An Investigation Into the Use of mHealth in Musculoskeletal Physiotherapy: Scoping Review

BACKGROUND: Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. OBJECTIVE: The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. METHODS: A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. RESULTS: Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. CONCLUSIONS: mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available

Usability of an Immersive Augmented Reality Based Telerehabilitation System with Haptics (ARTESH) for Synchronous Remote Musculoskeletal Examination

This study describes the features and utility of a novel augmented reality based telemedicine system with haptics that allows the sense of touch and direct physical examination during a synchronous immersive telemedicine consultation and physical examination. The system employs novel engineering features: (a) a new force enhancement algorithm to improve force rendering and overcoming the “just-noticeable-difference” limitation; (b) an improved force compensation method to reduce the delay in force rendering; (c) use of the “haptic interface point” to reduce disparity between the visual and haptic data; and (d) implementation of efficient algorithms to process, compress, decompress, transmit and render 3-D tele-immersion data. A qualitative pilot study (n=20) evaluated the usability of the system. Users rated the system on a 26-question survey using a seven-point Likert scale, with percent agreement calculated from the total users who agreed with a given statement. Survey questions fell into three main categories: (1) ease and simplicity of use, (2) quality of experience, and (3) comparison to in-person evaluation. Average percent agreements between the telemedicine and in-person evaluation were highest for ease and simplicity of use (86%) and quality of experience (85%), followed by comparison to in-person evaluation (58%). Eighty-nine percent (89%) of respondents expressed satisfaction with the overall quality of experience. Results suggest that the system was effective at conveying audio-visual and touch data in real-time across 20.3 miles, and warrants further development.

Enhancing Chronic Pain Management Motivational Interview Among Lower Back Pain Patients

Purpose: Untreated chronic pain is a nationwide epidemic affect individual physically, psychologically, and financially. Low back pain is the most common subset of chronic pain. Restricted clinic time and a focus on procedural/prescriptive methods for managing pain prohibits patient education regarding self-care, and formation of a relationship with the provider. Design: Article review yielded 20 articles that supported the use of motivational interviewing for chronic pain in lower back pain patients. They were evaluated for their strength of evidence on a scale of 1-6. One article was ranked level I as a meta-analysis, and six were ranked as level II which is randomized control trials. Methods: Implementation of monthly telephone follow-ups, guided by the 5A’s framework to strengthen self-motivated behavior modifications, develop patient-centered outcomes, and outline systematic follow-up care plans. Data collection utilized standardized rating scales and questionnaires. The process proceeded for six months concluding with program evaluation. Results: The average pain score improved from 4.6 down to 3.8 (-0.8) almost a 1-point decrease. The average QOL score had the most dramatic increase from 4.6 to 6 (+1.4). No improvement in pain medication usage. Conclusion: Timely utilization of evidence-based interventions for chronic back pain can improve patient-provider interaction and promote self-care by addressing quality of life issues, decreasing patient pain scores and limiting importance of opioid medications. Clinical Implications: Promotion of self-care behaviors encourages provider backed safety and holistic collaboration

Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19

Introduction and purpose: The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa’s regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions. Methodology: A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms. Results and Conclusions: The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a “big win” (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model.  Few studies were conducted in LMICs, indicating a gap in such research. &nbsp

Telerehabilitation in Scotland: Current initiatives and recommendations for future development.

Rehabilitation services are set to become central to modern health care systems as they strive to support an increasingly ageing population to live as independently as possible, while maintaining quality services. Alternative service delivery options such as telerehabilitation may assist in meeting the growing demand for services and many countries are exploring the potential use of telerehabilitation within their health care systems. The Scottish Centre for Telehealth commissioned an independent scoping study and subsequent report into the potential development and realisation of telerehabilitation services across Scotland. The scope of the report was restricted to adult rehabilitation services and aimed to identify opportunities for the use of telerehabilitation and to recommend clear and achievable steps towards implementation of telerehabilitation. This article outlines some of the telerehabilitation initiatives currently underway in Scotland and discusses some of the key recommendations made in the report to the Scottish Centre for Telehealth for the future advancement and application of telerehabilitation across Scotland

Mapping factors that affect the uptake of digital therapeutics within health systems: scoping review

BACKGROUND: Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. OBJECTIVE: In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. METHODS: A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. RESULTS: We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. CONCLUSIONS: The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics

The opinion of professional caregivers about the platform understAID for patients with dementia

