Evaluation studies of robotic rollators by the user perspective: A systematic review

Background: Robotic rollators enhance the basic functions of established devices by technically advanced physical, cognitive, or sensory support to increase autonomy in persons with severe impairment. In the evaluation of such Ambient Assisted Living solutions, both the technical and user perspectives are important to prove usability, effectiveness, and safety, and to ensure adequate device application.Objective: The aim of this systematic review is to summarize the methodology of studies evaluating robotic rollators with focus on the user perspective and to give recommendations for future evaluation studies.Methods: A systematic literature search up to December 31, 2014 was conducted based on the Cochrane Review methodology using the electronic databases PubMed and IEEE Xplore. Articles were selected according to the following inclusion criteria: Evaluation studies of robotic rollators documenting human-robot interaction, no case reports, published in English language.Results: Twenty-eight studies were identified that met the predefined inclusion criteria. Large heterogeneity in the definitions of the target user group, study populations, study designs, and assessment methods was found across the included studies. No generic methodology to evaluate robotic rollators could be identified. We found major methodological shortcomings related to insufficient sample descriptions and sample sizes, and lack of appropriate, standardized and validated assessment methods. Long-term use in habitual environment was also not evaluated.Conclusions: Apart from the heterogeneity, methodological deficits in most of the identified studies became apparent. Recommendations for future evaluation studies include: clear definition of target user group, adequate selection of subjects, inclusion of other assistive mobility devices for comparison, evaluation of the habitual use of advanced prototypes, adequate assessment strategy with established, standardized and validated methods, and statistical analysis of study results. Assessment strategies may additionally focus on specific functionalities of the robotic rollators allowing an individually tailored assessment of innovative features to document their added value

A systematic review of study results reported for the evaluation of robotic rollators from the perspective of users

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Purpose: To evaluate the effectiveness and perception of robotic rollators (RRs) from the perspective of users. Methods: Studies identified in a previous systematic review published on 2016 on the methodology of studies evaluating RRs by the user perspective were re-screened for eligibility based on the following inclusion criteria: evaluation of the human–robot interaction from the user perspective, use of standardized outcome measurements, and quantitative presentation of study results. Results: Seventeen studies were eligible for inclusion. Due to the clinical and methodological heterogeneity across studies, a narrative synthesis of study results was conducted. We found conflicting results concerning the effectiveness of the robotic functionalities of the RRs. Only a few studies reported superior user performance or reduced physical demands with the RRs compared to unassisted conditions or conventional assistive mobility devices; however, without providing statistical evidence. The user perception of the RRs was found to be generally positive. Conclusions: There is still no sufficient evidence on the effectiveness of RRs from the user perspective. More well-designed, high-quality studies with adequate study populations, larger sample sizes, appropriate assessment strategies with outcomes specifically tailored to the robotic functionalities, and statistical analyses of results are required to evaluate RRs at a higher level of evidence.Implications for Rehabilitation RRs cover intelligent functionalities that focus on gait assistance, obstacle avoidance, navigation assistance, sit-to-stand transfer, body weight support or fall prevention. The evaluation from the user perspective is essential to ensure that RRs effectively address users’ needs, requirements and preferences. The evidence on the effectiveness of RRs is severely hampered by the low methodological quality of most of the available studies. RRs seem generally to be perceived as positive by the users. There is very limited evidence on the effectiveness and benefits of RRs compared to conventional assistive mobility devices. Further research with high methodological quality needs to be conducted to reach more robust conclusions about the effectiveness of RRs

Will We Do If We Can? Habitual Qualitative and Quantitative Physical Activity in Multi-Morbid, Older Persons with Cognitive Impairment

This study aimed to identify determinants of quantitative dimensions of physical activity (PA; duration, frequency, and intensity) in community-dwelling, multi-morbid, older persons with cognitive impairment (CI). In addition, qualitative and quantitative aspects of habitual PA have been described. Quantitative PA and qualitative gait characteristics while walking straight and while walking turns were documented by a validated, sensor-based activity monitor. Univariate and multiple linear regression analyses were performed to delineate associations of quantitative PA dimensions with qualitative characteristics of gait performance and further potential influencing factors (motor capacity measures, demographic, and health-related parameters). In 94 multi-morbid, older adults (82.3 ± 5.9 years) with CI (Mini-Mental State Examination score: 23.3 ± 2.4), analyses of quantitative and qualitative PA documented highly inactive behavior (89.6% inactivity) and a high incidence of gait deficits, respectively. The multiple regression models (adjusted R$^{2}$ = 0.395–0.679, all p < 0.001) identified specific qualitative gait characteristics as independent determinants for all quantitative PA dimensions, whereas motor capacity was an independent determinant only for the PA dimension duration. Demographic and health-related parameters were not identified as independent determinants. High associations between innovative, qualitative, and established, quantitative PA performances may suggest gait quality as a potential target to increase quantity of PA in multi-morbid, older persons

