Design and evaluation of a flexible web-based screening service for clinimetrics

Clinimetrics is gaining significance in health related and clinical disciplines. However, obtaining and accessing outcome measures in a flexible manner is an issue because of difficult-to-use programs, fixed instruments and poor access to tools and results. Hence, we developed and evaluated a novel Software-as-a-Service to create, share, conduct and manage clinical screenings and tests. The service supports a wide variety of screening instruments. These instruments can then be used in a wide variety of ways: online and offline; on smartphone, tablet and computer; guided by a professional, or self-assessed. Both tests and results can be managed and shared among peers and patients. New screenings can be designed based on standardized instruments or tailored to outcome measure requirements. The service, called ReQuest, was successfully implemented in multiple research projects. Evaluation results show good acceptance in elderly asked to use the system for self-assessments. Researchers who use the service to conduct and manage screenings, value (i) secure on-site storage, (ii) the flexibility in which they can create or reuse screenings and (iii) sharing screenings with others

Using combined accelerometer and heart rate data to estimate physical fitness

Description of the results of an experiment performed on a treadmill, in which heart rate and accelerometer parameters were combined to estimate physical fitness. This to ultimately develop a method to estimate physical fitness (VO2max) in the home environment of a patient

An ontology-based recommender system to promote physical activity for pre-frail elderly

The increasing ageing population and the prevalence of chronic diseases have introduced new challenges to healthcare systems motivating researchers to use telemonitoring solutions for providing care. In some solutions, a special focus has been given to promoting physical activity as it can decrease the risk of becoming frail and prevents further health complications. The focus of this research is to keep seniors physically active by designing and developing an intelligent system that recommends exercises tailored to an individual’s health status, goals and preferences hence aiming for an adaptive personalized solution

Video teleconsultation service: Who is needed to do what, to get it implemented in daily care?

Introduction: In telemedicine, technology is used to deliver services. Because of this, it is expected that various actors other than those involved in traditional care are involved in and need to cooperate, to deliver these services. The aim of this study was to establish a clear understanding of these actors and their roles and interrelationships in the delivery of telemedicine. A video teleconsultation service is used as a study case. Methods: A business modeling approach as described in the Freeband Business Blueprint Method was used. The method brings together the four domains that make up a business model, that is, service, technology, organization, and finance, and covers the integration of these domains. The method uses several multidisciplinary workshops, addressing each of the four domains. Results: Results of the four domains addressed showed that (1) the video teleconsultation service is a store and put-forward video teleconsult for healthcare providers. The service is accepted and has added value for the quality of care. However, the market is small; (2) the technology consists of a secured Internet Web-based application, standard personal computer, broadband Internet connection, and a digital camera; (3) a new role and probably entity, responsible for delivering the integrated service to the healthcare professionals, was identified; and finally (4) financial reimbursement for the service delivery is expected to be most successful when set up through healthcare insurance companies. Pricing needs to account for the fee of healthcare professionals as well as for technical aspects, education, and future innovation. Discussion: Implementation of the video teleconsult service requires multidisciplinary cooperation and integration. Challenging aspects are the small market size and the slow implementation speed, among others. This supports the argument that accumulation of several telemedicine applications is necessary to make it financially feasible for at least some of the actors

Towards cancer rehabilitation at home: design of a telerehabilitation service for lung cancer patients

Although lung resection still provides the best long-term outcome for lung cancer, it is also associated with a considerable decay in physical and psychosocial health status. If not controlled, these symptoms can hamper postsurgical recovery, and lead to unscheduled healthcare use. This study aimed to determine the clinical relevance of and functional requirements for a telerehabilitation (TR) service to support recovery following lung resection. A modular remote monitoring and treatment service, consisting of an ambulant health monitoring module and an online exercise program, was developed to improve survivorship care following lung surgery through a user-centred design approach. Results from the requirement elicitation indicate positive intentions of both patients and professionals to use the RMT service as part of current care practice. In early phase evaluation usability and technical reliability of the developed system was found high. Future research should establish level of adoption of the system by the end users, as well as the effects on post-surgery recovery when integrated with current healthcare processes

Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome

Objectives: (1) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and (2) to explore the value of potentially prognostic factors further. Methods: Data were derived from a randomized controlled trial on the effect of a multidisciplinary rehabilitation program for chronic low back pain compared with usual care. The primary outcome measure was the Roland and Morris Disability Questionnaire and secondary outcomes were the Physical and Mental Component Summary Scales, derived from the Short Form Health Survey. Outcomes were expressed as the differences between baseline and follow-up (8 wk and 6 mo) values. A confirmatory and an exploratory model were defined. Baseline predictors included in the confirmatory model were pain intensity, work status, and Multidimensional Pain Inventory subgroup membership. The exploratory model included sick leave, compensation, depression, and fear-avoidance beliefs. Statistical analysis was performed using multiple linear regression analysis. Results: One hundred and sixty-three patients participated in the study. More pain was prognostic for more improvement in the rehabilitation group. No value was found for work status or the Multidimensional Pain Inventory subgroups. For the exploratory model, more depression and fear-avoidance beliefs predicted more improvement after rehabilitation. The explained variance ranged from 18.5% to 43.8% depending on the length of follow-up evaluation, the treatment group, and the outcome variable of interest. Discussion: The results of this study do not support the construction of a clinical prediction model. Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors

Advancing telemedicine services for the aging population: The challenge of interoperability

We reflect on our experiences in two projects in which we developed interoperable telemedicine applications for the aging population. While technically data exchange could be implemented technically, uptake was impeded by a lack of working procedures. We argue that development of interoperable health technology for the aging population should go accompanied by a thorough study into working protocols by consulting all end-users and stakeholders

A telecare programme for self-management of COPD exacerbations and promotion of an active lifestyle

Objective: The Condition Coach (CoCo) is a technology-supported care programme for self-management of COPD exacerbations and for promotion of an active lifestyle. The objective is to investigate the added value of the telecare programme in terms of clinical changes compared to usual care, and in addition, to evaluate its use and acceptance. Intervention: CoCo consists of four modules: 1) activity coach for ambulant activity registration and real-time feedback to improve daily activity behaviour, 2) web-based exercise programme set up by the patient’s primary care physiotherapist, 3) self-treatment of COPD exacerbations via a triage diary on the webportal that provides advice to start medication when necessary, and 4) teleconsultation via the webportal. The latter is accessible for the patient and the involved primary and secondary care professionals. Methods: Twenty-nine COPD patients with ≥3 exacerbations or 1 hospitalization in the past 2 years are randomly assigned to either the intervention group (CoCo programme for 9 months) or the control group (usual care). Exacerbations, activity level, exercise capacity, symptom levels, health status and quality of life are assessed to evaluate clinical changes. Page hits on the webportal show the use of the programme, and the Unified Theory of Acceptance & Use of Technology explains usage behaviour. Results: Preliminary findings show that the webportal is highly accessed by the patients (90% of the days) with good usability (median 5.8, 7-point Likert). Remaining data will be collected in the upcoming months. Conclusions: The CoCo programme has potential as the intervention is highly used and accepted. Final results are expected in July 2013

How do COPD patients distribute their daily activities?

Better insight in daily activity behaviour of COPD patients is needed as a first step to enable a tailoring of their treatment. The objective of this study was to measure the daily activity of COPD patients and to compare the daily activity distribution with asymptomatic controls, using triaxial accelerometry