Clinical research[Abstract] BACKGROUND: The person with dementia should be treated as an unique person regarding symptoms directly associated with dementia, such as problems with memory, hallucinations, and delusions, as well as other physical, mental, or neurological deficits. The symptoms not directly typical of dementia, such as musculoskeletal disorders or depression, should be also be considered in order to improve the quality of life of a person with dementia. That is why professional caregivers have to broaden their current knowledge not only of medical symptoms but also of the patient’s psychosocial condition and increase their inquisitiveness about the individual condition of the patient. The aim of the study was to get to know the opinion of professional caregivers about the UnderstAID platform and its usefulness for informal caregivers. MATERIAL AND METHODS: Participants in the study group consisted of professional caregivers: nurses, sociologists, psychologists, physiotherapists, and occupational therapists, all of whom specialized in geriatrics and had experience in working with people with dementia. All professional caregivers answered 24 questions that refer to positive and negative aspects of the UnderstAID platform. RESULTS: The study group of professional caregivers highly appreciated that the application could give support to caregivers (mean score of 4.78; 5 points means that they totally agreed, and 1 point means that they totally disagreed) and that a wide range of multimedia materials helped the informal caregivers to gain a better understanding of the contents (mean score of 4.78). There was a statistically significant correlation between the age of the professional caregivers and the frequency of positive opinions that the UnderstAID application gave support to caregivers of relatives with dementia (p=0.028) and the opinion that videos, photos, and pictures may help the informal caregivers to gain a better understanding of the contents (p=0.028). CONCLUSIONS: A group of professional caregivers positively assessed the UnderstAID platform. Caregivers, especially older caregivers, highly appreciated the usefulness of videos, photos, and pictures for gaining a better understanding of the contents.European Commission; AAL5/1/2013European Commission; AAL5/2/201

Expectations and Beliefs in Immersive Virtual Reality Environments: Managing of Body Perception

Real and Perceived Feet Orientation Under Fatiguing and Non-Fatiguing Conditions in an Immersive Virtual Reality Environment ABSTRACT Lower limbs position sense is a complex yet poorly understood mechanism, influenced by many factors. Hence, we investigated the position sense of lower limbs through feet orientation with the use of Immersive Virtual Reality (IVR). Participants had to indicate how they perceived the real 1050 orientation of their feet by orientating a virtual representation of the feet that was shown in an IVR 1051 scenario. We calculated the angle between the two virtual feet (α-VR) after a high-knee step-in-1052 place task. Simultaneously, we recorded the real angle between the two feet (α-R) (T1). Hence, we 1053 assessed if the acute fatigue impacted the position sense. The same procedure was repeated after 1054 inducing muscle fatigue (T2) and after 10 minutes from T2 (T3). Finally, we also recorded the time 1055 needed to confirm the perceived position before and after the acute fatigue protocol. Thirty healthy 1056 adults (27.5 ± 3.8: 57% female, 43% male) were immersed in an IVR scenario with a representation 1057 of two feet. We found a mean difference between α-VR and α-R of 20.89° [95% CI: 14.67°, 27.10°] 1058 in T1, 16.76° [9.57°, 23.94°] in T2, and 16.34° [10.00°, 22.68°] in T3. Participants spent 12.59, 17.50 1059 and 17.95 seconds confirming the perceived position of their feet at T1, T2, T3, respectively. 1060 Participants indicated their feet as forwarding parallel though divergent, showing a mismatch in the 1061 perceived position of feet. Fatigue seemed not to have an impact on position sense but delayed the 1062 time to accomplish this task.The Effect of Context on Eye-Height Estimation in Immersive Virtual Reality: a Cross-Sectional Study ABSTRACT Eye-height spatial perception provides a reference to scale the surrounding environment. It is the result of the integration of visual and postural information. When these stimuli are discordant, the perceived spatial parameters are distorted. Previous studies in immersive virtual reality (IVR) showed that spatial perception is influenced by the visual context of the environment. Hence, this study explored how manipulating the context in IVR affects individuals’ eye-height estimation. Two groups of twenty participants each were immersed in two different IVR environments, represented by a closed room (Wall - W) and an open field (No Wall - NW). Under these two different conditions, participants had to adjust their virtual perspective, estimating their eye height. We calculated the perceived visual offset as the difference between virtual and real eye height, to assess whether the scenarios and the presence of virtual shoes (Feet, No Feet) influenced participants’ estimates at three initial offsets (+100 cm, +0 cm, -100 cm). We found a mean difference between the visual 1679 offsets registered in those trials that started with 100 cm and 0 cm offsets (17.24 cm [8.78; 25.69]) 1680 and between 100 cm and -100 cm offsets (22.35 cm [15.65; 29.05]). Furthermore, a noticeable mean difference was found between the visual offsets recorded in group W, depending on the presence or absence of the virtual shoes (Feet VS No Feet: -6.12 [-10.29, -1.95]). These findings describe that different contexts influenced eye-height perception.Positive Expectations led to Motor Improvement: an Immersive Virtual Reality Pilot Study ABSTRACT This pilot study tested the feasibility of an experimental protocol that evaluated the effect of different positive expectations (verbal and visual-haptic) on anterior trunk flexion. Thirty-six participants were assigned to 3 groups (G0, G+ and G++) that received a sham manoeuvre while immersed in Immersive Virtual Reality (IVR). In G0, the manouvre was paired with by neutral verbal statement. In G+ and G++ the manouvre was paired with a positive verbal statement, but only G++ received a visual-haptic illusion. The illusion consisted of lifting a movable tile placed in front of the participants, using its height to raise the floor level in virtual reality. In this way, participants experienced the perception of touching the floor, through the tactile and the virtual visual afference. The distance between fingertips and the floor was measured before, immediately after, and after 5 minutes from the different manouvres. A major difference in anterior trunk flexion was found for G++ compared to the other groups, although it was only significant compared to G0. This result highlighted the feasibility of the present study for future research on people with mobility limitations (e.g., low back pain or kinesiophobia) and the potential role of a visual-haptic illusion in modifying the performance of trunk flexion