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

„Life-Space Mobilität“ bei älteren Menschen mit kognitiver Einschränkung nach Entlassung aus der geriatrischen Rehabilitation: Entwicklung von differenzierten Assessmentstrategien, Erfassung des Status und Evaluation von angepassten Interventionsstrategien

Die publikationsbasierte Dissertation befasst sich mit der Mobilität in der räumlichen Umgebung („Life-Space Mobilität“) von multimorbiden älteren Menschen mit kognitiver Einschränkung nach Entlassung aus der geriatrischen Rehabilitation. Aufgrund ihrer Akkumulation von negativen Einflussfaktoren auf die Mobilität weisen diese Personen ein hohes Risiko für den Verlust der Mobilität auf. Neben der kognitiven Einschränkung gehören Multimorbidität und körperliche Einschränkungen nach dem medizinischen Ereignis zu den Risikofaktoren sowie die kritische Phase des Übergangs von der stationären in die ambulante Versorgung. Mobilität in und außerhalb der Wohnung ist jedoch die Voraussetzung für eine autonome Lebensführung und gesellschaftliche Teilhabe. Neben der Methodenentwicklung zur Erfassung der Life-Space Mobilität in der Zielpopulation wurden in dieser Arbeit auch epidemiologische Untersuchungen zum Status der Life-Space Mobilität durchgeführt und Interventionseffekte eines heimbasierten Versorgungsangebots auf die (Life-Space) Mobilität bei Menschen mit kognitiver Einschränkung nach Entlassung aus der geriatrischen Rehabilitation evaluiert. Vorbereitend wurde zunächst eine Pilotstudie zur Durchführbarkeit und Effektivität eines poststationären Heimtrainings bei Personen mit kognitiver Einschränkung durchgeführt (Manuskript I). Basierend auf der erfolgreichen Evaluation wurde die HeikE (“Heimtraining bei Kognitiver Einschränkung”) Studie konzipiert (Manuskript II). Im Zusammenhang von erfolgreicher Rehabilitation, selbstständiger Lebensführung und sozialer Partizipation, ist das Konzept der Life-Space Mobilität als Maß für Mobilität, Selbstständigkeit und Partizipation bedeutsam. Basis für die Evaluation sind adäquate Assessmentinstrumente, jedoch lag zu Studienbeginn kein geeigneter Fragebogen zur Erfassung der Life-Space Mobilität bei hochbetagten Menschen mit kognitiver Einschränkung vor. Teilstudie I (Methodenentwicklung) bestand daher darin, systematisch verfügbare Life-Space Assessment Instrumente zu identifizieren und einzuordnen (Manuskript III), und geeignete Instrumente für die Population der älteren Menschen mit kognitiver Beeinträchtigung zu entwickeln und zu validieren. Dies wurde erfolgreich mit dem „Life-Space Assessment for Persons with Cognitive Impairment“ (LSA-CI) für im häuslichen Umfeld lebende Menschen umgesetzt (Manuskripte IV und V). Ein Cut-off wurde ermittelt zur Unterscheidung von hoher und geringer Life-Space Mobilität zur vereinfachten Beurteilung des Life-Space Mobilitätsstatus in der klinischen Anwendung (Manuskript VI). In einem assoziierten Projekt wurde die Erfassung der Life-Space Mobilität im institutionellen Setting (Krankenhaus, Rehabilitation, Pflegeeinrichtung) mit dem ebenso neu entwickelten „Life-Space Assessment für Institutionalized Settings“ (LSA-IS als selbst- oder Proxy-berichtete Version; Manuskripte VII und VIII) untersucht. Die Instrumente wurden in Populationen mit und ohne kognitive Beeinträchtigungen mit sehr guter Durchführbarkeit eingesetzt. Insbesondere die Gesamtscores der jeweiligen Instrumente wiesen sehr gute Konstruktvalidität, Test-Retest Reliabilität bei im Durchschnitt moderater Veränderungssensitivität auf, in Abhängigkeit von der Effektivität der jeweiligen LSM Intervention. Die Subscores wiesen vergleichbare, in der Tendenz geringfügig schlechtere Evaluationsergebnisse auf, was teilweise auf statistischen Effekte zurückzuführen war. Mit dem neu validierten Instrument LSA-CI konnte in Teilstudie II (Epidemiologische Untersuchung) der Status der Life-Space Mobilität bei 118 PatientInnen mit kognitiver Einschränkung