralex; IT4YOU Corp LLC) or a conventional HA (Siya 1 miniRITE; Oticon A/S). For the cross-over study design, participants used the alternate device and repeated the same 2-month trial. Audiological measurements were obtained using hearing tests, real-ear measurements, and the hearing-in-noise test (HINT). Subjective satisfaction was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and International Outcome Inventory for Hearing Aids (IOI-HA). Results: Overall, 63 participants were screened and 38 completed the study. In sound-field audiometry testing, the SHAA showed a 20- to 60-dB gain in the low-to-high frequencies of the hearing threshold level. The HA provided adequate gain in the middle-to-high frequencies (55, 65, and 75 dB in real-ear measurements), which is the sound level for most speaking volumes. However, the SHAA could not improve word recognition at 50 dB. The HA showed better audiological performance than the SHAA in both quiet and noisy conditions in the HINT. The IOI-HA scores were significantly improved by both the HA and SHAA versus unaided conditions. Among the SHAA users, 37\% (14/38), 42\% (16/38), 24\% (9/38), and 32\% (12/38) showed improvement in APHAB scores for ease of communication, reverberation, background noise, and aversiveness of sounds, respectively. There were no differences in adverse events between the 2 study groups. Conclusions: The HA showed better performance than the SHAA in word recognition and the HINT. However, the SHAA was significantly better than unaided hearing in terms of amplification. The SHAA may be a useful hearing assistance device for patients with mild-to-moderate hearing loss when listening to soft sounds in quiet conditions. The SHAA demonstrated poorer performance than the HA in the mid- to high-frequency sounds that are important for word recognition, sound quality, and hearing in noisy conditions. Further development of the signal technology of SHAAs is needed to improve the sound quality of mid- to high-frequency sounds and overcome noisy environments. Trial Registration: ClinicalTrials.gov NCT05644106; http://clinicaltrials.gov/ct2/show/NCT05644106 ",
doi="10.2196/46911",
url="https://mhealth.jmir.org/2023/1/e46911"
}


@Article{info:doi/10.2196/48229,
author="Patterson, Kacie
and Davey, Rachel
and Keegan, Richard
and Niyonsenga, Theo
and Mohanty, Itismita
and Bowen, Sarah
and Regan, Elizabeth
and Lander, Michelle
and van Berlo, Sander
and Freene, Nicole",
title="Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="3",
volume="11",
pages="e48229",
keywords="mobile health",
keywords="secondary prevention",
keywords="cardiovascular disease",
keywords="sedentary behavior",
keywords="hospital admissions",
keywords="cost-effectiveness",
keywords="mobile phone",
abstract="Background: People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. Objective: We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. Methods: A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. Results: Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5\%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95\% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95\% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95\% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus \$252.40 vs Aus \$859.38; P=.24; a currency exchange rate of Aus \$1=US \$0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95\% CI ?22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI ($\beta$=1.62; P=.05), waist circumference ($\beta$=5.81; P=.01), waist-to-hip ratio ($\beta$=.03, P=.03), and quality of life ($\beta$=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus \$351.77) and anxiety (ICER Aus \$10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus \$93,395.50) at 12 months. Conclusions: The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-040479 ",
doi="10.2196/48229",
url="https://mhealth.jmir.org/2023/1/e48229",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788043"
}


@Article{info:doi/10.2196/47502,
author="Ulrich, Lauro
and Thies, Phillip
and Schwarz, Annika",
title="Availability, Quality, and Evidence-Based Content of mHealth Apps for the Treatment of Nonspecific Low Back Pain in the German Language: Systematic Assessment",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="13",
volume="11",
pages="e47502",
keywords="mobile health",
keywords="mobile apps",
keywords="smartphone",
keywords="nonspecific low back pain",
keywords="German language",
keywords="intervention",
keywords="digital health",
keywords="home exercise",
keywords="digital rehabilitation",
keywords="workout",
keywords="mobile phone",
abstract="Background: Nonspecific low back pain (NSLBP) carries significant socioeconomic relevance and leads to substantial difficulties for those who are affected by it. The effectiveness of app-based treatments has been confirmed, and clinicians are recommended to use such interventions. As 88.8\% of the German population uses smartphones, apps could support therapy. The available apps in mobile app stores are poorly regulated, and their quality can vary. Overviews of the availability and quality of mobile apps for Australia, Great Britain, and Spain have been compiled, but this has not yet been done for Germany. Objective: We aimed to provide an overview of the availability and content-related quality of apps for the treatment of NSLBP in the German language. Methods: A systematic search for apps on iOS and Android was conducted on July 6, 2022, in the Apple App Store and Google Play Store. The inclusion and exclusion criteria were defined before the search. Apps in the German language that were available in both stores were eligible. To check for evidence, the apps found were assessed using checklists based on the German national guideline for NSLBP and the British equivalent of the National Institute for Health and Care Excellence. The quality of the apps was measured using the Mobile Application Rating Scale. To control potential inaccuracies, a second reviewer resurveyed the outcomes for 30\% (3/8) of the apps and checked the inclusion and exclusion criteria for these apps. The outcomes, measured using the assessment tools, are presented in tables with descriptive statistics. Furthermore, the characteristics of the included apps were summarized. Results: In total, 8 apps were included for assessment. Features provided with different frequencies were exercise tracking of prefabricated or adaptable workout programs, educational aspects, artificial intelligence--based therapy or workout programs, and motion detection. All apps met some recommendations by the German national guideline and used forms of exercises as recommended by the National Institute for Health and Care Excellence guideline. The mean value of items rated as ``Yes'' was 5.75 (SD 2.71) out of 16. The best-rated app received an answer of ``Yes'' for 11 items. The mean Mobile Application Rating Scale quality score was 3.61 (SD 0.55). The highest mean score was obtained in ``Section B--Functionality'' (mean 3.81, SD 0.54). Conclusions: Available apps in the German language meet guideline recommendations and are mostly of acceptable or good quality. Their use as a therapy supplement could help promote the implementation of home-based exercise protocols. A new assessment tool to obtain ratings on apps for the treatment of NSLBP, combining aspects of quality and evidence-based best practices, could be useful. Trial Registration: Open Science Framework Registries sq435; https://osf.io/sq435 ",
doi="10.2196/47502",
url="https://mhealth.jmir.org/2023/1/e47502",
url="http://www.ncbi.nlm.nih.gov/pubmed/37703072"
}


@Article{info:doi/10.2196/47324,
author="Yang, Wenwen
and Du, Yifei
and Chen, Mengran
and Li, Sufang
and Zhang, Fan
and Yu, Peiyang
and Xu, Xiaoxia",
title="Effectiveness of Home-Based Telerehabilitation Interventions for Dysphagia in Patients With Head and Neck Cancer: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="8",
volume="25",
pages="e47324",
keywords="head and neck cancer",
keywords="home-based rehabilitation",
keywords="remote intervention",
keywords="swallowing exercise",
keywords="systematic review",
abstract="Background: Multimodal treatment--induced dysphagia has serious negative effects on survivors of head and neck cancer. Owing to advances in communication technologies, several studies have applied telecommunication-based interventions that incorporate swallowing exercises, education, monitoring, feedback, self-management, and communication. It is especially urgent to implement home-based remote rehabilitation in the context of the COVID-19 pandemic. However, the optimal strategy and effectiveness of remote interventions are unclear. Objective: This systematic review aimed to examine the evidence regarding the efficacy of telerehabilitation for reducing physiological and functional impairments related to swallowing and for improving adherence and related influencing factors among head and neck cancer survivors. Methods: The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Library databases were systematically searched up to July 2023 to identify relevant articles. In total, 2 investigators independently extracted the data and assessed the methodological quality of the included studies using the quality assessment tool of the Joanna Briggs Institute. Results: A total of 1465 articles were initially identified; ultimately, 13 (0.89\%) were included in the systematic review. The quality assessment indicated that the included studies were of moderate to good quality. The results showed that home-based telerehabilitation improved the safety of swallowing and oral feeding, nutritional status, and swallowing-related quality of life; reduced negative emotions; improved swallowing rehabilitation adherence; was rated by participants as highly satisfactory and supportive; and was cost-effective. In addition, this review investigated factors that influenced the efficacy of telerehabilitation, which included striking a balance among swallowing training strategy, intensity, frequency, duration, and individual motor ability; treating side effects of radiotherapy; providing access to medical, motivational, and educational information; providing feedback on training; providing communication and support from speech pathologists, families, and other survivors; and addressing technical problems. Conclusions: Home-based telerehabilitation has shown great potential in reducing the safety risks of swallowing and oral feeding, improving quality of life and adherence, and meeting information needs for dysphagia among survivors of head and neck cancer. However, this review highlights limitations in the current literature, and the current research is in its infancy. In addition, owing to the diversity of patient sociodemographic, medical, physiological and functional swallowing, and behavioral factors, we recommend the development of tailored telemedicine interventions to achieve the best rehabilitation effects with the fewest and most precise interventions. ",
doi="10.2196/47324",
url="https://www.jmir.org/2023/1/e47324",
url="http://www.ncbi.nlm.nih.gov/pubmed/37682589"
}


@Article{info:doi/10.2196/47553,
author="Hu, Yuanjia
and Lu, Yang
and Tian, Chenghua
and He, Yunfan
and Rong, Kaiyi
and Pan, Sijia
and Lei, Jianbo",
title="Current Status and Trends in mHealth-Based Research for Treatment and Intervention in Tinnitus: Bibliometric and Comparative Product Analysis",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Aug",
day="24",
volume="11",
pages="e47553",
keywords="tinnitus",
keywords="mobile health",
keywords="mHealth",
keywords="internet",
keywords="application",
keywords="software",
keywords="bibliometrics",
keywords="mobile phone",
abstract="Background: As a global medical problem, tinnitus can seriously harm human health and is difficult to alleviate, ranking among the top 3 complex diseases in the otolaryngology field. Traditional cognitive behavioral therapy and sound therapy require offline face-to-face treatment with medical staff and have limited effectiveness. Mobile health (mHealth), which, in recent decades, has been greatly applied in the field of rehabilitation health care, improving access to health care resources and the quality of services, has potential research value in the adjunctive treatment of tinnitus. Objective: This study aimed to understand the research trends, product characteristics, problems, and research transformation of tinnitus treatment software by analyzing the research progress of mHealth for tinnitus treatment based on the literature and related marketed apps. Methods: Bibliometric methods were used to describe the characteristics of the relevant literature in terms of the number and topics of publications, authors, and institutions. We further compared the features and limitations of the currently available tinnitus treatment software. Results: Data published until February 28, 2022, were collected. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standardized screening process, 75 papers were included. The country with the highest number of publications was Germany, followed by the United Kingdom and the United States, whereas China had only a single relevant study. The most frequently found journals were the American Journal of Audiology and the Journal of the American Academy of Audiology (18/75, 24\%). With regard to publication topics, cognitive behavioral therapy started to become a hot topic in 2017, and research on mHealth apps has increased. In this study, 28 tinnitus treatment apps were obtained (n=24, 86\% from product data and n=4, 14\% from literature data); these apps were developed mainly in the United States (10/28, 36\%) or China (9/28, 32\%). The main treatment methods were sound therapy (10/28, 36\%) and cognitive behavioral therapy (2/28, 7\%). Of the 75 publications, 7 (9\%) described apps in the market stage. Of the 28 apps, 22 (79\%) lacked literature studies or evidence from professional bodies. Conclusions: We found that, as a whole, the use of mHealth for treatment and intervention in tinnitus was showing a rapid development, in which good progress had been made in studies around sound therapy and cognitive behavioral therapy, although most of the studies (50/75, 67\%) focused on treatment effects. However, the field is poorly accepted in top medical journals, and the majority are in the research design phase, with a lack of translation of the literature results and clinical validation of the marketed apps. Furthermore, in the future, novel artificial intelligence techniques should be used to address the issue of staged monitoring of tinnitus. ",
doi="10.2196/47553",
url="https://mhealth.jmir.org/2023/1/e47553",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616044"
}


@Article{info:doi/10.2196/45993,
author="Broderick, Michelle
and O'Shea, Robert
and Burridge, Jane
and Demain, Sara
and Johnson, Louise
and Bentley, Paul",
title="Examining Usability, Acceptability, and Adoption of a Self-Directed, Technology-Based Intervention for Upper Limb Rehabilitation After Stroke: Cohort Study",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="Aug",
day="21",
volume="10",
pages="e45993",
keywords="stroke rehabilitation",
keywords="interactive gaming",
keywords="rehabilitation technology",
keywords="technology usability",
keywords="technology acceptability",
keywords="self-management",
keywords="usability",
keywords="acceptability",
keywords="stroke",
keywords="rehabilitation",
keywords="adoption",
keywords="engagement",
keywords="acceptance",
keywords="limb",
keywords="mobility",
keywords="mobile phone",
abstract="Background: Upper limb (UL) recovery after stroke is strongly dependent upon rehabilitation dose. Rehabilitation technologies present pragmatic solutions to dose enhancement, complementing therapeutic activity within conventional rehabilitation, connecting clinicians with patients remotely, and empowering patients to drive their own recovery. To date, rehabilitation technologies have been poorly adopted. Understanding the barriers to adoption may shape strategies to enhance technology use and therefore increase rehabilitation dose, thus optimizing recovery potential. Objective: We examined the usability, acceptability, and adoption of a self-directed, exercise-gaming technology within a heterogeneous stroke survivor cohort and investigated how stroke survivor characteristics, technology usability, and attitudes toward technology influenced adoption. Methods: A feasibility study of a novel exercise-gaming technology for self-directed UL rehabilitation in early subacute stroke survivors (N=30) was conducted in an inpatient, acute hospital setting. Demographic and clinical characteristics were recorded; participants' performance in using the system (usability) was assessed using a 4-point performance rating scale (adapted from the Barthel index), and adherence with the system was electronically logged throughout the trial. The technology acceptance model was used to formulate a survey examining the acceptability of the system. Spearman rank correlations were used to examine associations between participant characteristics, user performance (usability), end-point technology acceptance, and intervention adherence (adoption). Results: The technology was usable for 87\% (n=26) of participants, and the overall technology acceptance rating was 68\% (95\% CI 56\%-79\%). Participants trained with the device for a median of 26 (IQR 16-31) minutes daily over an enrollment period of 8 (IQR 5-14) days. Technology adoption positively correlated with user performance (usability) ($\rho$=0.55; 95\% CI 0.23-0.75; P=.007) and acceptability as well as domains of perceived usefulness ($\rho$=0.42; 95\% CI 0.09-0.68; P=.03) and perceived ease of use ($\rho$=0.46; 95\% CI 0.10-0.74; P=.02). Technology acceptance decreased with increased global stroke severity ($\rho$=?0.56; 95\% CI ?0.79 to ?0.22; P=.007). Conclusions: This technology was usable and acceptable for the majority of the cohort, who achieved an intervention dose with technology-facilitated, self-directed UL training that exceeded conventional care norms. Technology usability and acceptability were determinants of adoption and appear to be mediated by stroke severity. The results demonstrate the importance of selecting technologies for stroke survivors on the basis of individual needs and abilities, as well as optimizing the accessibility of technologies for the target user group. Facilitating changes in stroke survivors' beliefs and attitudes toward rehabilitation technologies may enhance adoption. Further work is needed to understand how technology can be optimized to benefit those with more severe stroke. ",
doi="10.2196/45993",
url="https://rehab.jmir.org/2023/1/e45993",
url="http://www.ncbi.nlm.nih.gov/pubmed/37603405"
}


@Article{info:doi/10.2196/46359,
author="Zhong, Wen
and Liu, Rui
and Cheng, Hongxin
and Xu, Lin
and Wang, Lu
and He, Chengqi
and Wei, Quan",
title="Longer-Term Effects of Cardiac Telerehabilitation on Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jul",
day="28",
volume="11",
pages="e46359",
keywords="cardiac telerehabilitation",
keywords="coronary artery disease",
keywords="CAD",
keywords="cardiac rehabilitation",
keywords="CR",
keywords="long-term effect",
keywords="meta-analysis",
abstract="Background: Cardiac telerehabilitation offers a flexible and accessible model for patients with coronary artery disease (CAD), effectively transforming the traditional cardiac rehabilitation (CR) approach. Objective: This systematic review and meta-analysis aimed to evaluate the long-term effectiveness of cardiac telerehabilitation. Methods: We searched randomized controlled trials (RCTs) in 7 electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the China National Knowledge Infrastructure, and WANFANG. The primary outcome focused on cardiopulmonary fitness. For secondary outcomes, we examined cardiovascular risk factors (blood pressure, BMI, and serum lipids), psychological scales of depression and anxiety, quality of life (QoL), cardiac telerehabilitation adherence, and adverse events. Results: In total, 10 RCTs fulfilled the predefined criteria, which were reviewed in our meta-analysis. The results showed that after cardiac telerehabilitation, there was a significant difference in the improvement in long-term peak oxygen uptake compared to center-based CR (mean difference [MD] 1.61, 95\% CI 0.38-2.85, P=.01), particularly after 6-month rehabilitation training (MD 1.87, 95\% CI 0.34-3.39, P=.02). The pooled effect size of the meta-analysis indicated that there were no significant differences in the reduction in cardiovascular risk factor control. There was also no practical demonstration of anxiety scores or depression scores. However, cardiac telerehabilitation demonstrated an improvement in the long-term QoL of patients (MD 0.92, 95\% CI 0.06-1.78, P=.04). In addition, the study reported a high completion rate (80\%) for cardiac telerehabilitation interventions. The incidence of adverse events was also low during long-term follow-up. Conclusions: Cardiac telerehabilitation proves to be more effective in improving cardiopulmonary fitness and QoL during the long-term follow-up for patients with CAD. Our study highlights monitoring-enabled and patient-centered telerehabilitation programs, which play a vital role in the recovery and development of CAD and in the long-term prognosis of patients. ",
doi="10.2196/46359",
url="https://mhealth.jmir.org/2023/1/e46359",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505803"
}


@Article{info:doi/10.2196/44929,
author="Woodley, J. Stephanie
and Moller, Brittany
and Clark, R. Alys
and Bussey, D. Melanie
and Sangelaji, Bahram
and Perry, Meredith
and Kruger, Jennifer",
title="Digital Technologies for Women's Pelvic Floor Muscle Training to Manage Urinary Incontinence Across Their Life Course: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jul",
day="5",
volume="11",
pages="e44929",
keywords="apps",
keywords="culture",
keywords="life course",
keywords="mobile health",
keywords="mHealth",
keywords="pelvic floor muscle training",
keywords="urinary incontinence",
keywords="women's health",
keywords="mobile phone",
abstract="Background: Women with urinary incontinence (UI) may consider using digital technologies (DTs) to guide pelvic floor muscle training (PFMT) to help manage their symptoms. DTs that deliver PFMT programs are readily available, yet uncertainty exists regarding whether they are scientifically valid, appropriate, and culturally relevant and meet the needs of women at specific life stages. Objective: This scoping review aims to provide a narrative synthesis of DTs used for PFMT to manage UI in women across their life course. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework. A systematic search of 7 electronic databases was conducted, and primary quantitative and qualitative research and gray literature publications were considered. Studies were eligible if they focused on women with or without UI who had engaged with DTs for PFMT, reported on outcomes related to the use of PFMT DTs for managing UI, or explored users' experiences of DTs for PFMT. The identified studies were screened for eligibility. Data on the evidence base for and features of PFMT DTs using the Consensus on Exercise Reporting Template for PFMT, PFMT DT outcomes (eg, UI symptoms, quality of life, adherence, and satisfaction), life stage and culture, and the experiences of women and health care providers (facilitators and barriers) were extracted and synthesized by ?2 independent reviewers. Results: In total, 89 papers were included (n=45, 51\% primary and n=44, 49\% supplementary) involving studies from 14 countries. A total of 28 types of DTs were used in 41 primary studies, including mobile apps with or without a portable vaginal biofeedback or accelerometer-based device, a smartphone messaging system, internet-based programs, and videoconferencing. Approximately half (22/41, 54\%) of the studies provided evidence for or testing of the DTs, and a similar proportion of PFMT programs were drawn from or adapted from a known evidence base. Although PFMT parameters and program compliance varied, most studies that reported on UI symptoms showed improved outcomes, and women were generally satisfied with this treatment approach. With respect to life stage, pregnancy and the postpartum period were the most common focus, with more evidence needed for women of various age ranges (eg, adolescent and older women), including their cultural context, which is a factor that is rarely considered. Women's perceptions and experiences are often considered in the development of DTs, with qualitative data highlighting factors that are usually both facilitators and barriers. Conclusions: DTs are a growing mechanism for delivering PFMT, as evidenced by the recent increase in publications. This review highlighted the heterogeneity in types of DTs, PFMT protocols, the lack of cultural adaptations of most of the DTs reviewed, and a paucity in the consideration of the changing needs of women across their life course. ",
doi="10.2196/44929",
url="https://mhealth.jmir.org/2023/1/e44929",
url="http://www.ncbi.nlm.nih.gov/pubmed/37405818"
}


@Article{info:doi/10.2196/44442,
author="Ghaffari, Arash
and Kildahl Lauritsen, Emilie Rikke
and Christensen, Michael
and Rolighed Thomsen, Trine
and Mahapatra, Harshit
and Heck, Robert
and Kold, S{\o}ren
and Rahbek, Ole",
title="Exploring the Feasibility and Usability of Smartphones for Monitoring Physical Activity in Orthopedic Patients: Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jul",
day="4",
volume="11",
pages="e44442",
keywords="remote monitoring",
keywords="physical activity",
keywords="step count",
keywords="smartphone application",
keywords="wearable sensors",
keywords="mixed effects modeling",
keywords="step count prediction",
keywords="mobile phone",
abstract="Background: Smartphones are often equipped with inertial sensors that measure individuals' physical activity (PA). However, their role in remote monitoring of the patients' PAs in telemedicine needs to be adequately explored. Objective: This study aimed to explore the correlation between a participant's actual daily step counts and the daily step counts reported by their smartphone. In addition, we inquired about the usability of smartphones for collecting PA data. Methods: This prospective observational study was conducted among patients undergoing lower limb orthopedic surgery and a group of nonpatients as control. The data from the patients were collected from 2 weeks before surgery until 4 weeks after the surgery, whereas the data collection period for the nonpatients was 2 weeks. The participant's daily step count was recorded by PA trackers worn 24/7. In addition, a smartphone app collected the number of daily steps registered by the participants' smartphones. We compared the cross-correlation between the daily steps time series obtained from the smartphones and PA trackers in different groups of participants. We also used mixed modeling to estimate the total number of steps, using smartphone step counts and the characteristics of the patients as independent variables. The System Usability Scale was used to evaluate the participants' experience with the smartphone app and the PA tracker. Results: Overall, 1067 days of data were collected from 21 patients (n=11, 52\% female patients) and 10 nonpatients (n=6, 60\% female patients). The median cross-correlation coefficient on the same day was 0.70 (IQR 0.53-0.83). The correlation in the nonpatient group was slightly higher than that in the patient group (median 0.74, IQR 0.60-0.90 and median 0.69, IQR 0.52-0.81, respectively). The likelihood ratio tests on the models fitted by mixed effects methods demonstrated that the smartphone step count was positively correlated with the PA tracker's total number of steps ($\chi$21=34.7, P<.001). In addition, the median usability score for the smartphone app was 78 (IQR 73-88) compared with median 73 (IQR 68-80) for the PA tracker. Conclusions: Considering the ubiquity, convenience, and practicality of smartphones, the high correlation between the smartphones and the total daily step count time series highlights the potential usefulness of smartphones in detecting changes in the number of steps in remote monitoring of a patient's PA. ",
doi="10.2196/44442",
url="https://mhealth.jmir.org/2023/1/e44442",
url="http://www.ncbi.nlm.nih.gov/pubmed/37283228"
}


@Article{info:doi/10.2196/44585,
author="Lewkowicz, Daniel
and Bottinger, Erwin
and Siegel, Martin",
title="Economic Evaluation of Digital Therapeutic Care Apps for Unsupervised Treatment of Low Back Pain: Monte Carlo Simulation",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jun",
day="29",
volume="11",
pages="e44585",
keywords="cost-utility analysis",
keywords="cost",
keywords="probabilistic sensitivity analysis",
keywords="Monte Carlo simulation",
keywords="low back pain",
keywords="pain",
keywords="economic",
keywords="cost-effectiveness",
keywords="Markov model",
keywords="digital therapy",
keywords="digital health app",
keywords="mHealth, mobile health",
keywords="health app",
keywords="mobile app",
keywords="orthopedic",
keywords="QUALY",
keywords="DALY",
keywords="quality-adjusted life years",
keywords="disability-adjusted life years",
keywords="time horizon",
keywords="veteran",
keywords="statistics",
abstract="Background: Digital therapeutic care (DTC) programs are unsupervised app-based treatments that provide video exercises and educational material to patients with nonspecific low back pain during episodes of pain and functional disability. German statutory health insurance can reimburse DTC programs since 2019, but evidence on efficacy and reasonable pricing remains scarce. This paper presents a probabilistic sensitivity analysis (PSA) to evaluate the efficacy and cost-utility of a DTC app against treatment as usual (TAU) in Germany. Objective: The aim of this study was to perform a PSA in the form of a Monte Carlo simulation based on the deterministic base case analysis to account for model assumptions and parameter uncertainty. We also intend to explore to what extent the results in this probabilistic analysis differ from the results in the base case analysis and to what extent a shortage of outcome data concerning quality-of-life (QoL) metrics impacts the overall results. Methods: The PSA builds upon a state-transition Markov chain with a 4-week cycle length over a model time horizon of 3 years from a recently published deterministic cost-utility analysis. A Monte Carlo simulation with 10,000 iterations and a cohort size of 10,000 was employed to evaluate the cost-utility from a societal perspective. Quality-adjusted life years (QALYs) were derived from Veterans RAND 6-Dimension (VR-6D) and Short-Form 6-Dimension (SF-6D) single utility scores. Finally, we also simulated reducing the price for a 3-month app prescription to analyze at which price threshold DTC would result in being the dominant strategy over TAU in Germany. Results: The Monte Carlo simulation yielded on average a {\texteuro}135.97 (a currency exchange rate of EUR {\texteuro}1=US \$1.069 is applicable) incremental cost and 0.004 incremental QALYs per person and year for the unsupervised DTC app strategy compared to in-person physiotherapy in Germany. The corresponding incremental cost-utility ratio (ICUR) amounts to an additional {\texteuro}34,315.19 per additional QALY. DTC yielded more QALYs in 54.96\% of the iterations. DTC dominates TAU in 24.04\% of the iterations for QALYs. Reducing the app price in the simulation from currently {\texteuro}239.96 to {\texteuro}164.61 for a 3-month prescription could yield a negative ICUR and thus make DTC the dominant strategy, even though the estimated probability of DTC being more effective than TAU is only 54.96\%. Conclusions: Decision-makers should be cautious when considering the reimbursement of DTC apps since no significant treatment effect was found, and the probability of cost-effectiveness remains below 60\% even for an infinite willingness-to-pay threshold. More app-based studies involving the utilization of QoL outcome parameters are urgently needed to account for the low and limited precision of the available QoL input parameters, which are crucial to making profound recommendations concerning the cost-utility of novel apps. ",
doi="10.2196/44585",
url="https://mhealth.jmir.org/2023/1/e44585",
url="http://www.ncbi.nlm.nih.gov/pubmed/37384379"
}


@Article{info:doi/10.2196/45321,
author="Hutchison, G. Michael
and Di Battista, P. Alex
and Loenhart, M. Matthew",
title="A Continuous Aerobic Resistance Exercise Protocol for Concussion Rehabilitation Delivered Remotely via a Mobile App: Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="19",
volume="7",
pages="e45321",
keywords="Bayesian modeling",
keywords="concussion",
keywords="exercise rehabilitation",
keywords="mobile health",
keywords="mild traumatic brain injury",
keywords="persisting symptoms",
abstract="Background: In recent years, several studies have consistently reported the beneficial effects of aerobic exercise in alleviating symptoms following concussion. However, exercise modality recommendations by practitioners are often limited to traditional exercise equipment (eg, treadmills and stationary bikes). Advances in digital technologies may help to overcome this limitation, as mobile apps can now provide users with high-quality instructional videos, programs, and monitoring capabilities using alternative modalities such as resistance exercises. Mobile technologies are also rapidly expanding to deliver and complement in-person clinical care. Thus, it is imperative to evaluate this emerging technology on its feasibility, safety, and clinical utility for concussion care. Objective: The objective of the study was to determine the feasibility of a mobile app to deliver a resistance exercise protocol with minimal equipment to individuals following concussion. Feasibility was defined by retention, adverse events, and achievement of a target heart rate (HR) of 60\%{\textpm}5\% (age-adjusted percentage of max: 220 -- age). HR data were collected using an Apple Watch, Series 6. Symptoms were evaluated before and after 3 exercise sessions. Methods: A 2-week, prospective, single-arm pilot study was conducted on 21 adults diagnosed with a concussion. Users were provided a continuous aerobic resistance exercise (CARE) protocol through a mobile app. Results: A total of 18 participants (14 female and 4 male) completed a 3-session exercise plan. The median age-adjusted percent of HR max for session 1 was 55.5\% (IQR 49\%-63\%), 58.1\% (IQR 50.8\%-65.2\%) for session 2, and 57.4\% (IQR 49.5\%-64.7\%) for session 3. Individual median HR\% across all sessions ranged from 46.9\% to 67.4\%; furthermore, 10 participants (55.5\%) had a total mean HR\% within the target HR\%, 7 participants had a mean HR\% below 55\%, and 1 participant had a mean HR\% above 65\%. In addition, adherence to the plan resulted in a decrease in reported symptom burden with 94\% posterior probability. Conclusions: Following concussion, a CARE protocol delivered through a mobile app resulted in no adverse effects with 14\% (n=3/21) attrition over 3 sessions. CARE was successful in achieving an aerobic exercise intensity of 55\%-65\% of age-adjusted maximum HR in the majority of participants and resulted in a decrease in reported symptom burden. The potential for this platform in concussion rehabilitation warrants further investigation. Future studies are needed to assess the use of this technology throughout concussion recovery in both individuals with acute concussion, and those with persistent symptoms. ",
doi="10.2196/45321",
url="https://formative.jmir.org/2023/1/e45321",
url="http://www.ncbi.nlm.nih.gov/pubmed/37335605"
}


@Article{info:doi/10.2196/38798,
author="Kitagawa, Takashi
and Hayashi, Masateru",
title="mHealth for the Self-management of Knee Osteoarthritis: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="8",
volume="25",
pages="e38798",
keywords="knee osteoarthritis",
keywords="mobile health",
keywords="mHealth",
keywords="self-management",
keywords="knee joint",
keywords="scoping review",
keywords="pain",
keywords="physical function",
keywords="quality of life",
keywords="mobile phone app",
keywords="patient education",
abstract="Background: Educating patients on the self-management of knee osteoarthritis (OA) reportedly reduces pain, improves activities of daily living, and even reduces health care costs. Objective: This scoping review will summarize the current evidence on mobile health (mHealth) and smartphone app--based disease self-management for patients with knee OA. Methods: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and CINAHL were systematically searched in May 2021 using the keywords ``knee osteoarthritis,'' ``mobile health,'' and ``self-management.'' Studies that investigated patients with knee OA based on radiography or clinical diagnosis were included. The following criteria were applied to the mobile phone apps included in the search-derived studies: the ability to (1) record and manage symptoms, (2) provide patient education, and (3) guide and record activities of daily living. Studies eligible for inclusion in this scoping review were interventional trials or observational studies published in English. Results: This scoping review included 8 reports, of which 3 were randomized controlled trials and 1 was a conference abstract. Most studies provided data on the outcomes of pain, physical function, and quality of life. Conclusions: An increasing number of reports are addressing the effectiveness of mHealth in patients with knee OA, and the data suggest that mHealth efficacy is similar to conventional management of health. International Registered Report Identifier (IRRID): RR2-10.17504/protocols.io.buuxnwxn ",
doi="10.2196/38798",
url="https://www.jmir.org/2023/1/e38798",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155233"
}


@Article{info:doi/10.2196/44832,
author="Rozenberg, Dmitry
and Al Kaabi, Noor
and Camacho Perez, Encarna
and Nourouzpour, Sahar
and Lopez-Hernandez, Laura
and McGillis, Laura
and Goligher, Ewan
and Reid, Darlene W.
and Chow, Chung-Wai
and Ryan, M. Clodagh
and Kumbhare, Dinesh
and Huszti, Ella
and Champagne, Kateri
and Raj, Satish
and Mak, Susanna
and Santa Mina, Daniel
and Clarke, Hance
and Mittal, Nimish",
title="Evaluation and Management of Dyspnea in Hypermobile Ehlers-Danlos Syndrome and Generalized Hypermobility Spectrum Disorder: Protocol for a Pilot and Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="20",
volume="12",
pages="e44832",
keywords="Ehlers-Danlos Syndrome",
keywords="generalized hypermobility spectrum disorders",
keywords="inspiratory muscle training",
keywords="rehabilitation",
keywords="exercise",
keywords="mobile phone",
abstract="Background: Dyspnea is a prevalent symptom in individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD), yet its contributors have not been identified. One known contributor to dyspnea is respiratory muscle weakness. The feasibility and effectiveness of inspiratory muscle training (IMT) in combination with standard-of-care rehabilitation (aerobic, resistance, neuromuscular stabilization, and balance and proprioception exercises) in improving respiratory muscle strength and patient-reported outcomes in patients with hEDS or G-HSD have not been evaluated. Objective: This study aims to evaluate dyspnea, respiratory muscle strength, and patient-reported outcome measures (PROMs) in hEDS or G-HSD compared with healthy controls and to assess the feasibility of a randomized controlled trial of IMT and standard-of-care rehabilitation for improving respiratory muscle strength, exercise capacity, and PROMs compared with standard-of-care rehabilitation in hEDS and G-HSD. Methods: The study will include 34 participants with hEDS or G-HSD and 17 healthy, age- and sex-matched controls to compare respiratory muscle structure and function and PROMs. After baseline assessments, participants with hEDS or G-HSD will be randomized into the intervention group and provided IMT combined with Ehlers-Danlos Syndrome standard-of-care rehabilitation or into the usual care group, and provided only standard-of-care rehabilitation for 8 weeks. The intervention group will be prescribed IMT in their home environment using the POWERbreathe K5 IMT device (POWERbreathe International Ltd). IMT will comprise 2 daily sessions of 30 breaths for 5 days per week, with IMT progressing from 20\% to 60\% of the baseline maximal inspiratory pressure (MIP) over an 8-week period. Feasibility will be assessed through rates of recruitment, attrition, adherence, adverse events, and participant satisfaction. The primary pilot outcome is MIP change over an 8-week period in hEDS or G-HSD. Secondary outcomes will include the evaluation of dyspnea using Medical Research Council Scale and 18-point qualitative dyspnea descriptors; diaphragmatic thickening fraction using ultrasound; respiratory muscle endurance; pulmonary function; prefrontal cortical activity using functional near-infrared spectroscopy; aerobic capacity during cardiopulmonary exercise testing; quality of life using Short Form-36; and scores from the Depression, Anxiety, and Stress scale-21. These measures will also be performed once in healthy controls to compare normative values. Multivariable regression will be used to assess the contributors to dyspnea. Paired 2-tailed t tests will be used to assess the changes in MIP and secondary measures after 8 weeks of IMT. Results: Study recruitment began in August 2021 and, with several disruptions owing to COVID-19, is expected to be completed by December 2023. Conclusions: This study will provide a better understanding of the factors associated with dyspnea and the feasibility and effectiveness of IMT combined with standard-of-care rehabilitation. IMT may be a novel therapeutic strategy for improving respiratory muscle function and patient-reported outcomes in individuals with hEDS or G-HSD. Trial Registration: ClinicalTrials.gov NCT04972565; https://clinicaltrials.gov/ct2/show/NCT04972565 International Registered Report Identifier (IRRID): DERR1-10.2196/44832 ",
doi="10.2196/44832",
url="https://www.researchprotocols.org/2023/1/e44832",
url="http://www.ncbi.nlm.nih.gov/pubmed/36939815"
}


@Article{info:doi/10.2196/44316,
author="Scheer, Justin
and Areias, C. Anabela
and Molinos, Maria
and Janela, Dora
and Moulder, Robert
and Lains, Jorge
and Bento, Virg{\'i}lio
and Yanamadala, Vijay
and Dias Correia, Fernando
and Costa, Fab{\'i}ola",
title="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",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="16",
volume="11",
pages="e44316",
keywords="physical therapy",
keywords="physiotherapy",
keywords="remote care",
keywords="telerehabilitation",
keywords="digital therapy",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="musculoskeletal",
keywords="musculoskeletal conditions",
keywords="urban",
keywords="rural",
keywords="pain",
keywords="health inequity",
keywords="digital care",
keywords="pain management",
keywords="clinical outcome",
keywords="health equity",
keywords="engagement",
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 ",
doi="10.2196/44316",
url="https://mhealth.jmir.org/2023/1/e44316",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735933"
}


@Article{info:doi/10.2196/43775,
author="Teepe, Wilhelm Gisbert
and Kowatsch, Tobias
and Hans, Patricius Felix
and Benning, Leo",
title="Postmarketing Follow-Up of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time-Series and Matched-Pair Analysis",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="27",
volume="25",
pages="e43775",
keywords="digital therapeutics",
keywords="digital health",
keywords="musculoskeletal diseases",
keywords="exercise training",
abstract="Background: Musculoskeletal conditions are the main drivers of global disease burden and cause significant direct and indirect health care costs. Digital health applications improve the availability of and access to adequate care. The German health care system established a pathway for the approval of ``Digitale Gesundheitsanwendungen'' (DiGAs; Digital Health Applications) as collectively funded medical services through the ``Digitale-Versorgung-Gesetz'' (Digital Health Care Act) in 2019. Objective: This article presents real-world prescription data collected through the smartphone-based home exercise program ``Vivira,'' a fully approved DiGA, regarding its effect on self-reported pain intensity and physical inability in patients with unspecific and degenerative pain in the back, hip, and knee. Methods: This study included 3629 patients (71.8\% [2607/3629] female; mean age 47 years, SD 14.2 years). The primary outcome was the self-reported pain score, which was assessed with a verbal numerical rating scale. The secondary outcomes were self-reported function scores. To analyze the primary outcome, we used a 2-sided Skillings-Mack test. For function scores, a time analysis was not feasible; therefore, we calculated matched pairs using the Wilcoxon signed-rank test. Results: Our results showed significant reductions in self-reported pain intensity after 2, 4, 8, and 12 weeks in the Skillings-Mack test (T3628=5308;?P<.001). The changes were within the range of a clinically relevant improvement. Function scores showed a generally positive yet more variable response across the pain areas (back, hip, and knee). Conclusions: This study presents postmarketing observational data from one of the first DiGAs for unspecific and degenerative musculoskeletal pain. We noted significant improvements in self-reported pain intensity throughout the observation period of 12 weeks, which reached clinical relevance. Additionally, we identified a complex response pattern of the function scores assessed. Lastly, we highlighted the challenges of relevant attrition at follow-up and the potential opportunities for evaluating digital health applications. Although our findings do not have confirmatory power, they illustrate the potential benefits of digital health applications to improve the availability of and access to medical care. Trial Registration: German Clinical Trials Register DRKS00024051; https://drks.de/search/en/trial/DRKS00024051 ",
doi="10.2196/43775",
url="https://www.jmir.org/2023/1/e43775",
url="http://www.ncbi.nlm.nih.gov/pubmed/36848211"
}


@Article{info:doi/10.2196/40416,
author="Guo, Liquan
and Wang, Jiping
and Wu, Qunqiang
and Li, Xinming
and Zhang, Bochao
and Zhou, Linfu
and Xiong, Daxi",
title="Clinical Study of a Wearable Remote Rehabilitation Training System for Patients With Stroke: Randomized Controlled Pilot Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Feb",
day="23",
volume="11",
pages="e40416",
keywords="remote rehabilitation",
keywords="wearable devices",
keywords="human-computer interaction",
keywords="rehabilitation training",
keywords="stroke",
abstract="Background: In contrast to the large and increasing number of patients with stroke, clinical rehabilitation resources cannot meet their rehabilitation needs. Especially for those discharged, ways to carry out effective rehabilitation training without the supervision of physicians and receive guidance from physicians remain urgent problems to be solved in clinical rehabilitation and have become a research hot spot at home and abroad. At present, there are many studies on home rehabilitation training based on wearable devices, Kinect, among others, but these have disadvantages (eg, complex systems, high price, and unsatisfactory rehabilitation effects). Objective: This study aims to design a remote intelligent rehabilitation training system based on wearable devices and human-computer interaction training tasks, and to evaluate the effectiveness and safety of the remote rehabilitation training system for nonphysician-supervised motor rehabilitation training of patients with stroke through a clinical trial study. Methods: A total of 120 inpatients with stroke having limb motor dysfunction were enrolled via a randomized, parallel-controlled method in the rehabilitation institutions, and a 3-week clinical trial was conducted in the rehabilitation hall with 60 patients in the experimental group and 60 in the control group. The patients in the experimental group used the remote rehabilitation training system for rehabilitation training and routine clinical physical therapy (PT) training and received routine drug treatment every day. The patients in the control group received routine clinical occupational therapy (OT) training and routine clinical PT training and routine drug treatment every day. At the beginning of the training (baseline) and after 3 weeks, the Fugl-Meyer Motor Function Rating scale was scored by rehabilitation physicians, and the results were compared and analyzed. Results: Statistics were performed using SAS software (version 9.4). The total mean Fugl-Meyer score improved by 11.98 (SD 8.46; 95\% CI 9.69-14.27) in the control group and 17.56 (SD 11.65; 95\% CI 14.37-20.74) in the experimental group, and the difference between the 2 groups was statistically significant (P=.005). Among them, the mean Fugl-Meyer upper extremity score improved by 7.45 (SD 7.24; 95\% CI 5.50-9.41) in the control group and 11.28 (SD 8.59; 95\% CI 8.93-13.62) in the experimental group, and the difference between the 2 groups was statistically significant (P=.01). The mean Fugl-Meyer lower extremity score improved by 4.53 (SD 4.42; 95\% CI 3.33-5.72) in the control group and 6.28 (SD 5.28; 95\% CI 4.84-7.72) in the experimental group, and there was no significant difference between the 2 groups (P=.06). The test results showed that the experimental group was better than the control group, and that the patients' motor ability was improved. Conclusions: The remote rehabilitation training system designed based on wearable devices and human-computer interaction training tasks can replace routine clinical OT training. In the future, through medical device registration certification, the system will be used without the participation of physicians or therapists, such as in rehabilitation training halls, and in remote environments, such as communities and homes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200061310; https://tinyurl.com/34ka2725 ",
doi="10.2196/40416",
url="https://mhealth.jmir.org/2023/1/e40416",
url="http://www.ncbi.nlm.nih.gov/pubmed/36821348"
}


@Article{info:doi/10.2196/41691,
author="Han, Dong
and Ding, Y. Eric
and Cho, Chaeho
and Jung, Haewook
and Dickson, L. Emily
and Mohagheghian, Fahimeh
and Peitzsch, G. Andrew
and DiMezza, Danielle
and Tran, Khanh-Van
and McManus, D. David
and Chon, H. Ki",
title="A Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study",
journal="JMIR Cardio",
year="2023",
month="Feb",
day="13",
volume="7",
pages="e41691",
keywords="atrial fibrillation",
keywords="stroke",
keywords="smartwatch app",
keywords="smartphone apps",
keywords="wearable devices",
keywords="user experience",
keywords="older adults",
keywords="mobile phone",
abstract="Background: The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group. Objective: This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians. Methods: The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server. Results: We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64\%) endorsed that the smartwatch app is ``easy to use.'' For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection. Conclusions: This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system's usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment. Trial Registration: ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394 International Registered Report Identifier (IRRID): RR2-10.1016/j.cvdhj.2021.07.002 ",
doi="10.2196/41691",
url="https://cardio.jmir.org/2023/1/e41691",
url="http://www.ncbi.nlm.nih.gov/pubmed/36780211"
}


@Article{info:doi/10.2196/42219,
author="Inamoto, Yoko
and Mukaino, Masahiko
and Imaeda, Sayuri
and Sawada, Manami
and Satoji, Kumi
and Nagai, Ayako
and Hirano, Satoshi
and Okazaki, Hideto
and Saitoh, Eiichi
and Sonoda, Shigeru
and Otaka, Yohei",
title="A Tablet-Based Aphasia Assessment System ``STELA'': Feasibility and Validation Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="8",
volume="7",
pages="e42219",
keywords="aphasia",
keywords="tablet",
keywords="assessment",
keywords="validity",
keywords="internal consistency",
keywords="psychometric",
keywords="psychological health",
keywords="stress",
keywords="digital mental health intervention",
keywords="digital health intervention",
keywords="heuristic evaluation",
keywords="system usability",
keywords="auditory comprehension",
keywords="reading comprehension",
keywords="naming and sentence formation",
keywords="repetition",
keywords="reading aloud",
keywords="Cronbach $\alpha$",
keywords="speech",
abstract="Background: There is an extensive library of language tests, each with excellent psychometric properties; however, many of the tests available take considerable administration time, possibly bearing psychological strain on patients. The Short and Tailored Evaluation of Language Ability (STELA) is a simplified, tablet-based language ability assessment system developed to address this issue, with a reduced number of items and automated testing process. Objective: The aim of this paper is to assess the administration time, internal consistency, and validity of the STELA. Methods: The STELA consists of a tablet app, a microphone, and an input keypad for clinician's use. The system is designed to assess language ability with 52 questions grouped into 2 comprehension modalities (auditory comprehension and reading comprehension) and 3 expression modalities (naming and sentence formation, repetition, and reading aloud). Performance in each modality was scored as the correct answer rate (0-100), and overall performance expressed as the sum of modality scores (out of 500 points). Results: The time taken to complete the STELA was significantly less than the time for the WAB (mean 16.2, SD 9.4 vs mean 149.3, SD 64.1 minutes; P<.001). The STELA's total score was strongly correlated with the WAB Aphasia Quotient (r=0.93, P<.001), supporting the former's concurrent validity concerning the WAB, which is a gold-standard aphasia assessment. Strong correlations were also observed at the subscale level; STELA auditory comprehension versus WAB auditory comprehension (r=0.75, P<.001), STELA repetition versus WAB repetition (r=0.96, P<.001), STELA naming and sentence formation versus WAB naming and word finding (r=0.81, P<.001), and the sum of STELA reading comprehension or reading aloud versus WAB reading (r=0.82, P<.001). Cronbach $\alpha$ obtained for each modality was .862 for auditory comprehension, .872 for reading comprehension, .902 for naming and sentence formation, .787 for repetition, and .892 for reading aloud. Global Cronbach $\alpha$ was .961. The average of the values of item-total correlation to each subscale was 0.61 (SD 0.17). Conclusions: Our study confirmed significant time reduction in the assessment of language ability and provided evidence for good internal consistency and validity of the STELA tablet-based aphasia assessment system. ",
doi="10.2196/42219",
url="https://formative.jmir.org/2023/1/e42219",
url="http://www.ncbi.nlm.nih.gov/pubmed/36753308"
}


@Article{info:doi/10.2196/40844,
author="Moreno-Ligero, Marta
and Moral-Munoz, A. Jose
and Salazar, Alejandro
and Failde, Inmaculada",
title="mHealth Intervention for Improving Pain, Quality of Life, and Functional Disability in Patients With Chronic Pain: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Feb",
day="2",
volume="11",
pages="e40844",
keywords="chronic pain",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="health app",
keywords="digital intervention",
keywords="monitoring",
keywords="pain intensity",
keywords="quality of life",
keywords="functionality",
keywords="disability",
keywords="disabilities",
keywords="systematic review",
keywords="review methodology",
keywords="search strategy",
keywords="library science",
keywords="RCT",
keywords="randomized controlled trial",
keywords="pain",
keywords="health outcome",
keywords="self-management",
abstract="Background: Chronic pain (CP) is 1 of the leading causes of disability worldwide and represents a significant burden on individual, social, and economic aspects. Potential tools, such as mobile health (mHealth) systems, are emerging for the self-management of patients with CP. Objective: A systematic review was conducted to analyze the effects of mHealth interventions on CP management, based on pain intensity, quality of life (QoL), and functional disability assessment, compared to conventional treatment or nonintervention. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to conduct a systematic review of randomized controlled trials (RCTs) published in PubMed, Web of Science, Scopus, and Physiotherapy Evidence Database (PEDro) databases from February to March 2022. No filters were used. The eligibility criteria were RCTs of adults (?18 years old) with CP, intervened with mHealth systems based on mobile apps for monitoring pain and health-related outcomes, for pain and behavioral self-management, and for performing therapeutic approaches, compared to conventional treatments (physical, occupational, and psychological therapies; usual medical care; and education) or nonintervention, reporting pain intensity, QoL, and functional disability. The methodological quality and risk of bias (RoB) were assessed using the Checklist for Measuring Quality, the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and the Cochrane RoB 2.0 tool. Results: In total, 22 RCTs, involving 2641 patients with different CP conditions listed in the International Classification of Diseases 11th Revision (ICD-11), including chronic low back pain (CLBP), chronic musculoskeletal pain (CMSP), chronic neck pain (CNP), unspecified CP, chronic pelvic pain (CPP), fibromyalgia (FM), interstitial cystitis/bladder pain syndrome (IC/BPS), irritable bowel syndrome (IBS), and osteoarthritis (OA). A total of 23 mHealth systems were used to conduct a variety of CP self-management strategies, among which monitoring pain and symptoms and home-based exercise programs were the most used. Beneficial effects of the use of mHealth systems in reducing pain intensity (CNP, FM, IC/BPS, and OA), QoL (CLBP, CNP, IBS, and OA), and functional disability (CLBP, CMSP, CNP, and OA) were found. Most of the included studies (18/22, 82\%) reported medium methodological quality and were considered as highly recommendable; in addition, 7/22 (32\%) studies had a low RoB, 10/22 (45\%) had some concerns, and 5/22 (23\%) had a high RoB. Conclusions: The use of mHealth systems indicated positive effects for pain intensity in CNP, FM, IC/BPS, and OA; for QoL in CLBP, CNP, IBS, and OA; and for functional disability in CLBP, CMSP, CNP, and OA. Thus, mHealth seems to be an alternative to improving pain-related outcomes and QoL and could be part of multimodal strategies for CP self-management. High-quality studies are needed to merge the evidence and recommendations of the use of mHealth systems for CP management. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022315808; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=315808 ",
doi="10.2196/40844",
url="https://mhealth.jmir.org/2023/1/e40844",
url="http://www.ncbi.nlm.nih.gov/pubmed/36729570"
}


@Article{info:doi/10.2196/39898,
author="Hyodo, Kazuki
and Kidokoro, Tetsuhiro
and Yamaguchi, Daisuke
and Iida, Michitaka
and Watanabe, Yuya
and Ueno, Aiko
and Noda, Takayuki
and Kawahara, Kenji
and Nishida, Sumiyo
and Kai, Yuko
and Arao, Takashi",
title="Feasibility, Safety, Enjoyment, and System Usability of Web-Based Aerobic Dance Exercise Program in Older Adults: Single-Arm Pilot Study",
journal="JMIR Aging",
year="2023",
month="Jan",
day="16",
volume="6",
pages="e39898",
keywords="low-intensity exercise",
keywords="home exercise",
keywords="online exercise",
keywords="supervised exercise",
keywords="elderly",
keywords="COVID-19",
keywords="smartphone",
keywords="tablet",
keywords="videoconferencing platform",
abstract="Background: During the COVID-19 epidemic, opportunities for social interaction and physical activity among older people are decreasing, which may have a negative impact on their health. As a solution, a web-based group exercise program provided through a videoconferencing platform would be useful. As a web-based exercise program that older adults can easily, safely, and enjoyably perform at home, we developed a short-duration, light-intensity aerobic dance exercise program. Before studying the effectiveness of this exercise program, its characteristics, such as feasibility, safety, enjoyment, and system usability, should be examined among older adults. Objective: This pilot study aimed to examine the feasibility, safety, and enjoyment of a web-based aerobic dance exercise program and the usability of a web-based exercise delivery system using a videoconferencing platform for older adults. Methods: This study was designed as a prospective single-arm pilot study. A total of 16 older adults participated in an 8-week web-based aerobic dance program held every morning (8:30 AM to 8:50 AM) on weekdays at home. Retention and adherence rates were measured for the program's feasibility. Safety was assessed by the heart rate reserve, an index of exercise intensity calculated from heart rate, and the number of adverse events during exercise sessions. Enjoyment of this exercise program was assessed by an 11-point Likert scale ranging from 0 (not enjoyable at all) to 10 (extremely enjoyable) obtained through telephone interviews after the first-, third-, sixth-, and eighth-week intervention. For usability, the ease of the videoconferencing platform system was assessed through telephone interviews after the intervention. Results: A female participant with hypertension dropped out in the second week because of the continuously reported high blood pressure (?180 mmHg) before attending the exercise session in the first week. Therefore, the retention rate was 93.8\% (15/16). Among the remaining participants, the median (IQR) overall adherence rate was 97.4\% (94.7-100). Regarding safety, the mean (SD) heart rate reserve during the aerobic dance exercise was 29.8\% (6.8\%), showing that the exercise was relatively safe with very light to light intensity. There were no adverse events during the exercise session. The enjoyment score (0-10 points) significantly increased from the first (6.7 [1.7]) to sixth (8.2 [1.3]) and eighth week (8.5 [1.3]). Regarding usability, 11 participants reported difficulties at the beginning, such as basic touch panel operations and the use of unfamiliar applications; however, all got accustomed to it and subsequently reported no difficulty. Conclusions: This study showed high feasibility, enjoyment, and safety of the web-based aerobic dance exercise program in older adults, and the web-based exercise delivery system may have areas for improvement, albeit without serious problems. Our web-based aerobic dance exercise program may contribute to an increase in physical and social activities among older adults. ",
doi="10.2196/39898",
url="https://aging.jmir.org/2023/1/e39898",
url="http://www.ncbi.nlm.nih.gov/pubmed/36645705"
}


@Article{info:doi/10.2196/38986,
author="Suh, Myung-Whan
and Park, Kyun Moo
and Kim, Yoonjoong
and Kim, Ho Young",
title="The Treatment Outcome of Smart Device--Based Tinnitus Retraining Therapy: Prospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jan",
day="12",
volume="11",
pages="e38986",
keywords="tinnitus",
keywords="tinnitus retraining therapy",
keywords="smart device",
keywords="sound therapy",
keywords="rehabilitation",
keywords="therapy",
keywords="tablet application",
keywords="app-based",
keywords="digital therapy",
keywords="device-based therapy",
abstract="Background: Tinnitus retraining therapy (TRT) is a standard treatment for tinnitus that consists of directive counseling and sound therapy. However, it is based on face-to-face education and a time-consuming protocol. Smart device--based TRT (smart-TRT) seems to have many advantages, but the efficacy of this new treatment has been questioned. Objective: The aim of this study was to compare the efficacy between smart-TRT and conventional TRT (conv-TRT). Methods: We recruited 84 patients with tinnitus. Results were compared between 42 patients who received smart-TRT and 42 control participants who received conv-TRT. An interactive smart pad application was used for directive counseling in the smart-TRT group. The smart pad application included detailed education on ear anatomy, the neurophysiological model of tinnitus, concept of habituation, and sound therapy. The smart-TRT was bidirectional: There were 17 multiple choice questions between each lesson as an interim check. The conv-TRT group underwent traditional person-to-person counseling. The primary outcome measure was the Tinnitus Handicap Inventory (THI), and the secondary outcome measure was assessed using a visual analogue scale (VAS). Results: Both treatments had a significant treatment effect, which comparably improved during the first 2 months. The best improvements in THI were --23.3 (95\% CI --33.1 to --13.4) points at 3 months and --16.8 (95\% CI --30.8 to --2.8) points at 2 months in the smart-TRT group and conv-TRT group, respectively. The improvements on the VAS were also comparable: smart-TRT group: --1.2 to --3.3; conv-TRT: --0.7 to --1.7. Conclusions: TRT based on smart devices can be an effective alternative for tinnitus patients. Considering the amount of time needed for person-to-person counseling, smart-TRT can be a cost-effective solution with similar treatment outcomes as conv-TRT. ",
doi="10.2196/38986",
url="https://mhealth.jmir.org/2023/1/e38986",
url="http://www.ncbi.nlm.nih.gov/pubmed/36633890"
}


@Article{info:doi/10.2196/38649,
author="Teepe, Wilhelm Gisbert
and Kowatsch, Tobias
and Hans, Patricius Felix
and Benning, Leo",
title="Preliminary Use and Outcome Data of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time Series and Matched Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Dec",
day="2",
volume="10",
number="12",
pages="e38649",
keywords="digital health",
keywords="home exercise",
keywords="musculoskeletal conditions",
keywords="digital intervention",
keywords="exercise",
keywords="physical activity",
keywords="smartphone",
keywords="pain",
keywords="management",
keywords="back pain",
keywords="hip pain",
keywords="knee pain",
keywords="mobility",
keywords="intervention",
abstract="Background: Musculoskeletal conditions are among the main contributors to the global burden of disease. International guidelines consider patient education and movement exercises as the preferred therapeutic option for unspecific and degenerative musculoskeletal conditions. Innovative and decentralized therapeutic means are required to provide access to and availability of such care to meet the increasing therapeutic demand for this spectrum of conditions. Objective: This retrospective observational study of preliminary use and outcome data explores the clinical outcomes of Vivira (hereafter referred to as ``program''), a smartphone-based program for unspecific and degenerative pain in the back, hip, and knee before it received regulatory approval for use in the German statutory health insurance system. Methods: An incomplete matched block design was employed to assess pain score changes over the intended 12-week duration of the program. Post hoc analyses were performed. In addition, a matched comparison of self-reported functional scores and adherence rates is presented. Results: A total of 2517 participants met the inclusion criteria and provided sufficient data to be included in the analyses. Overall, initial self-reported pain scores decreased significantly from an average of 5.19 out of 10 (SD 1.96) to an average of 3.35 out of 10 (SD 2.38) after 12 weeks. Post hoc analyses indicate a particularly emphasized pain score reduction over the early use phases. Additionally, participants with back pain showed significant improvements in strength and mobility scores, whereas participants with hip or knee pain demonstrated significant improvements in their coordination scores. Across all pain areas and pain durations, a high yet expected attrition rate could be observed. Conclusions: This observational study provides the first insights into the clinical outcomes of an exercise program for unspecific and degenerative back, hip, and knee pain. Furthermore, it demonstrates a potential secondary benefit of improved functionality (ie, strength, mobility, coordination). However, as this study lacks confirmatory power, further research is required to substantiate the clinical outcomes of the program assessed. Trial Registration: German Clinical Trials Register DRKS00021785; https://drks.de/search/en/trial/DRKS00021785 ",
doi="10.2196/38649",
url="https://mhealth.jmir.org/2022/12/e38649",
url="http://www.ncbi.nlm.nih.gov/pubmed/36459399"
}


@Article{info:doi/10.2196/36049,
author="Lai, Byron
and Vogtle, Laura
and Young, Raven
and Craig, Mary
and Kim, Yumi
and Gowey, Marissa
and Swanson-Kimani, Erin
and Davis, Drew
and Rimmer, H. James",
title="Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="28",
volume="6",
number="10",
pages="e36049",
keywords="exercise",
keywords="developmental disability",
keywords="cerebral palsy",
keywords="telemedicine",
keywords="telerehabilitation",
keywords="therapy",
keywords="mobile phone",
abstract="Background: Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). Objective: The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. Methods: This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children's Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results: A total of 58 people were enrolled, of which 49 (84\%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68\%, starting from 90\% in week 1 and gradually declining to 43\% in week 4. Mean adherence to coaching calls was 91\%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children's Assessment of Participation and Enjoyment Active Physical Recreation--Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants' adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390 ",
doi="10.2196/36049",
url="https://formative.jmir.org/2022/10/e36049",
url="http://www.ncbi.nlm.nih.gov/pubmed/36306154"
}


@Article{info:doi/10.2196/39682,
author="Rintala, Aki
and Rantalainen, Roy
and Kaksonen, Anu
and Luomajoki, Hannu
and Kauranen, Kari",
title="mHealth Apps for Low Back Pain Self-management: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="26",
volume="10",
number="8",
pages="e39682",
keywords="low back pain",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="disability",
keywords="self-management",
keywords="mobile phone",
abstract="Background: The role of self-management in health promotion, as well as prevention and rehabilitation, is increasing through the use of mobile health (mHealth) apps. Such mHealth apps are also increasingly being used for self-management of low back pain (LBP), but their effectiveness has not been sufficiently explored. Objective: The aim of this scoping review was to provide an overview of the literature on self-management mHealth apps and their effects on the levels of pain and disability in people with LBP. Methods: We applied the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, including a priori research questions. A literature search was conducted in 2 databases (PubMed and PEDro) for studies published between January 1, 2015, and June 17, 2021. Interventional, cohort, or case series studies with an interventional period were included if the mHealth app included built-in self-management content, the app was used for self-management for people with LBP, and the study reported outcomes regarding pain and disability in people with LBP. Results: In total, 7 studies were selected for the review with overall 2307 persons with LBP, of whom 1328 (57.56\%) were women. Among the studies (5/7, 71\%) that reported the type of pain, 85\% (390/459) of the participants were experiencing chronic LBP. A total of 5 different mHealth apps were identified, of which 4 contributed to a statistically significant reduction in LBP and clinically meaningful changes. Of the 7 studies, 4 (57\%) used 4 different assessments for disability, of which 3 (75\%) showed statistically significant improvements in the level of functional ability of participants in the experimental groups using an mHealth app with built-in self-management content for LBP. Conclusions: This scoping review supports the conclusion that people with LBP may benefit from mHealth apps that provide self-management content. However, the generalizability of the findings is limited because of heterogeneity in the pain characterization of the included participants and the intervention durations. More high-quality studies with longer follow-up periods to investigate personalized mHealth approaches are recommended for LBP self-management. ",
doi="10.2196/39682",
url="https://mhealth.jmir.org/2022/8/e39682",
url="http://www.ncbi.nlm.nih.gov/pubmed/36018713"
}


@Article{info:doi/10.2196/34734,
author="Soulard, Julie
and Carlin, Thomas
and Knitza, Johannes
and Vuillerme, Nicolas",
title="Wearables for Measuring the Physical Activity and Sedentary Behavior of Patients With Axial Spondyloarthritis: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="22",
volume="10",
number="8",
pages="e34734",
keywords="axial spondyloarthritis",
keywords="rheumatology",
keywords="physical activity",
keywords="sedentary behavior",
keywords="objective measures",
keywords="wearable",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease associated with chronic back pain and restricted mobility and physical function. Increasing physical activity is a viable strategy for improving the health and quality of life of patients with axSpA. Thus, quantifying physical activity and sedentary behavior in this population is relevant to clinical outcomes and disease management. However, to the best of our knowledge, no systematic review to date has identified and synthesized the available evidence on the use of wearable devices to objectively measure the physical activity or sedentary behavior of patients with axSpA. Objective: This study aimed to review the literature on the use of wearable activity trackers as outcome measures for physical activity and sedentary behavior in patients with axSpA. Methods: PubMed, PEDro, and Cochrane electronic databases were searched in July 2021 for relevant original articles, with no limits on publication dates. Studies were included if they were original articles, targeted adults with a diagnosis of axSpA, and reported wearable device--measured physical activity or sedentary behavior among patients with axSpA. Data regarding the study's characteristics, the sample description, the methods used for measuring physical activity and sedentary behavior (eg, wearable devices, assessment methods, and outcomes), and the main results of the physical activity and sedentary behavior assessments were extracted. Results: A total of 31 studies were initially identified; 13 (13/31, 42\%) met the inclusion criteria, including 819 patients with axSpA. All the studies used accelerometer-based wearable devices to assess physical activity. Of the 13 studies, 4 (4/31, 31\%) studies also reported outcomes related to sedentary behavior. Wearable devices were secured on the wrists (3/13 studies, 23\%), lower back (3/13, 23\%), right hip (3/13, 23\%), waist (2/13, 15\%), anterior thigh (1/13, 8\%), or right arm (1/13, 8\%). The methods for reporting physical activity and sedentary behavior were heterogeneous. Approximately 77\% (10/13) of studies had a monitoring period of 1 week, including weekend days. Conclusions: To date, few studies have used wearable devices to quantify the physical activity and sedentary behavior of patients with axSpA. The methodologies and results were heterogeneous, and none of these studies assessed the psychometric properties of these wearables in this specific population. Further investigation in this direction is needed before using wearable device--measured physical activity and sedentary behavior as outcome measures in intervention studies in patients with axSpA. Trial Registration: PROSPERO CRD42020182398; https://tinyurl.com/ec22jzkt International Registered Report Identifier (IRRID): RR2-10.2196/23359 ",
doi="10.2196/34734",
url="https://mhealth.jmir.org/2022/8/e34734",
url="http://www.ncbi.nlm.nih.gov/pubmed/35994315"
}


@Article{info:doi/10.2196/38465,
author="Chang, Chien-Hsiang
and Yeh, Chung-Hsing
and Chang, Chien-Cheng
and Lin, Yang-Cheng",
title="Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study",
journal="JMIR Serious Games",
year="2022",
month="Jul",
day="14",
volume="10",
number="3",
pages="e38465",
keywords="dementia",
keywords="elderly",
keywords="usability",
keywords="gesture recognition",
keywords="card recognition rehabilitation",
keywords="interactive somatosensory game",
abstract="Background: In aging societies, dementia risk increases with advancing age, increasing the incidence of dementia-related degenerative diseases and other complications, especially fall risk. Dementia also escalates the care burden, impacting patients, their families, social welfare institutions, and the social structure and medical system. Objective: In elderly dementia, traditional card recognition rehabilitation (TCRR) does not effectively increase one's autonomy. Therefore, from the usability perspective, we used the Tetris game as a reference to develop an interactive somatosensory game rehabilitation (ISGR) with nostalgic style for elders with mild cognitive impairment (MCI). Through intuitive gesture-controlled interactive games, we evaluated subjective feelings concerning somatosensory game integration into rehabilitation to explore whether the ISGR could improve the willingness to use and motivation for rehabilitation among elders with MCI. Methods: A total of 15 elders with MCI (7 males and 8 females with an average age of 78.4 years) underwent 2 experiments for 15 minutes. During experiment 1, TCRR was performed, followed by completing the questionnaire of the System Usability Scale (SUS). After 3-5 minutes, the second experiment (the ISGR) was conducted, followed by completing another SUS. We used SUS to explore differences in impacts of TCRR and ISGR on willingness to use among elders with MCI. In addition, we further investigated whether the factor of gender or prior rehabilitation experience would affect the rehabilitation willingness or not. Results: The novel ISGR made the elderly feel interested and improved their willingness for continuous rehabilitation. According to the overall SUS score, the ISGR had better overall usability performance (73.7) than the TCRR (58.0) (t28=--4.62, P<.001). Furthermore, the ISGR individual item scores of ``Willingness to Use'' (t28=--8.27, P<.001), ``Easy to Use'' (t28=--3.17, P<.001), ``System Integration'' (t28=--5.07, P<.001), and ``Easy to Learn'' (t28=--2.81, P<.001) were better than TCRR. The somatosensory game was easier to learn and master for females than for males (t13=2.71, P=.02). Besides, the ISGR was easier to use (t12=--2.50, P=.02) and learn (t14=--3.33, P<.001) for those without prior rehabilitation experience. The result indicates that for elders with no rehabilitation experience ISGR was easier to use and simpler to learn than TCRR. Conclusions: Regardless of prior rehabilitation experience, the ISGR developed in this study was easy to learn and effective in continuously improving willingness to use. Furthermore, the adoption of a nostalgic game design style served the function of cognitive training and escalated interest in rehabilitation. The ISGR also improved user stickiness by introducing different game scenarios and difficulties, increasing long-term interest and motivation for rehabilitation. For future research on the adoption of interactive somatosensory games in rehabilitation, additional rehabilitation movements can be developed to benefit the elderly with MCI. ",
doi="10.2196/38465",
url="https://games.jmir.org/2022/3/e38465",
url="http://www.ncbi.nlm.nih.gov/pubmed/35834303"
}


@Article{info:doi/10.2196/32910,
author="Predel, Christopher
and Timmermann, Cristian
and Ursin, Frank
and Orzechowski, Marcin
and Ropinski, Timo
and Steger, Florian",
title="Conflicting Aims and Values in the Application of Smart Sensors in Geriatric Rehabilitation: Ethical Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jun",
day="23",
volume="10",
number="6",
pages="e32910",
keywords="personal data",
keywords="wearable",
keywords="older adults",
keywords="autonomy",
keywords="rehabilitation",
keywords="smart sensor",
keywords="machine learning",
keywords="ethics",
keywords="access to health care",
keywords="justice",
abstract="Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. Methods: On the basis of a systematic literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles. Results: We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients. Conclusions: The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access. ",
doi="10.2196/32910",
url="https://mhealth.jmir.org/2022/6/e32910",
url="http://www.ncbi.nlm.nih.gov/pubmed/35737429"
}


@Article{info:doi/10.2196/23887,
author="Ramezani, Ramin
and Zhang, Wenhao
and Roberts, Pamela
and Shen, John
and Elashoff, David
and Xie, Zhuoer
and Stanton, Annette
and Eslami, Michelle
and Wenger, S. Neil
and Trent, Jacqueline
and Petruse, Antonia
and Weldon, Amelia
and Ascencio, Andy
and Sarrafzadeh, Majid
and Naeim, Arash",
title="Physical Activity Behavior of Patients at a Skilled Nursing Facility: Longitudinal Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="May",
day="23",
volume="10",
number="5",
pages="e23887",
keywords="physical medicine and rehabilitation",
keywords="geriatrics",
keywords="remote sensing technology",
keywords="physical activity",
keywords="frailty",
keywords="health care delivery models",
keywords="wearable sensors",
keywords="indoor localization",
keywords="Bluetooth low energy beacons",
keywords="smartwatches",
abstract="Background: On-body wearable sensors have been used to predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In our previous work, we introduced a generic remote patient monitoring framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and the extraction of indoor localization using Bluetooth low energy beacons, in concert. Using the same framework, this paper addresses the longitudinal analyses of a group of patients in a skilled nursing facility. We try to investigate if the metrics derived from a remote patient monitoring system comprised of physical activity and indoor localization sensors, as well as their association with therapist assessments, provide additional insight into the recovery process of patients receiving rehabilitation. Objective: The aim of this paper is twofold: (1) to observe longitudinal changes of sensor-based physical activity and indoor localization features of patients receiving rehabilitation at a skilled nursing facility and (2) to investigate if the sensor-based longitudinal changes can complement patients' changes captured by therapist assessments over the course of rehabilitation in the skilled nursing facility. Methods: From June 2016 to November 2017, patients were recruited after admission to a subacute rehabilitation center in Los Angeles, CA. Longitudinal cohort study of patients at a skilled nursing facility was followed over the course of 21 days. At the time of discharge from the skilled nursing facility, the patients were either readmitted to the hospital for continued care or discharged to a community setting.A longitudinal study of the physical therapy, occupational therapy, and sensor-based data assessments was performed. A generalized linear mixed model was used to find associations between functional measures with sensor-based features. Occupational therapy and physical therapy assessments were performed at the time of admission and once a week during the skilled nursing facility admission. Results: Of the 110 individuals in the analytic sample with mean age of 79.4 (SD 5.9) years, 79 (72\%) were female and 31 (28\%) were male participants. The energy intensity of an individual while in the therapy area was positively associated with transfer activities ($\beta$=.22; SE 0.08; P=.02). Sitting energy intensity showed positive association with transfer activities ($\beta$=.16; SE 0.07; P=.02). Lying down energy intensity was negatively associated with hygiene activities ($\beta$=--.27; SE 0.14; P=.04). The interaction of sitting energy intensity with time ($\beta$=--.13; SE 0.06; P=.04) was associated with toileting activities. Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information to the story line of daily and longitudinal activity patterns of patients receiving rehabilitation at a skilled nursing facility. The findings suggest that detecting physical activity changes within locations may offer some insight into better characterizing patients' progress or decline. ",
doi="10.2196/23887",
url="https://mhealth.jmir.org/2022/5/e23887",
url="http://www.ncbi.nlm.nih.gov/pubmed/35604762"
}


@Article{info:doi/10.2196/35867,
author="Itoh, Naohiro
and Mishima, Hirokazu
and Yoshida, Yuki
and Yoshida, Manami
and Oka, Hiroyuki
and Matsudaira, Ko",
title="Evaluation of the Effect of Patient Education and Strengthening Exercise Therapy Using a Mobile Messaging App on Work Productivity in Japanese Patients With Chronic Low Back Pain: Open-Label, Randomized, Parallel-Group Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="May",
day="16",
volume="10",
number="5",
pages="e35867",
keywords="mobile app",
keywords="patient education",
keywords="chronic low back pain",
keywords="exercise regimen",
keywords="mobile phone",
abstract="Background: Artificial intelligence--assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions. Objective: This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment. Methods: Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed. Results: The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years; n=27, 56.3\% male patients) and 46.9 years (SD 12.3 years; n=28, 54.9\% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method; 0.062 vs 0.114; difference between groups ?0.053, 95\% CI ?0.184 to 0.079; P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8; difference between groups ?0.5, 95\% CI ?1.1 to 0.0; P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006; difference between groups 0.061, 95\% CI 0.008 to 0.114; P=.03), and fear of movement at week 12 (?2.3 vs 0.5; difference between groups ?2.8, 95\% CI ?5.5 to ?0.1; P=.04). Conclusions: This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041037; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000046866 ",
doi="10.2196/35867",
url="https://mhealth.jmir.org/2022/5/e35867",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576560"
}


@Article{info:doi/10.2196/32557,
author="Alhussein, Ghada
and Hadjileontiadis, Leontios",
title="Digital Health Technologies for Long-term Self-management of Osteoporosis: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="21",
volume="10",
number="4",
pages="e32557",
keywords="mHealth",
keywords="digital health",
keywords="osteoporosis",
keywords="self-management",
keywords="systematic review",
keywords="meta-analysis",
keywords="chronic disease",
keywords="bone health",
keywords="nutrition",
keywords="physical activity",
keywords="risk assessment",
keywords="mobile phone",
abstract="Background: Osteoporosis is the fourth most common chronic disease worldwide. The adoption of preventative measures and effective self-management interventions can help improve bone health. Mobile health (mHealth) technologies can play a key role in the care and self-management of patients with osteoporosis. Objective: This study presents a systematic review and meta-analysis of the currently available mHealth apps targeting osteoporosis self-management, aiming to determine the current status, gaps, and challenges that future research could address, as well as propose appropriate recommendations. Methods: A systematic review of all English articles was conducted, in addition to a survey of all apps available in iOS and Android app stores as of May 2021. A comprehensive literature search (2010 to May 2021) of PubMed, Scopus, EBSCO, Web of Science, and IEEE Xplore was conducted. Articles were included if they described apps dedicated to or useful for osteoporosis (targeting self-management, nutrition, physical activity, and risk assessment) delivered on smartphone devices for adults aged ?18 years. Of the 32 articles, a random effects meta-analysis was performed on 13 (41\%) studies of randomized controlled trials, whereas the 19 (59\%) remaining studies were only included in the narrative synthesis as they did not provide enough data. Results: In total, 3906 unique articles were identified. Of these 3906 articles, 32 (0.81\%) articles met the inclusion criteria and were reviewed in depth. The 32 studies comprised 14,235 participants, of whom, on average, 69.5\% (n=9893) were female, with a mean age of 49.8 (SD 17.8) years. The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth-supported interventions resulted in a significant reduction in pain (Hedges g ?1.09, 95\% CI ?1.68 to ?0.45) and disability (Hedges g ?0.77, 95\% CI ?1.59 to 0.05). The posttreatment effect of the digital intervention was significant for physical function (Hedges g 2.54, 95\% CI ?4.08 to 4.08) but nonsignificant for well-being (Hedges g 0.17, 95\% CI ?1.84 to 2.17), physical activity (Hedges g 0.09, 95\% CI ?0.59 to 0.50), anxiety (Hedges g ?0.29, 95\% CI ?6.11 to 5.53), fatigue (Hedges g ?0.34, 95\% CI ?5.84 to 5.16), calcium (Hedges g ?0.05, 95\% CI ?0.59 to 0.50), vitamin D intake (Hedges g 0.10, 95\% CI ?4.05 to 4.26), and trabecular score (Hedges g 0.06, 95\% CI ?1.00 to 1.12). Conclusions: Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be valuable tools for patients and health professionals. However, most of the apps that are currently available lack clinically validated evidence of their efficacy and focus on a limited number of symptoms. A more holistic and personalized approach within a cocreation design ecosystem is needed. Trial Registration: PROSPERO 2021 CRD42021269399; https://tinyurl.com/2sw454a9 ",
doi="10.2196/32557",
url="https://mhealth.jmir.org/2022/4/e32557",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451968"
}


@Article{info:doi/10.2196/33543,
author="Kutyba, Jolanta Justyna
and J?drzejczak, Wiktor W.
and Gos, El?bieta
and Raj-Koziak, Danuta
and Skarzynski, Henryk Piotr",
title="Chronic Tinnitus and the Positive Effects of Sound Treatment via a Smartphone App: Mixed-Design Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="21",
volume="10",
number="4",
pages="e33543",
keywords="tinnitus",
keywords="mobile app",
keywords="smartphone",
keywords="sound therapy",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: Tinnitus is a phantom auditory sensation in the absence of an external stimulus. It is accompanied by a broad range of negative emotional symptoms and a significantly lower quality of life. So far, there is no cure for tinnitus, although various treatment options have been tried. One of them is mobile technology employing dedicated apps based on sound therapy. The apps can be managed by the patient and tailored according to their needs. Objective: The study aims to assess the effect of a mobile app that generates background sounds on the severity of tinnitus. Methods: The study involved 68 adults who had chronic tinnitus. Participants were divided into a study group (44 patients) and a control group (24 patients). For 6 months those in the study group used a free mobile app that enriched the sound environment with a background sound. Participants were instructed to use the app for at least 30 minutes a day using their preferred sound. The participants in the control group did not use the app. Subjective changes in the day-to-day functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey. Results: After 3 months of using the app, the THI global score significantly decreased (P<.001) in the study group, decreasing again at 6 months (P<.001). The largest improvements were observed in the emotional and catastrophic reactions subscales. A clinically important change in the THI was reported by 39\% of the study group (17/44). Almost 90\% of the study participants (39/44) chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months. Conclusions: Although the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting. ",
doi="10.2196/33543",
url="https://mhealth.jmir.org/2022/4/e33543",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451975"
}


@Article{info:doi/10.2196/35462,
author="Rodr{\'i}guez S{\'a}nchez-Laulh{\'e}, Pablo
and Luque-Romero, Gabriel Luis
and Barrero-Garc{\'i}a, Jos{\'e} Francisco
and Biscarri-Carbonero, {\'A}ngela
and Blanquero, Jes{\'u}s
and Suero-Pineda, Alejandro
and Heredia-Rizo, Marcos Alberto",
title="An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="7",
volume="10",
number="4",
pages="e35462",
keywords="rheumatoid arthritis",
keywords="telerehabilitation",
keywords="self-management",
keywords="mHealth",
keywords="primary health care",
keywords="physical therapy",
keywords="exercise therapy",
keywords="mobile applications",
keywords="telehealth",
keywords="health education",
keywords="mobile phone",
abstract="Background: Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. Objective: This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. Methods: A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61\%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. Results: In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45\%; control group: 32/58, 55\%), were included in the analysis; 53\% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time{\texttimes}group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; $\eta$2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95\% CI 8.70-25.03) at 3 months and 17.21 points (95\% CI 4.78-29.63) at 6 months. No time{\texttimes}group interaction was observed for the secondary measures (all P>.05). Conclusions: Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. Trial Registration: ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04713-4 ",
doi="10.2196/35462",
url="https://mhealth.jmir.org/2022/4/e35462",
url="http://www.ncbi.nlm.nih.gov/pubmed/35389367"
}


@Article{info:doi/10.2196/33476,
author="Han, Gyu Ul
and Lee, Jung-Yup
and Kim, Ga-Young
and Jo, Mini
and Lee, Jaeseong
and Bang, Ho Kyoung
and Cho, Sang Young
and Hong, Hwa Sung
and Moon, Joon Il",
title="Real-World Effectiveness of Wearable Augmented Reality Device for Patients With Hearing Loss: Prospective Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="23",
volume="10",
number="3",
pages="e33476",
keywords="hearing loss",
keywords="hearing aids",
keywords="personal sound amplification product",
keywords="wearable augmented reality device",
abstract="Background: Hearing loss limits communication and social activity, and hearing aids (HAs) are an efficient rehabilitative option for improving oral communication and speech comprehension, as well as the psychosocial comfort of people with hearing loss. To overcome this problem, over-the-counter amplification devices including personal sound amplification products and wearable augmented reality devices (WARDs) have been introduced. Objective: This study aimed to evaluate the clinical effectiveness of WARDs for patients with mild to moderate hearing loss. Methods: A total of 40 patients (18 men and 22 women) with mild to moderate hearing loss were enrolled prospectively in this study. All participants were instructed to wear a WARD, Galaxy Buds Pro (Samsung Electronics), at least 4 hours a day for 2 weeks, for amplifying ambient sounds. Questionnaires including the Korean version of the abbreviated profile of hearing aid benefit (K-APHAB) and the Korean adaptation of the international outcome inventory for hearing aids (K-IOI-HA) were used to assess personal satisfaction in all participants. Audiologic tests, including sound field audiometry, sound field word recognition score (WRS), and the Korean version of hearing in noise test (K-HINT), were administered to 14 of 40 patients. The tests were performed under two conditions: unaided and aided with WARDs. Results: The mean age of the participants was 55.4 (SD 10.7) years. After 2 weeks of the field trial, participants demonstrated a benefit of WARDs on the K-APHAB. Scores of 3 subscales of ease of communication, reverberation, and background noise were improved significantly (P<.001). However, scores regarding aversiveness were worse under the aided condition (P<.001). K-IOI-HA findings indicated high user satisfaction after the 2-week field trial. On audiologic evaluation, the K-HINT did not show significant differences between unaided and aided conditions (P=.97). However, the hearing threshold on sound field audiometry (P=.001) and the WRS (P=.002) showed significant improvements under the aided condition. Conclusions: WARDs can be beneficial for patients with mild to moderate hearing loss as a cost-effective alternative to conventional hearing aids. ",
doi="10.2196/33476",
url="https://mhealth.jmir.org/2022/3/e33476",
url="http://www.ncbi.nlm.nih.gov/pubmed/35320113"
}


@Article{info:doi/10.2196/32027,
author="Peebles, T. Alexander
and van der Veen, Susanne
and Stamenkovic, Alexander
and France, R. Christopher
and Pidcoe, E. Peter
and Thomas, S. James",
title="A Virtual Reality Game Suite for Graded Rehabilitation in Patients With Low Back Pain and a High Fear of Movement: Within-Subject Comparative Study",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="23",
volume="10",
number="1",
pages="e32027",
keywords="virtual reality",
keywords="reaching",
keywords="intervention",
keywords="rehabilitation",
keywords="exergaming",
keywords="biomechanics",
keywords="serious games",
keywords="gamification",
keywords="movement",
keywords="physiotherapy",
keywords="lumbar",
abstract="Background: Complex movement pathologies that are biopsychosocial in nature (eg, back pain) require a multidimensional approach for effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality--based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic contact targets. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments. Objective: This study aims to compare lumbar flexion excursion and velocity across our previous and newly developed virtual reality tools in a healthy control cohort. Methods: A total of 31 healthy participants (16 males, 15 females) took part in 3 gamified virtual reality therapies (ie, Reachality, Fishality, and Dodgeality), while whole-body 3D kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task and between the 4 anthropometrically defined intended target impact locations using separate 2-way repeated measures analysis of variance models. Results: There was an interaction between game and impact height for each outcome (all P<.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to that during Dodgeality for the 2 higher impact heights but was greater during Reachality than during Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality than during Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to those during Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality compared to that for Fishality and for Fishality relative to that for Dodgeality. Conclusions: Lumbar flexion velocity was reduced during Fishality relative to that during Dodgeality and resembled velocity demands more similar to those for a self-paced reaching task (ie, Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar to those during Reachality than to those during Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with low back pain and a high fear of movement. ",
doi="10.2196/32027",
url="https://games.jmir.org/2022/1/e32027",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319471"
}


@Article{info:doi/10.2196/28751,
author="Jaffar, Aida
and Tan, Chai-Eng
and Mohd-Sidik, Sherina
and Admodisastro, Novia
and Goodyear-Smith, Felicity",
title="Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="22",
volume="10",
number="3",
pages="e28751",
keywords="urinary incontinence",
keywords="pelvic floor muscle training",
keywords="mHealth app",
keywords="persuasive technology",
keywords="capability, opportunity, and motivation--behavior model",
keywords="mobile phone",
abstract="Background: Pelvic floor muscle training (PFMT) is one of the first-line treatments for stress urinary incontinence among pregnant women. Mobile health (mHealth) technology is potentially effective for delivering PFMT to pregnant women. Persuasive technology in the development of such mobile apps may facilitate behavior change by improving adherence to the exercises. The Capability, Opportunity, and Motivation--Behavior (COM-B) model is potentially useful in selecting the appropriate interventions to be incorporated into the apps. Objective: This review of mHealth apps for PFMT aims to describe the principles of persuasion used for each app and to propose mHealth app design features based on the COM-B model. Methods: A systematic literature search was conducted to answer three main research questions: what are the available mHealth apps for PFMT in the published literature, what persuasive strategies were used in their studies how were they mapped to the COM-B model, and how effective were the selected persuasive strategies for PFMT adherence? We searched PubMed, CINAHL, Web of Science, Scopus, and local Malaysian databases such as MyCite and MyMedR for articles reporting mHealth apps used for the delivery of PFMT. We included original articles reporting experimental and cross-sectional studies, including pilot or feasibility trials. Systematic and narrative reviews were excluded. Narrative and thematic syntheses were conducted on the eligible articles based on the research questions. The Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Non-randomized Studies were used to assess study bias. Results: Of the 169 records from the initial search, 10 (5.9\%) articles meeting the selection criteria were included in this review. There were 8 mHealth apps designed for the delivery of PFMT. The T{\"a}t, which used 3 categories of persuasive system design, improved PFMT adherence and was cost-effective. Only 1 app, the iBall app, used all categories of persuasive system design, by including social support such as ``competition'' in its design. The Di{\'a}rio Sa{\'u}de app was the only app developed using operant conditioning. All apps incorporated Tailoring and Expertise as part of their PSD strategies. Only 3 apps, the Di{\'a}rio Sa{\'u}de, T{\"a}t, and Pen Yi Kang demonstrated improved PFMT adherence. Conclusions: Persuasive technology used in mobile apps may target desired behavior change more effectively. The persuasive system design can be mapped to the COM-B model to explain its effectiveness on behaviour change outcomes. ",
doi="10.2196/28751",
url="https://mhealth.jmir.org/2022/3/e28751",
url="http://www.ncbi.nlm.nih.gov/pubmed/35315777"
}


@Article{info:doi/10.2196/31974,
author="Sawa, Ryuichi
and Saitoh, Masakazu
and Morisawa, Tomoyuki
and Takahashi, Tetsuya
and Morimoto, Yuh
and Kagiyama, Nobuyuki
and Kasai, Takatoshi
and Dinesen, Birthe
and Daida, Hiroyuki",
title="The Potential Application of Commercially Available Active Video Games to Cardiac Rehabilitation: Scoping Review",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="18",
volume="10",
number="1",
pages="e31974",
keywords="active video game",
keywords="cardiac rehabilitation",
keywords="physical exercise",
keywords="rehabilitation",
keywords="serious games",
keywords="CVD",
keywords="AVG",
keywords="cardiovascular disease",
keywords="exercise",
keywords="safety",
keywords="adherence",
abstract="Background: Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. Objective: The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. Methods: Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. Results: Among 120 nonduplicate articles reviewed, 5 (4.2\%) were eligible for inclusion, of which 3 (2.5\%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. Conclusions: AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited. ",
doi="10.2196/31974",
url="https://games.jmir.org/2022/1/e31974",
url="http://www.ncbi.nlm.nih.gov/pubmed/35302503"
}


@Article{info:doi/10.2196/29171,
author="Sitges, Carolina
and Terrasa, L. Juan
and Garc{\'i}a-Dopico, Nuria
and Segur-Ferrer, Joan
and Velasco-Rold{\'a}n, Olga
and Cresp{\'i}-Palmer, Jaume
and Gonz{\'a}lez-Rold{\'a}n, Mar{\'i}a Ana
and Montoya, Pedro",
title="An Educational and Exercise Mobile Phone--Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="15",
volume="10",
number="3",
pages="e29171",
keywords="low back pain",
keywords="chronic pain",
keywords="mobile apps",
keywords="education",
keywords="exercise",
keywords="brain",
keywords="cognition",
keywords="depression",
keywords="pain threshold",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. Objective: The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. Methods: A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46\%; mean age 45.00, SD 9.13 years; 10/23, 43\% men) or a face-to-face group (27/50, 54\%; mean age 48.63, SD 7.54 years; 7/27, 26\% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). Results: After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance. Conclusions: Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention. Trial Registration: ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611 ",
doi="10.2196/29171",
url="https://mhealth.jmir.org/2022/3/e29171",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289758"
}


@Article{info:doi/10.2196/33157,
author="Gopal, Arpita
and Hsu, Wan-Yu
and Allen, D. Diane
and Bove, Riley",
title="Remote Assessments of Hand Function in Neurological Disorders: Systematic Review",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Mar",
day="9",
volume="9",
number="1",
pages="e33157",
keywords="neurological disease",
keywords="hand function",
keywords="remote assessment",
keywords="assessment",
keywords="telemedicine",
keywords="rehabilitation",
keywords="telerehabilitation",
keywords="review",
keywords="neurological",
keywords="hand",
keywords="function",
keywords="diagnosis",
keywords="intervention",
keywords="dysfunction",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be regularly assessed to monitor loss of fine motor skills in people with central nervous system disorders; however, there are challenges to in-clinic assessments. Remotely assessing hand function could facilitate monitoring and supporting of early diagnosis and intervention when warranted. Objective: Remote assessments can facilitate the tracking of limitations, aiding in early diagnosis and intervention. This study aims to systematically review existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction. Methods: PubMed and MEDLINE, CINAHL, Web of Science, and Embase were searched for studies that reported remote assessment of hand function (ie, outside of traditional in-person clinical settings) in adults with chronic central nervous system disorders. We excluded studies that included participants with orthopedic upper limb dysfunction or used tools for intervention and treatment. We extracted data on the evaluated hand function domains, validity and reliability, feasibility, and stage of development. Results: In total, 74 studies met the inclusion criteria for Parkinson disease (n=57, 77\% studies), stroke (n=9, 12\%), multiple sclerosis (n=6, 8\%), spinal cord injury (n=1, 1\%), and amyotrophic lateral sclerosis (n=1, 1\%). Three assessment modalities were identified: external device (eg, wrist-worn accelerometer), smartphone or tablet, and telerehabilitation. The feasibility and overall participant acceptability were high. The most common hand function domains assessed included finger tapping speed (fine motor control and rigidity), hand tremor (pharmacological and rehabilitation efficacy), and finger dexterity (manipulation of small objects required for daily tasks) and handwriting (coordination). Although validity and reliability data were heterogeneous across studies, statistically significant correlations with traditional in-clinic metrics were most commonly reported for telerehabilitation and smartphone or tablet apps. The most readily implementable assessments were smartphone or tablet-based. Conclusions: The findings show that remote assessment of hand function is feasible in neurological disorders. Although varied, the assessments allow clinicians to objectively record performance in multiple hand function domains, improving the reliability of traditional in-clinic assessments. Remote assessments, particularly via telerehabilitation and smartphone- or tablet-based apps that align with in-clinic metrics, facilitate clinic to home transitions, have few barriers to implementation, and prompt remote identification and treatment of hand function impairments. ",
doi="10.2196/33157",
url="https://rehab.jmir.org/2022/1/e33157",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262502"
}


@Article{info:doi/10.2196/31376,
author="Ward, E. Rebecca
and Setiawan, Agus I. Made
and Quinby, Eleanor
and Fair, Melva
and Ambadar, Zara
and Parmanto, Bambang
and Dicianno, E. Brad",
title="Mobile Health to Support Community-Integration of Individuals With Disabilities Using iMHere 2.0: Focus Group Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="4",
volume="9",
number="1",
pages="e31376",
keywords="community integration",
keywords="self-care",
keywords="mobile health",
keywords="smartphone",
keywords="rehabilitation",
keywords="disability",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) systems that support self-management can improve medical, functional, and psychosocial outcomes for individuals with disabilities and chronic conditions. The mHealth systems can potentially be expanded to support community integration. Objective: The purposes of this study were to (1) partner with a community-based organization that supports community integration of individuals with disabilities; (2) identify software requirements needed to support community participation; and (3) iteratively refine an existing mHealth application to include new requirements. Methods: Community Living and Support Services (CLASS), a nonprofit organization that serves individuals with disabilities in Pittsburgh, Pennsylvania, was identified as the focus group for this study. Key stakeholders within the Community Partners Program at CLASS proposed design requirements for an existing mHealth application, Interactive Mobile Health and Rehabilitation (iMHere) 2.0, that has been used to support self-management. Results: We gathered qualitative data from a focus group composed of CLASS members to develop and iteratively revise iMHere 2.0 to include new modules and features to support community integration. A caregiver app was also developed. The new system contains features to support finance, transportation, client and caregiver communication, calendar and checklist management, upcoming medical and nonmedical appointments, social engagement, pain management, and access to a personal profile. Modifications were made to the following existing modules: education, mood, personal health record, goals, medications, and nutrition. Conclusions: A successful partnership with a community-based organization that supports individuals with disabilities resulted in a newly designed mHealth system with features to support community integration. ",
doi="10.2196/31376",
url="https://humanfactors.jmir.org/2022/1/e31376",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254274"
}


@Article{info:doi/10.2196/32163,
author="Dodson, A. John
and Schoenthaler, Antoinette
and Sweeney, Greg
and Fonceva, Ana
and Pierre, Alicia
and Whiteson, Jonathan
and George, Barbara
and Marzo, Kevin
and Drewes, Wendy
and Rerisi, Elizabeth
and Mathew, Reena
and Aljayyousi, Haneen
and Chaudhry, I. Sarwat
and Hajduk, M. Alexandra
and Gill, M. Thomas
and Estrin, Deborah
and Kovell, Lara
and Jennings, A. Lee
and Adhikari, Samrachana",
title="Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="3",
volume="11",
number="3",
pages="e32163",
keywords="mobile health",
keywords="cardiac rehabilitation",
keywords="clinical trial",
keywords="rehabilitation",
keywords="cardiology",
keywords="heart disease",
keywords="ambulatory care",
keywords="mHealth",
keywords="health outcomes",
keywords="older adults",
abstract="Background: Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults' uptake, and efficacy data are currently lacking. Objective: This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. Methods: RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ?65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). Results: As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. Conclusions: The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. Trial Registration: ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130 International Registered Report Identifier (IRRID): DERR1-10.2196/32163 ",
doi="10.2196/32163",
url="https://www.researchprotocols.org/2022/3/e32163",
url="http://www.ncbi.nlm.nih.gov/pubmed/35238793"
}


@Article{info:doi/10.2196/30882,
author="Wu, Jinlong
and Zhang, Hui
and Chen, Ziyan
and Fu, Ruijia
and Yang, Hao
and Zeng, Hongfa
and Ren, Zhanbing",
title="Benefits of Virtual Reality Balance Training for Patients With Parkinson Disease: Systematic Review, Meta-analysis, and Meta-Regression of a Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="1",
volume="10",
number="1",
pages="e30882",
keywords="virtual reality",
keywords="Parkinson disease",
keywords="balance",
keywords="systematic review",
keywords="meta-analysis",
keywords="meta-regression",
keywords="serious games",
keywords="VR",
keywords="rehabilitation",
keywords="VR training",
abstract="Background: Virtual reality (VR) balance training is increasingly being pursued in biomedical research, specifically with respect to investigating balance ability with VR. However, existing systematic reviews have found inconsistent conclusions about the efficacy of VR in improving balance in Parkinson disease (PD) patients. Objective: The goal of the research was to evaluate the impact of VR balance training on the balance ability of patients with PD. Methods: All major databases, including Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang, were searched to identify all relevant studies published in English or Chinese since September 15, 2010. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation. Results: A total of 16 randomized controlled trials were analyzed (n=583 patients with PD), with the methodological quality evaluation score ranging from 5 to 8 points. A random effects model was selected to combine effect sizes. Meta-analysis showed that the balance ability of PD was significantly improved after VR training compared with the control group (standardized mean difference [SMD] 2.127, 95\% CI 1.202 to 3.052, P<.001, I2=95.1, df=15). It is worth noting that the intervention platform may be the main reason for heterogeneity. Meta regression analysis showed that no training program could predict the impact of VR training (P=.57 to .94) on PD balance ability. Subgroup result showed that a single training time of 0 to 20 minutes (SMD 6.446), 4 to 6 times per week (SMD 4.067), training for 3 to 5 weeks (SMD 62.478), training course reached more than 30 times (SMD 4.405), and 201 to 300 minutes per week (SMD 4.059) maybe have more benefit. Conclusions: A systematic review and meta-analysis confirmed that VR balance training is a highly effective means to improve balance performance with large effects in PD. In addition, we preliminarily extracted dose-effect relationships for training volume, informing clinicians and practitioners to design effective VR balance training for balance ability. Further research is needed to reveal optimal dose-response relationships following VR balance training. ",
doi="10.2196/30882",
url="https://games.jmir.org/2022/1/e30882",
url="http://www.ncbi.nlm.nih.gov/pubmed/35230242"
}


@Article{info:doi/10.2196/23794,
author="Chowdhary, Kuntal
and Yu, Xie Daihua
and Pramana, Gede
and Mesoros, Matthew
and Fairman, Andrea
and Dicianno, Edward Brad
and Parmanto, Bambang",
title="User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="24",
volume="9",
number="1",
pages="e23794",
keywords="cellular phone",
keywords="mobile apps",
keywords="telemedicine",
keywords="adaptive mHealth",
keywords="rehabilitation",
keywords="self-care",
keywords="spinal cord injury",
keywords="spina bifida",
keywords="chronic disease",
keywords="persons with disability",
keywords="accessibility",
keywords="dexterity impairments",
keywords="mobile phone",
abstract="Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules---MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants' dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. ",
doi="10.2196/23794",
url="https://humanfactors.jmir.org/2022/1/e23794",
url="http://www.ncbi.nlm.nih.gov/pubmed/35200144"
}


@Article{info:doi/10.2196/31020,
author="Garc{\'i}a-Mu{\~n}oz, Cristina
and Cort{\'e}s-Vega, Mar{\'i}a-Dolores
and Hern{\'a}ndez-Rodr{\'i}guez, Juan-Carlos
and Fern{\'a}ndez-Segu{\'i}n, M. Lourdes
and Escobio-Prieto, Isabel
and Casuso-Holgado, Jes{\'u}s Mar{\'i}a",
title="Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="16",
volume="10",
number="1",
pages="e31020",
keywords="immersive virtual reality",
keywords="vestibular rehabilitation",
keywords="multiple sclerosis",
keywords="exergames",
abstract="Background: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16\% in the physical health area at T2; 33.56\% in the mental health area at T2). The patient rated the usability of the system as 90\%, based on the System Usability Scale, and gave the system a grade of A. Conclusions: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation. ",
doi="10.2196/31020",
url="https://games.jmir.org/2022/1/e31020",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766551"
}


@Article{info:doi/10.2196/24946,
author="Blanc, Margaux
and Roy, Anne-Laure
and Fraudet, Bastien
and Piette, Patrice
and Le Toullec, Elodie
and Nicolas, Benoit
and Gallien, Philippe
and Leblong, Emilie",
title="Evaluation of a Digitally Guided Self-Rehabilitation Device Coupled With Telerehabilitation Monitoring in Patients With Parkinson Disease (TELEP@RK): Open, Prospective Observational Study",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="7",
volume="10",
number="1",
pages="e24946",
keywords="Parkinson's disease",
keywords="telerehabilitation",
keywords="serious games",
keywords="UTAUT",
keywords="physiotherapist",
keywords="acceptability",
keywords="acceptance",
abstract="Background: Parkinson disease is a neurodegenerative disease causing a progressive loss of autonomy. This requires long-term rehabilitation care. Currently, new technologies are being developed for use in daily life, and there is a progressive implementation of telerehabilitation. Objective: The aim of this study (the TELEP@RK study) is to evaluate the uses of a digital self-rehabilitation device in patients with Parkinson disease and their independent physiotherapists on the scale of a health territory. Methods: A total of 10 independent physiotherapists and 31 patients with Parkinson disease were followed for 1 year to evaluate the use of a telerehabilitation tool (digital tablet and inertial sensor) via questionnaires of the Unified Theory of Acceptance and Use of Technology (UTAUT). The questionnaires were submitted to participants at 0, 2, and 12 months from the start of follow-up. The averages of the scores of the different determinants and constructs of the UTAUT questionnaires were compared at the different follow-up times. Results: Among professionals, the averages of the various determinants were generally high at the beginning of the study with an average (out of 5) performance expectancy of 4.19, effort expectancy of 3.88, social influence of 3.95, facilitating conditions of 4, and intention to use of 3.97. These averages decreased over time. Conclusions: Acceptability, acceptance, and appropriation of the tool were very high among the physiotherapists as well as the patients, despite the tool's lack of evolution during the study. In the current health care context, these results allow us to envision a new organization of the care pathway for patients with chronic diseases, with the increased use of new technologies associated with telecare. ",
doi="10.2196/24946",
url="https://games.jmir.org/2022/1/e24946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129449"
}


@Article{info:doi/10.2196/32193,
author="Blanchard, Marc
and Backhaus, Lars
and Ming Azevedo, Pedro
and H{\"u}gle, Thomas",
title="An mHealth App for Fibromyalgia-like Post--COVID-19 Syndrome: Protocol for the Analysis of User Experience and Clinical Data",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="4",
volume="11",
number="2",
pages="e32193",
keywords="post--COVID-19 syndrome",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="mobile health",
keywords="application",
keywords="user experience",
keywords="testing",
keywords="user interface",
keywords="long-covid syndrome",
keywords="mHealth",
keywords="app",
keywords="protocol",
keywords="reinforcement",
keywords="learning",
keywords="strategy",
keywords="symptom",
keywords="outcome",
keywords="patient-reported outcome",
keywords="therapy",
keywords="rehabilitation",
keywords="monitoring",
abstract="Background: Post--COVID-19 syndrome, also referred as ``long covid,'' describes persisting symptoms after SARS-CoV-2 infection, including myalgia, fatigue, respiratory, or neurological symptoms. Objective symptoms are often lacking, thus resembling a fibromyalgia-like syndrome. Digital therapeutics have shown efficiency in similar chronic disorders such as fibromyalgia, offering specific disease monitoring and interventions such as cognitive behavioral therapy or physical and respiratory exercise guidance. Objective: This protocol aims to study the requirements and features of a new mobile health (mHealth) app among patients with fibromyalgia-like post--COVID-19 syndrome in a clinical trial. Methods: We created a web application prototype for the post--COVID-19 syndrome called ``POCOS,'' as a web-based rehabilitation tool aiming to improve clinical outcomes. Patients without organ damage or ongoing inflammation will be included in the study. App use will be assessed through user experience questionnaires, focus groups, and clinical data analysis. Subsequently, we will analyze cross-sectional and longitudinal clinical data. Results: The developed mHealth app consists of a clinically adapted app interface with a simplified patient-reported outcome assessment, monitoring of medical interventions, and disease activity as well as web-based instructions for specific physical and respiratory exercises, stress reduction, and lifestyle instructions. The enrollment of participants is expected to be carried out in November 2021. Conclusions: User experience plays an important role in digital therapeutics and needs to be clinically tested to allow further improvement. We here describe this process for a new app for the treatment of the fibromyalgia-like post--COVID-19 syndrome and discuss the relevance of the potential outcomes such as natural disease course and disease phenotypes. International Registered Report Identifier (IRRID): PRR1-10.2196/32193 ",
doi="10.2196/32193",
url="https://www.researchprotocols.org/2022/2/e32193",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982039"
}


@Article{info:doi/10.2196/27637,
author="Hoevenaars, Dirk
and Yocarini, E. Iris
and Paraschiakos, Stylianos
and Holla, M. Jasmijn F.
and de Groot, Sonja
and Kraaij, Wessel
and Janssen, J. Thomas W.",
title="Accuracy of Heart Rate Measurement by the Fitbit Charge 2 During Wheelchair Activities in People With Spinal Cord Injury: Instrument Validation Study",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Jan",
day="19",
volume="9",
number="1",
pages="e27637",
keywords="Fitbit Charge 2",
keywords="heart rate",
keywords="accuracy",
keywords="photoplethysmography",
keywords="spinal cord injury",
abstract="Background: Heart rate (HR) is an important and commonly measured physiological parameter in wearables. HR is often measured at the wrist with the photoplethysmography (PPG) technique, which determines HR based on blood volume changes, and is therefore influenced by blood pressure. In individuals with spinal cord injury (SCI), blood pressure control is often altered and could therefore influence HR accuracy measured by the PPG technique. Objective: The objective of this study is to investigate the HR accuracy measured with the PPG technique with a Fitbit Charge 2 (Fitbit Inc) in wheelchair users with SCI, how the activity intensity affects the HR accuracy, and whether this HR accuracy is affected by lesion level. Methods: The HR of participants with (38/48, 79\%) and without (10/48, 21\%) SCI was measured during 11 wheelchair activities and a 30-minute strength exercise block. In addition, a 5-minute seated rest period was measured in people with SCI. HR was measured with a Fitbit Charge 2, which was compared with the HR measured by a Polar H7 HR monitor used as a reference device. Participants were grouped into 4 groups---the no SCI group and based on lesion level into the <T5 (midthoracic and lower) group, T5-T1 (high-thoracic) group, and >T1 (cervical) group. Mean absolute percentage error (MAPE) and concordance correlation coefficient were determined for each group for each activity type, that is, rest, wheelchair activities, and strength exercise. Results: With an overall MAPEall lesions of 12.99\%, the accuracy fell below the standard acceptable MAPE of --10\% to +10\% with a moderate agreement (concordance correlation coefficient=0.577). The HR accuracy of Fitbit Charge 2 seems to be reduced in those with cervical lesion level in all activities (MAPEno SCI=8.09\%; MAPE<T5=11.16\%; MAPET1?T5=10.5\%; and MAPE>T1=20.43\%). The accuracy of the Fitbit Charge 2 decreased with increasing intensity in all lesions (MAPErest=6.5\%, MAPEactivity=12.97\%, and MAPEstrength=14.2\%). Conclusions: HR measured with the PPG technique showed lower accuracy in people with SCI than in those without SCI. The accuracy was just above the acceptable level in people with paraplegia, whereas in people with tetraplegia, a worse accuracy was found. The accuracy seemed to worsen with increasing intensities. Therefore, high-intensity HR data, especially in people with cervical lesions, should be used with caution. ",
doi="10.2196/27637",
url="https://rehab.jmir.org/2022/1/e27637",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044306"
}


@Article{info:doi/10.2196/24174,
author="Rivers, T. John
and Smith, Carla
and Smith, Ian
and Cameron, James",
title="The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study",
journal="JMIR Cardio",
year="2022",
month="Jan",
day="17",
volume="6",
number="1",
pages="e24174",
keywords="cardiac rehabilitation",
keywords="digital health",
keywords="smartphone app",
keywords="Cardihab",
keywords="participation rates",
keywords="rehabilitation",
keywords="cardiology",
keywords="heart",
keywords="app",
keywords="barrier",
abstract="Background: Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective: We evaluated the impact on CR participation rates associated with the addition of the option of mobile app--based CR (Cardihab) for patients declining conventional CR. Methods: A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results: CR participation improved from 21\% (95\% CI 14\%-30\%) to 63\% (95\% CI 53\%-71\%) with the addition of the app (P<.001). Approximately 25\% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions: Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake. ",
doi="10.2196/24174",
url="https://cardio.jmir.org/2022/1/e24174",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037891"
}


@Article{info:doi/10.2196/31482,
author="Pach, Daniel
and Bl{\"o}dt, Susanne
and Wang, Jiani
and Keller, Theresa
and Bergmann, Beatrice
and Rogge, A. Aliz{\'e}
and Barth, J{\"u}rgen
and Icke, Katja
and Roll, Stephanie
and Witt, M. Claudia",
title="App-Based Relaxation Exercises for Patients With Chronic Neck Pain: Pragmatic Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="7",
volume="10",
number="1",
pages="e31482",
keywords="neck pain",
keywords="relaxation",
keywords="RCT",
keywords="mHealth",
keywords="smartphone app",
keywords="mobile phone",
abstract="Background: Chronic neck pain is a highly prevalent condition. Learning a relaxation technique is recommended by numerous guidelines for chronic neck pain. Smartphone apps can provide relaxation exercises; however, their effectiveness, especially in a self-care setting, is unclear. Objective: The aim of this pragmatic randomized trial is to evaluate whether app-based relaxation exercises, including audio-based autogenic training, mindfulness meditation, or guided imagery, are more effective in reducing chronic neck pain than usual care alone. Methods: Smartphone owners aged 18 to 65 years with chronic (>12 weeks) neck pain and the previous week's average neck pain intensity ?4 on the Numeric Rating Scale (0=no pain to 10=worst possible pain) were randomized into either an intervention group to practice app-based relaxation exercises or a control group (usual care and app for data entry only). For both groups, the follow-up data were collected using app-based diaries and questionnaires. The primary outcome was the mean neck pain intensity during the first 3 months based on daily measurements. Secondary outcomes included neck pain based on weekly measurements, pain acceptance, neck pain--related stress, sick-leave days, pain medication intake, and adherence, which were all measured until the 6-month follow-up. For the primary analysis, analysis of covariance adjusted for baseline neck pain intensity was used. Results: We screened 748 participants and enrolled 220 participants (mean age 38.9, SD 11.3 years; mean baseline neck pain 5.7, SD 1.3 points). The mean neck pain intensity in both groups decreased over 3 months; however, no statistically significant difference between the groups was found (intervention: 4.1 points, 95\% CI 3.8-4.4; control: 3.8 points, 95\% CI 3.5-4.1; group difference: 0.3 points, 95\% CI ?0.2 to 0.7; P=.23). In addition, no statistically significant between-group differences regarding neck pain intensity after 6 months, responder rate, pain acceptance, pain medication intake, or sick-leave days were observed. There were no serious adverse events that were considered related to the trial intervention. In week 12, only 40\% (44/110) of the participants in the intervention group continued to practice the exercises with the app. Conclusions: The study app did not effectively reduce chronic neck pain or keep the participants engaged in exercising in a self-care setting. Future studies on app-based relaxation interventions should take into account the most recent scientific findings for behavior change techniques. Trial Registration: ClinicalTrials.gov NCT02019134; https://clinicaltrials.gov/ct2/show/NCT02019134 International Registered Report Identifier (IRRID): RR2-10.1186/1745-6215-15-490 ",
doi="10.2196/31482",
url="https://mhealth.jmir.org/2022/1/e31482",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994708"
}


@Article{info:doi/10.2196/30985,
author="Vinolo Gil, Jesus Maria
and Gonzalez-Medina, Gloria
and Lucena-Anton, David
and Perez-Cabezas, Veronica
and Ruiz-Molinero, Carmen Mar{\'i}a Del
and Mart{\'i}n-Valero, Roc{\'i}o",
title="Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis",
journal="JMIR Serious Games",
year="2021",
month="Dec",
day="15",
volume="9",
number="4",
pages="e30985",
keywords="augmented reality",
keywords="physical therapy",
keywords="rehabilitation",
keywords="functionality",
abstract="Background: Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective: This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods: A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta?Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation. The Cochrane Collaboration tool was used to evaluate the risk of bias. Results: In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36\%) contributed information to the meta-analysis. Overall, 64\% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95\% CI ?0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change ?1.211, 95\% CI ?3.2005 to 0.7768; z=?1.194; P=.23). Conclusions: AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020180766; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=180766 ",
doi="10.2196/30985",
url="https://games.jmir.org/2021/4/e30985",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914611"
}


@Article{info:doi/10.2196/31541,
author="Lowe, Cabella
and Hanuman Sing, Harry
and Marsh, William
and Morrissey, Dylan",
title="Validation of a Musculoskeletal Digital Assessment Routing Tool: Protocol for a Pilot Randomized Crossover Noninferiority Trial",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="13",
volume="10",
number="12",
pages="e31541",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="digital health",
keywords="digital technology",
keywords="musculoskeletal",
keywords="triage",
keywords="physiotherapy triage",
keywords="validation",
keywords="mobile phone",
abstract="Background: Musculoskeletal conditions account for 16\% of global disability, resulting in a negative effect on millions of patients and an increasing demand for health care use. Digital technologies to improve health care outcomes and efficiency are considered a priority; however, innovations are rarely tested with sufficient rigor in clinical trials, which is the gold standard for clinical proof of safety and efficacy. We have developed a new musculoskeletal digital assessment routing tool (DART) that allows users to self-assess and be directed to the right care. DART requires validation in a real-world setting before implementation. Objective: This pilot study aims to assess the feasibility of a future trial by exploring the key aspects of trial methodology, assessing the procedures, and collecting exploratory data to inform the design of a definitive randomized crossover noninferiority trial to assess DART safety and effectiveness. Methods: We will collect data from 76 adults with a musculoskeletal condition presenting to general practitioners within a National Health Service (NHS) in England. Participants will complete both a DART assessment and a physiotherapist-led triage, with the order determined by randomization. The primary analysis will involve an absolute agreement intraclass correlation (A,1) estimate with 95\% CI between DART and the clinician for assessment outcomes signposting to condition management pathways. Data will be collected to allow the analysis of participant recruitment and retention, randomization, allocation concealment, blinding, data collection process, and bias. In addition, the impact of trial burden and potential barriers to intervention delivery will be considered. The DART user satisfaction will be measured using the system usability scale. Results: A UK NHS ethics submission was done during June 2021 and is pending approval; recruitment will commence in early 2022, with data collection anticipated to last for 3 months. The results will be reported in a follow-up paper in 2022. Conclusions: This study will inform the design of a randomized controlled crossover noninferiority study that will provide evidence concerning mobile health DART system clinical signposting in an NHS setting before real-world implementation. Success should produce evidence of a safe, effective system with good usability, potentially facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This rigorous approach to mobile health system testing could be used as a guide for other developers of similar applications. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): PRR1-10.2196/31541 ",
doi="10.2196/31541",
url="https://www.researchprotocols.org/2021/12/e31541",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898461"
}


@Article{info:doi/10.2196/17839,
author="Chatterjee, Pothik
and Beck, M. Adam
and Brager, Levenson Jenna Ashley
and Durand, J. Daniel
and D'Adamo, R. Christopher",
title="The Effect of an Automated Mobile Patient Engagement Application on Emergency Department Revisits: Prospective Observational Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="13",
volume="5",
number="12",
pages="e17839",
keywords="patient engagement",
keywords="value-based care",
keywords="digital health",
keywords="mobile app",
keywords="automation",
keywords="readmission",
keywords="revisit",
keywords="emergency department",
abstract="Background: Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system's finances in a value-based care or global budget environment. LifeBridge Health, a community health system in Maryland, United States, implemented an automated mobile patient engagement application as part of our enterprise-wide digital health strategy to improve patient engagement and reduce revisits to the ED. Objective: The aim of this paper was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED. Methods: The LifeBridge Health Innovation Department and ED staff from 2 participating health system hospitals collaborated with GetWellNetwork to customize their patient engagement application with automated check-in questions and other on-demand resources (eg, streaming content explaining aspects of self-care during COVID-19). An application link was emailed to adult patients discharged home from the ED. A study of ED visits for patients treated for general medicine and cardiology conditions between August 1, 2018, and July 31, 2019, was conducted using CRISP (Chesapeake Regional Information System for our Patients), Maryland's state-designated health information exchange. We also used data within GetWell Loop (GetWellNetwork) to track patient activation and engagement. The primary outcome was the number of ED patients who experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary outcomes included the overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Bivariate analysis comparing outcomes among patients who activated the GetWell Loop application to patients who did not was conducted using the Fisher exact test. Multivariate logistic regression modeling with elastic net regularization was also performed to account for potential confounders and potential collinearity of covariates. Results: During this 1-year study, 1062 (27.4\%) of 3866 of all emergency patients treated for general medicine or cardiology conditions, who received an invite to use the digital application, activated their account. The patients discharged from the ED, who were treated for general medicine conditions (n=2087) and who activated their GetWell Loop account, experienced a 30-day revisit rate of 17.3\% (n=101) compared with 24.6\% (n=369) for those who did not activate their account (P<.001). Of the patients treated for cardiology conditions (n=1779), 12.8\% (n=61) of those who activated their GetWell account experienced a 30-day revisit compared with 17.7\% (n=231) of those who did not activate their account (P=.01). The significance of these findings persisted after adjustment for confounding variables including age, race, sex, and payor in logistic regression modeling (adjusted odds ratio 0.75, 95\% CI 0.62-0.92; P=.006). Conclusions: Our results suggest that a significant percentage of patients are willing to utilize a digital application following ED discharge to better engage in their own care, and that usage of such digital applications may significantly reduce 30-day revisit rates. LifeBridge Health's experience demonstrates that health care systems can leverage automated mobile apps to improve patient engagement and successfully impact clinical outcomes at scale. ",
doi="10.2196/17839",
url="https://formative.jmir.org/2021/12/e17839",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898451"
}


@Article{info:doi/10.2196/29563,
author="Moshontz, Hannah
and Colmenares, J. Alejandra
and Fronk, E. Gaylen
and Sant'Ana, J. Sarah
and Wyant, Kendra
and Wanta, E. Susan
and Maus, Adam
and Gustafson Jr, H. David
and Shah, Dhavan
and Curtin, J. John",
title="Prospective Prediction of Lapses in Opioid Use Disorder: Protocol for a Personal Sensing Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="7",
volume="10",
number="12",
pages="e29563",
keywords="digital therapeutics",
keywords="risk prediction",
keywords="opioid lapse",
keywords="mobile phone",
abstract="Background: Successful long-term recovery from opioid use disorder (OUD) requires continuous lapse risk monitoring and appropriate use and adaptation of recovery-supportive behaviors as lapse risk changes. Available treatments often fail to support long-term recovery by failing to account for the dynamic nature of long-term recovery. Objective: The aim of this protocol paper is to describe research that aims to develop a highly contextualized lapse risk prediction model that forecasts the ongoing probability of lapse. Methods: The participants will include 480 US adults in their first year of recovery from OUD. Participants will report lapses and provide data relevant to lapse risk for a year with a digital therapeutic smartphone app through both self-report and passive personal sensing methods (eg, cellular communications and geolocation). The lapse risk prediction model will be developed using contemporary rigorous machine learning methods that optimize prediction in new data. Results: The National Institute of Drug Abuse funded this project (R01DA047315) on July 18, 2019 with a funding period from August 1, 2019 to June 30, 2024. The University of Wisconsin-Madison Health Sciences Institutional Review Board approved this project on July 9, 2019. Pilot enrollment began on April 16, 2021. Full enrollment began in September 2021. Conclusions: The model that will be developed in this project could support long-term recovery from OUD---for example, by enabling just-in-time interventions within digital therapeutics. International Registered Report Identifier (IRRID): DERR1-10.2196/29563 ",
doi="10.2196/29563",
url="https://www.researchprotocols.org/2021/12/e29563",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559061"
}


@Article{info:doi/10.2196/30184,
author="Li, Chong
and Song, Xinyu
and Chen, Shugeng
and Wang, Chuankai
and He, Jieying
and Zhang, Yongli
and Xu, Shuo
and Yan, Zhijie
and Jia, Jie
and Shull, Peter",
title="Long-term Effectiveness and Adoption of a Cellphone Augmented Reality System on Patients with Stroke: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="23",
volume="9",
number="4",
pages="e30184",
keywords="stroke",
keywords="augmented reality",
keywords="serious game",
keywords="upper limb motor function",
keywords="cognitive function",
keywords="home-based rehabilitation",
abstract="Background: A serious game--based cellphone augmented reality system (CARS) was developed for rehabilitation of stroke survivors, which is portable, convenient, and suitable for self-training. Objective: This study aims to examine the effectiveness of CARS in improving upper limb motor function and cognitive function of stroke survivors via conducting a long-term randomized controlled trial and analyze the patient's acceptance of the proposed system. Methods: A double-blind randomized controlled trial was performed with 30 poststroke, subacute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), manual muscle test and Brunnstrom stage were used to assess motor function; the Mini-Mental State Examination, Add VS Sub, and Stroop Game were used to assess cognitive function; and the Barthel index was used to assess activities of daily living before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire was used to reflect the patients' adoption of the system in the experimental group after the final intervention. Results: All the assessment scores of the experimental group and control group were significantly improved after intervention. After the intervention. The experimental group's FMA-UE and ARAT scores increased by 11.47 and 5.86, respectively, and were both significantly higher than the increase of the control group. Similarly, the score of the Add VS Sub and Stroop Game in the experimental group increased by 7.53 and 6.83, respectively, after the intervention, which also represented a higher increase than that in the control group. The evaluation of the adoption of this system had 3 sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27 (SD 0.704) for the enjoyment of their experience with the system, a mean 4.33 (SD 0.816) for success in using the system, and a mean 4.67 (SD 0.617) for the ability to control the system. In terms of comfort, the patients reported a mean 4.40 (SD 0.737) for the clarity of information provided by the system and a mean 4.40 (SD 0.632) for comfort. In terms of acceptability, the patients reported a mean 4.27 (SD 0.884) for usefulness in their rehabilitation and a mean 4.67 (0.617) in agreeing that CARS is a suitable tool for home-based rehabilitation. Conclusions: The rehabilitation based on combined CARS and conventional OT was more effective in improving both upper limb motor function and cognitive function than was conventional OT. Due to the low cost and ease of use, CARS is also potentially suitable for home-based rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017568; https://tinyurl.com/xbkkyfyz ",
doi="10.2196/30184",
url="https://games.jmir.org/2021/4/e30184",
url="http://www.ncbi.nlm.nih.gov/pubmed/34817390"
}


@Article{info:doi/10.2196/25831,
author="Ambros-Antemate, Fernando Jorge
and Beristain-Colorado, Pilar Mar{\'i}a Del
and Vargas-Trevi{\~n}o, Marciano
and Guti{\'e}rrez-Guti{\'e}rrez, Jaime
and Hern{\'a}ndez-Cruz, Antonio Pedro
and Gallegos-Velasco, Belem Itandehui
and Moreno-Rodr{\'i}guez, Adriana",
title="Software Engineering Frameworks Used for Serious Games Development in Physical Rehabilitation: Systematic Review",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="11",
volume="9",
number="4",
pages="e25831",
keywords="serious game",
keywords="physical rehabilitation",
keywords="framework",
keywords="methodology",
abstract="Background: Serious games are a support in the rehabilitation process for treating people with physical disabilities. However, many of these serious games are not adapted to the patient's needs because they are not developed with a software engineering framework with a set of activities, actions, and tasks that must be executed when creating a software product. Better serious games for rehabilitation will be developed if the patient and therapist requirements are identified, the development is planned, and system improvements and feedback are involved. The goal is that the serious game must offer a more attractive environment, while maintaining patient interest in the rehabilitation process. Objective: This paper submits the results of a systematic review of serious games in physical rehabilitation identifying the benefits of using a software engineering framework. Methods: A systematic research was conducted using PubMed, PEDro (Physiotherapy Evidence Database), IEEE Xplore, ScienceDirect, ACM Digital Library, Mary Ann Liebert, Taylor \& Francis Online, Wiley Online Library, and Springer databases. The initial search resulted in 701 papers. After assessing the results according to the inclusion criteria, 83 papers were selected for this study. Results: From the 83 papers reviewed, 8 used a software engineering framework for its development. Most of them focused their efforts on 1 or more aspects, such as data acquisition and processing, game levels, motivation, therapist supervision. Conclusions: This systematic review proves that most of the serious games do not use a software engineering framework for their development. As a result, development systems overlook several aspects and do not have a standardized process, eventually omitting important implementation aspects, which impact the patient's recovery time. ",
doi="10.2196/25831",
url="https://games.jmir.org/2021/4/e25831",
url="http://www.ncbi.nlm.nih.gov/pubmed/34762052"
}


@Article{info:doi/10.2196/27087,
author="Soulard, Julie
and Vaillant, Jacques
and Baillet, Athan
and Gaudin, Philippe
and Vuillerme, Nicolas",
title="Gait and Axial Spondyloarthritis: Comparative Gait Analysis Study Using Foot-Worn Inertial Sensors",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="9",
volume="9",
number="11",
pages="e27087",
keywords="ankylosing spondylitis",
keywords="spondyloarthritis",
keywords="gait",
keywords="locomotion",
keywords="pain",
keywords="mobility",
keywords="spatiotemporal",
keywords="digital health",
keywords="sensors",
abstract="Background: Axial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice. Objective: This study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate. Methods: A total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms--1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground). Results: Age, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17). Conclusions: Gait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine. Trial Registration: ClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212 International Registered Report Identifier (IRRID): RR2-10.1007/s00296-019-04396-4  ",
doi="10.2196/27087",
url="https://mhealth.jmir.org/2021/11/e27087",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751663"
}


@Article{info:doi/10.2196/25453,
author="Jain, Deeptee
and Norman, Kevin
and Werner, Zachary
and Makovoz, Bar
and Baker, Turner
and Huber, Stephan",
title="Using Postmarket Surveillance to Assess Safety-Related Events in a Digital Rehabilitation App (Kaia App): Observational Study",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="9",
volume="8",
number="4",
pages="e25453",
keywords="lower back pain",
keywords="digital therapeutics",
keywords="adverse event",
keywords="pain",
keywords="safety",
keywords="digital health",
keywords="multidisciplinary pain treatment",
abstract="Background: Low back pain (LBP) affects nearly 4 out of 5 individuals during their lifetime and is the leading cause of disability globally. Digital therapeutics are emerging as effective treatment options for individuals experiencing LBP. Despite the growth of evidence demonstrating the benefits of these therapeutics in reducing LBP and improving functional outcomes, little data has been systematically collected on their safety profiles. Objective: This study aims to evaluate the safety profile of a multidisciplinary digital therapeutic for LBP, the Kaia App, by performing a comprehensive assessment of reported adverse events (AEs) by users as captured by a standardized process for postmarket surveillance. Methods: All users of a multidisciplinary digital app that includes physiotherapy, mindfulness techniques, and education for LBP (Kaia App) from 2018 to 2019 were included. Relevant messages sent by users via the app were collected according to a standard operating procedure regulating postmarket surveillance of the device. These messages were then analyzed to determine if they described an adverse event (AE). Messages describing an AE were then categorized based on the type of AE, its seriousness, and its relatedness to the app, and they were described by numerical counts. User demographics, including age and gender, and data on app use were collected and evaluated to determine if they were risk factors for increased AE reporting. Results: Of the 138,337 active users of the Kaia App, 125 (0.09\%) reported at least one AE. Users reported 0.00014 AEs per active day on the app. The most common nonserious AE reported was increased pain. Other nonserious AEs reported included muscle issues, unpleasant sensations, headache, dizziness, and sleep disturbances. One serious AE, a surgery, was reported. Details of the event and its connection to the intervention were not obtainable, as the user did not provide more information when asked to do so; therefore, it was considered to be possibly related to the intervention. There was no relationship between gender and AE reporting (P>.99). Users aged 25 to 34 years had reduced odds (odds ratio [OR] 0.31, 95\% CI 0.08-0.95; P=.03) of reporting AEs, while users aged 55 to 65 years (OR 2.53, 95\% CI 1.36-4.84, P=.002) and ?75 years (OR 4.36, 95\% CI 1.07-13.26; P=.02) had increased odds. AEs were most frequently reported by users who had 0 to 99 active days on the app, and less frequently reported by users with more active days on the app. Conclusions: This study on the Kaia App provides the first comprehensive assessment of reported AEs associated with real-world use of digital therapeutics for lower back pain. The overall rate of reported AEs was very low, but significant reporting bias is likely to be present. The AEs reported were generally consistent with those described for in-person therapies for LBP. ",
doi="10.2196/25453",
url="https://humanfactors.jmir.org/2021/4/e25453",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751664"
}


@Article{info:doi/10.2196/28634,
author="Herkert, Cyrille
and Graat-Verboom, Lidwien
and Gilsing-Fernhout, Judith
and Schols, Manon
and Kemps, Clemens Hareld Marijn",
title="Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="9",
volume="5",
number="11",
pages="e28634",
keywords="home-based exercise",
keywords="cardiac diseases",
keywords="pulmonary diseases",
keywords="comorbidities",
keywords="elderly",
abstract="Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50\% (5/10) were men. Of the 10 participants, 9 (90\%) completed the 8-week program. Median adherence to the exercise prescription was 75\% (IQR 37\%-88\%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86\%, IQR 51\%-100\%, and final 2 weeks: 57\%, IQR 8\%-75\%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44\%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 ",
doi="10.2196/28634",
url="https://formative.jmir.org/2021/11/e28634",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751655"
}


@Article{info:doi/10.2196/28079,
author="Garske, Alexander Christian
and Dyson, Matthew
and Dupan, Sigrid
and Morgan, Graham
and Nazarpour, Kianoush",
title="Serious Games Are Not Serious Enough for Myoelectric Prosthetics",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="8",
volume="9",
number="4",
pages="e28079",
keywords="rehabilitation",
keywords="serious games",
keywords="engagement",
keywords="transfer",
keywords="upper limb",
keywords="arm prosthesis",
keywords="virtual training",
keywords="virtual games",
doi="10.2196/28079",
url="https://games.jmir.org/2021/4/e28079",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747715"
}


@Article{info:doi/10.2196/25209,
author="Romeiser, L. Jamie
and Cavalcante, James
and Richman, C. Deborah
and Singh, M. Sunitha
and Liang, Xiaohui
and Pei, Allison
and Sharma, Samanvaya
and Lazarus, Zoe
and Gan, J. Tong
and Bennett-Guerrero, Elliott",
title="Comparing Email, SMS, and Concurrent Mixed Modes Approaches to Capture Quality of Recovery in the Perioperative Period: Retrospective Longitudinal Cohort Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="4",
volume="5",
number="11",
pages="e25209",
keywords="concurrent mixed modes",
keywords="recovery after surgery",
keywords="text messages",
keywords="SMS",
keywords="email",
keywords="perioperative recovery",
keywords="mobile phone",
abstract="Background: As patients are discharged from the hospital more quickly, the ability to monitor patient recovery between hospital discharge and the first follow-up clinic visit is becoming increasingly important. Despite substantial increase in both internet use and smartphone ownership over the past 5 years, clinicians have been slow to embrace the use of these devices to capture patient recovery information in the period between hospital discharge and the first clinical follow-up appointment. Objective: This study aims to investigate the generalizability of using a web-based platform to capture patient recovery in a broad surgical patient population and compare response rates for 3 different web-based strategies for delivering recovery surveys over the perioperative period: email, SMS text messaging, and a concurrent mixed approach of using both email and SMS text messaging. Methods: Patients undergoing surgeries managed with an enhanced recovery after surgery pathway were asked to participate in a web-based quality assurance monitoring program at the time of their preoperative surgery appointment. Different follow-up methods were implemented over 3 sequential phases. Patients received Health Insurance Portability and Accountability Act--compliant web-based survey links via email (phase 1), SMS text messaging (phase 2), or concurrently using both email and SMS text messaging (phase 3) using REDCap and Twilio software. Recovery assessments using the established Quality of Recovery-9 instrument were performed 4 days before surgery and at 7 and 30 days postoperatively. Generalizability of the web-based system was examined by comparing characteristics of those who participated versus those who did not. Differences in response rates by the web-based collection method were analyzed using adjusted models. Results: A total of 615 patients were asked to participate, with 526 (85.5\%) opting for the follow-up program. Those who opted in were younger, slightly healthier, and more likely to be in a partnership. The concurrent mixed modes method was the most successful for obtaining responses at each time point compared with text or email alone (pre: 119/160, 74.4\% vs 116/173, 67.1\% vs 56/130, 43.1\%, P<.001; 7 days: 115/172, 66.9\% vs 82/164, 50.0\% vs 59/126, 46.8\%, P=.001; 30 days: 152/234, 65.0\% vs 52/105, 49.5\% vs 53/123, 43.1\%, P=.001, respectively). In the adjusted model, the concurrent mixed modes method significantly predicted response compared with using email alone (odds ratio 3.4; P<.001) and SMS text messaging alone (odds ratio 1.9; P<.001). Additional significant predictors of response were race, partnership, and time. Conclusions: For internet users and smartphone owners, electronic capture of recovery surveys appear to be possible through this mechanism. Discrepancies in both inclusion and response rates still exist among certain subgroups of patients, but the concurrent approach of using both email and text messages was the most effective approach to reach the largest number of patients across all subgroups. ",
doi="10.2196/25209",
url="https://formative.jmir.org/2021/11/e25209",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734827"
}


@Article{info:doi/10.2196/27761,
author="Jacobs, Jonathan
and Heymann, Reolyn
and Greeff, Jacobus Jacob",
title="A Telehealth System Incorporating a Serious Game Intervention to Aid Occupational Therapists in Identifying and Treating Children With Difficulty Crossing the Body's Midline: Key Informant Interviews Among Occupational Therapists",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="1",
volume="9",
number="4",
pages="e27761",
keywords="serious games",
keywords="input device",
keywords="telehealth",
keywords="occupational therapy",
keywords="midline crossing",
abstract="Background: The midline is an imaginary line that isolates the left and right parts of the body. Crossing the midline infers that a body part (eg, hand or foot) can spontaneously move over to the opposite side of the body to perform an action. A child who has difficulty crossing the midline can physically perform actions that cross the center of the body; however, they do not intuitively cross the midline when challenged with a task that requires this movement, as their perceptual components prevent them from engaging on the contralateral side. This requires treatment from an occupational therapist. Owing to the recent COVID-19 pandemic, access to therapeutic sessions was not possible or reduced, putting the responsibility for treatment on caretakers at home. Caretakers do not have the knowledge and skills to provide treatment, and occupational therapists do not receive adequate feedback from caretakers on the child's progress. Objective: The first objective is to adapt a simple serious game, or applied game, into a telehealth solution. Children will play the game at home under the supervision of a caretaker, and the results will be stored on the web. Occupational therapists can monitor progress via a web-based dashboard, receive additional valuable feedback about the child's behavior during treatment, and easily adapt the game to target specific needs. The second objective is to evaluate whether the implemented telehealth solution is feasible as a treatment option for midline crossing difficulties and thus fit for purpose. Methods: To meet the first objective, engineering and game development stakeholders formed a team with an occupational therapist, and through a collaborative design process combined with an agile programming approach, a telehealth solution was designed to assist remote monitoring of the serious gameplay. For the second objective, 6 different occupational therapists were introduced to the game, had the opportunity to play the game, and then provided feedback regarding the feasibility, benefits, and applicability of the system during structured interviews. Results: A telehealth system was designed aimed to address this problem. All results are saved on the web and accessed by occupational therapists via a dashboard. In addition, observed behavioral information is also saved. During the interviews, occupational therapists indicated that the dashboard would support their treatment plan and was indeed a feasible solution. Conclusions: The feedback from the occupational therapists for this telehealth solution suggests a feasible method to treat midline crossing problems remotely. The therapists commented on the convenience of integrating both assessment and treatment into the same application, as it assists them when grading a child. The therapists collectively agreed that the quantitative aspect the serious game creates by providing measurable and standardized data proves advantageous when compared with traditional methods of assessment and treatment. ",
doi="10.2196/27761",
url="https://games.jmir.org/2021/4/e27761",
url="http://www.ncbi.nlm.nih.gov/pubmed/34723821"
}


@Article{info:doi/10.2196/30768,
author="Nelligan, K. Rachel
and Hinman, S. Rana
and McManus, Fiona
and Lamb, E. Karen
and Bennell, L. Kim",
title="Moderators of the Effect of a Self-directed Digitally Delivered Exercise Program for People With Knee Osteoarthritis: Exploratory Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="29",
volume="23",
number="10",
pages="e30768",
keywords="digital",
keywords="text messaging",
keywords="exercise",
keywords="moderators",
keywords="osteoarthritis",
keywords="RCT",
keywords="clinical trial",
keywords="subgroups",
keywords="pain",
keywords="function",
keywords="knee osteoarthritis",
keywords="rehabilitation",
keywords="digital health",
abstract="Background: A 24-week self-directed digitally delivered intervention was found to improve pain and function in people with knee osteoarthritis (OA). However, it is possible that this intervention may be better suited to certain subgroups of people with knee OA compared to others. Objective: The aim of this study was to explore whether certain individual baseline characteristics moderate the effects of a self-directed digitally delivered intervention on changes in pain and function over 24 weeks in people with knee OA. Methods: An exploratory analysis was conducted on data from a randomized controlled trial involving 206 people with a clinical diagnosis of knee OA. This trial compared a self-directed digitally delivered intervention comprising of web-based education, exercise, and physical activity program supported by automated exercise behavior change mobile phone text messages to web-based education alone (control). The primary outcomes were changes in overall knee pain (assessed on an 11-point numerical rating scale) and physical function (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale [WOMAC]) at 24 weeks. Five baseline patient characteristics were selected as the potential moderators: (1) number of comorbidities, (2) number of other painful joints, (3) pain self-efficacy, (4) exercise self-efficacy, and (5) self-perceived importance of exercise. Separate linear regression models for each primary outcome and each potential moderator were fit, including treatment group, moderator, and interaction between treatment group and moderator, adjusting for the outcome at baseline. Results: There was evidence that pain self-efficacy moderated the effect of the intervention on physical function compared to the control at 24 weeks (interaction P=.02). Posthoc assessment of the mean change in WOMAC function by treatment arm showed that each 1-unit increase in baseline pain self-efficacy was associated with a 1.52 (95\% CI 0.27 to 2.78) unit improvement in the control group. In contrast, a reduction of 0.62 (95\% CI --1.93 to 0.68) units was observed in the intervention group with each unit increase in pain self-efficacy. There was only weak evidence that pain self-efficacy moderated the effect of the intervention on pain and that number of comorbidities, number of other painful joints, exercise self-efficacy, or exercise importance moderated the effect of the intervention on pain or function. Conclusions: With the exception of pain self-efficacy, which moderated changes in function but not pain, we found limited evidence that our selected baseline patient characteristics moderated intervention outcomes. This indicates that people with a range of baseline characteristics respond similarly to the unsupervised digitally delivered exercise intervention. As these findings are exploratory in nature, they require confirmation in future studies. ",
doi="10.2196/30768",
url="https://www.jmir.org/2021/10/e30768",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714252"
}


@Article{info:doi/10.2196/28124,
author="Haglo, H{\aa}vard
and Wang, Eivind
and Berg, Kristian Ole
and Hoff, Jan
and Helgerud, Jan",
title="Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="21",
volume="9",
number="10",
pages="e28124",
keywords="VO2max",
keywords="maximal oxygen uptake",
keywords="mobile app",
keywords="cardiovascular health",
keywords="quality of life",
keywords="endurance training",
abstract="Background: Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding. Objective: This study sought to investigate if self-administered 4{\texttimes}4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4{\texttimes}4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL). Methods: Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4{\texttimes}4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85\% to 95\% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period. Results: VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected. Conclusions: High-intensity 4{\texttimes}4-min interval training increased VO2max and HRQoL, contributing to patients' reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population. Trial Registration: ClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528 ",
doi="10.2196/28124",
url="https://mhealth.jmir.org/2021/10/e28124",
url="http://www.ncbi.nlm.nih.gov/pubmed/34673536"
}


@Article{info:doi/10.2196/25217,
author="Kelly, J. Peter
and Beck, K. Alison
and Deane, P. Frank
and Larance, Briony
and Baker, L. Amanda
and Hides, Leanne
and Manning, Victoria
and Shakeshaft, Anthony
and Neale, Joanne
and Kelly, F. John
and Oldmeadow, Christopher
and Searles, Andrew
and Palazzi, Kerrin
and Lawson, Kenny
and Treloar, Carla
and Gray, M. Rebecca
and Argent, Angela
and McGlaughlin, Ryan",
title="Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="6",
volume="23",
number="10",
pages="e25217",
keywords="mHealth",
keywords="SMART Recovery",
keywords="mutual support group",
keywords="mutual aid",
keywords="routine outcome monitoring",
keywords="treatment progress feedback",
keywords="addiction",
keywords="mobile phone",
abstract="Background: Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. Objective: The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. Methods: SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28\%) and facilitators (n=8). Results: Of the 72 study participants, 68 (94\%) created a SMART Track account, 64 (88\%) used SMART Track at least once, and 42 (58\%) used the app for more than 5 weeks. During week 1, 83\% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31\% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95\% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95\% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95\% CI --2.02 to 2.24) was reported. Conclusions: Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 International Registered Report Identifier (IRRID): RR2-10.2196/15113 ",
doi="10.2196/25217",
url="https://www.jmir.org/2021/10/e25217",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612829"
}


@Article{info:doi/10.2196/31247,
author="Correia, D. Fernando
and Molinos, Maria
and Neves, Carlos
and Janela, Dora
and Carvalho, Diana
and Luis, Sara
and Francisco, E. Gerard
and Lains, Jorge
and Bento, Virgilio",
title="Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Sep",
day="30",
volume="8",
number="3",
pages="e31247",
keywords="acute ankle sprains",
keywords="physical rehabilitation",
keywords="home-based digital rehabilitation",
keywords="digital therapy",
keywords="rehabilitation",
keywords="sprain",
keywords="digital health",
keywords="therapy",
keywords="prospective",
keywords="longitudinal",
keywords="cohort",
keywords="ankle",
keywords="soft tissue",
keywords="physical therapy",
keywords="pain",
keywords="outcome",
keywords="fatigue",
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 ",
doi="10.2196/31247",
url="https://rehab.jmir.org/2021/3/e31247",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499038"
}


@Article{info:doi/10.2196/27535,
author="Anan, Tomomi
and Kajiki, Shigeyuki
and Oka, Hiroyuki
and Fujii, Tomoko
and Kawamata, Kayo
and Mori, Koji
and Matsudaira, Ko",
title="Effects of an Artificial Intelligence--Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="24",
volume="9",
number="9",
pages="e27535",
keywords="neck pain",
keywords="shoulder pain",
keywords="shoulder stiffness",
keywords="low back pain",
keywords="musculoskeletal symptoms",
keywords="digital intervention",
keywords="mobile app",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. Objective: This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)--assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants' adherence to exercises. Methods: We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone's chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). Results: We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92\% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95\% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75\%) out of 48 participants in the intervention group and 3 (7\%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95\% CI 11.25-164.28; P<.001). Conclusions: This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. Trial Registration: University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000038307. ",
doi="10.2196/27535",
url="https://mhealth.jmir.org/2021/9/e27535",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559054"
}


@Article{info:doi/10.2196/22818,
author="Smith-Turchyn, Jenna
and Adams, C. Scott
and Sabiston, M. Catherine",
title="Testing of a Self-administered 6-Minute Walk Test Using Technology: Usability, Reliability and Validity Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Sep",
day="23",
volume="8",
number="3",
pages="e22818",
keywords="exercise",
keywords="physical activity",
keywords="usability testing",
keywords="applications",
keywords="mobile phone",
abstract="Background: The need to attend a medically supervised hospital- or clinic-based appointment is a well-recognized barrier to exercise participation. The development of reliable and accurate home-based functional tests has the potential to decrease the burden on the health care system while enabling support, information, and assessment. Objective: This study aims to explore the usability (ie, acceptability, satisfaction, accuracy, and practicality) of the EasyMeasure app to self-administer the 6-minute walk test (6MWT) in young, healthy adults and determine parallel form reliability and construct validity of conducting a self-administered 6MWT using technology. Methods: We used a usability study design. English-speaking, undergraduate university students who had access to an iPhone or iPad device running iOS 10 or later and self-reported ability to walk for 6 minutes were recruited for this study. Consenting participants were randomized to either a standard 6MWT group (ie, supervised without the use of the app) or a technology 6MWT group (ie, unsupervised with the app to mimic independent implementation of the test). All participants performed a maximal treadmill test. Participants in the 6MWT group completed the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire and a satisfaction questionnaire after completing the assessment. Parallel form reliability of the 6MWT using technology was analyzed by comparing participant self-administered scores and assessor scores using Pearson correlation coefficients across and between trials. Construct validity was assessed by comparing participant 6MWT scores (both standard and using technology) with maximum treadmill test variables (peak oxygen uptake and ventilatory threshold [VT]). Results: In total, 20 university students consented to participate in the study. All but 2 participants (8/10, 80\%) in the technology 6MWT group had deviations that prevented them from accurately conducting the 6MWT using the app, and none of the participants were able to successfully score the 6MWT. However, a significantly strong correlation was found (r=.834; P=.003) when comparing participants' scores for the 6MWT using technology with the assessors' scores. No significant correlations were found between maximal treadmill test peak oxygen uptake scores and 6MWT prediction equations using standard 6MWT scores (equation 1: r=0.119; P=.78; equation 2: r=0.095; P=.82; equation 3: r=0.119; P=.78); however, standard 6MWT scores were significantly correlated with VT values (r=0.810; P=.02). The calculated submaximal treadmill scores and assessor 6MWT scores using technology also demonstrated a significant correlation (r=0.661; P=.04). Conclusions: This study demonstrated significant usability concerns regarding the accuracy of a self-administered 6MWT using the EasyMeasure app. However, the strong and significant correlation between the 6MWT and VT values demonstrates the potential of the 6MWT to measure functional capacity for community-based exercise screening and patient monitoring. ",
doi="10.2196/22818",
url="https://rehab.jmir.org/2021/3/e22818",
url="http://www.ncbi.nlm.nih.gov/pubmed/34554105"
}


@Article{info:doi/10.2196/27602,
author="Chamorro-Moriana, Gema
and Sevillano, Luis Jose
and Perez-Cabezas, V.",
title="Versatile GCH Control Software for Correction of Loads Applied to Forearm Crutches During Gait Recovery Through Technological Feedback: Development and Implementation Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="22",
volume="23",
number="9",
pages="e27602",
keywords="control and monitoring software",
keywords="feedback technology",
keywords="motor control",
keywords="gait",
keywords="crutches",
keywords="assisted gait for partial weight-bearing",
keywords="functional recovery of the gait",
keywords="unloading of lower limb musculoskeletal injury",
keywords="rehabilitation",
keywords="physical therapy",
keywords="lower limb",
keywords="injury",
keywords="injuries",
abstract="Background: Measuring weight bearing is an essential aspect of clinical care for lower limb injuries such as sprains or meniscopathy surgeries. This care often involves the use of forearm crutches for partial loads progressing to full loads. Therefore, feasible methods of load monitoring for daily clinical use are needed. Objective: The main objective of this study was to design an innovative multifunctional desktop load-measuring software that complements GCH System 2.0--instrumented forearm crutches and monitors the applied loads, displaying real-time graphical and numerical information, and enabling the correction of inaccuracies through feedback technology during assisted gait. The secondary objective was to perform a preliminary implementation trial. Methods: The software was designed for indoor use (clinics/laboratories). This software translates the crutch sensor signal in millivolts into force units, records and analyzes data (10-80 Hz), and provides real-time effective curves of the loads exerted on crutches. It covers numerous types of extrinsic feedback, including visual, acoustic (verbal/beeps), concurrent, terminal, and descriptive feedback, and includes a clinical and research use database. An observational descriptive pilot study was performed with 10 healthy subjects experienced in bilateral assisted gait. The Wilcoxon matched-pairs signed-rank test was used to evaluate the load accuracy evolution of each subject (ie, changes in the loads exerted on crutches for each support) among various walks, which was interpreted at the 95\% confidence level. Results: GCH Control Software was developed as a multifunctional desktop tool complementing GCH System 2.0--instrumented forearm crutches. The pilot implementation of the feedback mechanism observed 96/100 load errors at baseline (walk 0, no feedback) with 7/10 subjects exhibiting crutch overloading. Errors ranged from 61.09\% to 203.98\%, demonstrating heterogeneity. The double-bar feedback found 54/100 errors in walk 1, 28/100 in walk 2, and 14/100 in walk 3. The first walk with double-bar feedback (walk 1) began with errors similar to the baseline walk, generally followed by attempts at correction. The Wilcoxon matched-pairs signed-rank test used to evaluate each subject's progress showed that all participants steadily improved the accuracy of the loads applied to the crutches. In particular, Subject 9 required extra feedback with two single-bar walks to focus on the total load. The participants also corrected the load balance between crutches and fluency errors. Three subjects made one error of load balance and one subject made six fluctuation errors during the three double-bar walks. The latter subject performed additional feedback with two balance-bar walks to focus on the load balance. Conclusions: GCH Control Software proved to be useful for monitoring the loads exerted on forearm crutches, providing a variety of feedback for correcting load accuracy, load balance between crutches, and fluency. The findings of the complementary implementation were satisfactory, although clinical trials with larger samples are needed to assess the efficacy of the different feedback mechanisms and to select the best alternatives in each case. ",
doi="10.2196/27602",
url="https://www.jmir.org/2021/9/e27602",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550073"
}


@Article{info:doi/10.2196/24402,
author="Li, Qiaoqin
and Liu, Yongguo
and Zhu, Jiajing
and Chen, Zhi
and Liu, Lang
and Yang, Shangming
and Zhu, Guanyi
and Zhu, Bin
and Li, Juan
and Jin, Rongjiang
and Tao, Jing
and Chen, Lidian",
title="Upper-Limb Motion Recognition Based on Hybrid Feature Selection: Algorithm Development and Validation",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="2",
volume="9",
number="9",
pages="e24402",
keywords="feature selection",
keywords="inertial measurement unit",
keywords="motion recognition",
keywords="rehabilitation exercises",
keywords="machine learning",
abstract="Background: For rehabilitation training systems, it is essential to automatically record and recognize exercises, especially when more than one type of exercise is performed without a predefined sequence. Most motion recognition methods are based on feature engineering and machine learning algorithms. Time-domain and frequency-domain features are extracted from original time series data collected by sensor nodes. For high-dimensional data, feature selection plays an important role in improving the performance of motion recognition. Existing feature selection methods can be categorized into filter and wrapper methods. Wrapper methods usually achieve better performance than filter methods; however, in most cases, they are computationally intensive, and the feature subset obtained is usually optimized only for the specific learning algorithm. Objective: This study aimed to provide a feature selection method for motion recognition of upper-limb exercises and improve the recognition performance. Methods: Motion data from 5 types of upper-limb exercises performed by 21 participants were collected by a customized inertial measurement unit (IMU) node. A total of 60 time-domain and frequency-domain features were extracted from the original sensor data. A hybrid feature selection method by combining filter and wrapper methods (FESCOM) was proposed to eliminate irrelevant features for motion recognition of upper-limb exercises. In the filter stage, candidate features were first selected from the original feature set according to the significance for motion recognition. In the wrapper stage, k-nearest neighbors (kNN), Na{\"i}ve Bayes (NB), and random forest (RF) were evaluated as the wrapping components to further refine the features from the candidate feature set. The performance of the proposed FESCOM method was verified using experiments on motion recognition of upper-limb exercises and compared with the traditional wrapper method. Results: Using kNN, NB, and RF as the wrapping components, the classification error rates of the proposed FESCOM method were 1.7\%, 8.9\%, and 7.4\%, respectively, and the feature selection time in each iteration was 13 seconds, 71 seconds, and 541 seconds, respectively. Conclusions: The experimental results demonstrated that, in the case of 5 motion types performed by 21 healthy participants, the proposed FESCOM method using kNN and NB as the wrapping components achieved better recognition performance than the traditional wrapper method. The FESCOM method dramatically reduces the search time in the feature selection process. The results also demonstrated that the optimal number of features depends on the classifier. This approach serves to improve feature selection and classification algorithm selection for upper-limb motion recognition based on wearable sensor data, which can be extended to motion recognition of more motion types and participants. ",
doi="10.2196/24402",
url="https://mhealth.jmir.org/2021/9/e24402",
url="http://www.ncbi.nlm.nih.gov/pubmed/34473067"
}


@Article{info:doi/10.2196/27662,
author="Kim, Aram
and Yun, Jung Seo
and Sung, Kwan-Sik
and Kim, Yeonju
and Jo, Young Ju
and Cho, Hanseul
and Park, Kyudong
and Oh, Byung-Mo
and Seo, Gil Han",
title="Exercise Management Using a Mobile App in Patients With Parkinsonism: Prospective, Open-Label, Single-Arm Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="31",
volume="9",
number="8",
pages="e27662",
keywords="Parkinsonian disorders",
keywords="exercise",
keywords="mobile apps",
keywords="mhealth",
keywords="Parkinson",
abstract="Background: Patients with parkinsonism have higher inactivity levels than the general population, and this results in increased comorbidities. Although exercise has benefits for motor function and quality of life (QOL) in patients with parkinsonism, these patients face many barriers to exercise participation, such as lack of motivation, fatigue, depression, and time constraints. Recently, the use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases. Objective: This study aimed to evaluate the effects of home-based exercise management with a customized mobile app on the exercise amount, physical activity, and QOL of patients with parkinsonism. Methods: This was a prospective, open-label, single-arm pilot study. The therapist installed the app in the smartphones of the participants and educated them on how to use the app. The therapist developed an individualized multimodal exercise program that consisted of stretching, strengthening, aerobic, balance and coordination, and oral-motor and vocal exercises. Participants were encouraged to engage in an 8-week home-based exercise program delivered through a customized app. The alarm notifications of the app provided reminders to exercise regularly at home. The primary outcome was the exercise amount. The secondary outcomes were assessed using the International Physical Activity Questionnaire (IPAQ), Parkinson's Disease Questionnaire-39 (PDQ-39), and Geriatric Depression Scale (GDS). The usability of the customized app was assessed using a self-report questionnaire. Results: A total of 21 participants with parkinsonism completed the intervention and assessment between September and December 2020 (mean age: 72 years; women: 17/21, 81\%; men: 4/21, 19\%). The participants reported a significant increase in the total amount of exercise (baseline: mean 343.33, SD 206.70 min/week; 8-week follow-up: mean 693.10, SD 373.45 min/week; P<.001) and in the amount of each exercise component, including stretching, strengthening, balance and coordination, and oral-motor and vocal exercise after 8 weeks. Analysis of the secondary outcomes revealed significant improvements in the IPAQ (P=.006), PDQ-39 (P=.02), and GDS (P=.04) scores. The usability of the program with the mobile app was verified based on the positive responses such as ``intention to use'' and ``role expectation for rehabilitation.'' Conclusions: Exercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and QOL in patients with parkinsonism. This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism. In addition, this program proved useful as an alternative exercise management strategy during the COVID-19 pandemic when patients with Parkinson disease were less physically active than before and showed aggravation of symptoms. However, additional clinical trials are needed to evaluate the efficacy of this exercise program in a large population and to confirm its disease-modifying effects. ",
doi="10.2196/27662",
url="https://mhealth.jmir.org/2021/8/e27662",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463635"
}


@Article{info:doi/10.2196/26153,
author="Allegue, Rakia Dorra
and Kairy, Dahlia
and Higgins, Johanne
and Archambault, S. Philippe
and Michaud, Francois
and Miller, C. William
and Sweet, N. Shane
and Tousignant, Michel",
title="A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="31",
volume="9",
number="3",
pages="e26153",
keywords="stroke",
keywords="rehabilitation",
keywords="virtual reality",
keywords="video games",
keywords="telerehabilitation",
keywords="upper extremity",
keywords="motivation",
abstract="Background: In Canada, only 11\% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program. Objective: This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment. Methods: A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment--upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week. Results: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels. Conclusions: VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising.  International Registered Report Identifier (IRRID): RR2-10.2196/14629 ",
doi="10.2196/26153",
url="https://games.jmir.org/2021/3/e26153",
url="http://www.ncbi.nlm.nih.gov/pubmed/34132649"
}


@Article{info:doi/10.2196/27195,
author="McClincy, Michael
and Seabol, G. Liliana
and Riffitts, Michelle
and Ruh, Ethan
and Novak, E. Natalie
and Wasilko, Rachel
and Hamm, E. Megan
and Bell, M. Kevin",
title="Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="27",
volume="9",
number="3",
pages="e27195",
keywords="IHT",
keywords="pediatric",
keywords="sports medicine",
keywords="ACL",
keywords="orthopaedics",
keywords="rehabilitation",
keywords="health technology",
keywords="gamification",
abstract="Background: Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements.  Objective: This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods: In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post--ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70\% (7/10) were female. Most participants (7/10, 70\%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75\%-100\% in 40\% (4/10), 50\%-75\% in 40\% (4/10), and 25\%-50\% of prescribed exercises in 20\% (2/10) of the participants. Results: The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions: The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting. ",
doi="10.2196/27195",
url="https://games.jmir.org/2021/3/e27195",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448715"
}


@Article{info:doi/10.2196/26982,
author="Meinke, Anita
and Peters, Rick
and Knols, Ruud
and Karlen, Walter
and Swanenburg, Jaap",
title="Exergaming Using Postural Feedback From Wearable Sensors and Exercise Therapy to Improve Postural Balance in People With Nonspecific Low Back Pain: Protocol for a Factorial Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="26",
volume="10",
number="8",
pages="e26982",
keywords="low back pain",
keywords="exercise therapy",
keywords="postural balance",
keywords="postural feedback",
keywords="motor control",
keywords="fear of movement",
keywords="exergame",
keywords="randomized controlled trial",
keywords="physical activity",
keywords="smartphone",
keywords="sensors",
keywords="activity tracker",
keywords="mobile phone",
abstract="Background: Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP. Objective: This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP. Methods: The study was an assessor-blinded 2{\texttimes}2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet. Results: The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check. Conclusions: Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/26982 ",
doi="10.2196/26982",
url="https://www.researchprotocols.org/2021/8/e26982",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435954"
}


@Article{info:doi/10.2196/30239,
author="Motz, Victoria
and Faust, Alison
and Dahmus, Jessica
and Stern, Benjamin
and Soriano, Christopher
and Stine, G. Jonathan",
title="Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="17",
volume="5",
number="8",
pages="e30239",
keywords="physical activity",
keywords="fatty liver",
keywords="telemedicine",
keywords="liver",
keywords="nonalcoholic fatty liver disease",
keywords="liver disease",
keywords="fatty liver disease",
keywords="aerobic training",
keywords="telehealth",
keywords="fitness",
keywords="feasibility",
keywords="steatohepatitis",
abstract="Background: Most patients with nonalcoholic fatty liver disease (NAFLD) are physically inactive despite the well-known benefits of physical activity. Telehealth offers promise as a novel way to deliver an exercise training program and increase physical activity. However, the feasibility, safety, and efficacy of telehealth-based exercise programs is unknown in patients with NAFLD. Objective: The aim of this study was to determine the feasibility of a directly supervised exercise training program delivered exclusively with telehealth to patients with nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD. Methods: In response to COVID-19 research restrictions, we adapted an existing clinical trial and delivered 20 weeks of moderate-intensity aerobic training 5 days a week under real-time direct supervision using an audio--visual telehealth platform. Aerobic training was completed by walking outdoors or using a home treadmill. Fitness activity trackers with heart rate monitors ensured exercise was completed at the prescribed intensity with real-time feedback from an exercise physiologist. Results: Three female patients with biopsy-proven NASH were enrolled with a mean age of 52 (SD 14) years. The mean body mass index was 31.9 (SD 5.1) kg/m2. All patients had metabolic syndrome. All patients completed over 80\% of exercise sessions (mean 84\% [SD 3\%]) and no adverse events occurred. Body weight (mean --5.1\% [SD 3.7\%]), body fat (mean --4.4\% [SD 2.3\%]), and waist circumference (mean --1.3 in. [SD 1.6 in.]) all improved with exercise. The mean relative reduction in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was 35.1\% (SD 8.8\%). Mean reductions in hemoglobin A1c and Homeostatic Model Assessment for Insulin Resistance were also observed (--0.5\% [SD 0.2\%] and --4.0 [SD 1.2], respectively). The mean peak oxygen consumption (VO2peak) improved by 9.9 (SD 6.6) mL/kg/min. Conclusions: This proof-of-concept study found that supervised exercise training delivered via telehealth is feasible and safe in patients with NASH. Telehealth-based exercise training also appears to be highly efficacious in patients with NASH, but this will need to be confirmed by future large-scale trials. Trial Registration: ClinicalTrials.gov NCT03518294; https://clinicaltrials.gov/ct2/show/NCT03518294 ",
doi="10.2196/30239",
url="https://formative.jmir.org/2021/8/e30239",
url="http://www.ncbi.nlm.nih.gov/pubmed/34402795"
}


@Article{info:doi/10.2196/26344,
author="Brassel, Sophie
and Power, Emma
and Campbell, Andrew
and Brunner, Melissa
and Togher, Leanne",
title="Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="30",
volume="23",
number="7",
pages="e26344",
keywords="virtual reality",
keywords="acquired brain injury",
keywords="traumatic brain injury",
keywords="rehabilitation",
keywords="systematic review",
keywords="recommendations",
keywords="cognitive communication",
keywords="mobile phone",
abstract="Background: Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective: This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods: This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results: In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions: There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area. ",
doi="10.2196/26344",
url="https://www.jmir.org/2021/7/e26344",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328434"
}


@Article{info:doi/10.2196/26658,
author="Biebl, Theresia Johanna
and Rykala, Marzena
and Strobel, Maximilian
and Kaur Bollinger, Pawandeep
and Ulm, Bernhard
and Kraft, Eduard
and Huber, Stephan
and Lorenz, Andreas",
title="App-Based Feedback for Rehabilitation Exercise Correction in Patients With Knee or Hip Osteoarthritis: Prospective Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="13",
volume="23",
number="7",
pages="e26658",
keywords="mHealth",
keywords="digital health",
keywords="digital rehabilitation",
keywords="machine learning",
keywords="smartphone",
keywords="osteoarthritis",
keywords="exercise therapy",
abstract="Background: The use of digital therapeutic solutions for rehabilitation of conditions such as osteoarthritis provides scalable access to rehabilitation. Few validated technological solutions exist to ensure supervision of users while they exercise at home. Motion Coach (Kaia Health GmbH) provides audiovisual feedback on exercise execution in real time on conventional smartphones. Objective: We hypothesized that the interrater agreement between physiotherapists and Motion Coach would be noninferior to physiotherapists' interrater agreement for exercise evaluations in a cohort with osteoarthritis. Methods: Patients diagnosed with osteoarthritis of the knee or hip were recruited at a university hospital to perform a set of 6 exercises. Agreement between Motion Coach and 2 physiotherapists' corrections for segments of the exercises were compared using Cohen $\kappa$ and percent agreement. Results: Participants (n=24) were enrolled and evaluated. There were no significant differences between interrater agreements (Motion Coach app vs physiotherapists: percent agreement 0.828; physiotherapist 1 vs physiotherapist 2: percent agreement 0.833; P<.001). Age (70 years or under, older than 70 years), gender (male, female), or BMI (30 kg/m2 or under, greater than 30 kg/m2) subgroup analysis revealed no detectable difference in interrater agreement. There was no detectable difference in levels of interrater agreement between Motion Coach vs physiotherapists and between physiotherapists in any of the 6 exercises. Conclusions: The results demonstrated that Motion Coach is noninferior to physiotherapist evaluations. Interrater agreement did not differ between 2 physiotherapists or between physiotherapists and the Motion Coach app. This finding was valid for all investigated exercises and subgroups. These results confirm the ability of Motion Coach to detect user form during exercise and provide valid feedback to users with musculoskeletal disorders. ",
doi="10.2196/26658",
url="https://www.jmir.org/2021/7/e26658",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255677"
}


@Article{info:doi/10.2196/18130,
author="Ding, Y. Eric
and Erskine, Nathaniel
and Stut, Wim
and McManus, D. David
and Peterson, Amy
and Wang, Ziyue
and Escobar Valle, Jorge
and Albuquerque, Daniella
and Alonso, Alvaro
and Botkin, F. Naomi
and Pack, R. Quinn",
title="MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="8",
volume="8",
number="3",
pages="e18130",
keywords="cardiac rehabilitation",
keywords="telerehabilitation",
keywords="health watch",
keywords="mHealth",
keywords="exercise",
abstract="Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch--informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33\%) were women, and 6 (33\%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86\% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch--based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. ",
doi="10.2196/18130",
url="https://humanfactors.jmir.org/2021/3/e18130",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255660"
}


@Article{info:doi/10.2196/30621,
author="Kim, S. Esther
and Laird, Laura
and Wilson, Carlee
and Bieg, Till
and Mildner, Philip
and M{\"o}ller, Sebastian
and Schatz, Raimund
and Schwarz, Stephanie
and Spang, Robert
and Voigt-Antons, Jan-Niklas
and Rochon, Elizabeth",
title="Implementation and Effects of an Information Technology--Based Intervention to Support Speech and Language Therapy Among Stroke Patients With Aphasia: Protocol for a Virtual Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="2",
volume="10",
number="7",
pages="e30621",
keywords="aphasia",
keywords="rehabilitation",
keywords="speech-language pathology",
keywords="app-based therapy",
keywords="user-centered design",
keywords="mHealth",
keywords="adaptive software",
abstract="Background: Mobile app--based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia as adjuncts or substitutes for traditional in-person therapy approaches. These apps can increase the intensity of treatment and have resulted in meaningful outcomes across several domains. Objective: VoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to help people with aphasia in improving their naming abilities through interactions with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. Methods: A multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. The intervention group participants will engage in 5 weeks of training with the app, followed by posttreatment and follow-up assessments after an additional 5 weeks. Those in the waitlist control group will have no training for 5 weeks; this is followed by pretreatment assessment, training for 5 weeks, and posttreatment assessment. All trial procedures are being conducted remotely given the COVID-19 pandemic. Results: Recruitment of participants started in September 2020, and the study is expected to be completed by March 2022. Publication of results is expected within 6 months of study completion. Conclusions: The results of the RCT will provide information on evidence-based practice using technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in people with aphasia in an easily accessible and a cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can provide information to therapists on telerehabilitation practices and monitoring of app-based home therapy programs. Trial Registration: ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364 International Registered Report Identifier (IRRID): DERR1-10.2196/30621 ",
doi="10.2196/30621",
url="https://www.researchprotocols.org/2021/7/e30621",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255727"
}


@Article{info:doi/10.2196/28708,
author="Wickerson, Lisa
and Helm, Denise
and Gottesman, Chaya
and Rozenberg, Dmitry
and Singer, G. Lianne
and Keshavjee, Shaf
and Sidhu, Aman",
title="Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="17",
volume="9",
number="6",
pages="e28708",
keywords="telerehabilitation",
keywords="lung",
keywords="transplant",
keywords="rehabilitation",
keywords="COVID-19",
keywords="usage",
keywords="satisfaction",
keywords="app",
keywords="outcome",
keywords="telemedicine",
abstract="Background: The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. Objective: The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. Methods: This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. Results: In total, 78 LTx candidates and 33 recipients were included (57 [51\%] males, mean age 58 [SD 12] years, 58 [52\%] with interstitial lung disease, 34 [31\%] with chronic obstructive pulmonary disease). A total of 50 (64\%) LTx candidates and 17 (51\%) LTx recipients entered ?10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83\%) candidates agreed the app helped prepare them for surgery and 18/21 (85\%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ?4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57\% of LTx candidates scored as active, which improved to 87\% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76\% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62\% (SD 18\%) predicted (n=8). Conclusions: We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic. ",
doi="10.2196/28708",
url="https://mhealth.jmir.org/2021/6/e28708",
url="http://www.ncbi.nlm.nih.gov/pubmed/34048354"
}


@Article{info:doi/10.2196/25569,
author="Lambert, Genevieve
and Alos, Nathalie
and Bernier, Pascal
and Laverdi{\`e}re, Caroline
and Kairy, Dahlia
and Drummond, Kenneth
and Dahan-Oliel, No{\'e}mi
and Lemay, Martin
and Veilleux, Louis-Nicolas",
title="Home-Based Telehealth Exercise Intervention in Early-On Survivors of Childhood Acute Lymphoblastic Leukemia: Feasibility Study",
journal="JMIR Cancer",
year="2021",
month="Jun",
day="16",
volume="7",
number="2",
pages="e25569",
keywords="exercise therapy",
keywords="rehabilitation",
keywords="acute lymphoblastic leukemia",
keywords="intervention study",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: Acute lymphoblastic leukemia is the most common type of pediatric cancer. Acute lymphoblastic leukemia causes an altered bone mineral homeostasis state, which can contribute to osteopenia, and bone fractures, most commonly vertebral fractures. With the increasing number of childhood cancer survivors, late adverse effects such as musculoskeletal comorbidities are often reported and are further influenced by inactive lifestyle habits. Physical activity has been shown to increase the mechanical workload of the bone, mitigating bone impairment in other cancer-specific populations. Objective: This interventional pilot study aims to investigate the use of telehealth to deliver a home-based exercise intervention for early-on survivors of bone marrow--related hematological malignancies and to assess its impact on survivors' musculoskeletal and functional health. Methods: We aimed to recruit a group of 12 early-on survivors of acute lymphoblastic leukemia, within 6 months to 5 years of treatment, to participate in and complete the proposed telehealth intervention with a parent. The 16-week intervention included 40 potential home-based physical activity interventions supervised by a kinesiologist through a telehealth internet platform, with monthly progression. Patients were recruited to the cohort if they were able to participate in the intervention during the first month (minimum 12 weeks of intervention). Evaluation before and after the intervention protocol highlighted differences in functional capacities and musculoskeletal health of patients using mechanography, peripheral quantitative computed tomography, 6-minute walk test, and grip force test. Results: The recruitment rate for the intervention was low (12/57, 21\% of contacted patients). Of 12 patients, 3 were excluded (1=relapse, 1=failure to meet technical requirements, and 1=abandoned). The 9 patients who completed the intervention (6 girls; mean age 10.93, SD 2.83 years; mean BMI 21.58, SD 6.55 kg/m2; mean time since treatment completion 36.67, SD 16.37 months) had a mean adherence of 89\% and a completion rate of 75\%. In addition, these patients showed functional improvements in lower limb muscle force and power as well as in the 6-minute walk test distance. Participants also showed improved bone health after the intervention on the following parameters: bone mineral content, stress-strain index, total and cortical cross-sectional area at the 14\% site (P=.03, P=.01, P=.01, and P=.001, respectively) and 38\% site of the tibia (P=.003, P=.04, P=.001, and P=.003, respectively). Conclusions: High adherence and participation rates suggest that telehealth is a feasible method to deliver exercise interventions to young early-on survivors of acute lymphoblastic leukemia. The proposed intervention seems promising in providing benefits to patients' functional performance and bone health, but a large-scale study is needed to confirm this assumption. ",
doi="10.2196/25569",
url="https://cancer.jmir.org/2021/2/e25569",
url="http://www.ncbi.nlm.nih.gov/pubmed/34132645"
}


@Article{info:doi/10.2196/26095,
author="Chen, Mingrong
and Wu, Tingting
and Lv, Meina
and Chen, Chunmei
and Fang, Zongwei
and Zeng, Zhiwei
and Qian, Jiafen
and Jiang, Shaojun
and Chen, Wenjun
and Zhang, Jinhua",
title="Efficacy of Mobile Health in Patients With Low Back Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e26095",
keywords="mobile health",
keywords="mHealth",
keywords="low back pain",
keywords="meta-analysis",
keywords="pain intensity",
keywords="disability",
abstract="Background: Low back pain is one of the most common health problems and a main cause of disability, which imposes a great burden on patients. Mobile health (mHealth) affects many aspects of people's lives, and it has progressed rapidly, showing promise as an effective intervention for patients with low back pain. However, the efficacy of mHealth interventions for patients with low back pain remains unclear; thus, further exploration is necessary. Objective: The purpose of this study was to evaluate the efficacy of mHealth interventions in patients with low back pain compared to usual care. Methods: This was a systematic review and meta-analysis of randomized controlled trials designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. We searched for studies published in English before October 2020 in the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Two researchers independently scanned the literature, extracted data, and assessed the methodological quality of the included studies. Bias risks were assessed using the Cochrane Collaboration tool. We used RevMan 5.4 software to perform the meta-analysis. Results: A total of 9 studies with 792 participants met the inclusion criteria. The simultaneous use of mHealth and usual care showed a better reduction in pain intensity than usual care alone, as measured by the numeric rating scale (mean difference [MD] --0.85, 95\% CI --1.29 to --0.40; P<.001), and larger efficacy in reducing disability, as measured by the Rolland-Morris Disability Questionnaire (MD --1.54, 95\% CI --2.35 to --0.73; P<.001). Subgroup analyses showed that compared with usual care, mHealth using telephone calls significantly reduced pain intensity (MD --1.12, 95\% CI --1.71 to --0.53; P<.001) and disability score (MD --1.68, 95\% CI --2.74 to --0.63; P<.001). However, without the use of telephone calls, mHealth had no obvious advantage over usual care in improving pain intensity (MD --0.48, 95\% CI --1.16 to 0.20; P=.16) and the disability score (MD --0.41, 95\% CI --1.88 to 1.05; P=.58). The group that received a more sensitive feedback intervention showed a significantly reduced disability score (MD --4.30, 95\% CI --6.95 to --1.69; P=.001). Conclusions: The use of simultaneous mHealth and usual care interventions has better efficacy than usual care alone in reducing pain intensity and disability in patients with low back pain. Moreover, the results of subgroup analysis revealed that mHealth using telephone calls might play a positive role in improving pain intensity and disability in patients with low back pain. ",
doi="10.2196/26095",
url="https://mhealth.jmir.org/2021/6/e26095",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114965"
}


@Article{info:doi/10.2196/24076,
author="Stork, Jordan Matthew
and Bell, Gordon Ethan
and Jung, Elizabeth Mary",
title="Examining the Impact of a Mobile Health App on Functional Movement and Physical Fitness: Pilot Pragmatic Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="28",
volume="9",
number="5",
pages="e24076",
keywords="mHealth",
keywords="functional movement",
keywords="flexibility",
keywords="strength",
keywords="cardiovascular fitness",
abstract="Background: Numerous mobile apps available for download are geared toward health and fitness; however, limited research has evaluated the real-world effectiveness of such apps. The movr app is a mobile health app designed to enhance physical functioning by prescribing functional movement training based on individualized movement assessments. The influence of the movr app on functional movement and physical fitness (flexibility, strength, and cardiovascular fitness) has not yet been established empirically. Objective: This study aims to examine the real-world impact of the movr app on functional movement, flexibility, strength, and cardiovascular fitness. Methods: A total of 48 healthy adults (24 women and 24 men; mean age 24, SD 5 years) completed an 8-week pilot pragmatic randomized controlled trial in which they were randomly assigned to either 8-week use of the movr app (n=24) or 8-week waitlist control (n=24). Measures of functional movement (Functional Movement Screen [FMS]), strength (push-ups, handgrip strength, and countermovement jump), flexibility (shoulder flexibility, sit and reach, active straight leg raise [ASLR], and half-kneeling dorsiflexion), and cardiovascular fitness (maximal oxygen uptake []) were collected at baseline and the 8-week follow-up. Results: Repeated measures analyses of variance revealed significant group-by-time interactions for the 100-point FMS (P<.001), shoulder flexibility (P=.01), ASLR (P=.001), half-kneeling dorsiflexion (P<.001), and push-up tests (P=.03). Pairwise comparisons showed that FMS scores increased from pre- to postintervention for those in the movr group (P<.001) and significantly decreased for those in the control group (P=.04). For shoulder flexibility, ASLR, half-kneeling dorsiflexion, and push-up tests, improvements from pre- to postintervention were found in the movr group (all values of P<.05) but not in the control group (all values of P>.05). There were no changes in the sit and reach or handgrip strength test scores for either group (all values of P>.05). A significant main effect of time was found for the countermovement jump (P=.02), such that scores decreased from pre- to postintervention in the control group (P=.02) but not in the movr group (P=.38). Finally, a significant group-by-time interaction was found for  (P=.001), revealing that scores decreased pre- to postintervention in the control group (P<.001), but not in the movr group (P=.54). Conclusions: The findings revealed that movr improved indices of functional movement (FMS), flexibility (shoulder, ASLR, and dorsiflexion), and muscular endurance (push-ups) over an 8-week period compared with the control group while maintaining handgrip strength, lower body power (countermovement jump), and cardiovascular fitness (). Thus, this study provides initial evidence of the effectiveness of the movr app for enhancing functional movement and physical fitness among healthy adults. Trial Registration: ClinicalTrials.gov NCT04865666; https://clinicaltrials.gov/ct2/show/NCT04865666 ",
doi="10.2196/24076",
url="https://mhealth.jmir.org/2021/5/e24076",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047704"
}


@Article{info:doi/10.2196/25316,
author="Lopes, Filipa
and Rodrigues, M{\'a}rio
and Silva, G. Anabela",
title="User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="14",
volume="9",
number="5",
pages="e25316",
keywords="pain assessment",
keywords="mobile app",
keywords="validity",
keywords="reliability",
keywords="usability",
keywords="mHealth",
keywords="pain",
keywords="user-centered design",
abstract="Background: Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective: This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods: This study was divided into 2 phases: phase 1---development of the AvaliaDor app; and phase 2---assessment of the apps' usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results: The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions: A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain. ",
doi="10.2196/25316",
url="https://mhealth.jmir.org/2021/5/e25316",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988515"
}


@Article{info:doi/10.2196/24669,
author="Guay, Manon
and Labb{\'e}, Mathieu
and S{\'e}guin-Tremblay, No{\'e}mie
and Auger, Claudine
and Goyer, Genevi{\`e}ve
and Veloza, Emily
and Chevalier, Natalie
and Polgar, Jan
and Michaud, Fran{\c{c}}ois",
title="Adapting a Person's Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App's Acceptability",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="May",
day="11",
volume="8",
number="2",
pages="e24669",
keywords="occupational therapy",
keywords="mobile phone",
keywords="aging",
keywords="disability",
keywords="telehealth",
keywords="3D visualization",
keywords="universal design",
keywords="built environment",
keywords="camera",
keywords="remote assessment",
keywords="assistive technology",
abstract="Background: Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT's work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective: The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT's work when conducting assessments in which home representations are essential to fit a person's needs. Methods: A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results: A total of 24 stakeholders contributed significantly to MapIt technology's co-design over a span of 4 years. Fueled by the objective to enhance MapIt's acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders' perception was favorable regarding MapIt's acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions: MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person's occupational engagement. ",
doi="10.2196/24669",
url="https://rehab.jmir.org/2021/2/e24669",
url="http://www.ncbi.nlm.nih.gov/pubmed/33973867"
}


@Article{info:doi/10.2196/25717,
author="Bientzle, Martina
and Restle, Anne
and Kimmerle, Joachim",
title="Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="21",
volume="9",
number="4",
pages="e25717",
keywords="smartphone use",
keywords="phubbing",
keywords="physiotherapy",
keywords="smartphone",
keywords="therapy",
keywords="patients",
keywords="therapists",
keywords="therapeutic",
keywords="treatment",
abstract="Background: Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any purpose. This also applies to patients and therapists in treatment situations. Objective: The aim of this study was to investigate how purposeful smartphone use compared with recreational smartphone use (by a physiotherapist or by a patient) influenced the perception of a physiotherapeutic treatment situation. We examined the impact of smartphone use during a physiotherapy session on the perception of the physiotherapist, evaluation of attentiveness, and evaluation of smartphone use in physiotherapy in general. Methods: Members of various music and sports clubs were invited to participate in an online randomized controlled trial. Participants were randomly assigned to one of four conditions. They watched a video in which a physiotherapeutic treatment was shown and in which a smartphone was used or not used in the following four different ways: (1) therapeutically purposeful use, (2) recreational use by the physiotherapist (looking at the phone from time to time with no therapeutic purpose), (3) recreational use by the patient, and (4) no smartphone use (control condition). After watching the video, the participants indicated their perception of the physiotherapist's professional competence, social competence, and empathetic behavior. They also rated the physiotherapist's and patient's attentiveness and evaluated the usage of smartphones generally in physiotherapy. Results: The analysis included 118 participants (63 women and 55 men). When the physiotherapist used the smartphone in a purposeful way, the physiotherapist was perceived as more professionally competent (P=.007), socially competent (P=.03), and empathetic (P=.04) than if the physiotherapist used it with no therapeutic purpose. These effects occurred because recreational smartphone use by the physiotherapist was evaluated more negatively than the behavior in the control condition (professional competence: P=.001; social competence: P=.03; empathy: P=.04). Moreover, when the physiotherapist used the smartphone in a recreational way, the physiotherapist was perceived as being less attentive (P<.001). Likewise, when the patient used the smartphone in a recreational way, the patient was perceived as being less attentive (P<.001). Finally, smartphone use in physiotherapy was rated as more positive in general when the smartphone was used in a purposeful way compared with the conditions in which the physiotherapist or patient looked at the smartphone with no therapeutic purpose (P<.001). This positive evaluation occurred because purposeful use led to a more positive rating than no smartphone use (P<.001, R=0.42). Conclusions: Smartphones are only appropriate for therapists and patients if they are used directly for a therapeutic purpose. Otherwise, it is better not to use smartphones during treatment. Trial Registration: AsPredicted (aspredicted.org) \#24740; https://aspredicted.org/blind.php?x=vv532i ",
doi="10.2196/25717",
url="https://mhealth.jmir.org/2021/4/e25717",
url="http://www.ncbi.nlm.nih.gov/pubmed/33881402"
}


@Article{info:doi/10.2196/20468,
author="Park, G. Linda
and Elnaggar, Abdelaziz
and Lee, J. Sei
and Merek, Stephanie
and Hoffmann, J. Thomas
and Von Oppenfeld, Julia
and Ignacio, Nerissa
and Whooley, A. Mary",
title="Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="16",
volume="5",
number="4",
pages="e20468",
keywords="physical activity",
keywords="cardiac rehabilitation",
keywords="digital health",
keywords="mobile app",
keywords="wearable device",
keywords="mHealth",
abstract="Background: Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective: The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23\% (14/60) were female; retention rate was 85\% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions: This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. Trial Registration: ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313 ",
doi="10.2196/20468",
url="https://formative.jmir.org/2021/4/e20468",
url="http://www.ncbi.nlm.nih.gov/pubmed/33861204"
}


@Article{info:doi/10.2196/26519,
author="Lamberigts, Marie
and Van Hoof, Lucas
and Proesmans, Tine
and Vandervoort, Pieter
and Grieten, Lars
and Haemers, Peter
and Rega, Filip",
title="Remote Heart Rhythm Monitoring by Photoplethysmography-Based Smartphone Technology After Cardiac Surgery: Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="15",
volume="9",
number="4",
pages="e26519",
keywords="cardiac surgery",
keywords="postoperative follow-up",
keywords="cardiac rehabilitation",
keywords="postoperative arrhythmias",
keywords="atrial fibrillation",
keywords="photoplethysmography",
keywords="home-monitoring",
abstract="Background: Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery, yet the precise incidence and significance of arrhythmias after discharge home need to be better defined. Photoplethysmography (PPG)-based smartphone apps are promising tools to enable early detection and follow-up of arrhythmias. Objective: By using a PPG-based smartphone app, we aimed to gain more insight into the prevalence of AF and other rhythm-related complications upon discharge home after cardiac surgery and evaluate the implementation of this app into routine clinical care. Methods: In this prospective, single-center trial, patients recovering from cardiac surgery were asked to register their heart rhythm 3 times daily using a Food and Drug Administration--approved PPG-based app, for either 30 or 60 days after discharge home. Patients with permanent AF or a permanent pacemaker were excluded. Results: We included 24 patients (mean age 60.2 years, SD 12 years; 15/23, 65\% male) who underwent coronary artery bypass grafting and/or valve surgery. During hospitalization, 39\% (9/23) experienced postoperative AF. After discharge, the PPG app reported AF or atrial flutter in 5 patients. While the app notified flutter in 1 patient, this was a false positive, as electrocardiogram revealed a 2nd-degree, 2:1 atrioventricular block necessitating a permanent pacemaker. AF was confirmed in 4 patients (4/23, 17\%) and interestingly, was associated with an underlying postoperative complication in 2 participants (pneumonia n=1, pericardial tamponade n=1). A significant increase in the proportion of measurements indicating sinus rhythm was observed when comparing the first to the second month of follow-up (P<.001). In the second month of follow-up, compliance was significantly lower with 2.2 (SD 0.7) measurements per day versus 3.0 (SD 0.8) measurements per day in the first month (P=.002). The majority of participants (17/23, 74\%), as well as the surveyed primary care physicians, experienced positive value by using the app as they felt more involved in the postoperative rehabilitation. Conclusions: Implementation of smartphone-based PPG technology enables detection of AF and other rhythm-related complications after cardiac surgery. An association between AF detection and an underlying complication was found in 2 patients. Therefore, smartphone-based PPG technology may supplement rehabilitation after cardiac surgery by acting as a sentinel for underlying complications, rhythm-related or otherwise. ",
doi="10.2196/26519",
url="https://mhealth.jmir.org/2021/4/e26519",
url="http://www.ncbi.nlm.nih.gov/pubmed/33856357"
}


@Article{info:doi/10.2196/23304,
author="Lim, Young Ji
and Kim, Kwang Jong
and Kim, Yoon
and Ahn, So-Yeon
and Yu, Jonghan
and Hwang, Hye Ji",
title="A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="13",
volume="5",
number="4",
pages="e23304",
keywords="breast cancer",
keywords="mobile health",
keywords="rehabilitation",
keywords="cancer continuum",
abstract="Background: Although many mobile health (mHealth) apps have evolved as support tools for self-management of breast cancer, limited studies have developed a comprehensive app and described the algorithms for personalized rehabilitation throughout the breast cancer care continuum. Objective: This study aimed to develop a comprehensive mobile app and to describe an algorithm that adjusts personalized content to facilitate self-management throughout the breast cancer care continuum. Methods: The development process of the modular mHealth app included the following 4 steps: (1) organizing expert teams, (2) defining evidence-based fundamental content and modules, (3) classifying user information for algorithms to personalize the content, and (4) creating the app platform and connectivity to digital health care devices. Results: We developed a modular mHealth app service, which took 18 months, including a review of related literature and guidelines and the development of the app and connectivity to digital health care devices. A total of 11 functionalities were defined in the app with weekly analysis. The user information classification was formulated for personalized rehabilitation according to 5 key criteria: general user information, breast operation type, lymph node surgery type, chemotherapy and hormonal therapy use, and change in treatment after surgery. The main modules for personalized content included a self-monitoring screen, personalized health information, personalized exercise, and diet management. Conclusions: The strength of this study was the development of a comprehensive mHealth app and algorithms to adjust content based on user medical information for personalized rehabilitation during the breast cancer care continuum. ",
doi="10.2196/23304",
url="https://formative.jmir.org/2021/4/e23304",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847589"
}


@Article{info:doi/10.2196/27336,
author="Vanegas, Erik
and Salazar, Yolocuauhtli
and Igual, Ra{\'u}l
and Plaza, Inmaculada",
title="Force-Sensitive Mat for Vertical Jump Measurement to Assess Lower Limb Strength: Validity and Reliability Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="9",
volume="9",
number="4",
pages="e27336",
keywords="vertical jump",
keywords="mHealth",
keywords="mobile health",
keywords="force-sensitive resistor",
keywords="lower limb strength",
keywords="leg strength",
abstract="Background: Vertical jump height is widely used in health care and sports fields to assess muscle strength and power from lower limb muscle groups. Different approaches have been proposed for vertical jump height measurement. Some commonly used approaches need no sensor at all; however, these methods tend to overestimate the height reached by the subjects. There are also novel systems using different kind of sensors like force-sensitive resistors, capacitive sensors, and inertial measurement units, among others, to achieve more accurate measurements. Objective: The objective of this study is twofold. The first objective is to validate the functioning of a developed low-cost system able to measure vertical jump height. The second objective is to assess the effects on obtained measurements when the sampling frequency of the system is modified. Methods: The system developed in this study consists of a matrix of force-sensitive resistor sensors embedded in a mat with electronics that allow a full scan of the mat. This mat detects pressure exerted on it. The system calculates the jump height by using the flight-time formula, and the result is sent through Bluetooth to any mobile device or PC. Two different experiments were performed. In the first experiment, a total of 38 volunteers participated with the objective of validating the performance of the system against a high-speed camera used as reference (120 fps). In the second experiment, a total of 15 volunteers participated. Raw data were obtained in order to assess the effects of different sampling frequencies on the performance of the system with the same reference device. Different sampling frequencies were obtained by performing offline downsampling of the raw data. In both experiments, countermovement jump and countermovement jump with arm swing techniques were performed. Results: In the first experiment an overall mean relative error (MRE) of 1.98\% and a mean absolute error of 0.38 cm were obtained. Bland-Altman and correlation analyses were performed, obtaining a coefficient of determination equal to R2=.996. In the second experiment, sampling frequencies of 200 Hz, 100 Hz, and 66.6 Hz show similar performance with MRE below 3\%. Slower sampling frequencies show an exponential increase in MRE. On both experiments, when dividing jump trials in different heights reached, a decrease in MRE with higher height trials suggests that the precision of the proposed system increases as height reached increases. Conclusions: In the first experiment, we concluded that results between the proposed system and the reference are systematically the same. In the second experiment, the relevance of a sufficiently high sampling frequency is emphasized, especially for jump trials whose height is below 10 cm. For trials with heights above 30 cm, MRE decreases in general for all sampling frequencies, suggesting that at higher heights reached, the impact of high sampling frequencies is lesser. ",
doi="10.2196/27336",
url="https://mhealth.jmir.org/2021/4/e27336",
url="http://www.ncbi.nlm.nih.gov/pubmed/33835040"
}


@Article{info:doi/10.2196/22960,
author="Liu, Ting
and Xie, Sumei
and Wang, Yingmin
and Tang, Jie
and He, Xiaokuo
and Yan, Tiebin
and Li, Kun",
title="Effects of App-Based Transitional Care on the Self-Efficacy and Quality of Life of Patients With Spinal Cord Injury in China: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="1",
volume="9",
number="4",
pages="e22960",
keywords="spinal cord injury",
keywords="mobile app",
keywords="transitional care",
keywords="self-efficacy",
keywords="quality of life",
abstract="Background: Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of SCI patients and the current community care system. With the prevalence of mobile terminals, the usage of mobile health apps has the potential to fill this gap by extending qualified medical resources to the families of SCI patients. Our team developed the app Together for the transitional care of home-dwelling SCI patients in China. Objective: This study aimed to evaluate the effects of app-based transitional care on the self-efficacy and QOL of SCI patients. Methods: Through a three-round Delphi process, an Android app was designed. Both medical staff and patients could access the app. Medical staff used it for providing remote transitional care to SCI patients. Patients used it to view transitional care time and send messages to medical staff. Thereafter, a multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who had SCI and lived at home following discharge were recruited and randomly assigned to a study group (n=49) and control group (n=49) using a randomized number list in four research centers. Patients in both groups received systematic discharge education before discharge. The study group received five follow-ups conducted by trained nurses through the app, which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction, at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-Efficacy Scale (MSES) and 36-item Short-Form Health Survey (SF-36) scores. Data were collected before discharge (T0) and at weeks 12 (T1) and 24 following discharge (T2). Differences between the groups were tested by repeated measures analysis of variance and simple effect analysis. Results: After the follow-up, the total MSES scores in the study group improved over time (T0=67.80, T1=71.90, and T2=76.29) and were higher than those in the control group (T2=64.49) at 24 weeks following discharge (simple effect analysis: F1=8.506, P=.004). Regarding the total SF-36 score, although it was higher in patients from the study group (T2=65.36) than those from the control group (T2=58.77) at 24 weeks following discharge, only time effects were significant (F2,95=6.671, P=.002) and neither the group effects nor the interaction effects influenced the change in QOL (group effects: F1,96=0.082, P=.78; interaction effects: F2,95=3.059, P=.052). Conclusions: This study confirmed that app-based transitional care improves the self-efficacy of SCI patients. Nevertheless, QOL improvement is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012317; http://www.chictr.org.cn/showproj.aspx?proj=19828 ",
doi="10.2196/22960",
url="https://mhealth.jmir.org/2021/4/e22960",
url="http://www.ncbi.nlm.nih.gov/pubmed/33792555"
}


@Article{info:doi/10.2196/18942,
author="Zhuo, Xiaoqian Linda
and Macedo, Gazzi Luciana",
title="Feasibility and Convergent Validity of an Activity Tracker for Low Back Pain Within a Clinical Study: Cross-sectional Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Mar",
day="26",
volume="8",
number="1",
pages="e18942",
keywords="activity monitor",
keywords="activity tracker",
keywords="low back pain",
abstract="Background: Low back pain (LBP) is a highly prevalent condition affecting individuals of all ages. To manage the symptoms and prevent recurrences and flare-ups, physical activity in conjunction with self-management education is recommended. Tools such as diaries and questionnaires have been the gold standard for tracking physical activity in clinical studies. However, there are issues with consistency, accuracy, and recall with the use of these outcome measures. Given the growth of technology in today's society, consumer-grade activity monitors have become a common and convenient method of recording physical activity data. Objective: The aim of this study is to test the feasibility and convergent validity of a Garmin Vivofit 3 activity tracker in evaluating physical activity levels in a clinical trial of patients with LBP. Methods: We recruited 17 individuals with nonspecific LBP referred from health care professionals or self-referred through advertisements in the community. The participants entered into a 12-week physical activity and self-management program. Physical activity was assessed using a self-reported questionnaire and the Garmin activity tracker. Activity tracker data (eg, steps taken, distance walked, and intensity minutes) were extracted weekly from the Garmin Connect online platform. Outcomes of pain and activity limitation were assessed weekly using a mobile app. A linear regression was conducted to evaluate if demographic factors (ie, age, gender, pain level) affected the adherence rates to the activity monitor. We also used Pearson correlations to evaluate the convergent validity of the Garmin activity tracker with the physical activity questionnaire. Results: The mean daily adherence rate for activity monitors was 70\% (SD 31\%) over the 26 weeks of study. The mean response rate for the weekly physical activity measures using REDCap for the first 12 weeks of the study was 91\% (SD 17\%). None of the hypothesized variables or questionnaires were predictors of response rate. Conclusions: The majority of participants were compliant with wearing the tracker, and demographic factors were not found to be predictors of adherence to wearing the device. However, there were poor correlations between the modified International Physical Activity Questionnaire Short Form (IPAQ-SF) and the activity monitor, demonstrating problems with convergent validity. ",
doi="10.2196/18942",
url="https://rehab.jmir.org/2021/1/e18942",
url="http://www.ncbi.nlm.nih.gov/pubmed/33769301"
}


@Article{info:doi/10.2196/20916,
author="Xu, Yangfan
and Tong, Meiqinzi
and Ming, Wai-Kit
and Lin, Yangyang
and Mai, Wangxiang
and Huang, Weixin
and Chen, Zhuoming",
title="A Depth Camera--Based, Task-Specific Virtual Reality Rehabilitation Game for Patients With Stroke: Pilot Usability Study",
journal="JMIR Serious Games",
year="2021",
month="Mar",
day="24",
volume="9",
number="1",
pages="e20916",
keywords="virtual reality",
keywords="rehabilitation",
keywords="stroke",
keywords="lower extremity",
keywords="rehabilitation game",
abstract="Background: The use of virtual reality is popular in clinical rehabilitation, but the effects of using commercial virtual reality games in patients with stroke have been mixed. Objective: We developed a depth camera--based, task-specific virtual reality game, Stomp Joy, for poststroke rehabilitation of the lower extremities. This study aims to assess its feasibility and clinical efficacy. Methods: We carried out a feasibility test for Stomp Joy within representative user groups. Then, a clinical efficacy experiment was performed with a randomized controlled trial, in which 22 patients with stroke received 10 sessions (2 weeks) of conventional physical therapy only (control group) or conventional physical therapy plus 30 minutes of the Stomp Joy intervention (experimental group) in the clinic. The Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Modified Barthel Index (MBI), Berg Balance Scale (BBS) score, single-leg stance (SLS) time, dropout rate, and adverse effects were recorded. Results: This feasibility test showed that Stomp Joy improved interest, pressure, perceived competence, value, and effort using the Intrinsic Motivation Inventory. The clinical efficacy trial showed a significant time-group interaction effect for the FMA-LE (P=.006), MBI (P=.001), BBS (P=.004), and SLS time (P=.001). A significant time effect was found for the FMA-LE (P=.001), MBI (P<.001), BBS (P<.001), and SLS time (P=.03). These indicated an improvement in lower extremity motor ability, basic activities of daily living, balance ability, and single-leg stance time in both groups after 2 weeks of the intervention. However, no significant group effects were found for the FMA-LE (P=.06), MBI (P=.76), and BBS (P=.38), while a significant group interaction was detected for SLS time (P<.001). These results indicated that the experimental group significantly improved more in SLS time than did the control group. During the study, 2 dropouts, including 1 participant who fell, were reported. Conclusions: Stomp Joy is an effective depth camera--based virtual reality game for replacing part of conventional physiotherapy, achieving equally effective improvement in lower extremity function among stroke survivors. High-powered randomized controlled studies are now needed before recommending the routine use of Stomp Joy in order to confirm these findings by recruiting a large sample size. ",
doi="10.2196/20916",
url="https://games.jmir.org/2021/1/e20916",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759795"
}


@Article{info:doi/10.2196/21312,
author="Bhattacharjya, Sutanuka
and Cavuoto, Anne Lora
and Reilly, Brandon
and Xu, Wenyao
and Subryan, Heamchand
and Langan, Jeanne",
title="Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Mar",
day="22",
volume="8",
number="1",
pages="e21312",
keywords="stroke",
keywords="rehabilitation",
keywords="smart technology",
keywords="3-dimensional printing",
keywords="usability",
abstract="Background: Smart technology use in rehabilitation is growing and can be used remotely to assist clients in self-monitoring their performance. With written home exercise programs being the commonly prescribed form of rehabilitation after discharge, mobile health technology coupled with task-oriented programs can enhance self-management of upper extremity training. In the current study, a rehabilitation system, namely mRehab, was designed that included a smartphone app and 3D-printed household items such as mug, bowl, key, and doorknob embedded with a smartphone. The app interface allowed the user to select rehabilitation activities and receive feedback on the number of activity repetitions completed, time to complete each activity, and quality of movement. Objective: This study aimed to assess the usability, perceived usefulness, and acceptance of the mRehab system by individuals with stroke and identify the challenges experienced by them when using the system remotely in a home-based setting. Methods: A mixed-methods approach was used with 11 individuals with chronic stroke. Following training, individuals with stroke used the mRehab system for 6 weeks at home. Each participant completed surveys and engaged in a semistructured interview. Participants' qualitative reports regarding the usability of mRehab were integrated with their survey reports and quantitative performance data. Results: Of the 11 participants, 10 rated the mRehab system between the 67.5th and 97.5th percentile on the System Usability Scale, indicating their satisfaction with the usability of the system. Participants also provided high ratings of perceived usefulness (mean 5.8, SD 0.9) and perceived ease of use (mean 5.3, SD 1.5) on a 7-point scale based on the Technology Acceptance Model. Common themes reported by participants showed a positive response to mRehab with some suggestions for improvements. Participants reported an interest in activities they perceived to be adequately challenging. Some participants indicated a need for customizing the feedback to be more interpretable. Overall, most participants indicated that they would like to continue using the mRehab system at home. Conclusions: Assessing usability in the lived environment over a prolonged duration of time is essential to identify the match between the system and users' needs and preferences. While mRehab was well accepted, further customization is desired for a better fit with the end users. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ",
doi="10.2196/21312",
url="https://humanfactors.jmir.org/2021/1/e21312",
url="http://www.ncbi.nlm.nih.gov/pubmed/33749608"
}


@Article{info:doi/10.2196/22548,
author="Raiszadeh, Kamshad
and Tapicer, Jonathan
and Taitano, Lissa
and Wu, Jonathan
and Shahidi, Bahar",
title="In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="18",
volume="23",
number="3",
pages="e22548",
keywords="low back pain",
keywords="telehealth",
keywords="online therapy",
keywords="physical therapy",
keywords="integrated practice unit",
keywords="rehabilitation",
abstract="Background: The recent onset of the COVID-19 pandemic has highlighted the need to reduce barriers to access physical therapy and associated care through the use of web-based programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared the effectiveness of clinic-based versus web-based or telehealth services. Objective: This study aims to compare the clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit (C-IPU) model with online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP. Methods: A total of 1090 participants were prospectively recruited to participate in a clinical trial registry (NCT04081896) through the SpineZone rehabilitation IPU program. All participants provided informed consent. Participants were allocated to the C-IPU (N=988) or O-IPU (N=102) groups based on their personal preferences. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist-directed home core strengthening exercises through a web-based platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient-Specific Functional Scale), and frequency of opioid use were compared between the C-IPU and O-IPU groups using multivariate linear regression modeling adjusted for age, gender, treatment number, program duration, and baseline pain and disability. Results: Approximately 93.03\% (1014/1090) of the participants completed their recommended programs, with no group differences in dropout rates (P=.78). The C-IPU group showed greater pain relief (P<.001) and reductions in disability (P=.002) than the O-IPU group, whereas the O-IPU group reported greater improvements in goal achievement (P<.001). Both programs resulted in reduced opioid use frequency, with 19.0\% (188/988) and 21.5\% (22/102) of participants reporting cessation of opioid use for C-IPU and O-IPU programs, respectively, leaving only 5.59\% (61/1090) of participants reporting opioid use at the end of their treatment. Conclusions: Both in-clinic and web-based multidisciplinary programs are beneficial in reducing pain, disability, and opioid use and in improving goal achievement. The differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs. Trial Registration: ClinicalTrials.gov NCT04081896; https://clinicaltrials.gov/ct2/show/NCT04081896 ",
doi="10.2196/22548",
url="https://www.jmir.org/2021/3/e22548",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734088"
}


@Article{info:doi/10.2196/19519,
author="Richardson, Julie
and Letts, Lori
and Sinclair, Susanne
and Chan, David
and Miller, Jordan
and Donnelly, Catherine
and Smith-Turchyn, Jenna
and Wojkowski, Sarah
and Gravesande, Janelle
and Loyola S{\'a}nchez, Adalberto",
title="Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Mar",
day="18",
volume="8",
number="1",
pages="e19519",
keywords="rehabilitation",
keywords="physiotherapy",
keywords="occupational therapy",
keywords="self-management",
keywords="function",
keywords="web-based application",
keywords="usability",
keywords="user-centered design",
abstract="Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ?45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. ",
doi="10.2196/19519",
url="https://rehab.jmir.org/2021/1/e19519",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734090"
}


@Article{info:doi/10.2196/22659,
author="Van de Winckel, Ann
and Nawshin, Tanjila
and Byron, Casey",
title="Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="18",
volume="5",
number="3",
pages="e22659",
keywords="chronic disease",
keywords="spinal cord injury",
keywords="stroke",
keywords="telehealth",
keywords="telemedicine",
keywords="traumatic brain injury",
abstract="Background: Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective: To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods: We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results: Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51\%) and control (22/45, 49\%) groups, with 74\% (17/23) and 86\% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68\% (15/22) sent videos. They sent 68\% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87\% in the experimental group (P=.99), whereas it decreased from 89\% at 8 weeks to 74\% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions: The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration: ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280 ",
doi="10.2196/22659",
url="https://formative.jmir.org/2021/3/e22659",
url="http://www.ncbi.nlm.nih.gov/pubmed/33640865"
}


@Article{info:doi/10.2196/26320,
author="Koyama, Takafumi
and Sato, Shusuke
and Toriumi, Madoka
and Watanabe, Takuro
and Nimura, Akimoto
and Okawa, Atsushi
and Sugiura, Yuta
and Fujita, Koji",
title="A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="14",
volume="9",
number="3",
pages="e26320",
keywords="carpal tunnel syndrome",
keywords="anomaly detection",
keywords="machine learning",
keywords="smartphone",
keywords="screening",
keywords="thumb",
keywords="diagnostic",
keywords="data collection",
keywords="app",
keywords="algorithm",
abstract="Background: Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The symptoms include numbness of the fingers and atrophy of the thenar muscle. Thenar atrophy recovers slowly postoperatively; therefore, early diagnosis and surgery are important. While physical examinations and nerve conduction studies are used to diagnose CTS, problems with the diagnostic ability and equipment, respectively, exist. Despite research on a CTS-screening app that uses a tablet and machine learning, problems with the usage rate of tablets and data collection for machine learning remain. Objective: To make data collection for machine learning easier and more available, we developed a screening app for CTS using a smartphone and an anomaly detection algorithm, aiming to examine our system as a useful screening tool for CTS. Methods: In total, 36 participants were recruited, comprising 36 hands with CTS and 27 hands without CTS. Participants controlled the character in our app using their thumbs. We recorded the position of the thumbs and time; generated screening models that classified CTS and non-CTS using anomaly detection and an autoencoder; and calculated the sensitivity, specificity, and area under the curve (AUC). Results: Participants with and without CTS were classified with 94\% sensitivity, 67\% specificity, and an AUC of 0.86. When dividing the data by direction, the model with data in the same direction as the thumb opposition had the highest AUC of 0.99, 92\% sensitivity, and 100\% specificity. Conclusions: Our app could reveal the difficulty of thumb opposition for patients with CTS and screen for CTS with high sensitivity and specificity. The app is highly accessible because of the use of smartphones and can be easily enhanced by anomaly detection. ",
doi="10.2196/26320",
url="https://mhealth.jmir.org/2021/3/e26320",
url="http://www.ncbi.nlm.nih.gov/pubmed/33714936"
}


@Article{info:doi/10.2196/20405,
author="V{\"o}lter, Christiane
and St{\"o}ckmann, Carolin
and Schirmer, Christiane
and Dazert, Stefan",
title="Tablet-Based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: Prospective Intervention Pilot Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Mar",
day="12",
volume="8",
number="1",
pages="e20405",
keywords="computer-based auditory training",
keywords="correction of hearing impairment",
keywords="cochlear implant",
keywords="effectivity",
keywords="intervention study",
keywords="telerehabilitation",
keywords="pandemic",
abstract="Background: Technologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people's access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic's impact on health care, the need for new therapeutic settings has intensified. Objective: The aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic. Methods: In total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants' subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists. Results: Greater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program's usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment. Conclusions: The proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics. ",
doi="10.2196/20405",
url="https://rehab.jmir.org/2021/1/e20405",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709934"
}


@Article{info:doi/10.2196/21374,
author="Burns, David
and Boyer, Philip
and Razmjou, Helen
and Richards, Robin
and Whyne, Cari",
title="Adherence Patterns and Dose Response of Physiotherapy for Rotator Cuff Pathology: Longitudinal Cohort Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Mar",
day="11",
volume="8",
number="1",
pages="e21374",
keywords="rehabilitation",
keywords="treatment adherence and compliance",
keywords="wearable electronic devices",
keywords="machine learning",
keywords="rotator cuff",
abstract="Background: Physiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; however, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown. Objective: The purpose of this study was to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose response between physiotherapy activity and recovery, and explore patient factors predictive of physiotherapy participation. Methods: We report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smartwatch that recorded inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from smartwatch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand and numeric pain rating scale assessed every 4 weeks until 12 weeks follow-up. The relationships between participation, outcomes, and clinical patient variables were assessed in univariable analyses. Results: Mean physiotherapy exercise participation in clinic and at home were 11 minutes per week and 33 minutes per week, respectively, with patients participating in physiotherapy on 41\% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P=.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery demonstrated by pain scores at 8 weeks (P=.02) and 12 weeks (P=.05) and disability scores at 8 weeks (P=.04) and 12 weeks (P=.04). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation. Conclusions: There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders. International Registered Report Identifier (IRRID): RR2-10.2196/17841 ",
doi="10.2196/21374",
url="https://rehab.jmir.org/2021/1/e21374",
url="http://www.ncbi.nlm.nih.gov/pubmed/33704076"
}


@Article{info:doi/10.2196/25451,
author="Su, Dongning
and Liu, Zhu
and Jiang, Xin
and Zhang, Fangzhao
and Yu, Wanting
and Ma, Huizi
and Wang, Chunxue
and Wang, Zhan
and Wang, Xuemei
and Hu, Wanli
and Manor, Brad
and Feng, Tao
and Zhou, Junhong",
title="Simple Smartphone-Based Assessment of Gait Characteristics in Parkinson Disease: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="19",
volume="9",
number="2",
pages="e25451",
keywords="smartphone",
keywords="gait",
keywords="stride time (variability)",
keywords="validity",
keywords="Parkinson disease",
abstract="Background: Parkinson disease (PD) is a common movement disorder. Patients with PD have multiple gait impairments that result in an increased risk of falls and diminished quality of life. Therefore, gait measurement is important for the management of PD. Objective: We previously developed a smartphone-based dual-task gait assessment that was validated in healthy adults. The aim of this study was to test the validity of this gait assessment in people with PD, and to examine the association between app-derived gait metrics and the clinical and functional characteristics of PD. Methods: Fifty-two participants with clinically diagnosed PD completed assessments of walking, Movement Disorder Society Unified Parkinson Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scale tests. Participants followed multimedia instructions provided by the app to complete two 20-meter trials each of walking normally (single task) and walking while performing a serial subtraction dual task (dual task). Gait data were simultaneously collected with the app and gold-standard wearable motion sensors. Stride times and stride time variability were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone and from the wearable sensor system. Results: High correlations were observed between the stride time and stride time variability derived from the app and from the gold-standard system (r=0.98-0.99, P<.001), revealing excellent validity of the app-based gait assessment in PD. Compared with those from the single-task condition, the stride time (F1,103=14.1, P<.001) and stride time variability (F1,103=6.8, P=.008) in the dual-task condition were significantly greater. Participants who walked with greater stride time variability exhibited a greater UPDRS III total score (single task: $\beta$=.39, P<.001; dual task: $\beta$=.37, P=.01), HAM-A (single-task: $\beta$=.49, P=.007; dual-task: $\beta$=.48, P=.009), and HAM-D (single task: $\beta$=.44, P=.01; dual task: $\beta$=.49, P=.009). Moreover, those with greater dual-task stride time variability ($\beta$=.48, P=.001) or dual-task cost of stride time variability ($\beta$=.44, P=.004) exhibited lower MoCA scores. Conclusions: A smartphone-based gait assessment can be used to provide meaningful metrics of single- and dual-task gait that are associated with disease severity and functional outcomes in individuals with PD. ",
doi="10.2196/25451",
url="http://mhealth.jmir.org/2021/2/e25451/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33605894"
}


@Article{info:doi/10.2196/24080,
author="Kim, Mihui
and Kim, Changhwan
and Kim, Eunkyo
and Choi, Mona",
title="Effectiveness of Mobile Health--Based Exercise Interventions for Patients with Peripheral Artery Disease: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="15",
volume="9",
number="2",
pages="e24080",
keywords="peripheral artery disease",
keywords="mobile health",
keywords="exercise",
keywords="adherence",
keywords="meta-analysis",
abstract="Background: Peripheral artery disease (PAD) affects over 236 million people worldwide, and exercise interventions are commonly used to alleviate symptoms of this condition. However, no previous systematic review has evaluated the effects of mobile health (mHealth)--based exercise interventions for patients with PAD. Objective: This study aimed to assess the effect of mHealth-based exercise interventions on walking performance, functional status, and quality of life in patients with PAD. Methods: A systematic review and meta-analysis were conducted. We searched in seven databases to identify randomized controlled trials of patients with PAD published in English up to December 4, 2020. Studies were included if patients participated in mHealth-based exercise interventions and were assessed for walking performance. We analyzed pooled effect size on walking performance, functional status, and quality of life based on the standardized mean differences between groups. Results: A total of seven studies were selected for the systematic review, and six studies were included in the meta-analysis. The duration of interventions in the included studies was 12 to 48 weeks. In the pooled analysis, when compared with the control groups, the mHealth-based exercise intervention groups were associated with significant improvements in pain-free walking (95\% CI 0.13-0.88), maximal walking (95\% CI 0.03-0.87), 6-minute walk test (6MWT) distance (95\% CI 0.59-1.24), and walking distance (95\% CI 0.02-0.49). However, benefits of the interventions on walking speed, stair-climbing ability, and quality of life were not observed. Conclusions: mHealth-based exercise interventions for patients with PAD were beneficial for improving pain-free walking, maximal walking, and 6MWT distance. We found that exercise interventions using mHealth are an important strategy for improving the exercise effectiveness and adherence rate of patients with PAD. Future studies should consider the use of various and suitable functions of mHealth that can increase the adherence rates and improve the effectiveness of exercise. ",
doi="10.2196/24080",
url="http://mhealth.jmir.org/2021/2/e24080/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33587042"
}


@Article{info:doi/10.2196/21107,
author="Elgert, Lena
and Steiner, Bianca
and Saalfeld, Birgit
and Marschollek, Michael
and Wolf, Klaus-Hendrik",
title="Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Feb",
day="4",
volume="8",
number="1",
pages="e21107",
keywords="shoulder",
keywords="upper extremity",
keywords="musculoskeletal diseases",
keywords="exercises",
keywords="physical therapy",
keywords="telerehabilitation",
keywords="technology-assisted therapy",
keywords="assistive technologies",
keywords="mobile phone",
abstract="Background: Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. Objective: This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. Methods: The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. Results: Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient's range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients' evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. Conclusions: There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects. ",
doi="10.2196/21107",
url="http://rehab.jmir.org/2021/1/e21107/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33538701"
}


@Article{info:doi/10.2196/23548,
author="Bi, Junjie
and Yang, Wei
and Hao, Ping
and Zhao, Yongmei
and Wei, Dan
and Sun, Yipeng
and Lin, Yuhua
and Sun, Meng
and Chen, Xuan
and Luo, Xuming
and Li, Shanqun
and Zhang, Wei
and Wang, Xiongbiao",
title="WeChat as a Platform for Baduanjin Intervention in Patients With Stable Chronic Obstructive Pulmonary Disease in China: Retrospective Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="2",
volume="9",
number="2",
pages="e23548",
keywords="WeChat management",
keywords="chronic obstructive pulmonary disease",
keywords="Baduanjin rehabilitation",
abstract="Background: Pulmonary rehabilitation is a crucial part of the nonpharmacological treatment of stable chronic obstructive pulmonary disease (COPD), but management remains problematic. WeChat could serve as a useful tool in patient management. Baduanjin is a popular exercise in China that is usually applied in pulmonary rehabilitation, which has been confirmed to be effective in improving lung function and life quality. Objective: This study aimed to explore the efficiency of WeChat in the management of Baduanjin exercise in COPD patients. Methods: A total of 200 patients from the respiratory department of Putuo Hospital participated in the Baduanjin rehabilitation project from September 2018 to October 2019, and were randomly assigned to the WeChat and control groups and followed up using the WeChat platform or telephone for 12 weeks. The frequency of Baduanjin exercise, lung function (percentage of forced expiratory volume in 1 second predicted, FEV1\% predicted), and COPD assessment test (CAT) scores were collected and compared between the two groups. The number of message exchanges and a satisfaction survey on the WeChat platform were used to assess the feasibility of WeChat management outside the hospital. Results: The Baduanjin exercise frequency significantly differed between the control group and WeChat group (F=33.82, P<.001) and across various time points (F=214.87, P<.001). After the follow-up on WeChat, there were fewer patients not performing Baduanjin exercise. The FEV1\% predicted value significantly differed before and after Baduanjin exercise in the control group (Z=?3.686, P<.001) and the WeChat group (Z=?6.985, P<.001). A significant difference in the FEV1\% predicted value was observed after Baduanjin exercise between the two groups (Z=?3.679, P<.001). The CAT score significantly differed before and after Baduanjin exercise in the control group (Z=?4.937, P<.001) and the WeChat group (Z=?5.246, P<.001). A significant difference in the CAT score was observed after Baduanjin exercise between the two groups (Z=?5.246, P<.001). The number of completed Baduanjin exercises, lung function, and CAT scores in active patients were higher than those in nonactive patients. All satisfaction survey items were scored with more than 4 points. Among the items, the highest score (mean 4.54, SD 0.77) was for continued WeChat management, followed by the effective management of Baduanjin exercise (mean 4.46, SD 0.87). The patients in the WeChat group showed much higher enthusiasm for and compliance with Baduanjin exercise, resulting in better life quality and lung function. The patients were very satisfied with the WeChat management because of the obvious curative effect and home feeling. Conclusions: The WeChat platform provided a feasible, effective, and sustainable management plan for Baduanjin rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900028248; http://www.chictr.org.cn/showprojen.aspx?proj=46995 ",
doi="10.2196/23548",
url="https://mhealth.jmir.org/2021/2/e23548",
url="http://www.ncbi.nlm.nih.gov/pubmed/33528369"
}


@Article{info:doi/10.2196/22846,
author="Kelly, Ryan
and Jones, Simon
and Price, Blaine
and Katz, Dmitri
and McCormick, Ciaran
and Pearce, Oliver",
title="Measuring Daily Compliance With Physical Activity Tracking in Ambulatory Surgery Patients: Comparative Analysis of Five Compliance Criteria",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="26",
volume="9",
number="1",
pages="e22846",
keywords="activity tracking",
keywords="adherence",
keywords="compliance",
keywords="surgery",
keywords="total knee arthroplasty",
abstract="Background: Physical activity trackers such as the Fitbit can allow clinicians to monitor the recovery of their patients following surgery. An important issue when analyzing activity tracker data is to determine patients' daily compliance with wearing their assigned device, using an appropriate criterion to determine a valid day of wear. However, it is currently unclear as to how different criteria can affect the reported compliance of patients recovering from ambulatory surgery. Investigating this issue can help to inform the use of activity data by revealing factors that may impact compliance calculations. Objective: This study aimed to understand how using different criteria can affect the reported compliance with activity tracking in ambulatory surgery patients. It also aimed to investigate factors that explain variation between the outcomes of different compliance criteria. Methods: A total of 62 patients who were scheduled to undergo total knee arthroplasty (TKA, ie, knee replacement) volunteered to wear a commercial Fitbit Zip activity tracker over an 8-week perioperative period. Patients were asked to wear the Fitbit Zip daily, beginning 2 weeks prior to their surgery and ending 6 weeks after surgery. Of the 62 patients who enrolled in the study, 20 provided Fitbit data and underwent successful surgery. The Fitbit data were analyzed using 5 different daily compliance criteria, which consider patients as compliant with daily tracking if they either register >0 steps in a day, register >500 steps in a day, register at least one step in 10 different hours of the day, register >0 steps in 3 distinct time windows, or register >0 steps in 3 out of 4 six-hour time windows. The criteria were compared in terms of compliance outcomes produced for each patient. Data were explored using heatmaps and line graphs. Linear mixed models were used to identify factors that lead to variation between compliance outcomes across the sample. Results: The 5 compliance criteria produce different outcomes when applied to the patients' data, with an average 24\% difference in reported compliance between the most lenient and strictest criteria. However, the extent to which each patient's reported compliance was impacted by different criteria was not uniform. Some individuals were relatively unaffected, whereas others varied by up to 72\%. Wearing the activity tracker as a clip-on device, rather than on the wrist, was associated with greater differences between compliance outcomes at the individual level (P=.004, r=.616). This effect was statistically significant (P<.001) in the first 2 weeks after surgery. There was also a small but significant main effect of age on compliance in the first 2 weeks after surgery (P=.040). Gender and BMI were not associated with differences in individual compliance outcomes. Finally, the analysis revealed that surgery has an impact on patients' compliance, with noticeable reductions in activity following surgery. These reductions affect compliance calculations by discarding greater amounts of data under strict criteria. Conclusions: This study suggests that different compliance criteria cannot be used interchangeably to analyze activity data provided by TKA patients. Surgery leads to a temporary reduction in patients' mobility, which affects their reported compliance when strict thresholds are used. Reductions in mobility suggest that the use of lenient compliance criteria, such as >0 steps or windowed approaches, can avoid unnecessary data exclusion over the perioperative period. Encouraging patients to wear the device at their wrist may improve data quality by increasing the likelihood of patients wearing their tracker and ensuring that activity is registered in the 2 weeks after surgery. Trial Registration: ClinicalTrials.gov NCT03518866; https://clinicaltrials.gov/ct2/show/NCT03518866 ",
doi="10.2196/22846",
url="http://mhealth.jmir.org/2021/1/e22846/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33496677"
}


@Article{info:doi/10.2196/16054,
author="Enciso, James
and Variya, Dhruval
and Sunthonlap, James
and Sarmiento, Terrence
and Lee, Mun Ka
and Velasco, James
and Pebdani, N. Roxanna
and de Leon, D. Ray
and Dy, Christine
and Keslacy, Stefan
and Won, Soonmee Deborah",
title="Electromyography-Driven Exergaming in Wheelchairs on a Mobile Platform: Bench and Pilot Testing of the WOW-Mobile Fitness System",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Jan",
day="19",
volume="8",
number="1",
pages="e16054",
keywords="exergaming",
keywords="gamercising",
keywords="mobile health",
keywords="wheelchair exercises",
keywords="wireless electromyography",
keywords="mobile phone",
abstract="Background: Implementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. However, these exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements. Objective: This study aims to develop a mobile phone app that implements electromyography (EMG)-driven exergaming, to test the feasibility of using this app to enable people in wheelchairs to perform exergames independently and flexibly in their own home, and to assess the perceived usefulness and usability of this mobile health system. Methods: We developed an Android mobile phone app (Workout on Wheels, WOW-Mobile) that senses upper limb muscle activity (EMG) from wireless body-worn sensors to drive 3 different video games that implement upper limb exercises designed for people in wheelchairs. Cloud server recordings of EMG enabled long-term monitoring and feedback as well as multiplayer gaming. Bench testing of data transmission and power consumption were tested. Pilot testing was conducted on 4 individuals with spinal cord injury. Each had a WOW-Mobile system at home for 8 weeks. We measured the minutes for which the app was used and the exergames were played, and we integrated EMG as a measure of energy expended. We also conducted a perceived usefulness and usability questionnaire. Results: Bench test results revealed that the app meets performance specifications to enable real-time gaming, cloud storage of data, and live cloud server transmission for multiplayer gaming. The EMG sampling rate of 64 samples per second, in combination with zero-loss data communication with the cloud server within a 10-m range, provided seamless control over the app exergames and allowed for offline data analysis. Each participant successfully used the WOW-Mobile system at home for 8 weeks, using the app for an average of 146 (range 89-267) minutes per week with the system, actively exergaming for an average of 53\% of that time (39\%-59\%). Energy expenditure, as measured by integrated EMG, was found to be directly proportional to the time spent on the app (Pearson correlation coefficient, r=0.57-0.86, depending on the game). Of the 4 participants, 2 did not exercise regularly before the study; these 2 participants increased from reportedly exercising close to 0 minutes per week to exergaming 58 and 158 minutes on average using the WOW-Mobile fitness system. The perceived usefulness of WOW-Mobile in motivating participants to exercise averaged 4.5 on a 5-point Likert scale and averaged 5 for the 3 participants with thoracic level injuries. The mean overall ease of use score was 4.25 out of 5. Conclusions: Mobile app exergames driven by EMG have promising potential for encouraging and facilitating fitness for individuals in wheelchairs who have maintained arm and hand mobility. ",
doi="10.2196/16054",
url="http://rehab.jmir.org/2021/1/e16054/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464221"
}


@Article{info:doi/10.2196/19608,
author="Stamm, Oskar
and Heimann-Steinert, Anika",
title="Accuracy of Monocular Two-Dimensional Pose Estimation Compared With a Reference Standard for Kinematic Multiview Analysis: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="21",
volume="8",
number="12",
pages="e19608",
keywords="2D human pose estimation",
keywords="motion capturing",
keywords="kinematics",
keywords="clinical practice",
keywords="mobility",
keywords="smartphone app",
keywords="analysis",
abstract="Background: Expensive optoelectronic systems, considered the gold standard, require a laboratory environment and the attachment of markers, and they are therefore rarely used in everyday clinical practice. Two-dimensional (2D) human pose estimations for clinical purposes allow kinematic analyses to be carried out via a camera-based smartphone app. Since clinical specialists highly depend on the validity of information, there is a need to evaluate the accuracy of 2D pose estimation apps. Objective: The aim of the study was to investigate the accuracy of the 2D pose estimation of a mobility analysis app (Lindera-v2), using the PanopticStudio Toolbox data set as a reference standard. The study aimed to assess the differences in joint angles obtained by 2D video information generated with the Lindera-v2 algorithm and the reference standard. The results can provide an important assessment of the adequacy of the app for clinical use. Methods: To evaluate the accuracy of the Lindera-v2 algorithm, 10 video sequences were analyzed. Accuracy was evaluated by assessing a total of 30,000 data pairs for each joint (10 joints in total), comparing the angle data obtained from the Lindera-v2 algorithm with those of the reference standard. The mean differences of the angles were calculated for each joint, and a comparison was made between the estimated values and the reference standard values. Furthermore, the mean absolute error (MAE), root mean square error, and symmetric mean absolute percentage error of the 2D angles were calculated. Agreement between the 2 measurement methods was calculated using the intraclass correlation coefficient (ICC[A,2]). A cross-correlation was calculated for the time series to verify whether there was a temporal shift in the data. Results: The mean difference of the Lindera-v2 data in the right hip was the closest to the reference standard, with a mean value difference of --0.05{\textdegree} (SD 6.06{\textdegree}). The greatest difference in comparison with the baseline was found in the neck, with a measurement of --3.07{\textdegree} (SD 6.43{\textdegree}). The MAE of the angle measurement closest to the baseline was observed in the pelvis (1.40{\textdegree}, SD 1.48{\textdegree}). In contrast, the largest MAE was observed in the right shoulder (6.48{\textdegree}, SD 8.43{\textdegree}). The medians of all acquired joints ranged in difference from 0.19{\textdegree} to 3.17{\textdegree} compared with the reference standard. The ICC values ranged from 0.951 (95\% CI 0.914-0.969) in the neck to 0.997 (95\% CI 0.997-0.997) in the left elbow joint. The cross-correlation showed that the Lindera-v2 algorithm had no temporal lag. Conclusions: The results of the study indicate that a 2D pose estimation by means of a smartphone app can have excellent agreement compared with a validated reference standard. An assessment of kinematic variables can be performed with the analyzed algorithm, showing only minimal deviations compared with data from a massive multiview system. ",
doi="10.2196/19608",
url="http://mhealth.jmir.org/2020/12/e19608/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33346739"
}


@Article{info:doi/10.2196/17542,
author="Bashi, Nazli
and Varnfield, Marlien
and Karunanithi, Mohanraj",
title="A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="18",
volume="4",
number="12",
pages="e17542",
keywords="mobile health",
keywords="mHealth",
keywords="mobile health apps",
keywords="smartphone",
keywords="mobile phone",
keywords="self-management",
keywords="patient education",
keywords="cardiovascular disease",
keywords="acute coronary syndrome",
abstract="Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology--Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists' survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients' data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. ",
doi="10.2196/17542",
url="http://formative.jmir.org/2020/12/e17542/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33337339"
}


@Article{info:doi/10.2196/21576,
author="Baeza-Barrag{\'a}n, Rosa Maria
and Labajos Manzanares, Teresa Maria
and Ruiz Vergara, Carmen
and Casuso-Holgado, Jes{\'u}s Mar{\'i}a
and Mart{\'i}n-Valero, Roc{\'i}o",
title="The Use of Virtual Reality Technologies in the Treatment of Duchenne Muscular Dystrophy: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="8",
volume="8",
number="12",
pages="e21576",
keywords="Duchenne muscular dystrophy",
keywords="virtual reality",
keywords="upper limb",
keywords="physical therapy",
keywords="muscular dystrophy",
keywords="mutation",
keywords="muscle",
keywords="degeneration",
abstract="Background: Duchenne muscular dystrophy is a serious and progressive disease affecting one in 3500-6000 live male births. The use of new virtual reality technologies has revolutionized the world of youth rehabilitation. Objective: We performed a systematic review to study the effectiveness of the use of virtual reality systems applied in the rehabilitation of the upper limbs of individuals with Duchenne muscular dystrophy. Methods: Between June 2018 and September 2019, we carried out a series of searches in 5 scientific databases: (1) PubMed, (2) Web of Science, (3) Scopus, (4) The Cochrane Library, and (5) MEDLINE via EBSCO. Two evaluators independently conducted the searches following the PRISMA recommendations for systematic reviews for articles. Two independent evaluators collated the results. Article quality was determined using the PEDro scale. Results: A total of 7 clinical trials were included in the final review. These studies used new technologies as tools for physiotherapeutic rehabilitation of the upper limbs of patients with Duchenne muscular dystrophy. Collectively, the studies showed improvement in functionality, quality of life, and motivation with the use of virtual reality technologies in the rehabilitation of upper limbs of individuals with Duchenne muscular dystrophy. Conclusions: The treatment of neuromuscular diseases has changed in recent years, from palliative symptom management to preventive methods for capacity building. The use of virtual reality is beginning to be necessary in the treatment of progressive diseases involving movement difficulties, as it provides freedom and facilitates the improvement of results in capacity training. Given that new technologies are increasingly accessible, rehabilitation and physiotherapy programs can use these technologies more frequently, and virtual reality environments can be used to improve task performance, which is essential for people with disabilities. Ultimately, virtual reality can be a great tool for physiotherapy and can be used for Duchenne muscular dystrophy rehabilitation programs to improve patient performance during training. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018102548; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=102548 ",
doi="10.2196/21576",
url="http://mhealth.jmir.org/2020/12/e21576/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289679"
}


@Article{info:doi/10.2196/17957,
author="Subedi, Narayan
and Rawstorn, C. Jonathan
and Gao, Lan
and Koorts, Harriet
and Maddison, Ralph",
title="Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="27",
volume="8",
number="11",
pages="e17957",
keywords="heart diseases",
keywords="cardiac rehabilitation",
keywords="telerehabilitation",
keywords="implementation science",
keywords="smartphone",
keywords="systematic review",
abstract="Background: Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. Objective: This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. Methods: MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. Results: No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80\%), appropriateness (9/10, 90\%), adoption (6/10, 60\%), feasibility (6/10, 60\%), fidelity (7/10, 70\%), and implementation cost (4/10, 40\%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. Conclusions: Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=124254 ",
doi="10.2196/17957",
url="http://mhealth.jmir.org/2020/11/e17957/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33245286"
}


@Article{info:doi/10.2196/24311,
author="Malliaras, Peter
and Cridland, Kate
and Hopmans, Ruben
and Ashton, Simon
and Littlewood, Chris
and Page, Richard
and Harris, Ian
and Skouteris, Helen
and Haines, Terry",
title="Internet and Telerehabilitation-Delivered Management of Rotator Cuff--Related Shoulder Pain (INTEL Trial): Randomized Controlled Pilot and Feasibility Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="18",
volume="8",
number="11",
pages="e24311",
keywords="rotator cuff",
keywords="tendinopathy",
keywords="shoulder",
keywords="telemedicine",
keywords="telerehabilitation",
keywords="randomized controlled trial",
keywords="pilot",
keywords="feasibility",
keywords="pain",
keywords="internet-delivered intervention",
abstract="Background: Rotator cuff--related shoulder pain (RCRSP) is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes. Objective: The primary aim of this pilot randomized controlled trial was to assess the feasibility of a 12-week internet-delivered intervention for RCRSP comparing advice only, recommended care, and recommended care with group-based telerehabilitation. Methods: Reporting was in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist for pilot and feasibility trials. People with a primary complaint of RCRSP for 3 months or longer were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated (via a Zelen design) to receive (1) advice only, (2) recommended care (internet-delivered evidence-based exercise and education), or (3) recommended care and telerehabilitation (including a weekly group teleconference session). Progression criteria for a full-scale trial included (1) recruitment of 20\% or greater of eligible participants, (2) acceptable adherence (two or more of the three prescribed weekly sessions) among 70\% or greater of participants, (3) 80\% or greater retention of participants, (4) absence of intervention-related serious adverse events, and (5) 80\% or greater response rates to questionnaires. Secondary clinical and patient knowledge outcomes were collected (via email or text) at baseline, six weeks, and 12 weeks (for clinical and patient knowledge), and within-group change was reported descriptively. Results: We enrolled 36 of 38 (95\%) eligible participants and all participants were recruited within a 3-week period. Of the 36 participants, 12 participants were allocated to each of the three trial arms. The mean age of participants was between 51 and 56 years, and 83\% (10/12) to 92\% (11/12) were female. Retention at the 12-week endpoint was 94\% (34/36) and response to email questionnaires at other time points was 83\% or greater. We found acceptable adherence (defined as greater than 70\% of participants performing exercise 2 or 3 times/week) in the recommended care group with telerehabilitation but not in the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms), with the exception of one instance of elective surgery (unrelated to the person's shoulder condition). Conclusions: Our prespecified success criteria were met or exceeded, but there was a gender imbalance toward women. It is feasible to progress to a fully powered trial, but strategies to address the gender imbalance need to be implemented. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000248965); https://tinyurl.com/yy6eztf5 ",
doi="10.2196/24311",
url="http://mhealth.jmir.org/2020/11/e24311/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33206059"
}


@Article{info:doi/10.2196/20723,
author="Jia, Mengmeng
and Tang, Jie
and Xie, Sumei
and He, Xiaokuo
and Wang, Yingmin
and Liu, Ting
and Yan, Tiebin
and Li, Kun",
title="Using a Mobile App-Based International Classification of Functioning, Disability, and Health Set to Assess the Functioning of Spinal Cord Injury Patients: Rasch Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="11",
volume="8",
number="11",
pages="e20723",
keywords="International Classification of Functioning, Disability and Health",
keywords="spinal cord injuries",
keywords="mobile health app",
keywords="Rasch analysis",
abstract="Background: The International Classification of Functioning, Disability, and Health (ICF) is a unified system of functioning terminology that has been used to develop electronic health records and assessment instruments. Its application has been limited, however, by its complex terminology, numerous categories, uncertain operationalization, and the training required to use it well. Together is a mobile health app designed to extend medical support to the families of spinal cord injury (SCI) patients in China. The app's core framework is a set of only 31 ICF categories. The app also provides rating guidelines and automatically transforms routine assessment results to the terms of the ICF qualifiers. Objective: The goal of the research is to examine the suitability of the ICF set used in the app Together for use as an instrument for assessing the functioning of SCI patients. Methods: A cross-sectional study was conducted including 112 SCI patients recruited before discharge from four rehabilitation centers in China between May 2018 and October 2019. Nurses used the app to assess patient functioning in face-to-face interviews. The resulting data were then subjected to Rasch analysis. Results: After deleting two categories (family relationships and socializing) and one personal factor (knowledge about spinal cord injury) that did not fit the Rasch model, the body functions and body structures, activities and participation, and contextual factors components of the ICF exhibited adequate fit to the Rasch model. All three demonstrated acceptable person separation indices. The 28 categories retained in the set were free of differential item functioning by gender, age, education level, or etiology. Conclusions: Together overcomes some of the obstacles to practical application of the ICF. The app is a reliable assessment tool for assessing functioning after spinal cord injury. ",
doi="10.2196/20723",
url="https://mhealth.jmir.org/2020/11/e20723",
url="http://www.ncbi.nlm.nih.gov/pubmed/33174860"
}


@Article{info:doi/10.2196/18858,
author="Vaezipour, Atiyeh
and Campbell, Jessica
and Theodoros, Deborah
and Russell, Trevor",
title="Mobile Apps for Speech-Language Therapy in Adults With Communication Disorders: Review of Content and Quality",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="29",
volume="8",
number="10",
pages="e18858",
keywords="communication disorders",
keywords="speech therapy",
keywords="language therapy",
keywords="ergonomics",
keywords="rehabilitation",
keywords="mobile health",
keywords="mHealth",
abstract="Background: Worldwide, more than 75\% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. Objective: The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). Methods: Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. Results: From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61\% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61\% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20\% (14/70) on the Android platform, and 19\% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice,  and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). Conclusions: To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use. ",
doi="10.2196/18858",
url="http://mhealth.jmir.org/2020/10/e18858/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118953"
}


@Article{info:doi/10.2196/21704,
author="Biebl, Theresia Johanna
and Huber, Stephan
and Rykala, Marzena
and Kraft, Eduard
and Lorenz, Andreas",
title="Attitudes and Expectations of Health Care Professionals Toward App-Based Therapy in Patients with Osteoarthritis of the Hip or Knee: Questionnaire Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="28",
volume="8",
number="10",
pages="e21704",
keywords="mobile health",
keywords="digital health",
keywords="self-management",
keywords="osteoarthritis",
keywords="smartphone",
keywords="patient education",
keywords="exercise therapy",
abstract="Background: The use of mobile health (mHealth) apps is becoming increasingly widespread. However, little is known about the attitudes, expectations, and basic acceptance of health care professionals toward such treatment options. As physical activity and behavior modification are crucial in osteoarthritis management, app-based therapy could be particularly useful for the self-management of this condition. Objective: The objective of the study was to determine the expectations and attitudes of medical professionals toward app-based therapy for osteoarthritis of the hip or knee. Methods: Health care professionals attending a rehabilitation congress and employees of a university hospital were asked to fill out a questionnaire consisting of 16 items. A total of 240 questionnaires were distributed. Results: A total of 127 participants completed the questionnaire. At 95.3\% (121/127), the approval rate for app-based therapy for patients with osteoarthritis of the hip or knee was very high. Regarding possible concerns, aspects related to data protection and privacy were primarily mentioned (41/127, 32.3\%). Regarding potential content, educational units, physiotherapeutic exercise modules, and practices based on motivation psychology were all met with broad approval. Conclusions: The study showed a high acceptance of app-based therapy for osteoarthritis, indicating a huge potential of this form of treatment to be applied, prescribed, and recommended by medical professionals. It was widely accepted that the content should reflect a multimodal therapy approach. ",
doi="10.2196/21704",
url="http://mhealth.jmir.org/2020/10/e21704/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112255"
}


@Article{info:doi/10.2196/22080,
author="Kim, HyangHee
and Cho, Nam-Bin
and Kim, Jinwon
and Kim, Min Kyung
and Kang, Minji
and Choi, Younggeun
and Kim, Minjae
and You, Heecheon
and Nam, In Seok
and Shin, Soyeon",
title="Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="16",
volume="8",
number="10",
pages="e22080",
keywords="mHealth",
keywords="older adults",
keywords="swallowing tongue pressure",
keywords="Iowa Oral Performance Instrument",
keywords="app",
keywords="swallowing disorders",
keywords="swallowing maneuver",
keywords="effortful prolonged swallowing",
keywords="effortful pitch glide",
keywords="effortful tongue rotation",
abstract="Background: Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective: The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods: We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant's progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results: Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions: Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. International Registered Report Identifier (IRRID): RR2-10.2196/19585 ",
doi="10.2196/22080",
url="http://mhealth.jmir.org/2020/10/e22080/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33012704"
}


@Article{info:doi/10.2196/18985,
author="Landers, R. Merrill
and Ellis, D. Terry",
title="A Mobile App Specifically Designed to Facilitate Exercise in Parkinson Disease: Single-Cohort Pilot Study on Feasibility, Safety, and Signal of Efficacy",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="5",
volume="8",
number="10",
pages="e18985",
keywords="Parkinson disease",
keywords="smartphone",
keywords="mobile phone",
keywords="telehealth",
keywords="telerehabilitation",
keywords="digital health",
keywords="physical therapy",
abstract="Background: Many people with Parkinson disease do not have access to exercise programs that are specifically tailored to their needs and capabilities. This mobile app allows people with Parkinson disease to access Parkinson disease--specific exercises that are individually tailored using in-app demographic questions and performance tests which are fed into an algorithm which in turn produces a video-guided exercise program. Objective: To test the feasibility, safety, and signal of efficacy of a mobile app that facilitates exercise for people with Parkinson disease. Methods: A prospective, single-cohort design of people with Parkinson disease who had downloaded the 9zest app for exercise was used for this 12-week pilot study. Participants, who were recruited online, were encouraged to exercise with the full automated app for ?150 minutes each week. The primary endpoints were feasibility (app usage and usability questions) and safety (adverse events and falls). The primary endpoints for signal of efficacy were a comparison of the in-app baseline and 8-week outcomes on the 30-second Sit-To-Stand (STS) test, Timed Up and Go (TUG) test, and the Parkinson's Disease Questionnaire 8 (PDQ8). Results: For feasibility, of the 28 participants that completed the study, 12 participants averaged >150 minutes of app usage per week (3 averaged 120-150, 4 averaged 90-120, and 9 averaged less than 90 minutes). A majority of participants (>74\%) felt the exercise was of value (16/19; 9 nonrespondents), provided adequate instruction (14/19; 9 nonrespondents), and was appropriate for level of function (16/19; 9 nonrespondents). For safety, there were no serious adverse events that occurred during the app-guided exercise. There were 4 reports of strain/sprain injuries while using the app among 3 participants, none of which necessitated medical attention. For signal of efficacy, there was improvement for each of the primary endpoints: STS (P=.01), TUG (P<.001), and PDQ8 (P=.01). Conclusions: Independent, video-guided exercise using a mobile app designed for exercise in Parkinson disease was safe and feasible though there was variability in app usage. Despite this, the results provide evidence for a signal of efficacy as there were improvements in 3 of the 3 outcomes. Trial Registration: ClinicalTrials.gov NCT03459586; https://clinicaltrials.gov/ct2/show/NCT03459586 ",
doi="10.2196/18985",
url="https://mhealth.jmir.org/2020/10/e18985",
url="http://www.ncbi.nlm.nih.gov/pubmed/33016887"
}


@Article{info:doi/10.2196/19880,
author="Frost, Emily
and Porat, Talya
and Malhotra, Paresh
and Picinali, Lorenzo",
title="A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders",
journal="JMIR Hum Factors",
year="2020",
month="Sep",
day="30",
volume="7",
number="3",
pages="e19880",
keywords="cognitive decline",
keywords="mobile phone",
keywords="hearing loss",
abstract="Background: Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. Objective: This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. Methods: A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. Results: A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. Conclusions: The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability. ",
doi="10.2196/19880",
url="http://humanfactors.jmir.org/2020/3/e19880/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32996884"
}


@Article{info:doi/10.2196/21749,
author="Bennell, Kim
and Nelligan, K. Rachel
and Schwartz, Sarah
and Kasza, Jessica
and Kimp, Alexander
and Crofts, JC Samuel
and Hinman, S. Rana",
title="Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="28",
volume="22",
number="9",
pages="e21749",
keywords="knee osteoarthritis",
keywords="exercise",
keywords="patient compliance",
keywords="mobile phone",
keywords="randomized controlled trial",
abstract="Background: Exercise is a core recommended treatment for knee osteoarthritis (OA), yet adherence declines, particularly following cessation of clinician supervision. Objective: This study aims to evaluate whether a 24-week SMS intervention improves adherence to unsupervised home exercise in people with knee OA and obesity compared with no SMS. Methods: A two-group superiority randomized controlled trial was performed in a community setting. Participants were people aged 50 years with knee OA and BMI ?30 kg/m2 who had undertaken a 12-week physiotherapist-supervised exercise program as part of a preceding clinical trial. Both groups were asked to continue their home exercise program unsupervised three times per week for 24 weeks and were randomly allocated to a behavior change theory--informed, automated, semi-interactive SMS intervention addressing exercise barriers and facilitators or to control (no SMS). Primary outcomes were self-reported home exercise adherence at 24 weeks measured by the Exercise Adherence Rating Scale (EARS) Section B (0-24, higher number indicating greater adherence) and the number of days exercised in the past week (0-3). Secondary outcomes included self-rated adherence (numeric rating scale), knee pain, physical function, quality of life, global change, physical activity, self-efficacy, pain catastrophizing, and kinesiophobia. Results: A total of 110 participants (56 SMS group and 54 no SMS) were enrolled and 99 (90.0\%) completed both primary outcomes (48/56, 86\% SMS group and 51/54, 94\% no SMS). At 24 weeks, the SMS group reported higher EARS scores (mean 16.5, SD 6.5 vs mean 13.3, SD 7.0; mean difference 3.1, 95\% CI 0.8-5.5; P=.01) and more days exercised in the past week (mean 1.8, SD 1.2 vs mean 1.3, SD 1.2; mean difference 0.6, 95\% CI 0.2-1.0; P=.01) than the control group. There was no evidence of between-group differences in secondary outcomes. Conclusions: An SMS program increased self-reported adherence to unsupervised home exercise in people with knee OA and obesity, although this did not translate into improved clinical outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry 12617001243303; https://tinyurl.com/y2ud7on5 International Registered Report Identifier (IRRID): RR2-10.1186/s12891-019-2801-z ",
doi="10.2196/21749",
url="http://www.jmir.org/2020/9/e21749/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985994"
}


@Article{info:doi/10.2196/18233,
author="Durst, Jennifer
and Roesel, Inka
and Sudeck, Gorden
and Sassenberg, Kai
and Krauss, Inga",
title="Effectiveness of Human Versus Computer-Based Instructions for Exercise on Physical Activity--Related Health Competence in Patients with Hip Osteoarthritis: Randomized Noninferiority Crossover Trial",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="28",
volume="22",
number="9",
pages="e18233",
keywords="digital app",
keywords="exercise",
keywords="movement control",
keywords="self-efficacy",
keywords="control competence",
keywords="mHealth",
keywords="osteoarthritis",
keywords="tablet",
abstract="Background: Hip and knee osteoarthritis is ranked as the 11th highest contributor to global disability. Exercise is a core treatment in osteoarthritis. The model for physical activity--related health competence describes possibilities to empower patients to perform physical exercises in the best possible health-promoting manner while taking into account their own physical condition. Face-to-face supervision is the gold standard for exercise guidance. Objective: The aim of this study was to evaluate whether instruction and guidance via a digital app is not inferior to supervision by a physiotherapist with regard to movement quality, control competence for physical training, and exercise-specific self-efficacy. Methods: Patients with clinically diagnosed hip osteoarthritis were recruited via print advertisements, emails and flyers. The intervention consisted of two identical training sessions with one exercise for mobility, two for strength, and one for balance.  One session was guided by a physiotherapist and the other was guided by a fully automated tablet computer-based app. Both interventions took place at a university hospital. Outcomes were assessor-rated movement quality, and self-reported questionnaires on exercise-specific self-efficacy and control competence for physical training. Participants were randomly assigned to one of two treatment sequences. One sequence started with the app in the first session followed by the physiotherapist in the second session after a minimum washout phase of 27 days (AP group) and the other sequence occurred in the reverse order (PA group). Noninferiority was defined as a between-treatment effect (gIG)<0.2 in favor of the physiotherapist-guided training, including the upper confidence interval. Participants, assessors, and the statistician were neither blinded to the treatment nor to the treatment sequence. Results: A total of 54 participants started the first training session (32 women, 22 men; mean age 62.4, SD 8.2 years). The treatment sequence groups were similar in size (PA: n=26; AP: n=28). Seven subjects did not attend the second training session (PA: n=3; AP: n=4). The app was found to be inferior to the physiotherapist in all outcomes considered, except for movement quality of the mobility exercise (gIG --0.13, 95\% CI --0.41-0.16). In contrast to the two strengthening exercises in different positions (supine gIG 0.76, 95\% CI 0.39-1.13; table gIG 1.19, 95\% CI 0.84-1.55), movement quality of the balance exercise was close to noninferiority (gIG 0.15, 95\% CI --0.17-0.48). Exercise-specific self-efficacy showed a strong effect in favor of the physiotherapist (gIG 0.84, 95\% CI 0.46-1.22). In terms of control competence for physical training, the app was only slightly inferior to the physiotherapist (gIG 0.18, 95\% CI --0.14-0.50). Conclusions: Despite its inferiority in almost all measures of interest, exercise-specific self-efficacy and control competence for physical training did improve in patients who used the digital app. Movement quality was acceptable for exercises that are easy to conduct and instruct. The digital app opens up possibilities as a supplementary tool to support patients in independent home training for less complex exercises; however, it cannot replace a physiotherapist. Trial Registration: German Clinical Trial Register: DRKS00015759; http://www.drks.de/DRKS00015759 ",
doi="10.2196/18233",
url="http://www.jmir.org/2020/9/e18233/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985991"
}


@Article{info:doi/10.2196/15460,
author="Hawley-Hague, Helen
and Tacconi, Carlo
and Mellone, Sabato
and Martinez, Ellen
and Ford, Claire
and Chiari, Lorenzo
and Helbostad, Jorunn
and Todd, Chris",
title="Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="28",
volume="8",
number="9",
pages="e15460",
keywords="aged",
keywords="postural balance",
keywords="telerehabilitation",
keywords="patient compliance",
keywords="accidental falls",
abstract="Background: Falls have implications for older adults' health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps' usability and acceptability with both health professionals and patients. Methods: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of ``Motivate Me'' and ``My Activity Programme.'' Key changes from the workshops included being able to add more details about the patients' exercise program and a wider selection of goals within ``Motivate Me.'' The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable. ",
doi="10.2196/15460",
url="http://mhealth.jmir.org/2020/9/e15460/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985992"
}


@Article{info:doi/10.2196/22079,
author="Jones, Chelsea
and Miguel-Cruz, Antonio
and Smith-MacDonald, Lorraine
and Cruikshank, Emily
and Baghoori, Delaram
and Kaur Chohan, Avneet
and Laidlaw, Alexa
and White, Allison
and Cao, Bo
and Agyapong, Vincent
and Burback, Lisa
and Winkler, Olga
and Sevigny, R. Phillip
and Dennett, Liz
and Ferguson-Pell, Martin
and Greenshaw, Andrew
and Br{\'e}mault-Phillips, Suzette",
title="Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e22079",
keywords="trauma",
keywords="mental health",
keywords="telemedicine",
keywords="therapy",
keywords="rehabilitation",
keywords="digital health",
keywords="psychotherapy",
keywords="military",
keywords="veteran",
keywords="first responder",
keywords="public safety personnel",
keywords="teletherapy",
keywords="telepsychiatry",
keywords="mobile phone",
abstract="Background: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. Objective: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. Methods: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military \& Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. Results: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. Conclusions: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted. ",
doi="10.2196/22079",
url="http://mhealth.jmir.org/2020/9/e22079/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955456"
}


@Article{info:doi/10.2196/22208,
author="Seo, Minseok
and Shin, Myung-Jun
and Park, Sung Tae
and Park, Jong-Hwan",
title="Clinometric Gait Analysis Using Smart Insoles in Patients With Hemiplegia After Stroke: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="10",
volume="8",
number="9",
pages="e22208",
keywords="stroke",
keywords="hemiplegia",
keywords="gait",
keywords="smart insole",
keywords="medical informatics",
keywords="rehabilitation",
keywords="observational",
keywords="wearable",
keywords="assessment",
abstract="Background: For effective rehabilitation after stroke, it is essential to conduct an objective assessment of the patient's functional status. Several stroke severity scales have been used for this purpose, but such scales have various limitations. Objective: Gait analysis using smart insole technology can be applied continuously, objectively, and quantitatively, thereby overcoming the shortcomings of other assessment tools. Methods: To confirm the reliability of gait analysis using smart insole technology, normal healthy controls wore insoles in their shoes during the Timed Up and Go (TUG) test. The gait parameters were compared with the manually collected data. To determine the gait characteristics of patients with hemiplegia due to stroke, they were asked to wear insoles and take the TUG test; gait parameters were calculated and compared with those of control subjects. To investigate whether the gait analysis accurately reflected the patients' clinical condition, we analyzed the relationships of 22 gait parameters on 4 stroke severity scales. Results: The smart insole gait parameter data were similar to those calculated manually. Among the 18 gait parameters tested, 14 were significantly effective at distinguishing patients from healthy controls. The smart insole data revealed that the stance duration on both sides was longer in patients than controls, which has proven difficult to show using other methods. Furthermore, the sound side in patients showed a markedly longer stance duration. Regarding swing duration, that of the sound side was shorter in patients than controls, whereas that of the hemiplegic side was longer. We identified 10 significantly correlated gait parameters on the stroke severity scales. Notably, the difference in stance duration between the sound and hemiplegic sides was significantly correlated with the Fugl-Meyer Assessment (FMA) lower extremity score. Conclusions: This study confirmed the feasibility and applicability of the smart insole as a device to assess the gait of patients with hemiplegia due to stroke. In addition, we demonstrated that the FMA score was significantly correlated with the smart insole data. Providing an environment where stroke patients can easily measure walking ability helps to maintain chronic functions as well as acute rehabilitation. Trial Registration: UMIN Clinical Trials Registry UMIN000041646, https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000047538 ",
doi="10.2196/22208",
url="http://mhealth.jmir.org/2020/9/e22208/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32909949"
}


@Article{info:doi/10.2196/17822,
author="LaPiana, Nina
and Duong, Alvin
and Lee, Alex
and Alschitz, Leon
and Silva, L. Rafael M.
and Early, Jody
and Bunnell, Aaron
and Mourad, Pierre",
title="Acceptability of a Mobile Phone--Based Augmented Reality Game for Rehabilitation of Patients With Upper Limb Deficits from Stroke: Case Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Sep",
day="2",
volume="7",
number="2",
pages="e17822",
keywords="augmented reality",
keywords="stroke",
keywords="upper limb rehabilitation",
keywords="gamification",
keywords="motor rehabilitation",
keywords="motivation",
keywords="participation",
abstract="Background: Upper limb functional deficits are common after stroke and result from motor weakness, ataxia, spasticity, spatial neglect, and poor stamina. Past studies employing a range of commercial gaming systems to deliver rehabilitation to stroke patients provided short-term efficacy but have not yet demonstrated whether or not those games are acceptable, that is, motivational, comfortable, and engaging, which are all necessary for potential adoption and use by patients. Objective: The goal of the study was to assess the acceptability of a smartphone-based augmented reality game as a means of delivering stroke rehabilitation for patients with upper limb motor function loss. Methods: Patients aged 50 to 70 years, all of whom experienced motor deficits after acute ischemic stroke, participated in 3 optional therapy sessions using augmented reality therapeutic gaming over the course of 1 week, targeting deficits in upper extremity strength and range of motion. After completion of the game, we administered a 16-item questionnaire to the patients to assess the game's acceptability; 8 questions were answered by rating on a scale from 1 (very negative experience) to 5 (very positive experience); 8 questions were qualitative. Results: Patients (n=5) completed a total of 23 out of 45 scheduled augmented reality game sessions, with patient fatigue as the primary factor for uncompleted sessions. Each patient consented to 9 potential game sessions and completed a mean of 4.6 (SE 1.3) games. Of the 5 patients, 4 (80\%) completed the questionnaire at the end of their final gaming session. Of note, patients were motivated to continue to the end of a given gaming session (mean 4.25, 95\% CI 3.31-5.19), to try other game-based therapies (mean 3.75, 95\% CI 2.81-4.69), to do another session (mean 3.50, 95\% CI 2.93-4.07), and to perform other daily rehabilitation exercises (mean 3.25, 95\% CI 2.76-3.74). In addition, participants gave mean scores of 4.00 (95\% CI 2.87-5.13) for overall experience; 4.25 (95\% CI 3.31-5.19) for comfort; 3.25 (95\% CI 2.31-4.19) for finding the study fun, enjoyable, and engaging; and 3.50 (95\% CI 2.52-4.48) for believing the technology could help them reach their rehabilitation goals. For each of the 4 patients, their reported scores were statistically significantly higher than those generated by a random sampling of values (patient 1: P=.04; patient 2: P=.04; patient 4: P=.004; patient 5: P=.04). Conclusions: Based on the questionnaire scores, the patients with upper limb motor deficits following stroke who participated in our case study found our augmented reality game motivating, comfortable, engaging, and tolerable. Improvements in augmented reality technology motivated by this case study may one day allow patients to work with improved versions of this therapy independently in their own home. We therefore anticipate that smartphone-based augmented reality gaming systems may eventually provide useful postdischarge self-treatment as a supplement to professional therapy for patients with upper limb deficiencies from stroke. ",
doi="10.2196/17822",
url="http://rehab.jmir.org/2020/2/e17822/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32876580"
}


@Article{info:doi/10.2196/19807,
author="Jones, Chelsea
and O'Toole, Kaitlin
and Jones, Kevin
and Br{\'e}mault-Phillips, Suzette",
title="Quality of Psychoeducational Apps for Military Members With Mild Traumatic Brain Injury: An Evaluation Utilizing the Mobile Application Rating Scale",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="18",
volume="8",
number="8",
pages="e19807",
keywords="psychoeducation",
keywords="mTBI",
keywords="military",
keywords="app",
keywords="smartphone",
keywords="mHealth, concussion",
keywords="Mobile App Rating Scale",
keywords="MARS",
keywords="mobile phone",
abstract="Background: Military personnel have an elevated risk of sustaining mild traumatic brain injuries (mTBI) and postconcussion symptoms (PCS). Smartphone apps that provide psychoeducation may assist those with mTBI or PCS to overcome unique barriers that military personnel experience with stigma and access to health care resources. Objective: This study aims to (1) use the Mobile Application Rating Scale (MARS) to evaluate smartphone apps purporting to provide psychoeducation for those who have sustained an mTBI or a PCS; (2) explore the relevance, utility, and effectiveness of these apps in facilitating symptom management and overall recovery from mTBI and PCS among military personnel; and (3) discuss considerations pertinent to health care professionals and patients with mTBI when considering the use of mobile health (mHealth), including apps for mTBI psychoeducation. Methods: A five-step systematic search for smartphone apps for military members with mTBI or PCS was conducted on January 31, 2020. Cost-free apps meeting the inclusion criteria were evaluated using the MARS and compared with evidence-based best practice management protocols for mTBI and PCS. Results: The search yielded a total of 347 smartphone apps. After applying the inclusion and exclusion criteria, 13 apps were subjected to evaluation. Two apps were endorsed by the US Department of Veterans Affairs and the US Department of Defense; all the others (n=11) were developed for civilians. When compared with evidence-based best practice resources, the apps provided various levels of psychoeducational content. There are multiple considerations that health care professionals and those who sustain an mTBI or a PCS have to consider when choosing to use mHealth and selecting a specific app for mTBI psychoeducation. These may include factors such as the app platform, developer, internet requirement, cost, frequency of updates, language, additional features, acknowledgment of mental health, accessibility, military specificity, and privacy and security of data. Conclusions: Psychoeducational interventions have a good evidence base as a treatment for mTBI and PCS. The use of apps for this purpose may be clinically effective, cost-effective, confidential, user friendly, and accessible. However, more research is needed to explore the effectiveness, usability, safety, security, and accessibility of apps designed for mTBI management. ",
doi="10.2196/19807",
url="http://mhealth.jmir.org/2020/8/e19807/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32808937"
}


@Article{info:doi/10.2196/18632,
author="Elbers, Stefan
and Pool, Jan
and Wittink, Harri{\"e}t
and K{\"o}ke, Alb{\`e}re
and Scheffer, Else
and Smeets, Rob",
title="Mobile Health App (AGRIPPA) to Prevent Relapse After Successful Interdisciplinary Treatment for Patients With Chronic Pain: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="18",
volume="9",
number="8",
pages="e18632",
keywords="telemedicine",
keywords="chronic pain",
keywords="recurrence",
keywords="clinical trial protocol",
keywords="rehabilitation",
keywords="randomized controlled trial",
keywords="cost-benefit analysis",
keywords="treatment adherence and compliance",
keywords="mobile apps",
keywords="patient care team",
abstract="Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice. Trial Registration: Netherlands Trial Register NL8076; https://www.trialregister.nl/trial/8076 International Registered Report Identifier (IRRID): DERR1-10.2196/18632 ",
doi="10.2196/18632",
url="https://www.researchprotocols.org/2020/8/e18632",
url="http://www.ncbi.nlm.nih.gov/pubmed/32808931"
}


@Article{info:doi/10.2196/17799,
author="Hennessy, White Rebecca
and Rumble, Deanna
and Christian, Mike
and Brown, A. David
and Trost, Zina",
title="A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design",
journal="JMIR Serious Games",
year="2020",
month="Aug",
day="10",
volume="8",
number="3",
pages="e17799",
keywords="virtual reality",
keywords="chronic low back pain",
keywords="walking",
keywords="rehabilitation",
keywords="virtual reality exposure therapy",
abstract="Background: Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP. Objective: This study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities. Methods: We recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up. Results: The 12 participants who completed the study period assigned higher avoidance (P=.002), expected pain (P=.002), and expected concern (P=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; P=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (P=.20) nor pain-related fear (P=.58) changed significantly across sessions. Conclusions: The GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely. ",
doi="10.2196/17799",
url="http://games.jmir.org/2020/3/e17799/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773381"
}


@Article{info:doi/10.2196/18465,
author="Jim{\'e}nez-Reguera, Bego{\~n}a
and Maroto L{\'o}pez, Eva
and Fitch, Shane
and Juarros, Lourdes
and S{\'a}nchez Cort{\'e}s, Marta
and Rodr{\'i}guez Hermosa, Luis Juan
and Calle Rubio, Myriam
and Hern{\'a}ndez Criado, Teresa Mar{\'i}a
and L{\'o}pez, Marta
and Angulo-D{\'i}az-Parre{\~n}o, Santiago
and Mart{\'i}n-Pintado-Zugasti, Aitor
and Vilar{\'o}, Jordi",
title="Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="31",
volume="8",
number="7",
pages="e18465",
keywords="adherence",
keywords="pulmonary rehabilitation",
keywords="mHealth",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
abstract="Background: Pulmonary rehabilitation is one of the main interventions to reduce the use of health resources, and it promotes a reduction in chronic obstructive pulmonary disease (COPD) costs. mHealth systems in COPD aim to improve adherence to maintenance programs after pulmonary rehabilitation by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease. Objective: This study aimed to assess the effects of an integrated care plan based on an mHealth web-based platform (HappyAir) on adherence to a 1-year maintenance program applied after pulmonary rehabilitation in COPD patients. Methods: COPD patients from three hospitals were randomized to a control group or an intervention group (HappyAir group). Patients from both groups received an 8-week program of pulmonary rehabilitation and educational sessions about their illness. After completion of the process, only the HappyAir group completed an integrated care plan for 10 months, supervised by an mHealth system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using a respiratory physiotherapy adherence self-report (CAP FISIO) questionnaire. Other variables analyzed were adherence to physical activity (Morisky-Green Test), quality of life (Chronic Obstructive Pulmonary Disease Assessment Test, St. George's Respiratory Questionnaire, and EuroQOL-5D), exercise capacity (6-Minute Walk Test), and lung function. Results: In total, 44 patients were recruited and randomized in the control group (n=24) and HappyAir group (n=20). Eight patients dropped out for various reasons. The CAP FISIO questionnaire results showed an improvement in adherence during follow-up period for the HappyAir group, which was statistically different compared with the control group at 12 months (56.1 [SD 4.0] vs 44.0 [SD 13.6]; P=.004) after pulmonary rehabilitation. Conclusions: mHealth systems designed for COPD patients improve adherence to maintenance programs as long as they are accompanied by disease awareness and patient involvement in management. Trial Registration: ClinicalTrials.gov NCT04479930; https://clinicaltrials.gov/ct2/show/NCT04479930 ",
doi="10.2196/18465",
url="http://mhealth.jmir.org/2020/7/e18465/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32513646"
}


@Article{info:doi/10.2196/19721,
author="Brennan, Louise
and Kessie, Threase
and Caulfield, Brian",
title="Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="29",
volume="8",
number="7",
pages="e19721",
keywords="breast cancer",
keywords="physiotherapy",
keywords="rehabilitation",
keywords="mHealth",
keywords="biofeedback",
keywords="user-centred design",
keywords="cancer",
abstract="Background: Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective: The aims of this study were to explore patients' rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods: This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of ``Rehabilitation'' and ``Technology'' and performed a thematic analysis on the interview data. Results: Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer--specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions: There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance. ",
doi="10.2196/19721",
url="http://mhealth.jmir.org/2020/7/e19721/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32687476"
}


@Article{info:doi/10.2196/17036,
author="Signal, June Nada Elizabeth
and McLaren, Ruth
and Rashid, Usman
and Vandal, Alain
and King, Marcus
and Almesfer, Faisal
and Henderson, Jeanette
and Taylor, Denise",
title="Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="29",
volume="8",
number="7",
pages="e17036",
keywords="stroke",
keywords="rehabilitation",
keywords="physical activity",
keywords="movement",
keywords="disability",
keywords="technology",
keywords="upper limb",
keywords="wearable",
keywords="haptic",
keywords="nudge",
abstract="Background: As many as 80\% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. Objective: This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. Methods: A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a ``Planned Nudge'' to the odds of affected limb movement during the observation period following ``No Nudge.'' Results: The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95\% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95\% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95\% CI 0.99-1.29, P=.07). Conclusions: Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. Trial Registration: Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687\&isReview=true ",
doi="10.2196/17036",
url="https://mhealth.jmir.org/2020/7/e17036",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723718"
}


@Article{info:doi/10.2196/19582,
author="Langan, Jeanne
and Bhattacharjya, Sutanuka
and Subryan, Heamchand
and Xu, Wenyao
and Chen, Baicheng
and Li, Zhengxiong
and Cavuoto, Lora",
title="In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e19582",
keywords="stroke",
keywords="rehabilitation",
keywords="smart technology",
keywords="3D printing",
keywords="usability",
abstract="Background: Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback. Objective: To examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments. Methods: mRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user's perception of mRehab. Results: A total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant's perception of mRehab was positive. Conclusions: Despite heterogeneity in participants' use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ",
doi="10.2196/19582",
url="http://mhealth.jmir.org/2020/7/e19582/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706702"
}


@Article{info:doi/10.2196/18584,
author="De Oliveira Silva, Danilo
and Pazzinatto, F. Marcella
and Crossley, M. Kay
and Azevedo, M. Fabio
and Barton, J. Christian",
title="Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="22",
volume="22",
number="7",
pages="e18584",
keywords="pain",
keywords="internet",
keywords="knee",
keywords="rehabilitation",
keywords="eHealth",
abstract="Background: Patellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation. Objective: This study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care. Methods: Phase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks. Results: A total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100\% (35/35) and 88\% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20\% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93\% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40\% (14/35) of the participants following phase 1 and 71\% (25/35) of the participants following phase 2. Conclusions: Self-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20\% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP. ",
doi="10.2196/18584",
url="http://www.jmir.org/2020/7/e18584/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706674"
}


@Article{info:doi/10.2196/17216,
author="Chae, Hoon Sang
and Kim, Yushin
and Lee, Kyoung-Soub
and Park, Hyung-Soon",
title="Development and Clinical Evaluation of a Web-Based Upper Limb Home Rehabilitation System Using a Smartwatch and Machine Learning Model for Chronic Stroke Survivors: Prospective Comparative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="9",
volume="8",
number="7",
pages="e17216",
keywords="home-based rehabilitation",
keywords="artificial intelligence",
keywords="machine learning",
keywords="wearable device",
keywords="smartwatch",
keywords="chronic stroke",
abstract="Background: Recent advancements in wearable sensor technology have shown the feasibility of remote physical therapy at home. In particular, the current COVID-19 pandemic has revealed the need and opportunity of internet-based wearable technology in future health care systems. Previous research has shown the feasibility of human activity recognition technologies for monitoring rehabilitation activities in home environments; however, few comprehensive studies ranging from development to clinical evaluation exist. Objective: This study aimed to (1) develop a home-based rehabilitation (HBR) system that can recognize and record the type and frequency of rehabilitation exercises conducted by the user using a smartwatch and smartphone app equipped with a machine learning (ML) algorithm and (2) evaluate the efficacy of the home-based rehabilitation system through a prospective comparative study with chronic stroke survivors. Methods: The HBR system involves an off-the-shelf smartwatch, a smartphone, and custom-developed apps. A convolutional neural network was used to train the ML algorithm for detecting home exercises. To determine the most accurate way for detecting the type of home exercise, we compared accuracy results with the data sets of personal or total data and accelerometer, gyroscope, or accelerometer combined with gyroscope data. From March 2018 to February 2019, we conducted a clinical study with two groups of stroke survivors. In total, 17 and 6 participants were enrolled for statistical analysis in the HBR group and control group, respectively. To measure clinical outcomes, we performed the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment of Upper Extremity, grip power test, Beck Depression Inventory, and range of motion (ROM) assessment of the shoulder joint at 0, 6, and 12 months, and at a follow-up assessment 6 weeks after retrieving the HBR system. Results: The ML model created with personal data involving accelerometer combined with gyroscope data (5590/5601, 99.80\%) was the most accurate compared with accelerometer (5496/5601, 98.13\%) or gyroscope data (5381/5601, 96.07\%). In the comparative study, the drop-out rates in the control and HBR groups were 40\% (4/10) and 22\% (5/22) at 12 weeks and 100\% (10/10) and 45\% (10/22) at 18 weeks, respectively. The HBR group (n=17) showed a significant improvement in the mean WMFT score (P=.02) and ROM of flexion (P=.004) and internal rotation (P=.001). The control group (n=6) showed a significant change only in shoulder internal rotation (P=.03). Conclusions: This study found that a home care system using a commercial smartwatch and ML model can facilitate participation in home training and improve the functional score of the WMFT and shoulder ROM of flexion and internal rotation in the treatment of patients with chronic stroke. This strategy can possibly be a cost-effective tool for the home care treatment of stroke survivors in the future. Trial Registration: Clinical Research Information Service KCT0004818; https://tinyurl.com/y92w978t ",
doi="10.2196/17216",
url="http://mhealth.jmir.org/2020/7/e17216/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32480361"
}


@Article{info:doi/10.2196/14178,
author="Jung, Timothy
and Moorhouse, Natasha
and Shi, Xin
and Amin, Farhan Muhammad",
title="A Virtual Reality--Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="7",
volume="22",
number="7",
pages="e14178",
keywords="virtual reality",
keywords="COPD",
keywords="rehabilitation",
abstract="Background: The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely. Objective: This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs. Methods: This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale. Results: In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures. Conclusions: Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale. ",
doi="10.2196/14178",
url="https://www.jmir.org/2020/7/e14178",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673224"
}


@Article{info:doi/10.2196/17841,
author="Burns, David
and Razmjou, Helen
and Shaw, James
and Richards, Robin
and McLachlin, Stewart
and Hardisty, Michael
and Henry, Patrick
and Whyne, Cari",
title="Adherence Tracking With Smart Watches for Shoulder Physiotherapy in Rotator Cuff Pathology: Protocol for a Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="5",
volume="9",
number="7",
pages="e17841",
keywords="rehabilitation",
keywords="treatment adherence and compliance",
keywords="wearable electronic devices",
keywords="machine learning",
keywords="rotator cuff",
abstract="Background: Physiotherapy is essential for the successful rehabilitation of common shoulder injuries and following shoulder surgery. Patients may receive some training and supervision for shoulder physiotherapy through private pay or private insurance, but they are typically responsible for performing most of their physiotherapy independently at home. It is unknown how often patients perform their home exercises and if these exercises are performed correctly without supervision. There are no established tools for measuring this. It is, therefore, unclear if the full benefit of shoulder physiotherapy treatments is being realized. Objective: The proposed research will (1) validate a smartwatch and machine learning (ML) approach for evaluating adherence to shoulder exercise participation and technique in a clinical patient population with rotator cuff pathology; (2) quantify the rate of home physiotherapy adherence, determine the effects of adherence on recovery, and identify barriers to successful adherence; and (3) develop and pilot test an ethically conscious adherence-driven rehabilitation program that individualizes patient care based on their capacity to effectively participate in their home physiotherapy. Methods: This research will be conducted in 2 phases. The first phase is a prospective longitudinal cohort study, involving 120 patients undergoing physiotherapy for rotator cuff pathology. Patients will be issued a smartwatch that will record 9-axis inertial sensor data while they perform physiotherapy exercises both in the clinic and in the home setting. The data collected in the clinic under supervision will be used to train and validate our ML algorithms that classify shoulder physiotherapy exercise. The validated algorithms will then be used to assess home physiotherapy adherence from the inertial data collected at home. Validated outcome measures, including the Disabilities of the Arm, Shoulder, and Hand questionnaire; Numeric Pain Rating Scale; range of motion; shoulder strength; and work status, will be collected pretreatment, monthly through treatment, and at a final follow-up of 12 months. We will then relate improvement in patient outcomes to measured physiotherapy adherence and patient baseline variables in univariate and multivariate analyses. The second phase of this research will involve the evaluation of a novel rehabilitation program in a cohort of 20 patients. The program will promote patient physiotherapy engagement via the developed technology and support adherence-driven care decisions. Results: As of December 2019, 71 patients were screened for enrollment in the noninterventional validation phase of this study; 65 patients met the inclusion and exclusion criteria. Of these, 46 patients consented and 19 declined to participate in the study. Only 2 patients de-enrolled from the study and data collection is ongoing for the remaining 44. Conclusions: This study will provide new and important insights into shoulder physiotherapy adherence, the relationship between adherence and recovery, barriers to better adherence, and methods for addressing them. International Registered Report Identifier (IRRID): DERR1-10.2196/17841 ",
doi="10.2196/17841",
url="https://www.researchprotocols.org/2020/7/e17841",
url="http://www.ncbi.nlm.nih.gov/pubmed/32623366"
}


@Article{info:doi/10.2196/19116,
author="Li, C. Linda
and Feehan, M. Lynne
and Xie, Hui
and Lu, Na
and Shaw, D. Christopher
and Gromala, Diane
and Zhu, Siyi
and Avi{\~n}a-Zubieta, Antonio J.
and Hoens, M. Alison
and Koehn, Cheryl
and Tam, Johnathan
and Therrien, Stephanie
and Townsend, F. Anne
and Noonan, Gregory
and Backman, L. Catherine",
title="Effects of a 12-Week Multifaceted Wearable-Based Program for People With Knee Osteoarthritis: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="3",
volume="8",
number="7",
pages="e19116",
keywords="physical activity",
keywords="counseling",
keywords="knee osteoarthritis",
keywords="physiotherapy",
keywords="wearables",
abstract="Background: Current guidelines emphasize an active lifestyle in the management of knee osteoarthritis (OA), but up to 90\% of patients with OA are inactive. In a previous study, we demonstrated that an 8-week physiotherapist (PT)-led counseling intervention, with the use of a Fitbit, improved step count and quality of life in patients with knee OA, compared with a control. Objective: This study aimed to examine the effect of a 12-week, multifaceted wearable-based program on physical activity and patient outcomes in patients with knee OA. Methods: This was a randomized controlled trial with a delay-control design. The immediate group (IG) received group education, a Fitbit, access to FitViz (a Fitbit-compatible app), and 4 biweekly phone calls from a PT over 8 weeks. Participants then continued using Fitbit and FitViz independently up to week 12. The delay group (DG) received a monthly electronic newsletter in weeks 1 to 12 and started the same intervention in week 14. Participants were assessed in weeks 13, 26, and 39. The primary outcome was time spent in daily moderate-to-vigorous physical activity (MVPA; in bouts ?10 min) measured with a SenseWear Mini. Secondary outcomes included daily steps, time spent in purposeful activity and sedentary behavior, Knee Injury and OA Outcome Score, Patient Health Questionnaire-9, Partners in Health Scale, Theory of Planned Behavior Questionnaire, and Self-Reported Habit Index. Results: We enrolled 51 participants (IG: n=26 and DG: n=25). Compared with the IG, the DG accumulated significantly more MVPA time at baseline. The adjusted mean difference in MVPA was 13.1 min per day (95\% CI 1.6 to 24.5). A significant effect was also found in the adjusted mean difference in perceived sitting habit at work (0.7; 95\% CI 0.2 to 1.2) and during leisure activities (0.7; 95\% CI 0.2 to 1.2). No significant effect was found in the remaining secondary outcomes. Conclusions: A 12-week multifaceted program with the use of a wearable device, an app, and PT counseling improved physical activity in people with knee OA. Trial Registration: ClinicalTrials.gov NCT02585323; https://clinicaltrials.gov/ct2/show/NCT02585323 ",
doi="10.2196/19116",
url="https://mhealth.jmir.org/2020/7/e19116",
url="http://www.ncbi.nlm.nih.gov/pubmed/32618578"
}


@Article{info:doi/10.2196/15375,
author="Fatoye, Francis
and Gebrye, Tadesse
and Fatoye, Clara
and Mbada, E. Chidozie
and Olaoye, I. Mistura
and Odole, C. Adesola
and Dada, Olumide",
title="The Clinical and Cost-Effectiveness of Telerehabilitation for People With Nonspecific Chronic Low Back Pain: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="24",
volume="8",
number="6",
pages="e15375",
keywords="cost-utility analysis",
keywords="quality-adjusted life years",
keywords="telerehabilitation",
keywords="low back pain",
keywords="mobile phone",
abstract="Background: Telerehabilitation can facilitate multidisciplinary management for people with nonspecific chronic low back pain (NCLBP). It provides health care access to individuals who are physically and economically disadvantaged. Objective: This study aimed to evaluate the clinical and cost-effectiveness of telerehabilitation compared with a clinic-based intervention for people with NCLBP in Nigeria. Methods: A cost-utility analysis alongside a randomized controlled trial from a health care perspective was conducted. Patients with NCLBP were assigned to either telerehabilitation-based McKenzie therapy (TBMT) or clinic-based McKenzie therapy (CBMT). Interventions were carried out 3 times weekly for a period of 8 weeks. Patients' level of disability was measured using the Oswestry Disability Index (ODI) at baseline, week 4, and week 8. To estimate the health-related quality of life of the patients, the ODI was mapped to the short-form six dimensions instrument to generate quality-adjusted life years (QALYs). Health care resource use and costs were assessed based on the McKenzie extension protocol in Nigeria in 2019. Descriptive and inferential data analyses were also performed to assess the clinical effectiveness of the interventions. Bootstrapping was conducted to generate the point estimate of the incremental cost-effectiveness ratio (ICER). Results: A total of 47 patients (TBMT, n=21 and CBMT, n=26), with a mean age of 47 (SD 11.6) years for telerehabilitation and 50 (SD 10.7) years for the clinic-based intervention, participated in this study. The mean cost estimates of TBMT and CBMT interventions per person were 22,200 naira (US \$61.7) and 38,200 naira (US \$106), respectively. QALY gained was 0.085 for TBMT and 0.084 for CBMT. The TBMT arm was associated with an additional 0.001 QALY (95\% CI 0.001 to 0.002) per participant compared with the CBMT arm. Thus, the ICER showed that the TBMT arm was less costly and more effective than the CBMT arm. Conclusions: The findings of the study suggested that telerehabilitation for people with NCLBP was cost saving. Given the small number of participants in this study, further examination of effects and costs of the interventions is needed within a larger sample size. In addition, future studies are required to assess the cost-effectiveness of this intervention in the long term from the patient and societal perspective. ",
doi="10.2196/15375",
url="http://mhealth.jmir.org/2020/6/e15375/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32357128"
}


@Article{info:doi/10.2196/18204,
author="van Beek, Willemijn Judith Jantine
and van Wegen, Henri Erwin Everardus
and Rietberg, Berend Marc
and Nyffeler, Thomas
and Bohlhalter, Stephan
and Kamm, Philipp Christian
and Nef, Tobias
and Vanbellingen, Tim",
title="Feasibility of a Home-Based Tablet App for Dexterity Training in Multiple Sclerosis: Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="9",
volume="8",
number="6",
pages="e18204",
keywords="dexterity",
keywords="feasibility",
keywords="multiple sclerosis",
keywords="rehabilitation",
keywords="app",
keywords="home-based training",
abstract="Background: Persons with multiple sclerosis (MS) often experience dexterous difficulties during the performance of activities of daily living, such as fastening buttons, handling coins, or writing, therefore impacting their health-related quality of life. Mobile health (mHealth) solutions, such as tablet apps, may be used to train impaired dexterous skills. The feasibility of a tablet app--based dexterity home-based intervention in MS (TAD-MS) has not been explored yet in persons with MS. Objective: The aim of this pilot study was to evaluate the feasibility and usability of home-based dexterity training with a tablet app in both persons with MS and healthy subjects. Methods: A total of 9 persons with MS, aged 35-71 years, with an Expanded Disability Status Scale score between 2 and 7.5, performed the TAD-MS for 4 weeks, five times a week, with each training session lasting approximately 30 minutes. Participants' impaired dexterity was measured by the Nine-Hole Peg Test. A total of 10 age-matched healthy subjects also tested and rated the usability of the app. Outcome measures were the adherence rate as well as usability measured by the System Usability Scale and a Custom User Engagement Questionnaire (CUEQ). Results: High feasibility of the tablet app--based dexterity training program was shown by a 97\% adherence rate to the training protocol (ie, mean 19.4/20 sessions completed, SD 0.8). High system usability scores (ie, mean 85.39\%, SD  11.67) and overall high scores given in the CUEQ (ie, mean 8.2/10, SD 1.4) further point to high usability of the app. Neither demographic variables nor dexterity levels affected the use of the app. Conclusions: This pilot study is the first to demonstrate high feasibility and usability of a new tablet app--based dexterity home-based training program among both persons with MS and healthy individuals. Whether this kind of training improves dexterity will need to be evaluated in a randomized controlled trial. ",
doi="10.2196/18204",
url="http://mhealth.jmir.org/2020/6/e18204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32515747"
}


@Article{info:doi/10.2196/16203,
author="Bentley, L. Claire
and Powell, Lauren
and Potter, Stephen
and Parker, Jack
and Mountain, A. Gail
and Bartlett, Kiera Yvonne
and Farwer, Jochen
and O'Connor, Cath
and Burns, Jennifer
and Cresswell, L. Rachel
and Dunn, D. Heather
and Hawley, S. Mark",
title="The Use of a Smartphone App and an Activity Tracker to Promote Physical Activity in the Management of Chronic Obstructive Pulmonary Disease: Randomized Controlled Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="3",
volume="8",
number="6",
pages="e16203",
keywords="mobile health",
keywords="mHealth",
keywords="chronic obstructive pulmonary disease",
keywords="feasibility",
keywords="physical activity",
keywords="activity tracker",
keywords="Fitbit",
keywords="self-management",
keywords="health behavior change",
keywords="pulmonary rehabilitation",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR). Objective: This study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness. Methods: We conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity--based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology. Results: Overall, 47\% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation. Conclusions: mHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates. ",
doi="10.2196/16203",
url="https://mhealth.jmir.org/2020/6/e16203",
url="http://www.ncbi.nlm.nih.gov/pubmed/32490838"
}


@Article{info:doi/10.2196/17804,
author="Held, Oskar Jeremia Philipp
and Yu, Kevin
and Pyles, Connor
and Veerbeek, Marieke Janne
and Bork, Felix
and Heining, Sandro-Michael
and Navab, Nassir
and Luft, R{\"u}diger Andreas",
title="Augmented Reality--Based Rehabilitation of Gait Impairments: Case Report",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="26",
volume="8",
number="5",
pages="e17804",
keywords="HoloLens 2",
keywords="gait",
keywords="rehabilitation",
keywords="stroke",
keywords="augmented reality",
keywords="sensors",
abstract="Background: Gait and balance impairments are common in neurological diseases, including stroke, and negatively affect patients' quality of life. Improving balance and gait are among the main goals of rehabilitation. Rehabilitation is mainly performed in clinics, which lack context specificity; therefore, training in the patient's home environment is preferable. In the last decade, developed rehabilitation technologies such as virtual reality and augmented reality (AR) have enabled gait and balance training outside clinics. Here, we propose a new method for gait rehabilitation in persons who have had a stroke in which mobile AR technology and a sensor-based motion capture system are combined to provide fine-grained feedback on gait performance in real time. Objective: The aims of this study were (1) to investigate manipulation of the gait pattern of persons who have had a stroke based on virtual augmentation during overground walking compared to walking without AR performance feedback and (2) to investigate the usability of the AR system. Methods: We developed the ARISE (Augmented Reality for gait Impairments after StrokE) system, in which we combined a development version of HoloLens 2 smart glasses (Microsoft Corporation) with a sensor-based motion capture system. One patient with chronic minor gait impairment poststroke completed clinical gait assessments and an AR parkour course with patient-centered performance gait feedback. The movement kinematics during gait as well as the usability and safety of the system were evaluated. Results: The patient changed his gait pattern during AR parkour compared to the pattern observed during the clinical gait assessments. He recognized the virtual objects and ranked the usability of the ARISE system as excellent. In addition, the patient stated that the system would complement his standard gait therapy. Except for the symptom of exhilaration, no adverse events occurred. Conclusions: This project provided the first evidence of gait adaptation during overground walking based on real-time feedback through visual and auditory augmentation. The system has potential to provide gait and balance rehabilitation outside the clinic. This initial investigation of AR rehabilitation may aid the development and investigation of new gait and balance therapies. ",
doi="10.2196/17804",
url="http://mhealth.jmir.org/2020/5/e17804/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452815"
}


@Article{info:doi/10.2196/17326,
author="De Canni{\`e}re, H{\'e}l{\`e}ne
and Smeets, P. Christophe J.
and Schoutteten, Melanie
and Varon, Carolina
and Van Hoof, Chris
and Van Huffel, Sabine
and Groenendaal, Willemijn
and Vandervoort, Pieter",
title="Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="20",
volume="22",
number="5",
pages="e17326",
keywords="wearables",
keywords="sensor",
keywords="6MWT",
keywords="rehabilitation",
keywords="cardiovascular",
abstract="Background: Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified. Objective: The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy. Methods: A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated. Results: All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HRpeak) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F4,92=8.321, P<.001). Similar results were obtained for the recovery heart rate (HRrec) values, which increased significantly over time during every minute of recuperation, for the high-response group (HRrec1: P<.001, HRrec2: P<.001, HRrec3: P<.001, HRrec4: P<.001, and HRrec5: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients' cardiac responses. Conclusions: This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome. ",
doi="10.2196/17326",
url="http://www.jmir.org/2020/5/e17326/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32432552"
}


@Article{info:doi/10.2196/16605,
author="Stevens, Timothy
and McGinnis, S. Ryan
and Hewgill, Blake
and Choquette, H. Rebecca
and Tourville, W. Timothy
and Harvey, Jean
and Lachapelle, Richard
and Beynnon, D. Bruce
and Toth, J. Michael
and Skalka, Christian",
title="A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile--Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation",
journal="JMIR Hum Factors",
year="2020",
month="May",
day="11",
volume="7",
number="2",
pages="e16605",
keywords="device use tracking",
keywords="internet of things",
keywords="neuromuscular electrical stimulation",
keywords="exercise",
keywords="smart devices",
keywords="mHealth",
keywords="rehabilitation",
keywords="mobile health",
keywords="digital health",
abstract="Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System--based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software--tracked device use, the RehabTracker system recorded 83\% (40/48) of the rehabilitation sessions, with 100\% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100\% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. ",
doi="10.2196/16605",
url="http://humanfactors.jmir.org/2020/2/e16605/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32384052"
}


@Article{info:doi/10.2196/15344,
author="Tacchino, Andrea
and Veldkamp, Renee
and Coninx, Karin
and Brulmans, Jens
and Palmaers, Steven
and H{\"a}m{\"a}l{\"a}inen, P{\"a}ivi
and D'hooge, Mieke
and Vanzeir, Ellen
and Kalron, Alon
and Brichetto, Giampaolo
and Feys, Peter
and Baert, Ilse",
title="Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="16",
volume="8",
number="4",
pages="e15344",
keywords="tablet",
keywords="mobile device",
keywords="cognitive rehabilitation",
keywords="cognitive impairment",
keywords="dual-task training",
keywords="cognitive-motor interference",
keywords="dual-task cost",
keywords="adherence",
keywords="multiple sclerosis",
keywords="walking",
abstract="Background: Dual tasking constitutes a large portion of most activities of daily living; in real-lifesituations, people need to not only maintain balance and mobility skills, but also perform other cognitive or motor tasks at the same time. Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective: To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods: CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C\# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results: The adherence rate was 91\%. DTT was perceived as ``somewhat difficult'' (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions: CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS. ",
doi="10.2196/15344",
url="http://mhealth.jmir.org/2020/4/e15344/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343258"
}


@Article{info:doi/10.2196/14465,
author="Nguyen, Thi An
and Somerville, Kling Emily
and Esp{\'i}n-Tello, Martina Sandra
and Keglovits, Marian
and Stark, Lynn Susan",
title="A Mobile App Directory of Occupational Therapists Who Provide Home Modifications: Development and Preliminary Usability Evaluation",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Mar",
day="30",
volume="7",
number="1",
pages="e14465",
keywords="mHealth",
keywords="mobile app",
keywords="occupational therapist",
keywords="occupational therapy",
keywords="older adult",
keywords="user-computer interface",
abstract="Background: Home modifications provided by occupational therapists (OTs) are effective in improving daily activity performance and reducing fall risk among community-dwelling older adults. However, the prevalence of home modification is low. One reason is the lack of a centralized database of OTs who provide home modifications. Objective: This study aimed to develop and test the usability of a mobile app directory of OTs who provide home modifications in the United States. Methods: In phase 1, a prototype was developed by identifying OTs who provide home modifications through keyword Web searches. Referral information was confirmed by phone or email. In phase 2, community-dwelling older adults aged older than 65 years and OTs currently working in the United States were purposefully recruited to participate in a single usability test of the mobile app, Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semistructured interview questions. Interview data were coded, and themes were derived using a grounded theory approach. Results: In phase 1, referral information for 101 OTs across 49 states was confirmed. In phase 2, 6 OTs (mean clinical experience 4.3 years, SD 1.6 years) and 6 older adults (mean age 72.8 years, SD 5.0 years) participated. The mean SUS score for OTs was 91.7 (SD 8.0; out of 100), indicating good usability. The mean SUS score for older adults was 71.7 (SD 27.1), indicating considerable variability in usability. In addition, the SUS scores indicated that the app is acceptable to OTs and may be acceptable to some older adults. For OTs, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information. Conclusions: Home Maddirs demonstrates good preliminary acceptability and usability to OTs. Older adults' perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make improvements to this promising new tool for increasing older adults' access to home modifications. ",
doi="10.2196/14465",
url="http://rehab.jmir.org/2020/1/e14465/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32224486"
}


@Article{info:doi/10.2196/16650,
author="Wang, Jingying
and Gong, Dawei
and Luo, Huichun
and Zhang, Wenbin
and Zhang, Lei
and Zhang, Han
and Zhou, Junhong
and Wang, Shouyan",
title="Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson's Disease by Wearable Sensors: Controlled Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="20",
volume="8",
number="3",
pages="e16650",
keywords="Parkinson's disease",
keywords="gait",
keywords="angular velocity",
keywords="inertial sensor",
keywords="step angle",
keywords="deep brain stimulation",
keywords="acute levodopa challenge test",
abstract="Background: Gait impairments including shuffling gait and hesitation are common in people with Parkinson's disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. Objective: This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). Methods: A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. Results: The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=--0.60, P<.001; dual task: r=--0.52, P<.001), initial step angle (single task: r=--0.35, P=.006; dual task: r=--0.35, P=.01), and last step angle (single task: r=--0.43, P=.001; dual task: r=--0.41, P=.002). Conclusions: This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort. ",
doi="10.2196/16650",
url="http://mhealth.jmir.org/2020/3/e16650/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32196458"
}


@Article{info:doi/10.2196/14435,
author="Kim, Yoon
and Seo, Jinserk
and An, So-Yeon
and Sinn, Hyun Dong
and Hwang, Hye Ji",
title="Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="11",
volume="8",
number="3",
pages="e14435",
keywords="mHealth",
keywords="hepatocellular carcinoma",
keywords="rehabilitation",
keywords="exercise",
keywords="physical fitness",
keywords="physical activity",
abstract="Background: Exercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients. Objective: The aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients. Methods: A total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants' physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the  European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted. Results: Of the 37 patients, 31 (84\%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration. Conclusions: Following 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy. ",
doi="10.2196/14435",
url="http://mhealth.jmir.org/2020/3/e14435/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32159517"
}


@Article{info:doi/10.2196/15377,
author="Kim, Yeon Do
and Kwon, Hee
and Nam, Ki-Woong
and Lee, Yongseok
and Kwon, Hyung-Min
and Chung, Seob Young",
title="Remote Management of Poststroke Patients With a Smartphone-Based Management System Integrated in Clinical Care: Prospective, Nonrandomized, Interventional Study",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="27",
volume="22",
number="2",
pages="e15377",
keywords="mHealth",
keywords="mobile apps",
keywords="stroke care",
keywords="health care",
keywords="patient education",
keywords="self-monitoring of blood pressure",
abstract="Background: Advances in mobile health (mHealth) have enabled systematic and continuous management of patients with chronic diseases. Objective: We developed a smartphone-based mHealth system and aimed to evaluate its effects on health behavior management and risk factor control in stroke patients. Methods: With a multifaceted stroke aftercare management system that included exercise, medication, and educational materials, we performed a 12-week single-arm intervention among eligible poststroke patients in the stroke clinic from September to December 2016. The intervention consisted of (1) regular blood pressure (BP), blood glucose, and physical activity measurements; (2) stroke education; (3) an exercise program; (4) a medication program; and (5) feedback on reviewing of records by clinicians. Clinical assessments consisted of the stroke awareness score, Beck Depression Inventory-II (BDI), EuroQol-5 Dimensions (EQ-5D), and BP at visit 1 (baseline), visit 2 (4 weeks), and visit 3 (12 weeks). Temporal differences in the parameters over 12 weeks were investigated with repeated-measures analysis of variance. Changes in medication adherence at visit 1-2 (from visit 1 to visit 2) and visit 2-3 (from visit 2 to visit 3) were compared. System satisfaction was evaluated with a self-questionnaire using a 5-point Likert scale at visit 3. Results: The study was approved by the Institutional Review Board in September 2016, and participants were enrolled from September to December 2016. Among the 110 patients enrolled for the study, 99 were included in our analyses. The mean stroke awareness score (baseline: 59.6 [SD 18.1]; 4 weeks: 67.6 [SD 16.0], P<.001; 12 weeks: 74.7 [SD 14.0], P<.001) and BDI score (baseline: 12.7 [SD 10.1]; 4 weeks: 11.2 [SD 10.2], P=.01; 12 weeks: 10.7 [SD 10.2], P<.001) showed gradual improvement; however, no significant differences were found in the mean EQ-5D score (baseline: 0.66 [SD 0.33]; 4 weeks: 0.69 [SD 0.34], P=.01; 12 weeks: 0.69 [SD 0.34], P<.001). Twenty-six patients who had uncontrolled BP at baseline had ?13.92 mmHg (P=.001) and ?6.19 mmHg (P<.001) reductions on average in systolic and diastolic BP, respectively, without any antihypertensive medication change. Medication compliance was better at visit 2-3 (60.9\% [SD 37.2\%]) than at visit 1-2 (47.8\% [SD 38.7\%], P<.001). Conclusions: Awareness of stroke, depression, and BP was enhanced when using the smartphone-based mHealth system. Emerging mHealth techniques have potential as new nonpharmacological secondary prevention methods because of their ubiquitous access, near real-time responsiveness, and comparatively lower cost. ",
doi="10.2196/15377",
url="http://www.jmir.org/2020/2/e15377/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130140"
}


@Article{info:doi/10.2196/16403,
author="Dittrich, Florian
and Back, Alexander David
and Harren, Katharina Anna
and J{\"a}ger, Marcus
and Landgraeber, Stefan
and Reinecke, Felix
and Beck, Sascha",
title="A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Feb",
day="26",
volume="8",
number="2",
pages="e16403",
keywords="smartphone",
keywords="ankle sprain",
keywords="rehabilitation",
keywords="self-care",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients' young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective: In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)--based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods: The development process of the Ankle Joint App was defined in chronological order using a protocol. The app's quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results: A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app's content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95\% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions: The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app's effects on economical and medical aspects in comparison with established nondigital therapy paths. ",
doi="10.2196/16403",
url="http://mhealth.jmir.org/2020/2/e16403/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130171"
}


@Article{info:doi/10.2196/14282,
author="Clausen, Jan-Dierk
and Nahen, Niclas
and Horstmann, Hauke
and Lasch, Florian
and Krutsch, Werner
and Krettek, Christian
and Weber-Spickschen, Sanjay Thomas",
title="Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approach",
journal="JMIR Serious Games",
year="2020",
month="Jan",
day="24",
volume="8",
number="1",
pages="e14282",
keywords="serious gaming",
keywords="knee trainer",
keywords="games, experimental",
keywords="exercise therapy",
keywords="physical and rehabilitation medicine",
keywords="anterior cruciate ligament reconstruction",
keywords="knee injuries",
abstract="Background: Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. Objective: Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. Methods: We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. Results: In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and --4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention -- control) of 59.7 N (95\% CI 10.1-109.3; P=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. Conclusions: Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement. ",
doi="10.2196/14282",
url="https://games.jmir.org/2020/1/e14282",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012046"
}


@Article{info:doi/10.2196/15981,
author="Parker, Jack
and Powell, Lauren
and Mawson, Susan",
title="Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="8",
volume="22",
number="1",
pages="e15981",
keywords="wearable electronic devices",
keywords="stroke",
keywords="rehabilitation",
keywords="upper extremity",
abstract="Background: With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77\% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. Objective: This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. Methods: Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. Results: In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P?.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. Conclusions: This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. Trial Registration: PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=57715 ",
doi="10.2196/15981",
url="https://www.jmir.org/2020/1/e15981",
url="http://www.ncbi.nlm.nih.gov/pubmed/31913131"
}


@Article{info:doi/10.2196/15466,
author="Dobson, Rosie
and Herbst, Pauline
and Candy, Sarah
and Brott, Tamzin
and Garrett, Jeffrey
and Humphrey, Gayl
and Reeve, Julie
and Tawhai, Merryn
and Taylor, Denise
and Warren, Jim
and Whittaker, Robyn",
title="Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews",
journal="JMIR Form Res",
year="2019",
month="Dec",
day="20",
volume="3",
number="4",
pages="e15466",
keywords="mHealth",
keywords="rehabilitation",
keywords="COPD",
abstract="Background: Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. Objective: The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. Methods: A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. Results: Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. Conclusions: These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population. ",
doi="10.2196/15466",
url="http://formative.jmir.org/2019/4/e15466/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31859681"
}


@Article{info:doi/10.2196/12981,
author="Zhou, Leming
and Parmanto, Bambang",
title="Reaching People With Disabilities in Underserved Areas Through Digital Interventions: Systematic Review",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="25",
volume="21",
number="10",
pages="e12981",
keywords="systematic review",
keywords="digital intervention",
keywords="electronic intervention",
keywords="e-intervention",
keywords="underserved area",
keywords="disability",
keywords="telemedicine",
keywords="telerehabilitation",
keywords="eHealth",
keywords="digital health",
abstract="Background: People with disabilities need rehabilitation interventions to improve their physical functioning, mental status, and quality of life. Many rehabilitation interventions can be delivered electronically (``digitally'') via telehealth systems. For people with disabilities in underserved areas, electronically delivered rehabilitation interventions may be the only feasible service available for them. Objective: The objective of this study was to evaluate the current status of digital interventions for people with disabilities in remote and underserved areas. Methods: A systematic review was conducted on this topic. Keyword searches in multiple databases (PubMed, CINAHL, and Inspec) were performed to collect articles published in this field. The obtained articles were selected based on our selection criteria. Of the 198 identified articles, 16 duplicates were removed. After a review of the titles and abstracts of the remaining articles, 165 were determined to be irrelevant to this study and were therefore removed. The full texts of the remaining 17 articles were reviewed, and 6 of these articles were removed as being irrelevant to this study. The 11 articles remaining were discussed and summarized by 2 reviewers. Results: These 11 studies cover a few types of disabilities, such as developmental disabilities and mobility impairments as well as several types of disability-causing disorders such as stroke, multiple sclerosis, traumatic brain injury, and facio-scapulo-humeral muscular dystrophy. Most of these studies were small-scale case studies and relatively larger-scale cohort studies; the project evaluation methods were mainly pre-post comparison, questionnaires, and interviews. A few studies also performed objective assessment of functional improvement. The intervention technology was mainly videoconferencing. Moreover, 10 of these studies were for people with disabilities in rural areas and 1 was for people in urban communities. Conclusions: A small number of small-scale studies have been conducted on digital interventions for people with disabilities in underserved areas. Although the results reported in these studies were mostly positive, they are not sufficient to prove the effectiveness of telehealth-based digital intervention in improving the situation among people with disabilities because of the small sample sizes and lack of randomized controlled trials. ",
doi="10.2196/12981",
url="http://www.jmir.org/2019/10/e12981/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31654569"
}


@Article{info:doi/10.2196/13640,
author="Rold{\'a}n-Jim{\'e}nez, Cristina
and Martin-Martin, Jaime
and Cuesta-Vargas, I. Antonio",
title="Reliability of a Smartphone Compared With an Inertial Sensor to Measure Shoulder Mobility: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Sep",
day="06",
volume="7",
number="9",
pages="e13640",
keywords="shoulder",
keywords="kinematics",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: The shoulder is one of the joints with the greatest mobility within the human body and its evaluation is complex. An assessment can be conducted using questionnaires or functional tests, and goniometry can complement the information obtained in this assessment. However, there are now validated devices that can provide more information on the realization of movement, such as inertial sensors. The cost of these devices is usually high and they are not available to all clinicians, but there are also inertial sensors that are implemented in mobile phones which are cheaper and widely available. Results from the inertial sensors integrated into mobile devices can have the same reliability as those from dedicated sensors. Objective: This study aimed to validate the use of the Nexus 4 smartphone as a measuring tool for the mobility of the humerus during shoulder movement compared with a dedicated InertiaCube3 (Intersense) sensor. Methods: A total of 43 subjects, 27 affected by shoulder pathologies and 16 asymptomatic, participated in the study. Shoulder flexion, abduction, and scaption were measured using an InertiaCube3 and a Nexus 4 smartphone, which were attached to the participants to record the results simultaneously. The interclass correlation coefficient (ICC) was calculated based on the 3 movements performed. Results: The smartphone reliably recorded the velocity values and simultaneously recorded them alongside the inertial sensor. The ICCs of the 3 gestures and for each of the axes of movement were analyzed with a 95\% CI. In the abduction movement, the devices demonstrated excellent interclass reliability for the abduction humeral movement axis (Cronbach alpha=.98). The axis of abduction of the humeral showed excellent reliability for the movements of flexion (Cronbach alpha=.93) and scaption (Cronbach alpha=.98). Conclusions: Compared with the InertiaCube3, the Nexus 4 smartphone is a reliable and valid tool for recording the velocity produced in the shoulder. ",
doi="10.2196/13640",
url="http://mhealth.jmir.org/2019/9/e13640/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31493320"
}


@Article{info:doi/10.2196/12434,
author="Rivera, Diego
and Garc{\'i}a, Antonio
and Ortega, Eugenio Jose
and Alarcos, Bernardo
and van der Meulen, Kevin
and Velasco, R. Juan
and del Barrio, Cristina",
title="Intraindividual Variability Measurement of Fine Manual Motor Skills in Children Using an Electronic Pegboard: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Aug",
day="28",
volume="7",
number="8",
pages="e12434",
keywords="child development",
keywords="psychology, developmental",
keywords="play and playthings",
keywords="motor skills",
keywords="smartphone",
abstract="Background: Pegboard tests are a powerful technique used by health and education professionals to evaluate manual dexterity and fine motor speed, both in children and adults. Using traditional pegboards in tests, the total time that, for example, a 4-year-old child needs for inserting pegs in a pegboard, with the left or right hand, can be measured. However, these measurements only allow for studying the variability among individuals, whereas no data can be obtained on the intraindividual variability in inserting and removing these pegs with one and the other hand. Objective: The aim of this research was to study the intraindividual variabilities in fine manual motor skills of 2- to 3-year-old children during playing activities, using a custom designed electronic pegboard. Methods: We have carried out a pilot study with 39 children, aged between 25 and 41 months. The children were observed while performing a task involving removing 10 pegs from 10 holes on one side and inserting them in 10 holes on the other side of a custom-designed sensor-based electronic pegboard, which has been built to be able to measure the times between peg insertions and removals. Results: A sensor-based electronic pegboard was successfully developed, enabling the collection of single movement time data. In the piloting, a lower intraindividual variability was found in children with lower placement and removal times, confirming Adolph et al's hypothesis. Conclusions: The developed pegboard allows for studying intraindividual variability using automated wirelessly transmitted data provided by its sensors. This novel technique has been useful in studying and validating the hypothesis that children with lower movement times present lower intraindividual variability. New research is necessary to confirm these findings. Research with larger sample sizes and age ranges that include additional testing of children's motor development level is currently in preparation. ",
doi="10.2196/12434",
url="http://mhealth.jmir.org/2019/8/e12434/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31464193"
}


@Article{info:doi/10.2196/12587,
author="Dufour, Sin{\'e}ad
and Fedorkow, Donna
and Kun, Jessica
and Deng, Xiaoxuan Shirley
and Fang, Qiyin",
title="Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="11",
volume="7",
number="7",
pages="e12587",
keywords="postpartum",
keywords="pelvic floor",
keywords="mobile health",
keywords="feasibility study",
keywords="wireless technology",
keywords="wearable technology",
keywords="computer games",
keywords="biofeedback",
abstract="Background: The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective: The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods: A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne's interpretive description approach. Results: A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77\%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77\%), a cumbersome initiation process (n=8, 61\%), and discomfort from the device (n=8, 61\%) were reasons impeding intervention acceptability. Most participants (n=17, 74\%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions: Our pilot study demonstrated the potential for mHealth solution--enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome. Trial Registration: ClinicalTrials.gov NCT02865954;?https://clinicaltrials.gov/ct2/show/NCT02865954 ",
doi="10.2196/12587",
url="http://mhealth.jmir.org/2019/7/e12587/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31298221"
}


@Article{info:doi/10.2196/12645,
author="Ji, Wonjun
and Kwon, Hee
and Lee, Sungin
and Kim, Seulgi
and Hong, Sook Jeong
and Park, Rang Yu
and Kim, Ryul Hyeong
and Lee, Cheol Jae
and Jung, Ji Eun
and Kim, Donghyun
and Choi, Chang-Min",
title="Mobile Health Management Platform--Based Pulmonary Rehabilitation for Patients With Non--Small Cell Lung Cancer: Prospective Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="21",
volume="7",
number="6",
pages="e12645",
keywords="mHealth",
keywords="pulmonary rehabilitation",
keywords="lung cancer",
keywords="telemedicine",
keywords="telerehabilitation",
keywords="carcinoma, non-small-cell lung",
abstract="Background: Lung cancer patients experience various symptoms during treatment. Although pulmonary rehabilitation is an effective way to improve these symptoms, a medical environment of limited availability makes it difficult to provide seamless and adequate rehabilitation for lung cancer patients. Objective: This study aimed to investigate the effects of a personalized pulmonary rehabilitation program using real-time mobile patient health data for patients with non--small cell lung cancer. Methods: We conducted a prospective clinical trial in 64 patients with non--small cell lung cancer aged between 20 and 80 years at a large tertiary hospital in Seoul, South Korea. A 12-week personalized pulmonary rehabilitation program, called efil breath, was administered to determine the effectiveness of the newly developed rehabilitation app. Participants were randomly allocated to the fixed exercise or fixed-interactive exercise group (which received the personalized program). We measured changes in 6-minute walk distance (6MWD) and dyspnea (modified Medical Research Council [mMRC] score) at 6 weeks; and quality of life and service satisfaction at 12 weeks. We used the paired t test to analyze the variables. Results: Patients used the newly developed mobile health pulmonary rehabilitation app and a real-time patient monitoring website. In all participants, significant changes were observed in 6MWD at 12 weeks from a mean of 433.43m (SD 65.60) to 471.25m (SD 75.69; P=.001), and mMRC from a mean score of 0.94 (0.66) to 0.61 (SD 0.82; P=.02). The intervention significantly improved their quality of life (EuroQol-visual analog scale [EQ-VAS]) compared with baseline (mean score 76.05, SD 12.37 vs 82.09, SD 13.67, respectively; P=.002). Conclusions: A personalized mobile health--based pulmonary rehabilitation app for recording and monitoring real-time health data of patients with non--small cell lung cancer can supplement traditional health care center--based rehabilitation programs. This technology can encourage improvement of physical activity, dyspnea, and quality of life. ",
doi="10.2196/12645",
url="http://mhealth.jmir.org/2019/6/e12645/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31228180"
}


@Article{info:doi/10.2196/14523,
author="Dias Correia, Fernando
and Nogueira, Andr{\'e}
and Magalh{\~a}es, Ivo
and Guimar{\~a}es, Joana
and Moreira, Maria
and Barradas, Isabel
and Molinos, Maria
and Teixeira, Laetitia
and Pires, Joaquim
and Seabra, Rosmaninho
and Lains, Jorge
and Bento, Virg{\'i}lio",
title="Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study",
journal="JMIR Rehabil Assist Technol",
year="2019",
month="Jun",
day="21",
volume="6",
number="1",
pages="e14523",
keywords="THA",
keywords="THR",
keywords="digital physiotherapy",
keywords="telerehabilitation",
keywords="biofeedback",
keywords="motion trackers",
keywords="AI-powered rehabilitation",
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 ",
doi="10.2196/14523",
url="http://rehab.jmir.org/2019/1/e14523/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31228176"
}


@Article{info:doi/10.2196/10449,
author="Gibson, Colin Ryan
and Bouamrane, Matt-Mouley
and Dunlop, Mark",
title="Design Requirements for a Digital Aid to Support Adults With Mild Learning Disabilities During Clinical Consultations: Qualitative Study With Experts",
journal="JMIR Rehabil Assist Technol",
year="2019",
month="Mar",
day="04",
volume="6",
number="1",
pages="e10449",
keywords="learning disabilities",
keywords="intellectual disability",
keywords="communicative disorder",
keywords="augmentative and alternative communications systems",
keywords="primary care",
abstract="Background: Adults with mild learning disabilities (MLDs) face a plethora of obstacles when accessing effective health care. Central to many of these barriers is communication, with medical practitioners often remaining untrained on how to interact with patients who have learning disabilities (LDs). To date, research on how to promote this communication has largely centered on the development of low-tech aids. Objective: The objective of this study was to assess the feasibility of utilizing tablet technologies to promote communication between general practitioners and patients with MLDs. We achieved this by identifying a set of design requirements from experts in LDs. Methods: A set of design guidelines was formed during a 2-phase process. Phase 1 involved conducting a series of requirements-gathering interviews with 10 experts in LDs---the protocol of which emerged from the results of a separate scoping review. The interviews were subjected to a framework analysis to discern the key requirements discussed by the experts, and these were embedded within a technology probe. In phase 2, this probe was presented to a subset (n=4) of the experts during a round of usability studies, and the feedback received was used to update the requirements identified in phase 1. Results: An initial set of design requirements has been produced that may assist in the development of clinical Alternative and Augmentative Communication technologies for adults with MLDs. Factors that must be considered range from the health, physical and cognitive needs of stakeholders, to the more individual needs of users. Conclusions: The experts involved in the study were optimistic about the proposed app. They believe that such technologies can help to alleviate time constraints and promote communication by presenting information in a form understood by both practitioners and patients. ",
doi="10.2196/10449",
url="http://rehab.jmir.org/2019/1/e10449/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30829575"
}


@Article{info:doi/10.2196/10201,
author="Hou, Jingyi
and Yang, Rui
and Yang, Yaping
and Tang, Yiyong
and Deng, Haiquan
and Chen, Zhong
and Wu, Yanfeng
and Shen, Huiyong",
title="The Effectiveness and Safety of Utilizing Mobile Phone--Based Programs for Rehabilitation After Lumbar Spinal Surgery: Multicenter, Prospective Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="20",
volume="7",
number="2",
pages="e10201",
keywords="mobile phone",
keywords="low back pain",
keywords="rehabilitation",
abstract="Background: Rehabilitation is crucial for postoperative patients with low back pain (LBP). However, the implementation of traditional clinic-based programs is limited in developing countries, such as China, because of the maldistribution of medical resources. Mobile phone--based programs may be a potential substitute for those who have no access to traditional rehabilitation. Objective: The aim of this study was to examine the efficacy of mobile phone--based rehabilitation systems in patients who underwent lumbar spinal surgery. Methods: Patients who accepted spinal surgeries were recruited and randomized into 2 groups of rehabilitation treatments: (1) a mobile phone--based eHealth (electronic health) program (EH) or (2) usual care treatment (UC). The primary outcomes were (1) function and pain status assessed by the Oswestry Disability Index (ODI) and (2) the visual analog scale (VAS). Secondary outcomes were (1) general mental health and (2) quality of life (Likert scales, EuroQol-5 Dimension health questionnaire, and 36-item Short-Form Health Survey). All the patients were assessed preoperatively and then at 3, 6, 12, and 24 months postoperatively. Results: A total of 168 of the 863 eligible patients were included and randomized in this study. Our analysis showed that the improvement of primary outcomes in the EH group was superior to the UC group at 24 months postoperatively (ODI mean 7.02, SD 3.10, P<.05; VAS mean 7.59, SD 3.42, P<.05). No significant difference of primary outcomes was found at other time points. A subgroup analysis showed that the improvements of the primary outcomes were more significant in those who completed 6 or more training sessions each week throughout the trial (the highest compliance group) compared with the UC group at 6 months (ODI mean 17.94, SD 5.24, P<.05; VAS mean 19.56, SD 5.27, P<.05), 12 months (ODI mean 13.39, SD 5.32, P<.05; VAS mean 14.35, SD 5.23, P<.05), and 24 months (ODI mean 18.80, SD 5.22, P<.05; VAS mean 21.56, SD 5.28, P<.05). Conclusions: This research demonstrated that a mobile phone--based telerehabilitation system is effective in self-managed rehabilitation for postoperative patients with LBP. The effectiveness of eHealth was more evident in participants with higher compliance. Future research should focus on improving patients' compliance. Trial Registration: Chinese Clinical Trial Registry ChiCTR-TRC-13003314; http://www.chictr.org.cn/showproj.aspx?proj=6245 (Archived by WebCite at http://www.webcitation.org/766RAIDNc) ",
doi="10.2196/10201",
url="http://mhealth.jmir.org/2019/2/e10201/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30785406"
}


@Article{info:doi/10.2196/11094,
author="Park, Sojung
and Kim, Youn Ji
and Lee, Cheol Jae
and Kim, Ryul Hyeong
and Song, Seungjae
and Kwon, Hee
and Ji, Wonjun
and Choi, Min Chang",
title="Mobile Phone App--Based Pulmonary Rehabilitation for Chemotherapy-Treated Patients With Advanced Lung Cancer: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="04",
volume="7",
number="2",
pages="e11094",
keywords="chemotherapy",
keywords="physical fitness",
keywords="lung cancer",
keywords="rehabilitation",
keywords="quality of life",
abstract="Background: Advanced lung cancer patients often have chronic lung disease with reduced exercise capacities and various symptoms leading to altered quality of life (QoL). No studies have assessed pulmonary rehabilitation (PR) employing a mobile app and an Internet of Things device in advanced lung cancer patients undergoing chemotherapy. Objective: This study aimed to determine the feasibility and efficacy of smartphone app--based PR on exercise capacity, symptom management, and QoL in patients with advanced lung cancer undergoing chemotherapy. Methods: A total of 100 patients were recruited in a prospective, single-arm intervention study using a smartphone app--based PR program for 12 weeks. Exercise capacity (6-min walking distance, 6MWD), QoL, symptom scale scores, and distress indexes were investigated. Results: A total of 90 patients completed the PR program. The most common cause of drop out was hospitalization because of cancer progression. After PR, there was significant improvement in the 6MWD; 380.1 m (SD 74.1) at baseline, 429.1 m (SD 58.6) at 6 weeks (P<.001), and 448.1 m (SD 50.0) at 12 weeks (P<.001). However, the dyspnea scale score showed no significant improvement in the patients overall, but there was a trend for improvement in those with a stable tumor response (P=.07). Role (P=.02), emotional (P<.001), and social functioning (P=.002) scale scores showed significant improvement after PR. Symptom scale scores for fatigue (P<.001), anorexia (P=.047), and diarrhea (P=.01) also showed significant improvement. There was significant improvement in depression (P=.048) and anxiety (P=.01), whereas there was no significant change in QoL (P=.06) and severity of pain (P=.24). Conclusions: Smartphone app--based PR represents an effective and feasible program to improve exercise capacity and to manage symptoms and distress in patients with advanced lung cancer who are undergoing chemotherapy. ",
doi="10.2196/11094",
url="http://mhealth.jmir.org/2019/2/e11094/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30714943"
}


@Article{info:doi/10.2196/10342,
author="Hoogland, Jildou
and Wijnen, Annet
and Munsterman, Tjerk
and Gerritsma, LE Carina
and Dijkstra, Baukje
and Zijlstra, P. Wierd
and Annegarn, Janneke
and Ibarra, Francisco
and Zijlstra, Wiebren
and Stevens, Martin",
title="Feasibility and Patient Experience of a Home-Based Rehabilitation Program Driven by a Tablet App and Mobility Monitoring for Patients After a Total Hip Arthroplasty",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="31",
volume="7",
number="1",
pages="e10342",
keywords="home-based rehabilitation",
keywords="mobile phone",
keywords="osteoarthritis",
keywords="physiotherapy",
keywords="total hip arthroplasty",
abstract="Background: Recent developments in technology are promising for providing home-based exercise programs. Objective: The objective of this study was to evaluate the feasibility and patient experience of a home-based rehabilitation program after total hip arthroplasty (THA) delivered using videos on a tablet personal computer (PC) and a necklace-worn motion sensor to continuously monitor mobility-related activities. Methods: We enrolled 30 independently living patients aged 18-75 years who had undergone THA as a treatment for primary or secondary osteoarthritis (OA) between December 2015 and February 2017. Patients followed a 12-week exercise program with video instructions on a tablet PC and daily physical activity registration through a motion sensor. Patients were asked to do strengthening and walking exercises at least 5 days a week. There was weekly phone contact with a physiotherapist. Adherence and technical problems were recorded during the intervention. User evaluation was done in week 4 (T1) and at the end of the program (T2). Results: Overall, 26 patients completed the program. Average adherence for exercising 5 times a week was 92\%. Reasons mentioned most often for nonadherence were vacation or a day or weekend off 25\% (33/134) and work 15\% (20/134). The total number of technical issues was 8. The average score on the user evaluation questionnaire (range 0-5) was 4.6 at T1 and 4.5 at T2. The highest score was for the subscale ``coaching'' and the lowest for the subscale ``sensor.'' Conclusions: A home-based rehabilitation program driven by a tablet app and mobility monitoring seems feasible for THA patients. Adherence was good and patient experience was positive. The novel technology was well accepted. When the home-based rehabilitation program proves to be effective, it could be used as an alternative to formal physiotherapy. However, further research on its effectiveness is needed. ",
doi="10.2196/10342",
url="http://mhealth.jmir.org/2019/1/e10342/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30702438"
}


@Article{info:doi/10.2196/mhealth.9865,
author="Thijs, Isabeau
and Fresiello, Libera
and Oosterlinck, Wouter
and Sinnaeve, Peter
and Rega, Filip",
title="Assessment of Physical Activity by Wearable Technology During Rehabilitation After Cardiac Surgery: Explorative Prospective Monocentric Observational Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="31",
volume="7",
number="1",
pages="e9865",
keywords="fitness trackers",
keywords="coronary artery bypass",
keywords="cardiac surgery",
keywords="cardiac rehabilitation",
keywords="postoperative care",
keywords="wearable",
keywords="physical activity",
keywords="exercise",
abstract="Background: Wearable technology is finding its way into clinical practice. Physical activity describes patients' functional status after cardiac surgery and can be monitored remotely by using dedicated trackers. Objective: The aim of this study was to compare the progress of physical activity in cardiac rehabilitation by using wearable fitness trackers in patients undergoing coronary artery bypass surgery by either the conventional off-pump coronary artery bypass (OPCAB) or the robotically assisted minimally invasive coronary artery bypass (RA-MIDCAB). We hypothesized faster recovery of physical activity after RA-MIDCAB in the first weeks after discharge as compared to OPCAB. Methods: Patients undergoing RA-MIDCAB or OPCAB were included in the study. Each patient received a Fitbit Charge HR (Fitbit Inc, San Francisco, CA) physical activity tracker following discharge. Rehabilitation progress was assessed by measuring the number of steps and physical activity level daily. The physical activity level was calculated as energy expenditure divided by the basic metabolic rate. Results: A total of 10 RA-MIDCAB patients with a median age of 68 (min, 55; max, 83) years and 12 OPCAB patients with a median age of 69 (min, 50; max, 82) years were included. Baseline characteristics were comparable except for body mass index (RA-MIDCAB: 26 kg/m{\texttwosuperior}; min, 22; max, 28 versus OPCAB: 29 kg/m{\texttwosuperior}; min, 27; max, 33; P<.001). Intubation time (P<.05) was significantly lower in the RA-MIDCAB group. A clear trend, although not statistically significant, was observed towards a higher number of steps in RA-MIDCAB patients in the first week following discharge. Conclusions: RA-MIDCAB patients have an advantage in recovery in the first weeks of revalidation, which is reflected by the number of steps and physical activity level measured by the Fitbit Charge HR, as compared to OPCAB patients. However, unsupervised assessment of daily physical activity varied widely and could have consequences with regard to the use of these trackers as research tools. ",
doi="10.2196/mhealth.9865",
url="http://mhealth.jmir.org/2019/1/e9865/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30702433"
}


@Article{info:doi/10.2196/11099,
author="Coswig, Victor
and Silva, E. Anselmo De Athayde Costa
and Barbalho, Matheus
and Faria, De Fernando Rosch
and Nogueira, D. Claudio
and Borges, Mariane
and Buratti, R. J{\'e}ssica
and Vieira, B. Ivaldo
and Rom{\'a}n, L{\'o}pez Francisco Javier
and Gorla, I. Jos{\'e}",
title="Assessing the Validity of the MyJump2 App for Measuring Different Jumps in Professional Cerebral Palsy Football Players: An Experimental Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="30",
volume="7",
number="1",
pages="e11099",
keywords="cerebral palsy football",
keywords="jump performance",
keywords="mobile apps",
keywords="mobile phone",
keywords="paralympic sports",
abstract="Background: Vertical jumps can be used to assess neuromuscular status in sports performance. This is particularly important in Cerebral Palsy Football (CP Football) because players are exposed to high injury risk, but it may be complicated because the gold standard for assessing jump performance is scarce in field evaluation. Thus, field techniques, such as mobile apps, have been proposed as an alternative method for solving this problem. Objective: This study aims to evaluate the reliability of the measures of the MyJump2 app to assess vertical jump performance in professional CP Football. Methods: We assessed 40 male CP Football athletes (age 28.1 [SD 1.4] years, weight 72.5 [SD 6.2] kg, and height 176 [SD 4.2] cm) through the countermovement jump (CMJ) and squat jump (SJ) using a contact mat. At the same time, we assessed the athletes using the MyJump2 app. Results: There were no significant differences between the instruments in SJ height (P=.12) and flight time (P=.15). Additionally, there were no significant differences between the instruments for CMJ in jump height (P=.16) and flight time (P=.13). In addition, it was observed that there were significant and strong intraclass correlations in all SJ variables varying from 0.86 to 0.89 (both P<.001), which was classified as ``almost perfect.'' Similar results were observed in all variables from the CMJ, varying from 0.92 to 0.96 (both P ?.001). Conclusions: We conclude that the MyJump2 app presents high validity and reliability for measuring jump height and flight time of the SJ and CMJ in CP Football athletes. ",
doi="10.2196/11099",
url="http://mhealth.jmir.org/2019/1/e11099/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30698529"
}


@Article{info:doi/10.2196/jmir.9711,
author="Weichelt, Bryan
and Bendixsen, Casper
and Keifer, Matthew",
title="Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="29",
volume="21",
number="1",
pages="e9711",
keywords="agriculture",
keywords="farmworkers",
keywords="injuries",
keywords="occupational medicine",
keywords="return to work",
keywords="software application",
abstract="Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers' compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners' and managers' attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company's human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software's impact on patients and employers. ",
doi="10.2196/jmir.9711",
url="https://www.jmir.org/2019/1/e9711/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30694202"
}


@Article{info:doi/10.2196/mhealth.9931,
author="Yu, Daihua
and Parmanto, Bambang
and Dicianno, Brad",
title="An mHealth App for Users with Dexterity Impairments: Accessibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="08",
volume="7",
number="1",
pages="e202",
keywords="accessibility",
keywords="dexterity impairments",
keywords="disability",
keywords="mHealth",
keywords="self-management",
keywords="smartphone apps",
keywords="spina bifida",
keywords="spinal cord injury",
keywords="wellness",
keywords="mobile phone",
abstract="Background: A mobile health (mHealth) system called iMHere (interactive mobile health and rehabilitation) was developed to support individuals with chronic conditions and disability in their self-management regimens. The initial design of iMHere, however, lacked sufficient accessibility for users with a myriad of dexterity impairments. The accessibility of self-management apps is essential in ensuring usability. Objective: This study aims to increase the usability of the iMHere system for users with dexterity impairments by increasing the app's accessibility. Methods: We targeted the accessibility redesign by focusing on the physical presentation and the navigability of the iMHere apps. Six participants presenting with dexterity impairments were included in the usability study of the original and redesigned apps. Results: We observed a lower number of touches needed to complete tasks (P=.09) and time to complete individual tasks (P=.06) with the redesigned app than with the original app; a significantly lower time for users to complete all tasks (P=.006); and a significantly lower error rate (P=.01) with the redesigned app than with the original app. In fact, no errors occurred with use of the redesigned app. Participant-reported overall average usability of the redesigned app (P=.007) and usability of individual modules (P<.001) were significantly higher than that of the original app due mostly to better ease of use and learnability, interface quality, and reliability. Conclusions: Improved usability was achieved using a redesigned app. This study offers insight into the importance of personalization in enhancing the accessibility and also identifies strategies for improving usability in app development. ",
doi="10.2196/mhealth.9931",
url="https://mhealth.jmir.org/2019/1/e202/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30622096"
}


@Article{info:doi/10.2196/11748,
author="Barbareschi, Giulia
and Holloway, Catherine
and Bianchi-Berthouze, Nadia
and Sonenblum, Sharon
and Sprigle, Stephen",
title="Use of a Low-Cost, Chest-Mounted Accelerometer to Evaluate Transfer Skills of Wheelchair Users During Everyday Activities: Observational Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Dec",
day="20",
volume="5",
number="2",
pages="e11748",
keywords="wheelchair transfers",
keywords="movement evaluation",
keywords="machine learning",
keywords="activity monitoring",
keywords="accelerometer",
abstract="Background: Transfers are an important skill for many wheelchair users (WU). However, they have also been related to the risk of falling or developing upper limb injuries. Transfer abilities are usually evaluated in clinical settings or biomechanics laboratories, and these methods of assessment are poorly suited to evaluation in real and unconstrained world settings where transfers take place. Objective: The objective of this paper is to test the feasibility of a system based on a wearable low-cost sensor to monitor transfer skills in real-world settings. Methods: We collected data from 9 WU wearing triaxial accelerometer on their chest while performing transfers to and from car seats and home furniture. We then extracted significant features from accelerometer data based on biomechanical considerations and previous relevant literature and used machine learning algorithms to evaluate the performance of wheelchair transfers and detect their occurrence from a continuous time series of data. Results: Results show a good predictive accuracy of support vector machine classifiers when determining the use of head-hip relationship (75.9\%) and smoothness of landing (79.6\%) when the starting and ending of the transfer are known. Automatic transfer detection reaches performances that are similar to state of the art in this context (multinomial logistic regression accuracy 87.8\%). However, we achieve these results using only a single sensor and collecting data in a more ecological manner. Conclusions: The use of a single chest-placed accelerometer shows good predictive accuracy for algorithms applied independently to both transfer evaluation and monitoring. This points to the opportunity for designing ubiquitous-technology based personalized skill development interventions for WU. However, monitoring transfers still require the use of external inputs or extra sensors to identify the start and end of the transfer, which is needed to perform an accurate evaluation. ",
doi="10.2196/11748",
url="http://rehab.jmir.org/2018/2/e11748/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30573447"
}


@Article{info:doi/10.2196/11315,
author="Agarwal, Vibhu
and Smuck, Matthew
and Tomkins-Lane, Christy
and Shah, H. Nigam",
title="Inferring Physical Function From Wearable Activity Monitors: Analysis of Free-Living Activity Data From Patients With Knee Osteoarthritis",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="18",
volume="6",
number="12",
pages="e11315",
keywords="physical function",
keywords="passive monitoring",
keywords="physical function profile",
keywords="wearable activity data",
keywords="statistical learning",
abstract="Background: Clinical assessments for physical function do not objectively quantify routine daily activities. Wearable activity monitors (WAMs) enable objective measurement of daily activities, but it remains unclear how these map to clinically measured physical function measures. Objective: This study aims to derive a representation of physical function from daily measurements of free-living activity obtained through a WAM. In addition, we evaluate our derived measure against objectively measured function using an ordinal classification setup. Methods: We defined function profiles representing average time spent in a set of pattern classes over consecutive days. We constructed a function profile using minute-level activity data from a WAM available from the Osteoarthritis Initiative. Using the function profile as input, we trained statistical models that classified subjects into quartiles of objective measurements of physical function as measured through the 400-m walk test, 20-m walk test, and 5 times sit-stand test. Furthermore, we evaluated model performance on held-out data. Results: The function profile derived from minute-level activity data can accurately predict physical performance as measured through clinical assessments. Using held-out data, the Goodman-Kruskal Gamma statistic obtained in classifying performance values in the first quartile, interquartile range, and the fourth quartile was 0.62, 0.53, and 0.51 for the 400-m walk, 20-m walk, and 5 times sit-stand tests, respectively. Conclusions: Function profiles accurately represent physical function, as demonstrated by the relationship between the profiles and clinically measured physical performance. The estimation of physical performance through function profiles derived from free-living activity data may enable remote functional monitoring of patients. ",
doi="10.2196/11315",
url="http://mhealth.jmir.org/2018/12/e11315/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30394876"
}


@Article{info:doi/10.2196/mhealth.8127,
author="Lo, Ambrose Wai Leung
and Lei, Di
and Li, Le
and Huang, Feng Dong
and Tong, Kin-Fai",
title="The Perceived Benefits of an Artificial Intelligence--Embedded Mobile App Implementing Evidence-Based Guidelines for the Self-Management of Chronic Neck and Back Pain: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Nov",
day="26",
volume="6",
number="11",
pages="e198",
keywords="low back pain",
keywords="neck pain",
keywords="mobile app",
keywords="exercise therapy",
keywords="mHealth",
abstract="Background: Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technology has been suggested as an alternative way to increase adherence to exercise therapy, which may improve clinical outcomes. Objective: The aim was to investigate the self-perceived benefits of an artificial intelligence (AI)--embedded mobile app to self-manage chronic neck and back pain. Methods: A total of 161 participants responded to the invitation. The evaluation questionnaire included 14 questions that were intended to explore if using the AI rehabilitation system may (1) increase time spent on therapeutic exercise, (2) affect pain level (assessed by the 0-10 Numerical Pain Rating Scale), and (3) reduce the need for other interventions. Results: An increase in time spent on therapeutic exercise per day was observed. The median Numerical Pain Rating Scale scores were 6 (interquartile range [IQR] 5-8) before and 4 (IQR 3-6) after using the AI-embedded mobile app (95\% CI 1.18-1.81). A 3-point reduction was reported by the participants who used the AI-embedded mobile app for more than 6 months. Reduction in the usage of other interventions while using the AI-embedded mobile app was also reported. Conclusions: This study demonstrated the positive self-perceived beneficiary effect of using the AI-embedded mobile app to provide a personalized therapeutic exercise program. The positive results suggest that it at least warrants further study to investigate the physiological effect of the AI-embedded mobile app and how it compares with routine clinical care. ",
doi="10.2196/mhealth.8127",
url="http://mhealth.jmir.org/2018/11/e198/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30478019"
}


@Article{info:doi/10.2196/11031,
author="Backman, Chantal
and Harley, Anne
and Peyton, Liam
and Kuziemsky, Craig
and Mercer, Jay
and Monahan, Anne Mary
and Schmidt, Sandra
and Singh, Harvinder
and Gravelle, Deborah",
title="Development of a Path to Home Mobile App for the Geriatric Rehabilitation Program at Bruy{\`e}re Continuing Care: Protocol for User-Centered Design and Feasibility Testing Studies",
journal="JMIR Res Protoc",
year="2018",
month="Sep",
day="24",
volume="7",
number="9",
pages="e11031",
keywords="patient discharge",
keywords="care transition",
keywords="user-centered design",
keywords="geriatric rehabilitation",
keywords="mHealth",
keywords="transitional care",
keywords="rehabilitation",
keywords="health services for the aged",
keywords="telemedicine",
abstract="Background: As the population ages, the need for appropriate geriatric rehabilitation services will also increase. Pressures faced by hospitals to reduce length of stay and reduce costs have driven the need for more complex care being delivered in the home or community setting. As a result, a multifaceted approach that can provide geriatric rehabilitation patients with safe and effective person- and family-centered care during transitions from hospital to home is required. We hypothesize that a technology-supported person- and family-centered care transition could empower geriatric rehabilitation patients, engage them in shared decision making, and ultimately help them to safely manage their personalized needs during care transitions from hospital to home. Objective: The purpose of this study is to design and test the feasibility of a novel Path to Home mobile app to manage the personalized needs of geriatric rehabilitation patients during their transitions from hospital to home. Methods: This study will consist of (1) codesigning a patient- and provider-tailored mobile app, and (2) feasibility pilot testing of the mobile app to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we will follow a user-centered design process integrated with a modern agile software development methodology to iteratively codesign the personalized care transition Path to Home mobile app. In phase 2, we will conduct a single-arm feasibility pilot test with geriatric rehabilitation patients using the personalized care transition Path to Home mobile app to manage their needs during the transition from hospital to home. Results: The project was funded in May 2018, and enrollment and data analysis are underway. First results are expected to be submitted for publication in 2019. Conclusions: Our findings will help validate the use of this technology for geriatric rehabilitation patients discharged from the hospital to home. Future research will more rigorously evaluate the health and economic benefits to inform wide-scale adoption of the technology. Registered Report Identifier: RR1-10.2196/11031 ",
doi="10.2196/11031",
url="http://www.researchprotocols.org/2018/9/e11031/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249591"
}


@Article{info:doi/10.2196/mhealth.8256,
author="Selter, Aliza
and Tsangouri, Christina
and Ali, B. Sana
and Freed, Diana
and Vatchinsky, Adrian
and Kizer, James
and Sahuguet, Arnaud
and Vojta, Deneen
and Vad, Vijay
and Pollak, JP
and Estrin, Deborah",
title="An mHealth App for Self-Management of Chronic Lower Back Pain (Limbr): Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Sep",
day="17",
volume="6",
number="9",
pages="e179",
keywords="low back pain",
keywords="chronic disease",
keywords="self-assessment",
keywords="telemedicine",
keywords="self-management",
keywords="activities of daily living",
keywords="pain",
keywords="rehabilitation",
abstract="Background: Although mobile health (mHealth) interventions can help improve outcomes among patients with chronic lower back pain (CLBP), many available mHealth apps offer content that is not evidence based. Limbr was designed to enhance self-management of CLBP by packaging self-directed rehabilitation tutorial videos, visual self-report tools, remote health coach support, and activity tracking into a suite of mobile phone apps, including Your Activities of Daily Living, an image-based tool for quantifying pain-related disability. Objective: The aim is to (1) describe patient engagement with the Limbr program, (2) describe patient-perceived utility of the Limbr program, and (3) assess the validity of the Your Activities of Daily Living module for quantifying functional status among patients with CLBP. Methods: This was a single-arm trial utilizing a convenience sample of 93 adult patients with discogenic back pain who visited a single physiatrist from January 2016 to February 2017. Eligible patients were enrolled in 3-month physical therapy program and received the Limbr mobile phone app suite for iOS or Android. The program included three daily visual self-reports to assess pain, activity level, and medication/coping mechanisms; rehabilitation video tutorials; passive activity-level measurement; and chat-based health coaching. Patient characteristics, patient engagement, and perceived utility were analyzed descriptively. Associations between participant characteristics and program interaction were analyzed using multiple linear regression. Associations between Your Activities of Daily Living and Oswestry Disability Index (ODI) assessments were examined using Pearson correlation and hierarchical linear modeling. Results: A total of 93 participants were enrolled; of these, 35 (38\%) completed the program (age: mean 46, SD 16 years; female: 22/35, 63\%). More than half of completers finished assessments at least every 3 days and 70\% (19/27) used the rehabilitation component at least once a week. Among respondents to a Web-based feedback survey, 76\% (16/21) found the daily notifications helped them remember to complete their exercises, 81\% (17/21) found the system easy to use, and 62\% (13/21) rated their overall experience good or excellent. Baseline Your Activities of Daily Living score was a significant predictor of baseline ODI score, with ODI increasing by 0.30 units for every 1-unit increase in Your Activities of Daily Living (P<.001). Similarly, hierarchical linear modeling analysis indicated that Your Activities of Daily Living daily assessment scores were significant predictors of ODI scores over the course of the study (P=.01). Conclusions: Engagement among participants who completed the Limbr program was high, and program utility was rated positively by most respondents. Your Activities of Daily Living was significantly associated with ODI scores, supporting the validity of this novel tool. Future studies should assess the effect of Limbr on clinical outcomes, evaluate its use among a wider patient sample, and explore strategies for reducing attrition. Trial Registration: ClinicalTrials.gov NCT03040310; https://clinicaltrials.gov/ct2/show/NCT03040310 (Archived by WebCite at http://www.webcitation.org/722mEvAiv) ",
doi="10.2196/mhealth.8256",
url="http://mhealth.jmir.org/2018/9/e179/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30224333"
}


@Article{info:doi/10.2196/10092,
author="Mueller, E. Nora
and Panch, Trishan
and Macias, Cathaleene
and Cohen, M. Bruce
and Ongur, Dost
and Baker, T. Justin",
title="Using Smartphone Apps to Promote Psychiatric Rehabilitation in a Peer-Led Community Support Program: Pilot Study",
journal="JMIR Ment Health",
year="2018",
month="Aug",
day="15",
volume="5",
number="3",
pages="e10092",
keywords="psychosis",
keywords="smartphone",
keywords="app",
abstract="Background: Management of severe and persistent mental illness is a complex, resource-intensive challenge for individuals, their families, treaters, and the health care system at large. Community-based rehabilitation, in which peer specialists provide support for individuals managing their own condition, has demonstrated effectiveness but has only been implemented in specialty centers. It remains unclear how the peer-based community rehabilitation model could be expanded, given that it requires significant resources to both establish and maintain. Objective: Here, we describe the results from a study of one such program implemented within Waverley Place, a community support program at McLean Hospital, emphasizing psychiatric rehabilitation for individuals with severe and persistent mental illness, as well as describing the challenges encountered during the implementation of the program. Key questions were whether the patients could, and would, successfully use the app. Methods: The smartphone app offered multiple features relevant to psychiatric rehabilitation, including daily task lists, activity tracking, and text messaging with peer specialists. A 90-day program of activities, goals, and content specific to the community support program was created on the basis of a prior pilot, in collaboration between members of the app development team (WellFrame), and peers, clinical, and research staff associated with the program. Hospital research staff recruited patients into the study, monitored peer and patient engagement, and handled all raw data acquired from the study. Results: Of 100 people approached for the study, a total of 13 provided consent, of which 10 downloaded and used the app. Two patients were unable to complete the app installation. Five used the app regularly as part of their daily lives for at least 20 days of the 90-day program. We were unable to identify any specific factors (eg, clinical or demographic) that affected willingness to consent or engage with the app platform in the very limited sample, although the individuals with significant app use were generally satisfied with the experience. Conclusions: Smartphone apps may become a useful tool for psychiatric rehabilitation, addressing both psychiatric and co-occurring medical problems. Individualizing functions to each patient and facilitating connection with a certified peer specialist may be an important feature of useful apps. Unlike prior reports emphasizing that patients with schizophrenia will adopt smartphone platforms, we found that implementation of digital tools into existing community support programs for severe and persistent mental illness has many challenges yet to be fully overcome to realize the potential benefits such apps could have to promote systematization and cost reduction for psychiatric rehabilitation. ",
doi="10.2196/10092",
url="http://mental.jmir.org/2018/3/e10092/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30111526"
}


@Article{info:doi/10.2196/jmir.9739,
author="Vugts, AP Miel
and Joosen, CW Margot
and Mert, Agali
and Zedlitz, ME Aglaia
and Vrijhoef, JM Hubertus",
title="Effectiveness of Serious Gaming During the Multidisciplinary Rehabilitation of Patients With Complex Chronic Pain or Fatigue: Natural Quasi-Experiment",
journal="J Med Internet Res",
year="2018",
month="Aug",
day="15",
volume="20",
number="8",
pages="e250",
keywords="behavioral intervention",
keywords="chronic pain",
keywords="serious games",
keywords="musculoskeletal disease",
keywords="rehabilitation",
keywords="therapy",
abstract="Background: Current evidence for the effectiveness of specialist multidisciplinary programs for burdensome chronic pain and functional somatic syndromes drives the effort to improve approaches, strategies, and delivery modes. It remains unknown to what extent and in what respect serious gaming during the regular outpatient rehabilitation can contribute to health outcomes. Objective: The objectives of our study were to determine the effect of additional serious gaming on (1) physical and emotional functioning in general; (2) particular outcome domains; and (3) patient global impressions of change, general health, and functioning and to determine (4) the dependency of serious gaming effects on adherence. Methods: We conducted a naturalistic quasi-experiment using embedded qualitative methods. The intervention group patients received an additional guided (mindfulness-based) serious gaming intervention during weeks 9-12 of a 16-week rehabilitation program at 2 sites of a Dutch rehabilitation clinic. Simultaneously, 119 control group patients followed the same program without serious gaming at 2 similar sites of the same clinic. Data consisted of 10 semistructured patient interviews and routinely collected patient self-reported outcomes. First, multivariate linear mixed modeling was used to simultaneously estimate a group effect on the outcome change between weeks 8 and 16 in 4 primary outcomes: current pain intensity, fatigue, pain catastrophizing, and psychological distress. Second, similar univariate linear mixed models were used to estimate effects on particular (unstandardized) outcomes. Third, secondary outcomes (ie, global impression of change, general health, functioning, and treatment satisfaction) were compared between the groups using independent t tests. Finally, subgroups were established according to the levels of adherence using log data. Influences of observed confounding factors were considered throughout analyses. Results: Of 329 eligible patients, 156 intervention group and 119 control group patients (N=275) with mostly chronic back pain and concomitant psychosocial problems participated in this study. Of all, 119 patients played ?75\% of the game. First, the standardized means across the 4 primary outcomes showed a significantly more favorable degree of change during the second part of the treatment for the intervention group than for the control group (beta=?0.119, SE=0.046, P=.009). Second, the intervention group showed a greater outcome change in depressive mood (b=?2.748, SE=1.072, P=.011) but not in ``insufficiency'' or concentration problems. Third, no significant group effects on secondary outcomes were found. Fourth, adherence was generally high and invariant. Conclusions: The findings of this study suggest a very small favorable average effect on relevant health outcomes of additional serious gaming during multidisciplinary rehabilitation. The indication that serious gaming could be a relatively time-efficient component warrants further research into if, when, how, and for which patients serious gaming could be cost-effective in treatment and why. Trial Registration: Netherlands Trial Registry NTR6020; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6020 (Archived by WebCite at http://www.webcitation.org/71IIoTXkj) ",
doi="10.2196/jmir.9739",
url="http://www.jmir.org/2018/8/e250/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30111527"
}


@Article{info:doi/10.2196/rehab.8638,
author="van Reijen, Miriam
and Asscheman, Marianne
and Vriend, Ingrid
and van Mechelen, Willem
and Verhagen, Evert",
title="Users' Perspectives, Opportunities, and Barriers of the Strengthen Your Ankle App for Evidence-Based Ankle Sprain Prevention: Mixed-Methods Process Evaluation for a Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Jul",
day="06",
volume="5",
number="2",
pages="e13",
keywords="injury prevention",
keywords="ankle injury",
keywords="eHealth",
keywords="qualitative analysis",
keywords="process evaluation",
abstract="Background: The ``Strengthen Your Ankle'' neuromuscular training program has been thoroughly studied over the past 8 years. This process evaluation is a part of a randomized controlled trial that examined both the short- and long-term effectiveness of this particular program. Although it was shown previously that the program, available both in a printed booklet and as a mobile app, is able to effectively reduce the number of recurrent ankle sprains, participants' compliance with the program is an ongoing challenge. Objective: This process evaluation explored participants' opinions regarding both the methods of delivery, using RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) Framework to identify barriers and challenges to program compliance. Although Reach, Effectiveness, and Adaptation were the focus of a previous study, this paper focuses on the implementation and maintenance phases. Methods: Semistructured interviews and online questionnaires were analyzed using qualitative content analysis. Fisher exact, chi-square, and t tests assessed between-group differences in quantitative survey responses. Interviews were assessed by thematic analysis to identify key themes. Results: While there were no significant differences in the perceived simplicity, usefulness, and liking of the exercise during the 8 weeks of the neuromuscular training program, semistructured interviews showed that 14 of 16 participants agreed that an app would be of additional benefits over a booklet. After the 12-month follow-up, when asked how they evaluated the overall use of the app or the booklet, the users of the app gave a mean score of 7.7 (SD 0.99) versus a mean score 7.1 (SD 1.23) for the users of the booklet. This difference in mean score was significant (P=.006). Conclusions: Although both the app and booklet showed a high user satisfaction, the users of the app were significantly more satisfied. Semistructured questionnaires allowed users to address issues they would like to improve in future updates. Including a possibility for feedback and postponement of exercises, an explanation of the use of specific exercises and possibly music were identified as features that might further improve the contentment of the program, probably leading to increased compliance. Trial Registration: Netherlands Trial Register NTR4027; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4027 (Archived by Webcite at http://www.webcitation.org/70MTo9dMV) ",
doi="10.2196/rehab.8638",
url="http://rehab.jmir.org/2018/2/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29980497"
}


@Article{info:doi/10.2196/cardio.9424,
author="Zhang, Ling
and Ding, Ding
and Neubeck, Lis
and Gallagher, Patrick
and Paull, Glenn
and Gao, Yan
and Gallagher, Robyn",
title="Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study",
journal="JMIR Cardio",
year="2018",
month="Jun",
day="26",
volume="2",
number="1",
pages="e13",
keywords="cultural and linguistic diverse",
keywords="cardiac rehabilitation",
keywords="technology",
keywords="mobile technology",
keywords="information technology",
abstract="Background: Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined. Objective: This study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above. Methods: This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use. Results: `Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3\% (48/90) male. The majority (82/90, 91.1\%) used at least one technology device, with 87.8\% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3\%), tablets (28/90, 31.1\%), and text/voice-only phones (24/90, 26.7\%). More English-speaking participants used computers than Mandarin or ``other'' language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with ``other'' language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9\%), text message (54/82, 65.9\%), the internet (39/82, 47.6\%), email (36/82, 43.9\%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7\%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95\% CI 1.262-41.522; P=.03, OR 0.089, 95\% CI 0.016-0.490; P=.006 and OR 0.191, 95\% CI 0.037-0.984; P=.05). Conclusions: This study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR. ",
doi="10.2196/cardio.9424",
url="http://cardio.jmir.org/2018/1/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758767"
}


@Article{info:doi/10.2196/10422,
author="Clement, Innocent
and Lorenz, Andreas
and Ulm, Bernhard
and Plidschun, Anne
and Huber, Stephan",
title="Implementing Systematically Collected User Feedback to Increase User Retention in a Mobile App for Self-Management of Low Back Pain: Retrospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="06",
volume="6",
number="6",
pages="e10422",
keywords="low back pain",
keywords="app",
keywords="mHealth",
keywords="retrospective cohort study",
keywords="self-management",
keywords="user feedback",
keywords="quality management",
keywords="usability",
abstract="Background: Promising first results for Kaia, a mobile app digitalizing multidisciplinary rehabilitation for low back pain, were recently published. It remains unclear whether the implementation of user feedback in an updated version of this app leads to desired effects in terms of increased app usage and clinical outcomes. Objective: The aim is to elucidate the effect on user retention and clinical outcomes of an updated version of the Kaia app where user feedback was included during development. Methods: User feedback of the initial app versions (0.x) was collected in a quality management system and systematically analyzed to define requirements of a new version. For this study, the anonymized data of Kaia users was analyzed retrospectively and users were grouped depending on the available version at the time of the sign-up (0.x vs 1.x). The effect on the duration of activity of users in the app, the number of completed exercises of each type, and user-reported pain levels were compared. Results: Overall, data of 1251 users fulfilled the inclusion criteria, of which 196 users signed up using version 0.x and 1055 users signed up with version 1.x. There were significant differences in the demographic parameters for both groups. A log-rank test showed no significant differences for the duration of activity in the app between groups (P=.31). Users signing up during availability of the 1.x version completed significantly more exercises of each type in the app (physical exercises: 0.x mean 1.99, SD 1.61 units/week vs 1.x mean 3.15, SD1.72 units/week; P<.001; mindfulness exercises: 0.x mean 1.36, SD 1.43 units/week vs 1.x mean 2.42, SD 1.82 units/week; P<.001; educational content: 0.x mean 1.51, SD 1.42 units/week vs 1.x mean 2.71, SD 1.89 units/week; P<.001). This translated into a stronger decrease in user-reported pain levels in versions 1.x (F1,1233=7.084, P=.008). Conclusions: Despite the limitations of retrospective cohort studies, this study indicates that the implementation of systematically collected user feedback during development of updated versions can contribute to improvements in terms of frequency of use and potentially even clinical endpoints such as pain level. The clinical efficiency of the Kaia app needs to be validated in prospective controlled trials to exclude bias. ",
doi="10.2196/10422",
url="http://mhealth.jmir.org/2018/6/e10422/"
}


@Article{info:doi/10.2196/10181,
author="Thirumalai, Mohanraj
and Rimmer, H. James
and Johnson, George
and Wilroy, Jereme
and Young, Hui-Ju
and Mehta, Tapan
and Lai, Byron",
title="TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="24",
volume="6",
number="5",
pages="e10181",
keywords="multiple sclerosis",
keywords="exercise",
keywords="therapy",
keywords="mHealth",
keywords="user-centered design",
abstract="Background: People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective: This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods: Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results: During testing of the app's effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53\% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions: A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis). ",
doi="10.2196/10181",
url="http://mhealth.jmir.org/2018/5/e10181/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29798832"
}


@Article{info:doi/10.2196/rehab.7805,
author="Marziniak, Martin
and Brichetto, Giampaolo
and Feys, Peter
and Meyding-Lamad{\'e}, Uta
and Vernon, Karen
and Meuth, G. Sven",
title="The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Apr",
day="24",
volume="5",
number="1",
pages="e5",
keywords="communication",
keywords="eHealth",
keywords="technology",
keywords="multiple sclerosis",
keywords="telehealth",
keywords="telemedicine",
keywords="telerehabilitation",
doi="10.2196/rehab.7805",
url="http://rehab.jmir.org/2018/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29691208"
}


@Article{info:doi/10.2196/mhealth.8518,
author="Argent, Rob
and Daly, Ailish
and Caulfield, Brian",
title="Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence?",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="01",
volume="6",
number="3",
pages="e47",
keywords="patient compliance",
keywords="rehabilitation",
keywords="exercise therapy",
keywords="biomedical technology",
keywords="review",
doi="10.2196/mhealth.8518",
url="https://mhealth.jmir.org/2018/3/e47/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29496655"
}


@Article{info:doi/10.2196/mhealth.8388,
author="Han, Hui
and Zhang, Ying Jing
and Hser, Yih-Ing
and Liang, Di
and Li, Xu
and Wang, Shan Shan
and Du, Jiang
and Zhao, Min",
title="Feasibility of a Mobile Phone App to Support Recovery From Addiction in China: Secondary Analysis of a Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Feb",
day="27",
volume="6",
number="2",
pages="e46",
keywords="mHealth",
keywords="substance use",
keywords="heroin dependence",
keywords="amphetamine-type stimulant (ATS) dependence",
keywords="mobile app",
keywords="China",
abstract="Background: Mobile health technologies have been found to improve the self-management of chronic diseases. However, there is limited research regarding their feasibility in supporting recovery from substance use disorders (SUDs) in China. Objective: The objective of this study was to examine the feasibility of a mobile phone-based ecological momentary assessment (EMA) app by testing the concordance of drug use assessed by the EMA, urine testing, and a life experience timeline (LET) assessment. Methods: A total of 75 participants dependent on heroin or amphetamine-type stimulant (ATS) in Shanghai were recruited to participate in a 4-week pilot study. Of the participants, 50 (67\% [50/75]) were randomly assigned to the experimental group and 25 (33\% [25/75]) were assigned to the control group. The experimental group used mobile health (mHealth) based EMA technology to assess their daily drug use in natural environments and received 2 short health messages each day, whereas the control group only received 2 short health messages each day from the app. Urine tests and LET assessments were conducted each week and a post-intervention survey was administered to both groups. The correlations among the EMA, the LET assessment, and the urine test were investigated. Results: The mean age of the participants was 41.6 (SD 8.0) years, and 71\% (53/75) were male. During the 4 weeks of observation, 690 daily EMA survey data were recorded, with a response rate of 49.29\% (690/1400). With respect to drug use, the percent of agreement between the EMA and the LET was 66.7\%, 79.2\%, 72.4\%, and 85.8\%, respectively, for each of the 4 weeks, whereas the percent of agreement between the EMA and the urine test was 51.2\%, 65.1\%, 61.9\%, and 71.5\%, respectively. The post-intervention survey indicated that 46\% (32/70) of the participants preferred face-to-face interviews rather than the mHealth app. Conclusions: This study demonstrated poor agreement between the EMA data and the LET and found that the acceptance of mHealth among individuals with SUDs in China was not positive. Hence, greater efforts are needed to improve the feasibility of mHealth in China. ",
doi="10.2196/mhealth.8388",
url="http://mhealth.jmir.org/2018/2/e46/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29487040"
}


@Article{info:doi/10.2196/mhealth.8815,
author="Manor, Brad
and Yu, Wanting
and Zhu, Hao
and Harrison, Rachel
and Lo, On-Yee
and Lipsitz, Lewis
and Travison, Thomas
and Pascual-Leone, Alvaro
and Zhou, Junhong",
title="Smartphone App--Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jan",
day="30",
volume="6",
number="1",
pages="e36",
keywords="smartphone",
keywords="gait assessment",
keywords="pocket",
keywords="dual task",
keywords="validity",
keywords="reliability",
keywords="mobile applications",
abstract="Background: Walking is a complex cognitive motor task that is commonly completed while performing another task such as talking or making decisions. Gait assessments performed under normal and ``dual-task'' walking conditions thus provide important insights into health. Such assessments, however, are limited primarily to laboratory-based settings. Objective: The objective of our study was to create and test a smartphone-based assessment of normal and dual-task walking for use in nonlaboratory settings. Methods: We created an iPhone app that used the phone's motion sensors to record movements during walking under normal conditions and while performing a serial-subtraction dual task, with the phone placed in the user's pants pocket. The app provided the user with multimedia instructions before and during the assessment. Acquired data were automatically uploaded to a cloud-based server for offline analyses. A total of 14 healthy adults completed 2 laboratory visits separated by 1 week. On each visit, they used the app to complete three 45-second trials each of normal and dual-task walking. Kinematic data were collected with the app and a gold-standard--instrumented GAITRite mat. Participants also used the app to complete normal and dual-task walking trials within their homes on 3 separate days. Within laboratory-based trials, GAITRite-derived heel strikes and toe-offs of the phone-side leg aligned with smartphone acceleration extrema, following filtering and rotation to the earth coordinate system. We derived stride times---a clinically meaningful metric of locomotor control---from GAITRite and app data, for all strides occurring over the GAITRite mat. We calculated stride times and the dual-task cost to the average stride time (ie, percentage change from normal to dual-task conditions) from both measurement devices. We calculated similar metrics from home-based app data. For these trials, periods of potential turning were identified via custom-developed algorithms and omitted from stride-time analyses. Results: Across all detected strides in the laboratory, stride times derived from the app and GAITRite mat were highly correlated (P<.001, r2=.98). These correlations were independent of walking condition and pocket tightness. App- and GAITRite-derived stride-time dual-task costs were also highly correlated (P<.001, r2=.95). The error of app-derived stride times (mean 16.9, SD 9.0 ms) was unaffected by the magnitude of stride time, walking condition, or pocket tightness. For both normal and dual-task trials, average stride times derived from app walking trials demonstrated excellent test-retest reliability within and between both laboratory and home-based assessments (intraclass correlation coefficient range .82-.94). Conclusions: The iPhone app we created enabled valid and reliable assessment of stride timing---with the smartphone in the pocket---during both normal and dual-task walking and within both laboratory and nonlaboratory environments. Additional work is warranted to expand the functionality of this tool to older adults and other patient populations. ",
doi="10.2196/mhealth.8815",
url="http://mhealth.jmir.org/2018/1/e36/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29382625"
}


@Article{info:doi/10.2196/humanfactors.8017,
author="Beatty, L. Alexis
and Magnusson, L. Sara
and Fortney, C. John
and Sayre, G. George
and Whooley, A. Mary",
title="VA FitHeart, a Mobile App for Cardiac Rehabilitation: Usability Study",
journal="JMIR Hum Factors",
year="2018",
month="Jan",
day="15",
volume="5",
number="1",
pages="e3",
keywords="cardiac rehabilitation",
keywords="mobile applications",
keywords="exercise therapy",
keywords="exercise",
keywords="rehabilitation research",
keywords="telemedicine",
keywords="habits",
keywords="qualitative research",
abstract="Background: Cardiac rehabilitation (CR) improves outcomes for patients with ischemic heart disease or heart failure but is underused. New strategies to improve access to and engagement in CR are needed. There is considerable interest in technology-facilitated home CR. However, little is known about patient acceptance and use of mobile technology for CR. Objective: The aim of this study was to develop a mobile app for technology-facilitated home CR and seek to determine its usability. Methods: We recruited patients eligible for CR who had access to a mobile phone, tablet, or computer with Internet access. The mobile app includes physical activity goal setting, logs for tracking physical activity and health metrics (eg, weight, blood pressure, and mood), health education, reminders, and feedback. Study staff demonstrated the mobile app to participants in person and then observed participants completing prespecified tasks with the mobile app. Participants completed the System Usability Scale (SUS, 0-100), rated likelihood to use the mobile app (0-100), questionnaires on mobile app use, and participated in a semistructured interview. The Unified Theory of Acceptance and Use of Technology and the Theory of Planned Behavior informed the analysis. On the basis of participant feedback, we made iterative revisions to the mobile app between users. Results: We conducted usability testing in 13 participants. The first version of the mobile app was used by the first 5 participants, and revised versions were used by the final 8 participants. From the first version to revised versions, task completion success rate improved from 44\% (11/25 tasks) to 78\% (31/40 tasks; P=.05), SUS improved from 54 to 76 (P=.04; scale 0-100, with 100 being the best usability), and self-reported likelihood of use remained high at 76 and 87 (P=.30; scale 0-100, with 100 being the highest likelihood). In interviews, patients expressed interest in tracking health measures (``I think it'll be good to track my exercise and to see what I'm doing''), a desire for introductory training (``Initially, training with a technical person, instead of me relying on myself''), and an expectation for sharing data with providers (``It would also be helpful to share with my doctor, it just being a matter of clicking a button and sharing it with my doctor''). Conclusions: With participant feedback and iterative revisions, we significantly improved the usability of a mobile app for CR. Patient expectations for using a mobile app for CR include tracking health metrics, introductory training, and sharing data with providers. Iterative mixed-method evaluation may be useful for improving the usability of health technology. ",
doi="10.2196/humanfactors.8017",
url="http://humanfactors.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29335235"
}


@Article{info:doi/10.2196/humanfactors.8096,
author="Lau, YS Annie
and Piper, Kalman
and Bokor, Desmond
and Martin, Paige
and Lau, SL Victor
and Coiera, Enrico",
title="Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study",
journal="JMIR Hum Factors",
year="2017",
month="Dec",
day="07",
volume="4",
number="4",
pages="e31",
keywords="mobile application",
keywords="mobile health",
keywords="personal health record",
keywords="patients",
keywords="health services",
keywords="medical informatics",
keywords="surgery",
keywords="orthopedics",
keywords="shoulder",
keywords="rotator cuff",
keywords="rehabilitation",
abstract="Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective: The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods: A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results: Participant completion was low (47\%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions: Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians. ",
doi="10.2196/humanfactors.8096",
url="http://humanfactors.jmir.org/2017/4/e31/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29217504"
}


@Article{info:doi/10.2196/rehab.9032,
author="Huber, Stephan
and Priebe, A. Janosch
and Baumann, Kaja-Maria
and Plidschun, Anne
and Schiessl, Christine
and T{\"o}lle, R. Thomas",
title="Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results",
journal="JMIR Rehabil Assist Technol",
year="2017",
month="Dec",
day="04",
volume="4",
number="2",
pages="e11",
keywords="lower back pain",
keywords="app",
keywords="mHealth",
keywords="retrospective study",
keywords="self-management",
abstract="Background: Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. Objective: The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Methods: Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Results: Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective RCTs will adjust for potential bias and selection effects. ",
doi="10.2196/rehab.9032",
url="http://rehab.jmir.org/2017/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29203460"
}


@Article{info:doi/10.2196/mhealth.8656,
author="Adusumilli, Gautam
and Joseph, Eben Solomon
and Samaan, A. Michael
and Schultz, Brooke
and Popovic, Tijana
and Souza, B. Richard
and Majumdar, Sharmila",
title="iPhone Sensors in Tracking Outcome Variables of the 30-Second Chair Stand Test and Stair Climb Test to Evaluate Disability: Cross-Sectional Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="27",
volume="5",
number="10",
pages="e166",
keywords="osteoarthritis",
keywords="telemedicine",
keywords="mobile phone",
keywords="mobile apps",
keywords="algorithms",
keywords="medical informatics",
abstract="Background: Performance tests are important to characterize patient disabilities and functional changes. The Osteoarthritis Research Society International and others recommend the 30-second Chair Stand Test and Stair Climb Test, among others, as core tests that capture two distinct types of disability during activities of daily living. However, these two tests are limited by current protocols of testing in clinics. There is a need for an alternative that allows remote testing of functional capabilities during these tests in the osteoarthritis patient population. Objective: Objectives are to (1) develop an app for testing the functionality of an iPhone's accelerometer and gravity sensor and (2) conduct a pilot study objectively evaluating the criterion validity and test-retest reliability of outcome variables obtained from these sensors during the 30-second Chair Stand Test and Stair Climb Test. Methods: An iOS app was developed with data collection capabilities from the built-in iPhone accelerometer and gravity sensor tools and linked to Google Firebase. A total of 24 subjects performed the 30-second Chair Stand Test with an iPhone accelerometer collecting data and an external rater manually counting sit-to-stand repetitions. A total of 21 subjects performed the Stair Climb Test with an iPhone gravity sensor turned on and an external rater timing the duration of the test on a stopwatch. App data from Firebase were converted into graphical data and exported into MATLAB for data filtering. Multiple iterations of a data processing algorithm were used to increase robustness and accuracy. MATLAB-generated outcome variables were compared to the manually determined outcome variables of each test. Pearson's correlation coefficients (PCCs), Bland-Altman plots, intraclass correlation coefficients (ICCs), standard errors of measurement, and repeatability coefficients were generated to evaluate criterion validity, agreement, and test-retest reliability of iPhone sensor data against gold-standard manual measurements. Results: App accelerometer data during the 30-second Chair Stand Test (PCC=.890) and gravity sensor data during the Stair Climb Test (PCC=.865) were highly correlated to gold-standard manual measurements. Greater than 95\% of values on Bland-Altman plots comparing the manual data to the app data fell within the 95\% limits of agreement. Strong intraclass correlation was found for trials of the 30-second Chair Stand Test (ICC=.968) and Stair Climb Test (ICC=.902). Standard errors of measurement for both tests were found to be within acceptable thresholds for MATLAB. Repeatability coefficients for the 30-second Chair Stand Test and Stair Climb Test were 0.629 and 1.20, respectively. Conclusions: App-based performance testing of the 30-second Chair Stand Test and Stair Climb Test is valid and reliable, suggesting its applicability to future, larger-scale studies in the osteoarthritis patient population. ",
doi="10.2196/mhealth.8656",
url="http://mhealth.jmir.org/2017/10/e166/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29079549"
}


@Article{info:doi/10.2196/mhealth.8352,
author="Gallagher, Robyn
and Roach, Kellie
and Sadler, Leonie
and Glinatsis, Helen
and Belshaw, Julie
and Kirkness, Ann
and Zhang, Ling
and Gallagher, Patrick
and Paull, Glenn
and Gao, Yan
and Partridge, Ruth Stephanie
and Parker, Helen
and Neubeck, Lis",
title="Mobile Technology Use Across Age Groups in Patients Eligible for Cardiac Rehabilitation: Survey Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="24",
volume="5",
number="10",
pages="e161",
keywords="mobile phone",
keywords="cell phone",
keywords="digital divide",
keywords="cardiac rehabilitation",
keywords="cardiovascular disease",
abstract="Background: Emerging evidence indicates mobile technology--based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardiac patients' use of mobile technology, particularly for health reasons and whether the usage varies across patient demographics. Objective: This study aimed to describe cardiac patients' use of mobile technology and to determine variations between age groups after adjusting for education, employment, and confidence with using mobile technology. Methods: Cardiac patients eligible for attending cardiac rehabilitation were recruited from 9 hospital and community sites across metropolitan and rural settings in New South Wales, Australia. Participants completed a survey on the use of mobile technology devices, features used, confidence with using mobile technology, willingness and interest in learning, and health-related use. Results: The sample (N=282) had a mean age of 66.5 (standard deviation [SD] 10.6) years, 71.9\% (203/282) were male, and 79.0\% (223/282) lived in a metropolitan area. The most common diagnoses were percutaneous coronary intervention (33.3\%, 94/282) and myocardial infarction (22.7\%, 64/282). The majority (91.1\%, 257/282) used at least one type of technology device, 70.9\% (200/282) used mobile technology (mobile phone/tablet), and 31.9\% (90/282) used all types. Technology was used by 54.6\% (154/282) for health purposes, most often to access information on health conditions (41.4\%, 117/282) and medications (34.8\%, 98/282). Age had an important independent association with the use of mobile technology after adjusting for education, employment, and confidence. The youngest group (<56 years) was over 4 times more likely to use any mobile technology than the oldest (>69 years) age group (odds ratio [OR] 4.45, 95\% CI 1.46-13.55), 5 times more likely to use mobile apps (OR 5.00, 95\% CI 2.01-12.44), and 3 times more likely to use technology for health-related reasons (OR 3.31, 95\% CI 1.34-8.18). Compared with the older group, the middle age group (56-69 years) was more than twice as likely to use any mobile technology (OR 2.42, 95\% CI 1.27-4.59) and mobile technology for health-related purposes (OR 1.92, 95\% CI 1.04-3.53). Participants who had completed high school were twice as likely to use mobile technology (OR 2.62, 95\% CI 1.45-4.70), mobile apps (OR 2.05, 95\% CI 1.09-3.84), and mobile technology for health-related reasons (OR 5.09, 95\% CI 2.89-8.95) than those who had not completed high school. Associations were also present between participants living in metropolitan areas and mobile technology use (OR 1.07, 95\% CI 1.07-4.24) and employment and mobile app use (OR 2.72, 95\% CI 1.44-5.140). Conclusions: Mobile technology offers an important opportunity to improve access to secondary prevention for cardiac patients, particularly when modified to suit subgroups. High levels of mobile technology use and health motivation need to be harnessed for secondary prevention. ",
doi="10.2196/mhealth.8352",
url="http://mhealth.jmir.org/2017/10/e161/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29066425"
}


@Article{info:doi/10.2196/mhealth.8201,
author="Shawen, Nicholas
and Lonini, Luca
and Mummidisetty, Krishna Chaithanya
and Shparii, Ilona
and Albert, V. Mark
and Kording, Konrad
and Jayaraman, Arun",
title="Fall Detection in Individuals With Lower Limb Amputations Using Mobile Phones: Machine Learning Enhances Robustness for Real-World Applications",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="11",
volume="5",
number="10",
pages="e151",
keywords="fall detection",
keywords="lower limb amputation",
keywords="mobile phones",
keywords="machine learning",
abstract="Background: Automatically detecting falls with mobile phones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is beneficial for populations that are prone to falling, such as people with lower limb amputations. Prior studies have focused on fall detection in able-bodied individuals using data from a laboratory setting. Such approaches may provide a limited ability to detect falls in amputees and in real-world scenarios. Objective: The aim was to develop a classifier that uses data from able-bodied individuals to detect falls in individuals with a lower limb amputation, while they freely carry the mobile phone in different locations and during free-living. Methods: We obtained 861 simulated indoor and outdoor falls from 10 young control (non-amputee) individuals and 6 individuals with a lower limb amputation. In addition, we recorded a broad database of activities of daily living, including data from three participants' free-living routines. Sensor readings (accelerometer and gyroscope) from a mobile phone were recorded as participants freely carried it in three common locations---on the waist, in a pocket, and in the hand. A set of 40 features were computed from the sensors data and four classifiers were trained and combined through stacking to detect falls. We compared the performance of two population-specific models, trained and tested on either able-bodied or amputee participants, with that of a model trained on able-bodied participants and tested on amputees. A simple threshold-based classifier was used to benchmark our machine-learning classifier. Results: The accuracy of fall detection in amputees for a model trained on control individuals (sensitivity: mean 0.989, 1.96*standard error of the mean [SEM] 0.017; specificity: mean 0.968, SEM 0.025) was not statistically different (P=.69) from that of a model trained on the amputee population (sensitivity: mean 0.984, SEM 0.016; specificity: mean 0.965, SEM 0.022). Detection of falls in control individuals yielded similar results (sensitivity: mean 0.979, SEM 0.022; specificity: mean 0.991, SEM 0.012). A mean 2.2 (SD 1.7) false alarms per day were obtained when evaluating the model (vs mean 122.1, SD 166.1 based on thresholds) on data recorded as participants carried the phone during their daily routine for two or more days. Machine-learning classifiers outperformed the threshold-based one (P<.001). Conclusions: A mobile phone-based fall detection model can use data from non-amputee individuals to detect falls in individuals walking with a prosthesis. We successfully detected falls when the mobile phone was carried across multiple locations and without a predetermined orientation. Furthermore, the number of false alarms yielded by the model over a longer period of time was reasonably low. This moves the application of mobile phone-based fall detection systems closer to a real-world use case scenario. ",
doi="10.2196/mhealth.8201",
url="http://mhealth.jmir.org/2017/10/e151/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29021127"
}


@Article{info:doi/10.2196/humanfactors.7196,
author="Vorrink, Sigrid
and Huisman, Chantal
and Kort, Helianthe
and Troosters, Thierry
and Lammers, Jan-Willem",
title="Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention",
journal="JMIR Hum Factors",
year="2017",
month="Sep",
day="19",
volume="4",
number="3",
pages="e20",
keywords="telemedicine",
keywords="self care",
keywords="physical therapists",
keywords="pulmonary disease, chronic obstructive",
abstract="Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their physiotherapists (PHTs) value an eHealth self-management intervention following a period of use. Objective: The study aimed to evaluate the perceptions of COPD patients and their PHTs as eHealth users. Methods: In this study, an eHealth self-management intervention (website and mobile phone app) aimed at stimulating physical activity (PA) in COPD patients was evaluated by its users (patients and PHTs). As participants in a randomized controlled trial (RCT), they were asked how they valued the eHealth intervention after 6 months' use. Interview requests were made to 33 PHTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analyzed in Excel (Microsoft). The interviews with the PHTs and text messages (short message service, SMS) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH). Results: A total of 60 patients with COPD filled out the questionnaire, and 24 PHTs were interviewed. The mobile phone app was used 89.0\% (160.2/180 days) (standard deviation [SD] 18.5) of the time by patients; 53\% (13/24) of PHTs reported low or no use. Patients scored the ease of use of the app 5.09 (SD 1.14) (on a 7-point scale). They found the presentation of the PA information in the app to be clear, insightful, and stimulating. All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients. Patients mostly sent informative, neutral messages concerning the PA goal, and PHTs sent mostly motivating, positive messages concerning the PA goal. Messages were not perceived as supportive in reaching the PA goal according to the patients. Perceived usefulness of the intervention for the PHTs was the objective measurement of PA, the ability to see PA patterns over time, and the ability to use the intervention as a tool to give their patients insight into their PA. For patients, it was that the intervention supported them in increasing their PA and that it made them feel fitter. Barriers to use of the intervention according to the PHTs were time constraints and financial reasons. Seventy-nine percent (19/24) of the PHTs and 58\% (35/60) of the patients mentioned they would be interested in using the intervention in the future. Conclusions: PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention. This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future. ",
doi="10.2196/humanfactors.7196",
url="http://humanfactors.jmir.org/2017/3/e20/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28928110"
}


@Article{info:doi/10.2196/mhealth.7335,
author="Dicianno, Edward Brad
and Henderson, Geoffrey
and Parmanto, Bambang",
title="Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="24",
volume="5",
number="7",
pages="e103",
keywords="goals",
keywords="self-care",
keywords="mobile health",
keywords="rehabilitation",
keywords="smartphone",
keywords="spinal cord injury",
keywords="spinal dysraphism",
abstract="Background: Goal-setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to (1) qualitatively analyze data from a wellness program for patients with spina bifida (SB) and spinal cord injury (SCI) in order to generate software requirements for a goal-setting module to support their complex goal-setting routines, (2) design a prototype of a goal-setting module within an existing mobile health (mHealth) system, and (3) identify what educational content might be necessary to integrate into the system. Methods: A total of 750 goals were analyzed from patients with SB and SCI enrolled in a wellness program. These goals were qualitatively analyzed in order to operationalize a set of software requirements for an mHealth goal-setting module and identify important educational content. Results: Those of male sex (P=.02) and with SCI diagnosis (P<.001) were more likely to achieve goals than females or those with SB. Temporality (P<.001) and type (P<.001) of goal were associated with likelihood that the goal would be achieved. Nearly all (210/213; 98.6\%) of the fact-finding goals were achieved. There was no significant difference in achievement based on goal theme. Checklists, data tracking, and fact-finding tools were identified as three functionalities that could support goal-setting and achievement in an mHealth system. Based on the qualitative analysis, a list of software requirements for a goal-setting module was generated, and a prototype was developed. Targets for educational content were also generated. Conclusions: Innovative mHealth tools can be developed to support commonly set goals by individuals with disabilities. ",
doi="10.2196/mhealth.7335",
url="http://mhealth.jmir.org/2017/7/e103/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28739558"
}


@Article{info:doi/10.2196/rehab.7085,
author="St{\"u}tz, Thomas
and Emsenhuber, Gerlinde
and Huber, Daniela
and Domhardt, Michael
and Tiefengrabner, Martin
and Oostingh, Janneke Gertie
and F{\"o}tschl, Ulrike
and Matis, Nicholas
and Ginzinger, Simon",
title="Mobile Phone--Supported Physiotherapy for Frozen Shoulder: Feasibility Assessment Based on a Usability Study",
journal="JMIR Rehabil Assist Technol",
year="2017",
month="Jul",
day="20",
volume="4",
number="2",
pages="e6",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="frozen shoulder",
keywords="adhesive capsulitis",
keywords="physiotherapy (techniques)",
keywords="home health aides",
keywords="mobile phone",
abstract="Background: Patients with frozen shoulder show limited shoulder mobility often accompanied by pain. Common treatment methods include physiotherapy, pain medication, administration of corticosteroids, and surgical capsulotomy. Frozen shoulder often lasts from months to years and mostly affects persons in the age group of 40 to 70 years. It severely reduces the quality of life and the ability to work. Objective: The objective of this study was to evaluate the feasibility of a mobile health (mHealth) intervention that supports patients affected by ``stage two'' frozen shoulder. Patients were supported with app-based exercise instructions and tools to monitor their training compliance and progress. These training compliance and progress data supplement the patients' oral reports to the physiotherapists and physicians and can assist them in therapy adjustment. Methods: In order to assess the feasibility of the mHealth intervention, a pilot study of a newly developed app for frozen shoulder patients was conducted with 5 patients for 3 weeks. The main function of the app was the instruction for exercising at home. Standardized questionnaires on usability such as System Usability Scale (SUS) and USE (Usefulness, Satisfaction, and Ease of use), and Technology Acceptance Model-2 (TAM-2) were completed by the study participants at the end of the study. Additionally, a nonstandardized questionnaire was completed by all patients. The correctness of the exercises as conducted by the patients was assessed by a physiotherapist at the end of the study. The mobility of the shoulder and pain in shoulder movement was assessed by a physiotherapist at the start and the end of the study. Results: The pilot study was successfully conducted, and the app was evaluated by the patients after 3 weeks. The results of the standardized questionnaires showed high acceptance (TAM-2) and high usability (SUS) of the developed app. The overall usability of the system as assessed by the SUS questionnaire was very good (an average score of 88 out of 100). The average score of the TAM-2 questionnaire on the intention to further use the app was 4.2 out of 5, which indicated that most patients would use the app if further available. The results of the USE questionnaires highlighted that the patients learned how to use the app easily (an average score of 4.2 out of 5) and were satisfied with the app (an average score of 4.7 out of 5). The frequency of app usage and training was very high based on patient reports and verified by analysis of the usage data. The patients conducted the exercises almost flawlessly. Conclusions: Our results indicate the feasibility of the mHealth intervention, as the app was easy to use and frequently used by the patients. The app supported the patients' physiotherapy by providing clear exercising instructions. ",
doi="10.2196/rehab.7085",
url="http://rehab.jmir.org/2017/2/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28729234"
}


@Article{info:doi/10.2196/mhealth.7863,
author="Li, C. Linda
and Sayre, C. Eric
and Xie, Hui
and Clayton, Cam
and Feehan, M. Lynne",
title="A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jun",
day="26",
volume="5",
number="6",
pages="e86",
keywords="osteoarthritis",
keywords="physical activity",
keywords="sedentary behavior",
keywords="sedentary lifestyle",
keywords="wearables",
keywords="digital technology",
keywords="fitness trackers",
keywords="exercise",
abstract="Background: Physical activity can improve health outcomes in people with knee osteoarthritis (OA); however, participation in physical activity is very low in this population. Objective: The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables (Fitbit Flex) and telephone counselling by a physical therapist (PT) for improving physical activity in people with a physician-confirmed diagnosis of knee OA, or who have passed 2 validated criteria for early OA.  Methods: We conducted a community-based feasibility randomized controlled trial. The immediate group (n=17) received a brief education session by a physical therapist, a Fitbit Flex activity tracker, and a weekly telephone call for activity counselling with the physical therapist. The delayed group (n=17) received the same intervention 1 month later. All participants were assessed at baseline (T0), and the end of 1 month (T1) and 2 months (T2). Outcomes were (1) mean moderate to vigorous physical activity time, (2) mean time spent on sedentary behavior, (3) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (4) Partners in Health Scale. Feasibility data were summarized with descriptive statistics. We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2, after adjusting for blocking and T0. We assessed planned contrasts of changes in outcome measures over measurement periods. Results: We identified 46 eligible individuals; of those, 34 (74\%) enrolled and no one dropped out. All but 1 participant adhered to the intervention protocol. We found a significant effect, with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group. The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale, favoring the delayed group. Conclusions: This study demonstrated the feasibility of a behavioral intervention, supported by the use of a wearable device, to promote physical activity among people with knee OA. Trial Registration: ClinicalTrials.gov NCT02313506; https://clinicaltrials.gov/ct2/show/NCT02313506 (Archived by WebCite at http://www.webcitation.org/6r4P3Bub0) ",
doi="10.2196/mhealth.7863",
url="http://mhealth.jmir.org/2017/6/e86/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28652228"
}


@Article{info:doi/10.2196/jmir.7385,
author="O'Brien, K. Megan
and Shawen, Nicholas
and Mummidisetty, K. Chaithanya
and Kaur, Saninder
and Bo, Xiao
and Poellabauer, Christian
and Kording, Konrad
and Jayaraman, Arun",
title="Activity Recognition for Persons With Stroke Using Mobile Phone Technology: Toward Improved Performance in a Home Setting",
journal="J Med Internet Res",
year="2017",
month="May",
day="25",
volume="19",
number="5",
pages="e184",
keywords="smartphone",
keywords="activities of daily living",
keywords="ambulatory monitoring",
keywords="machine learning",
keywords="stroke rehabilitation",
abstract="Background: Smartphones contain sensors that measure movement-related data, making them promising tools for monitoring physical activity after a stroke. Activity recognition (AR) systems are typically trained on movement data from healthy individuals collected in a laboratory setting. However, movement patterns change after a stroke (eg, gait impairment), and activities may be performed differently at home than in a lab. Thus, it is important to validate AR for gait-impaired stroke patients in a home setting for accurate clinical predictions. Objective: In this study, we sought to evaluate AR performance in a home setting for individuals who had suffered a stroke, by using different sets of training activities. Specifically, we compared AR performance for persons with stroke while varying the origin of training data, based on either population (healthy persons or persons with stoke) or environment (laboratory or home setting). Methods: Thirty individuals with stroke and fifteen healthy subjects performed a series of mobility-related activities, either in a laboratory or at home, while wearing a smartphone. A custom-built app collected signals from the phone's accelerometer, gyroscope, and barometer sensors, and subjects self-labeled the mobility activities. We trained a random forest AR model using either healthy or stroke activity data. Primary measures of AR performance were (1) the mean recall of activities and (2) the misclassification of stationary and ambulatory activities. Results: A classifier trained on stroke activity data performed better than one trained on healthy activity data, improving average recall from 53\% to 75\%. The healthy-trained classifier performance declined with gait impairment severity, more often misclassifying ambulatory activities as stationary ones. The classifier trained on in-lab activities had a lower average recall for at-home activities (56\%) than for in-lab activities collected on a different day (77\%). Conclusions: Stroke-based training data is needed for high quality AR among gait-impaired individuals with stroke. Additionally, AR systems for home and community monitoring would likely benefit from including at-home activities in the training data. ",
doi="10.2196/jmir.7385",
url="http://www.jmir.org/2017/5/e184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28546137"
}


@Article{info:doi/10.2196/mhealth.7184,
author="Lilje, Charlotta Stina
and Olander, Ewy
and Berglund, Johan
and Skillgate, Eva
and Anderberg, Peter",
title="Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Mar",
day="30",
volume="5",
number="3",
pages="e39",
keywords="text messages",
keywords="older adults",
keywords="recurrent low back pain",
keywords="manual therapy",
abstract="Background: Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients' experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. Objectives: The aim of this study was to explore older persons' common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. Methods: A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi's principles of psychological phenomenological analysis. Results: The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. Conclusions: It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed. ",
doi="10.2196/mhealth.7184",
url="http://mhealth.jmir.org/2017/3/e39/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28360026"
}


@Article{info:doi/10.2196/humanfactors.6481,
author="Alnosayan, Nagla
and Chatterjee, Samir
and Alluhaidan, Ala
and Lee, Edward
and Houston Feenstra, Linda",
title="Design and Usability of a Heart Failure mHealth System: A Pilot Study",
journal="JMIR Hum Factors",
year="2017",
month="Mar",
day="24",
volume="4",
number="1",
pages="e9",
keywords="mHealth",
keywords="telehealth",
keywords="heart failure",
keywords="human factors engineering",
keywords="self-management",
abstract="Background: Despite the advances in mobile health (mHealth) systems, little is known about patients' and providers' experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants' feedback on the system's design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users' satisfaction with the system ranked 73\%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users' experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes. ",
doi="10.2196/humanfactors.6481",
url="http://humanfactors.jmir.org/2017/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28341615"
}


@Article{info:doi/10.2196/rehab.6319,
author="Constantinescu, Gabriela
and Loewen, Irene
and King, Ben
and Brodt, Chris
and Hodgetts, William
and Rieger, Jana",
title="Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2017",
month="Mar",
day="24",
volume="4",
number="1",
pages="e3",
keywords="app design",
keywords="dysphagia",
keywords="games for health",
keywords="gamification",
keywords="head and neck cancer",
keywords="mHealth",
keywords="mobile health",
keywords="patient adherence",
keywords="patient engagement",
abstract="Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app. Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use. Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development. ",
doi="10.2196/rehab.6319",
url="http://rehab.jmir.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582245"
}