eHealth for Patient Engagement: a systematic review

eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e. alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in Ehealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities

Detecting early egocentric and allocentric impairments deficits in Alzheimer's disease: an experimental study with virtual reality

Several studies have pointed out that egocentric and allocentric spatial impairments are one of the earliest manifestations of Alzheimer's Disease (AD). It is less clear how a break in the continuous interaction between these two representations may be a crucial marker to detect patients who are at risk to develop dementia. The main objective of this study is to compare the performances of participants suffering from amnestic mild cognitive impairment (aMCI group), patients with AD (AD group) and a control group (CG), using a virtual reality (VR)-based procedure for assessing the abilities in encoding, storing and syncing different spatial representations. In the first task, participants were required to indicate on a real map the position of the object they had memorized, while in the second task they were invited to retrieve its position from an empty version of the same virtual room, starting from a different position. The entire procedure was repeated across three different trials, depending on the object location in the encoding phase. Our finding showed that aMCI patients performed significantly more poorly in the third trial of the first task, showing a deficit in the ability to encode and store an allocentric viewpoint independent representation. On the other hand, AD patients performed significantly more poorly when compared to the CG in the second task, indicating a specific impairment in storing an allocentric viewpoint independent representation and then syncing it with the allocentric viewpoint dependent representation. Furthermore, data suggested that these impairments are not a product of generalized cognitive decline or of general decay in spatial abilities, but instead may reflect a selective deficit in the spatial organization Overall, these findings provide an initial insight into the cognitive underpinnings of amnestic impairment in aMCI and AD patient exploiting the potentiality of VR

When music flows. State and Trait Flow in musical performance, composition and listening: A systematic review

It is not unusual to experience a sense of total absorption, concentration, action-awareness, distortion of time and intrinsic enjoyment during an activity that involves music. Indeed, it is noted that there is a special relationship between these two aspects (i.e., music and flow experience). In order to deeply explore flow in the musical domain, it is crucial to consider the complexity of the flow experience—both as a state and as a trait. Secondly, since music is a multifaceted domain, it is necessary to concentrate on specific music settings, such as (i) musical composition; (ii) listening; and (iii) musical performance. To address these issues, the current review aims to outline flow experience as a trait and as a state in the three above-mentioned musical domains. Clear and useful guidelines to distinguish between flow as a state and as a trait are provided by literature concerning flow assessment. For this purpose, three aspects of the selected studies are discussed and analyzed: (i) the characteristics of the flow assessments used; (ii) the experimental design; (iii) the results; and (iv) the interrelations between the three domains. Results showed that the dispositional approach is predominant in the above-mentioned settings, mainly regarding music performance. Several aspects concerning musical contexts still need to be deeply analyzed.Future challenges could include the role of a group level of analysis, overcoming a frequency approach towards dispositional flow, and integrating both state and dispositional flow perspectives in order to deepen comprehension of how flow takes place in musical contexts.Finally, to explain the complex relationship between these two phenomena, we suggest that music and flow could be seen as an emergent embodied system

Assessment and rehabilitation of neglect using virtual reality: A systematic review

After experiencing a stroke in the right hemisphere, almost 50% of patients showed Unilateral Spatial Neglect (USN). In recent decades, Virtual Reality (VR) has been used as an effective tool both for the assessment and rehabilitation of USN. Indeed, this advanced technology allows post-stroke patients to interact with ecological and engaging environments similar to real ones, but in a safe and controlled way. To provide an overview of the most recent VR applications for the assessment and rehabilitation of USN, a systematic review has been carried out. Since 2010, 13 studies have proposed and tested innovative VR tools for USN. After a wide description of the selected studies, we discuss the main features of these VR tools in order to provide crucial indications for future studies, neurorehabilitation interventions, and clinical practice

Virtual multiple errands test (VMET): A virtual reality-based tool to detect early executive functions deficit in parkinson's disease

Introduction: Several recent studies have pointed out that early impairment of executive functions (EFs) in Parkinson's Disease (PD) may be a crucial marker to detect patients at risk for developing dementia. The main objective of this study was to compare the performances of PD patients with mild cognitive impairment (PD-MCI) with PD patients with normal cognition (PD-NC) and a control group (CG) using a traditional assessment of EFs and the Virtual Multiple Errands Test (VMET), a virtual reality (VR)-based tool. In order to understand which subcomponents of EFs are early impaired, this experimental study aimed to investigate specifically which instrument best discriminates among these three groups.Materials and methods: The study included three groups of 15 individuals each (for a total of 45 participants): 15. PD-NC; 15. PD-MCI, and 15 cognitively healthy individuals (CG). To assess the global neuropsychological functioning and the EFs, several tests (including the Mini Mental State Examination (MMSE), Clock Drawing Test, and Tower of London test) were administered to the participants. The VMET was used for a more ecologically valid neuropsychological evaluation of EFs. Results: Findings revealed significant differences in the VMET scores between the PD-NC patients vs. the controls. In particular, patients made more errors in the tasks of the VMET and showed a poorer ability to use effective strategies to complete the tasks. This VMET result seems to be more sensitive in the early detection of executive deficits because these two groups did not differ in the traditional assessment of EFs (neuropsychological battery). Conclusion: This study offers initial evidence that a more ecologically valid evaluation of EFs is more likely to lead to detection of subtle executive deficits