nach Entlassung in das häusliche Umfeld ermittelt werden. Zudem konnten assoziierte Faktoren aus einer Vielzahl an potenziellen Einflussfaktoren (basierend auf einem etablierten Mobilitäts-Modell) identifiziert werden. Die Analyse zeigt den geringen Life-Space Mobilitäts-Status in der Population auf und erlaubt die Identifikation besonders gefährdeter Personen mit Interventionsbedarf. Insbesondere Frauen wiesen eine reduzierte Life-Space Mobilität auf. Körperliche Leistungsfähigkeit, körperliche Aktivität und soziale Aktivitäten wurden als relevante modifizierbare Einflussfaktoren ermittelt (Manuskript IX), die in die Planung von Interventionen einbezogen werden können. Die Berücksichtigung von Parametern der Gangqualität anstelle der körperlichen Leistungsfähigkeit konnte den Anteil der aufgeklärten Varianz noch steigern (Manuskript X). In Teilstudie III (Interventionseffekte) wurden die Effekte eines speziell entwickelten 12-wöchigen Heimtrainingsprogramms auf die Mobilität, mit Fokus auf der Verbesserung der Life-Space Mobilität, untersucht. Neben etablierten validierten Tests zur Erfassung der allgemeinen körperlichen Leistungsfähigkeit, Fragebögen zu verschiedenen psychosozialen Variablen (wie Sturzangst, Apathie, depressive Symptomatik) und der sensorbasierten Erfassung der körperlichen Aktivität wurde der neu entwickelte LSA-CI zur Prüfung der Effekte des Heimtrainingsprogramms eingesetzt. Das Trainingsprogramm bestand aus sechs Übungen für Balance und Kraft der unteren Extremitäten zur Verbesserung der körperlichen Leistungsfähigkeit und einem täglichen Spaziergang zur Steigerung der körperlichen Aktivität, unterstützt durch ein speziell entwickeltes Motivationskonzept mit Fokus auf sozialen Kontakten, Monitoring und positivem Feedback. Übergeordnetes Ziel war die Verbesserung der poststationären Versorgungssituation für geriatrische PatientInnen mit kognitiver Einschränkung. Bei den insgesamt 118 älteren Teilnehmenden mit kognitiver Einschränkung konnten signifikante und nachhaltige Effekte auf die körperliche Leistungsfähigkeit und auf Faktoren der Sturzangst in der Interventionsgruppe im Vergleich zur Kontrollgruppe aufgezeigt werden. Effekte auf die körperliche Aktivität konnten nicht festgestellt werden (Manuskript XI). Die Interventionsgruppe wies nach der Intervention eine signifikant bessere Life-Space Mobilität auf, sowohl in Bezug auf den Gesamtscore als auch für den Subscore für den Life-Space, der unabhängig von Hilfspersonen und -mitteln erreicht wurde (Manuskript XII). Zudem konnte eine sehr gute Durchführbarkeit und hohe Adhärenz erreicht werden (Manuskript XIII). Durch das zielgruppenspezifische Heimtrainingsprogramm konnten damit wichtige Parameter für die Selbstständigkeit und Teilhabe signifikant und teilweise nachhaltig verbessert werden. Personen mit kognitiver Einschränkung können dadurch während des Übergangs vom stationären Setting zur ambulanten Versorgung, einer besonders kritischen Phase mit hohem Risiko für Mobilitäts- und Autonomieverlust und Institutionalisierung, in ihrer individuellen Mobilität unterstützt werden. Perspektivisch können Pflegebedürftigkeit und Institutionalisierung gemindert oder verhindert werden. Die gewonnenen Erkenntnisse sollen Forschern und Klinikern zukünftig helfen, den Status der Life-Space Mobilität von Menschen mit (und ohne) kognitive Einschränkungen im häuslichen Umfeld oder institutionellen Setting bestimmen, sowie die Wirksamkeit von Therapien und Interventionen bei der gefährdeten Population älterer Menschen mit kognitiven Einschränkungen evaluieren zu können. Zudem ist mit dem HeikE-Programm ein innovatives und niedrigschwelliges, effektives und kostengünstiges heimbasiertes Versorgungsangebot evaluiert worden, welches umgehend in die Versorgungslandschaft implementiert werden kann. Keywords: Life-Space Mobilität, Aktivität, Partizipation, gesellschaftliche Teilhabe, Entlassung, Assessment, kognitive Einschränkunge

