Technical features, feasibility, and acceptability of augmented telerehabilitation in post-stroke aphasia – experiences from a randomized control trial

Background: Post-stroke aphasia is a communication disorder where existing evidence favors intensive therapy methods. Telerehabilitation represents a service model for geographically remote settings, or other barriers to clinic attendance or to facilitate an augmentation of therapy across a continuum of care. Evidence to support efficiency, feasibility, and acceptability is however still scarce. Appraising aphasia telerehabilitation in controlled trials beyond its effectiveness, by investigating feasibility and acceptability, may facilitate implementation into clinical practice. Methods: In our pilot randomized controlled trial, we investigated the feasibility and acceptability of speech and language therapy by videoconference, in addition to usual care, in people with aphasia following stroke. To improve functional, expressive language, a tailored intervention was given 1 h per day, five times per week over four consecutive weeks. Feasibility measures included evaluation of technical setup using diary logs. Acceptability was investigated by examining adherence and satisfaction with therapy alongside evaluation of data safety and privacy. Results: Feasibility and acceptability data were collected in relation to 556.5 h of telerehabilitation delivered to 30 participants over a 2-years intervention period by three speech-language pathologists. Protocol adherence was high, with a tolerable technical fault rate; 86 faults were registered over 541 video sessions. Most (80%; n = 30) of the participants experienced zero to three faults. The main cause of technical failures was flawed internet connection, causing delayed or interrupted therapy. Total satisfaction with telerehabilitation was rated good or very good by 93.1% (n = 29) of participants and two of three speech-language pathologists. Within a moderate variance of technical failure, participants experiencing more faults were more satisfied. No serious events regarding security and privacy were reported. Our model is feasibly and ready to be implemented across a range of clinical settings and contexts. Conclusions: Synchronous telerehabilitation for post-stroke aphasia is feasible and acceptable and shows tolerable technical fault rates with high satisfaction among patients and pathologists. Within a low rate of faults, satisfaction was not negatively influenced by fault frequency. Access to clinical and technical expertise is needed when developing telerehabilitation services. Telerehabilitation may be a viable service delivery model for aphasia rehabilitation

Hvorfor tar pasienten medisinen? : Et dokumentasjonsforbedringsprosjekt

Sammendrag Bakgrunn/emne: Egne erfaringer fra praksis har vært at mange har savnet lett og oversiktlig tilgang til informasjon om hvorfor pasienten står på de ulike medisinene, spesielt geriatriske pasienter med komorbide tilstander og polyfarmasi. Dersom medikamentindikasjon er lettere tilgjengelig for alle behandlende instanser, vil dette styrke dokumentasjonen i journalen. Positive ringvirkninger kan være at uheldige interaksjoner lettere oppdages og gjøre revisjon av medikamentlister enklere. 3000 dødsfall årlig i Norge kan skyldes uhensiktsmessig legemiddelbruk. Kunnskapsgrunnlag: Det ble foretatt systematiske søk i Pubmed/Medline, UpToDate og Cochrane, flere studier illustrerte behovet for bedre dokumentasjon av pasienters medikamentbruk for å sikre forsvarlige forskrivningsrutiner. Artiklene nevnte ikke direkte at omfanget av mangelfull medikamentindikasjon er stor, men det er nærliggende å tro at dokumentasjonsmangelen omfatter alle deler av journalsystemet, og at vår problemstilling derfor er meget aktuell. Forelesningene til J. Straand brukes også som en del av kunnskapsgrunnlaget. Juridisk sett, viser utvalgte kapitler i Hpl, Prl og Sphlsl at journalføring er lovpålagt, den skal inneholde nødvendige opplysninger om pasienten og begrunne helsehjelpen som ytes. Begrunnet tiltak og metode: Vårt tiltak er å føre indikasjon på medisinlisten på førstedagsnotatet på samme måte som dosering og styrke føres på nå. Prosessmålet blir førstedagsnotatet, mens resultatmålet og indikatoren er antall epikriser med påført medikamentindikasjon. Tiltaket skal innføres på geriatrisk avd., Ullevål, OUS. Alle pasienter på avdelingen inkluderes. Organisering: Ansvaret for å påføre indikasjon på medikamenter tillegges den enkelte legen på post. Overlegene har det overordnete ansvaret for å påse at tiltaket følges opp, mens assistentlegene vil ha ansvaret for å telle opp andel medisinlister med indikasjon påført, i hhv. førstedagsnotatet og den tilsvarende epikrisen. I 1 mnd før intervensjonen igangsettes vil man måle resultatmålet, andel epikriser med indikasjon, for å ha et sammenligningsgrunnlag. Resultater/vurdering: Tiltaket skal innføres på geriatrisk avd., Ullevål, OUS og vare 1 måned. Etter denne perioden skal andel førstedagsnotater og epikriser med medikamentindikasjon påført registreres. Dette tallet vil vise hvor godt tiltaket har blitt implementert på avdelingen. Man kan så sammenligne dette resultatet, med resultatmålet man fant 1 måned før intervensjonen startet

Participatory Continuing Design: “Living with” Videoconferencing in Rehabilitation

While much research emphasizes design-before-use, we here study design-in-use. The notion of participatory continuing design is introduced to draw attention to the ongoing work of incorporating information and communication technology into work processes in healthcare institutions. Through an empirical case study of how telemedicine, in the form of videoconferencing, was taken up in a rehabilitation hospital in Norway, the nature of such ongoing experimentation, learning, and redesign is described. When contrasted with traditional design-before-use practices, participatory continuing design differs in terms of its timing, object, process, outcome, and participants. We offer recommendations or how such processes can be supported in healthcare organizations

Hospital based care at home; study protocol for a mixed epidemiological and randomized controlled trial

Abstract Background Individuals with spinal cord injuries (SCI) are prone to pressure ulcers (PUs) because of the loss of sensorimotor function involved as well as increased skin moisture. Treatment of PU after SCI is complicated, involving different specialties and with need for long-lasting follow-up. This study should identify risk factors for PU after SCI, and find an effective and less time-consuming treatment for the condition among different available methods for follow-up. Method/design The first part of this research project aims to investigate the prevalence of PU among persons with SCI based on an epidemiological design. The study will identify possible risk factors for acquiring PU. A questionnaire focusing on previous and present PUs will be sent to persons who suffered SCIs between January 2004 and January 2014. In the second part we will compare two different treatment regimens of PU through a randomized controlled pilot trial (RCT) where we will compare outpatient SCI follow-up in a hospital versus outpatient follow-up from the patient’s home, using telemedicine (teleSCI) interventions. We will compare the healing of the PU in the two groups (usual care versus teleSCI). The Tissue, Infection, Moisture Edge (TIME) registration form, the Photographic Wound Assessment Tool (PWAT) and the change in the ulcer size will be used to monitor the healing. Changes in health-related quality of life (HRQoL) and the need for assistance will be assessed using the Five Dimensions European Quality of Life scale (EQ-5D), the generic Medical Outcomes Study 12-item Short Form Health Survey (SF-12) modified version, the International Spinal Cord Injury Quality of Life Data set (ISCI-QoL Data set), and the Spinal Cord Independence Measure scale, version III (SCIM III). In addition to primary outcome measures, a cost-benefit evaluation and an assessment of patient satisfaction and participation will be performed, using customized questionnaires. Discussion The first part of the research project will reveal the epidemiology of PU after SCI, and explore the risk factors. This part enables further prevention of PU after SCI and this information will be used in the follow-up RCT. Videoconferencing in the outpatient follow-up of persons with SCI and PU will change clinical routines and facilitate interdisciplinary collaboration, communication and competence exchange among participants of the health care services. Our research protocol allows comparing methods for interaction between medical specialists at hospitals, local caregivers in the community, next of kin, and persons with SCI and PU. The RCT should identify advantages as well as challenges in the management of PU in different follow-up settings. This study aims to identify risk factors for PU after SCI, and find an effective and less time consuming treatment for the condition among different available methods for follow- up. Trial registration 1. www.ClinicalTrials.gov, ID: NCT02800915, last update 9 October 2017.2.The National Regional Ethical Committee (REC) 2014/ 684/ REK-Nord. https://helseforskning.etikkom.no/prosjekterirek/prosjektregister/prosjekt?p_document_id=469163&p_parent_id=473640&_ikbLanguageCode=n 3. https://app.cristin.no/projects/show.jsf?id=545284 4. https://www.sunnaas.no/kliniske-studier/bruk-av-telemedisin-som-virkemiddel-til-samhandling-i-poliklinisk-oppfolging-av-pasienter-med-ryggmargsskade-og-trykksa

A Mindfulness-Based Stress Reduction Program via Group Video Conferencing for Adults With Cerebral Palsy ? A Pilot Study

Purpose: Adults with cerebral palsy experience challenges related to lifelong disability, such as stress, fatigue, pain and emotional issues. E-health services can be delivered regardless of residence and level of functioning. The aim of this pilot study was to explore the potential benefits and feasibility of a mindfulness-based program delivered to adults with cerebral palsy via group video conferencing. Methods: Six adults with cerebral palsy received an 8 week mindfulness group-based program via video conferencing. A multiple single-case study design was applied, including quantitative and qualitative elements. Pain was assessed 16 times through the study period. Questionnaires were administered to gather data on pain catastrophizing, stress, fatigue, emotional distress, positive and negative affect, and quality of life. A focus group interview addressed experiences with the intervention and the mode of delivery. Results: The participants' pain levels showed varied trajectories. Pain catastrophizing and negative affect were statistically significant decreased. Qualitative data indicated benefits from mindfulness in coping and stress management. The video conferencing delivery was evaluated as feasible, with no major adverse effects. Conclusion: Since the pilot study had a small sample size, potential treatment benefits should be interpreted with caution. However, this pilot study provides important information in the planning of future larger and controlled studies on mindfulness-based interventions programs via video conferencing for adults with cerebral palsy and other persons living with long-term disability