Gamification frameworks and models for health contexts: an integrative review

Objective: identify in the literature the state of the art of gamification frameworks and models developed for health contexts. Methods: an integrative literature review of articles indexed in the LILACS, SciELO, PubMed, CINAHL, Scopus and Web of Science databases, in english and published between January 2010 and July 2020. Results: among the 10 studies included in the analysis, nine were published in journals and one in conference proceedings. As well as 100% of the analyzed studies were published between the years 2015 and 2020. Thus, among the articles are studies related to three health contexts, where six frameworks and two models were identified. Conclusions: it is noteworthy that the main gap related to the development of gamification frameworks and models for health contexts is the validation process. As well as, the trend and the possibility of observing the use of participatory approaches in models and frameworks of gamification for some health contexts was evidenced

Home-based rehabilitation of the shoulder using auxiliary systems and artificial intelligence: an overview

Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.info:eu-repo/semantics/publishedVersio

Health-Enabling Technologies for Telerehabilitation of the Shoulder: A Feasibility and User Acceptance Study

BACKGROUND: After discharge from a rehabilitation center the continuation of therapy is necessary to secure already achieved healing progress and sustain (re-)integration into working life. To this end, home-based exercise programs are frequently prescribed. However, many patients do not perform their exercises as frequently as prescribed or even with incorrect movements. The telerehabilitation system AGT-Reha was developed to support patients with shoulder diseases during their home-based aftercare rehabilitation. OBJECTIVES: The presented pilot study AGT-Reha-P2 evaluates the technical feasibility and user acceptance of the home-based telerehabilitation system AGT-Reha. METHODS: A nonblinded, nonrandomized exploratory feasibility study was conducted over a 2-year period in patients' homes. Twelve patients completed a 3-month telerehabilitation exercise program with AGT-Reha. Primary outcome measures are the satisfying technical functionality and user acceptance assessed by technical parameters, structured interviews, and a four-dimensional questionnaire. Secondary endpoints are the medical rehabilitation success measured by the active range of motion and the shoulder function (pain and disability) assessed by employing the Neutral-0 Method and the standardized questionnaire "Shoulder Pain and Disability Index" (SPADI), respectively. To prepare an efficacy trial, various standardized questionnaires were included in the study to measure ability to work, capacity to work, and subjective prognosis of work capacity. The participants have been assessed at three measurement points: prebaseline (admission to rehabilitation center), baseline (discharge from rehabilitation center), and posttherapy. RESULTS: Six participants used the first version of AGT-Reha, while six other patients used an improved version. Despite minor technical problems, all participants successfully trained on their own with AGT-Reha at home. On average, participants trained at least once per day during their training period. Five of the 12 participants showed clinically relevant improvements of shoulder function (improved SPADI score > 11). The work-related parameters suggested a positive impact. All participants would recommend the system, ten participants would likely reuse it, and seven participants would have wanted to continue their use after 3 months. CONCLUSION: The findings show that home-based training with AGT-Reha is feasible and well accepted. Outcomes of SPADI indicate the effectiveness of aftercare with AGT-Reha. A controlled clinical trial to test this hypothesis will be conducted with a larger number of participants

Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data

Digital health applications in rehabilitation: Adherence and motivation by gamification

Bei der Entwicklung Digitaler Gesundheitsanwendungen (DiGA) sind eine Reihe rechtlicher, finanzieller und qualitativer Rahmenbedingungen zu berücksichtigen. Hinzu kommen organisatorische und technische Anforderungen zur Einbindung einer DiGA in Versorgungsprozesse. In Rehabilitationsprozessen spielt die Therapieadhärenz der Patienten eine wesentliche Rolle. Wie bereits vergangene Studien gezeigt haben, können diese durch den Einsatz von Spiel-Design-Elementen gesteigert werden. Die Auswahl, Kombination und das Design einzelner Spiele-Komponenten wirkt jedoch oftmals unüberlegt. Das Ziel dieser Dissertation ist es, einen ganzheitlichen Ansatz zur Entwicklung und Verbesserung von DiGA für die Rehabilitation zum Zweck der Adhärenzsteigerung durch Gamification zu erstellen und in der Praxis zu erproben. Um den Realitätsbezug des Ansatzes zu sichern, wurde das Krankheitsbild der Schulterläsionen als Anwendungsbeispiel genutzt. In acht Ebenen erfolgte die systematische Entwicklung des GISMOR-Ansatzes – ‘Gamification Increasing Motivation for Rehabilitation’. GISMOR unterstützt sowohl bei der Identifikation potentieller Adhärenzfaktoren (Patientenebene) als auch bei der adäquaten auf die Zielgruppe ausgerichteten Auswahl, Kombination und Umsetzung von Spiel-Design-Elementen (Gamificationebene). Dabei legt GISMOR besonderen Wert auf die Interaktion zwischen der DiGA und dem Patienten und stellt damit nicht nur die interaktive und visuelle Gestaltung des User Interface in den Vordergrund, sondern auch die resultierende User Experience (Interaktionsebene). Darüber hinaus gibt GISMOR den rechtlichen, finanziellen und qualitativen Rahmen für die Umsetzung abrechnungsfähiger DiGA vor (Dienstleistungsebene). Für den erfolgreichen Einsatz von DiGA liefert GISMOR weiterhin Anhaltspunkte zur Einbindung dieser in Rehabilitationsprozesse (Prozessebene) sowie zur Integration in transinstitutionelle Informationssystemarchitekturen (Informationssystemebene). Über den Anwendungsleitfaden zu GISMOR wird der entwickelte Ansatz schließlich in der Praxis einsetzbar. Als eigenständiges Dokument dient der Anwendungsleitfaden Softwareentwicklern, Medizininformatikern und Gesundheitsversorgern als Handlungshilfe zur Entwicklung und Verbesserung von DiGA sowie Medizinischen Assistenzsystemen. Am Beispiel des Telerehabilitationssystems AGT-Reha konnte dabei gezeigt werden, dass GISMOR sowohl für die Analyse als auch Ausarbeitung konkreter Maßnahmen zur Verbesserung einer DiGA geeignet ist.A number of legal, financial, and qualitative constraints must be considered in developing operational and billable digital health applications (DiGA). Furthermore, there are organizational and technical requirements for integrating DiGAs into care processes. In rehabilitation processes, patients' motivation and adherence are essential factors as well. Past studies have already shown that these can be increased through the use of game design elements. However, the selection, combination, and design of game components often seems rash. The objective of this thesis is to design and evaluate a holistic approach for developing and improving DiGAs in rehabilitation for the purpose of increasing motivation and adherence through gamification. Shoulder lesions were used as a consistent application example. The systematic development of GISMOR – ‘Gamification Increasing Motivation for Rehabilitation’ – was done in eight tiers. GISMOR supports both the identification of potential adherence factors (patient tier) and the adequate selection, combination, and implementation of game design elements aligned with the target group (gamification tier). GISMOR emphasizes the interaction between a DiGA and the patient, thus focusing not only on the interactive and visual design of the user interface, but also on the resulting user experience (interaction tier). In addition, GISMOR provides a legal, financial and qualitative framework for the implementation of billable DiGAs (service tier). For the successful use of DiGAs, GISMOR continues to provide guidance on how to embed them in rehabilitation processes (process tier) and how to integrate them into transinstitutional information system architectures (information system tier). By means of the GISMOR guide for use, the developed approach will finally be applicable in practice. As a stand-alone document, the User Guide serves software developers, medical informaticians, and healthcare providers as a reference for action in the development and improvement of DiGAs and Medical Assistance Systems. Using the telerehabilitation system AGT-Reha as an example, it could be shown that GISMOR is suitable for both the analysis and the development of concrete measures for the improvement of a DiGA

Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic

During the COVID-19 pandemic, the higher susceptibility of post-stroke patients to infection calls for extra safety precautions. Despite the imposed restrictions, early neurorehabilitation cannot be postponed due to its paramount importance for improving motor and functional recovery chances. Utilizing accessible state-of-the-art technologies, home-based rehabilitation devices are proposed as a sustainable solution in the current crisis. In this paper, a comprehensive review on developed home-based rehabilitation technologies of the last 10 years (2011–2020), categorizing them into upper and lower limb devices and considering both commercialized and state-of-the-art realms. Mechatronic, control, and software aspects of the system are discussed to provide a classified roadmap for home-based systems development. Subsequently, a conceptual framework on the development of smart and intelligent community-based home rehabilitation systems based on novel mechatronic technologies is proposed. In this framework, each rehabilitation device acts as an agent in the network, using the internet of things (IoT) technologies, which facilitates learning from the recorded data of the other agents, as well as the tele-supervision of the treatment by an expert. The presented design paradigm based on the above-mentioned leading technologies could lead to the development of promising home rehabilitation systems, which encourage stroke survivors to engage in under-supervised or unsupervised therapeutic activities

Smart Sensing Technologies for Personalised Coaching

People living in both developed and developing countries face serious health challenges related to sedentary lifestyles. It is therefore essential to find new ways to improve health so that people can live longer and can age well. With an ever-growing number of smart sensing systems developed and deployed across the globe, experts are primed to help coach people toward healthier behaviors. The increasing accountability associated with app- and device-based behavior tracking not only provides timely and personalized information and support but also gives us an incentive to set goals and to do more. This book presents some of the recent efforts made towards automatic and autonomous identification and coaching of troublesome behaviors to procure lasting, beneficial behavioral changes