Examining the replicability of backfire effects after standalone corrections

Abstract Corrections are a frequently used and effective tool for countering misinformation. However, concerns have been raised that corrections may introduce false claims to new audiences when the misinformation is novel. This is because boosting the familiarity of a claim can increase belief in that claim, and thus exposing new audiences to novel misinformation—even as part of a correction—may inadvertently increase misinformation belief. Such an outcome could be conceptualized as a familiarity backfire effect, whereby a familiarity boost increases false-claim endorsement above a control-condition or pre-correction baseline. Here, we examined whether standalone corrections—that is, corrections presented without initial misinformation exposure—can backfire and increase participants’ reliance on the misinformation in their subsequent inferential reasoning, relative to a no-misinformation, no-correction control condition. Across three experiments (total N = 1156) we found that standalone corrections did not backfire immediately (Experiment 1) or after a one-week delay (Experiment 2). However, there was some mixed evidence suggesting corrections may backfire when there is skepticism regarding the correction (Experiment 3). Specifically, in Experiment 3, we found the standalone correction to backfire in open-ended responses, but only when there was skepticism towards the correction. However, this did not replicate with the rating scales measure. Future research should further examine whether skepticism towards the correction is the first replicable mechanism for backfire effects to occur

Development of a home-based training program for post-ward geriatric rehabilitation patients with cognitive impairment: study protocol of a randomized-controlled trail

Abstract Background Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI. Methods A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness. Discussion Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI. Trial registration International Standard Randomized Controlled Trial (# ISRCTN82378327 ). Registered: August 10, 2015

Validation of the interview-based life-space assessment in institutionalized settings (LSA-IS) for older persons with and without cognitive impairment

Background!#!Self-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings. This study evaluated construct validity, test-retest reliability, sensitivity to change, and feasibility of a new Life-Space Assessment for Institutionalized Settings (LSA-IS) in geriatric patients.!##!Methods!#!Psychometric properties of the LSA-IS in 119 hospitalized geriatric patients (83.0 ± 6.2 years) with and without cognitive impairment (CI) [Mini-Mental State Examination: 22.4 ± 4.9 scores] were evaluated within a comprehensive validation design. For the total group and subgroups according to cognitive status, construct validity was assessed by calculating Spearman's rank correlation coefficients (rho) with established construct variables, test-retest reliability by intra-class correlation coefficients (ICCs), sensitivity to change by standardized response means (SRMs) calculated for effects of early ward-based rehabilitation during hospital stay.!##!Results!#!The LSA-IS (total score) demonstrated good test-retest reliability (ICC = .704), and large sensitivity to change (SRM = .806), while construct validity was small to high indicated by significant correlations of the LSA-IS to construct variables (rho = .208-716), depending on relative construct association. On average results of LSA-IS sub-scores confirmed results of the total score. Subgroups according to cognitive status did not differ for most analyzed variables. A completion rate of 100% and a completion time of 3.2 ± 1.2 min documented excellent feasibility.!##!Conclusions!#!The interview-based LSA-IS has proven to be valid, reliable, sensitive, and feasible in hospitalized, multi-morbid, geriatric patients with and without CI documenting good psychometric properties for institutionalized settings.!##!Trial registration!#!DRKS00016028

Increasing life-space mobility in community-dwelling older persons with cognitive impairment following rehabilitation: A randomized controlled trial

Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk for losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The study aim was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group (IG) received a CI-specific, home-based strength, balance and walking training supported by tailored motivational strategies. The control group (CG) received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI), including a composite score for LSM and three sub-scores for maximal, equipment-assisted and independent life-space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3±6.0 years) with CI (MMSE: 23.3±2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the LSA-CI composite scores (b=8.15; 95% confidence interval: 2.89-13.41; p=.003) and independent life-space sub-scores (b= 0.39; 95% confidence interval: 0.00-0.78; p=.048) in the IG (n=63) compared to CG (n=55). Other sub-scores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life-space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction