Background: Virtual reality (VR) can supplement exercise therapy for poststroke upper-arm hemiparesis, but treatments have been largely limited by specialized or costly equipment, hindering replicability and generalizability.
Objective: This study examined the feasibility of using a commercially available bundle of VR supplies to improve hemiparetic arm function before and after an exergaming program in an individual post stroke.
Methods: We conducted a pre-post case study (male, aged 72 years, chronic stroke) of a 20-day VR exergaming program (1-hour session per day) using a head-mounted display (Meta Quest 2), with adaptive software (WalkinVR) to boost and adjust in-game movements. Measures of upper-arm function were performed at preintervention (day 0), midintervention (day 10), and postintervention (day 21) and included the Wolf Motor Function Test (WMFT) and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). Data were descriptively analyzed.
Results: The participant demonstrated improvement in the mean time to complete tasks of the WMFT by 70.5% (δ=11.73 s; preintervention mean time 16.63, SD 31 s; effect size=0.54) from preintervention to midintervention and 78% (δ=12.96 s; effect size=0.59) from preintervention to postintervention. WMFT mean functional ability score demonstrated an improvement of 18% (δ=0.46 points; preintervention mean score 2.67, SD 0.87 points; effect size=0.59) from preintervention to midintervention and 23% (δ=0.6 points; effect size=0.79) from preintervention to postintervention. Range of motion improved in all joints by an average of 35.64% (SD 20%) from preintervention to postintervention. DASH scores demonstrated minimal improvements across the intervention.
Conclusions: VR exergaming with adaptive software could be an easy-to-adopt method for improving the functional ability of the hemiparetic arm among people post stroke. Improvements were potentially meaningful but warrant confirmation in more rigorous study designs.
Background: Burn injuries are a major global health problem, particularly in low- and middle-income countries, accounting for most burn-related deaths and disabilities. In Saudi Arabia, burns remain a frequent cause of morbidity, often resulting from domestic accidents involving hot liquids, open flames, or electricity. The Jazan region, with its dense population and reliance on traditional cooking methods, is considered at higher risk. Understanding public knowledge, attitudes, and practices regarding burns and first aid is essential for guiding preventive strategies and health education efforts.
Objective: This study aimed to assess the level of awareness, knowledge, and practices related to burn causes and first aid management among residents of the Jazan region, Saudi Arabia.
Methods: A cross-sectional online survey was conducted using a validated Arabic questionnaire distributed through social media platforms. The questionnaire covered demographics, knowledge of burn causes and types, first aid management, and preventive practices. Data were analyzed using SPSS version 26.0.
Results: Out of 404 participants aged 18-60 years, 228 (56.4%) demonstrated poor knowledge and awareness regarding burn causes and first aid management. The internet was the most commonly reported source of information (171/236, 72.5%), followed by formal courses (76/236, 32.2%), paper leaflets (75/236, 31.8%), television (67/236, 28.4%), and daily newspapers (23/236, 9.7%). Additionally, 215 (53.2%) participants had previously experienced burns, with hot water (136/215, 63.8%) and fire (105/215, 48.8%) cited as the most common causes. The most frequently affected sites were the hand (111/215, 51.6%), arm (85/215, 39.5%), and thigh (49/215, 22.8%).
Conclusions: The study highlights limited awareness and improper first aid practices among the Jazan population. Targeted community-based educational programs are needed to enhance burn prevention and management knowledge.
Background: The fast rate of technological advances in the health care sector remain as a pressing need for effective solutions that address the unique health care needs of sexual and gender minorities. If these innovative solutions are considered, societal challenges such as stigma, discrimination, and a lack of tailored health care resources, as experienced by the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more (LGBTQIA+) individuals could be addressed at lower cost.
Objective: This study aimed to develop a mobile health (mHealth) app specifically designed to address the sexual and reproductive health (SRH) of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more (LGBTQIA+) individuals in Gauteng Province, South Africa.
Methods: This study used a Design Science Research (DSR) framework and a mixed-method exploratory sequential approach. DSR was executed in three cycles: cycle one followed an ethnography approach; involved 33 health care providers (HCPs) and 22 LGBTQIA+ individuals, focusing on identifying specific SRH and the challenges encountered in accessing and providing these services. Participants shared their views on the potential role of mHealth apps in addressing these issues. Cycle two engaged 13 experts through Participatory Action Research (PAR) approach using the Nominal Group Technique (NGT) to collaboratively identify essential content for the app, fostering a co-creation process. Lastly, cycle three followed an interventional pre-experimental approach by involving software developers and principal investigator working together to develop a functional prototype of the mHealth app.
Results: This study revealed critical insights into the specific SRH of LGBTQIA+ individuals, alongside the barriers faced by health care providers in meeting these needs. The co-created app prototype named "Queery wellness hub" was developed and incorporated features tailored to enhance accessibility, confidentiality, and user engagement, addressing both user and provider perspectives.
Conclusions: The findings underscore the potential of mHealth apps in transforming the delivery of SRH for LGBTQIA+ individuals in South Africa. Continued collaboration with stakeholders is essential for further refinement and successful implementation of the app, ultimately contributing to better health outcomes for sexual and gender minorities.
Background: The clinical and cost-related consequences of internet-based depression screening, in combination with automated feedback, have been rarely investigated. We aimed to conduct a cost-effectiveness analysis of DISCOVER, a 3-armed, observer-masked, randomized controlled trial that focused on 2 versions of automated feedback interventions after internet-based depression screening.
Objective: This study aimed to evaluate the cost-effectiveness of automated nontailored and tailored feedback interventions after internet-based depression screening from a societal perspective.
Methods: Participants were recruited from the general population via traditional and social media. Participants who were undiagnosed but screened positive for depression on an online version of the Patient Health Questionnaire-9 (≥10 points) were randomized to automatically receive no feedback, nontailored feedback, or tailored feedback. The feedback interventions included the depression screening result, a recommendation to seek professional advice, and brief general information about depression. The tailored feedback was additionally framed according to the participants' symptom profiles, treatment preferences, health insurance plans, and local residency. The time horizon was 6 months. The main outcome was the incremental cost-effectiveness ratio (ICER) from a societal perspective using quality-adjusted life years (QALY) based on the EuroQol-5D-5L. Cost-effectiveness acceptability curves were constructed. Furthermore, several sensitivity analyses and explorative subgroup analyses were conducted.
Results: A total of 1012 participants (no feedback: n=343, 33.9%; nontailored feedback: n=338, 33.4%; and tailored feedback: n=331, 32.7%) were included. Differences in costs and effects were not statistically significant. However, ICER results indicated that both no feedback and tailored feedback exhibited dominance over nontailored feedback. The ICER of tailored feedback compared to no feedback was €109,730 per QALY (a currency exchange rate of €1=US $1.02 was applicable as of December 31, 2022), whereas both costs and QALYs were lower in tailored feedback. The cost-effectiveness probability of tailored feedback compared to no feedback ranged between 41% and 80%. Sensitivity analyses exhibited similar trends.
Conclusions: Six months postintervention, feedback interventions had no statistically significant effect on costs from a societal perspective or on QALYs. Tailored feedback was associated with moderate cost-effectiveness probabilities compared to no feedback. Explorative subgroup analyses revealed subpopulations for which the interventions might be cost-effective.
Background: Access to rehabilitation services is a critical yet under-studied dimension of health equity. Among the 6 domains of access, health care provider availability, defined as the presence of sufficient health care providers to meet population needs, is particularly underexplored in rehabilitation professions such as physical and occupational therapy. Current data reporting often lacks the geographic granularity required for effective workforce planning.
Objective: The purpose of this study was to demonstrate the feasibility of mapping rehabilitation provider availability at the census tract level using geographic information systems and integrating public licensure and population data to inform equitable workforce planning.
Methods: A descriptive, cross-sectional study was conducted using publicly available state licensure data for physical and occupational therapists and demographic data from the American Community Survey. Residential addresses of rehabilitation providers were geocoded and matched to 2020 census tracts. Population-to-provider ratios were calculated and mapped using choropleth and bivariate mapping techniques. Population-to-provider ratios were calculated per tract and summarized overall and by rurality using 2020 Rural-Urban Commuting Area (RUCA) codes (urban: RUCA of 1-3; rural: RUCA of ≥4). The spatial dependence of ratios was tested using a spatial autocorrelation statistic, the global Moran I, in ArcGIS Pro using edge contiguity neighbors and row standardization.
Results: Across 6896 tracts, ratios ranged from 4.5 to 11,147 persons per provider (median 1131, IQR 537-2501). By rurality, urban tracts (n=5734, 83.1%) had a median ratio of 1141 (IQR 2054), and rural tracts (n=1162, 16.9%) had a median ratio of 1093 (IQR 1690), indicating a broadly similar central tendency with somewhat greater variability in urban areas. The population-to-provider ratio exhibited significant positive spatial autocorrelation (global Moran I=0.305; Z=40.28; P<.001), consistent with clustered pockets of high and low availability rather than random dispersion.
Conclusions: A replicable geographic information system protocol can integrate licensure and demographic data to produce interpretable population-to-provider metrics and spatial diagnostics at the census-tract level. In Texas, rehabilitation workforce availability is spatially clustered and not explained solely by an urban-rural divide, underscoring the value of small-area mapping for equitable workforce planning and policy decisions.
Background: Digital short cognitive tests administered by medical assistants (MAs) in general practitioners' (GPs) practices have great potential for the timely identification of patients with dementia, because they can lead to targeted specialist referrals or to immediate reassurance of patients regarding their perceived concerns. However, integration of this testing approach into clinical practice requires good usability for the test itself, especially for cognitively impaired older adults.
Objective: In this implementation study, the digital version of the Montreal Cognitive Assessment (MoCA) Duo was conducted by MAs in general practice. We tested if the interaction with the test is associated with usability problems for the patients and aimed to find additional relevant constructs that should be considered for the potential implementation of such digital tests into clinical practice. We focused the study on subjective success, usability, and workload as well as their association with the result of the cognitive test to assess whether the MoCA Duo can be implemented into general practice.
Methods: In total, 10 GPs took part in the study. Within their practices, 299 GP patients (aged 51-97 years) with cognitive concerns completed the MoCA Duo administered by MAs. Subsequently, patients and MAs completed digital questionnaires regarding the interaction with the app. Usability was measured using the adapted System Usability Scale, and perceived workload using the National Aeronautics and Space Administration Task Load Index. For the perceived workload, we included an assessment of the patient by the MA. Results of the MoCA Duo were supplied to the GPs for their consultation with the patient.
Results: The results indicated good usability for the MoCA Duo. Self-assessment by the patients indicated that 64% (191/299) could perform in the test to the best of their ability, affected by their MoCA score. We found significant higher usability ratings by patients with better MoCA scores as well as by younger patients. Furthermore, the perceived workload showed overall medium workload. We found significant correlations between the subjective perceived workload of the patients and the assessment by MAs. Self-assessments as well as assessments by the MAs were significantly influenced by the MoCA scores and the age of the participants.
Conclusions: The results indicate good usability of the digital MoCA within the sample, supporting the idea that the resulting scores are adequate to assess cognitive status without dependence on technological affinity. Furthermore, the results highlight the relevance of heterogenous samples for comparable evaluation studies, based on the significant effect of cognitive status and age on usability and workload.
Background: The integration of artificial intelligence (AI) in radiology has advanced significantly, but research on how it affects the daily work of radiology staff is limited.
Objective: This study aimed to explore the experiences of radiology staff on the integration of an AI application in a radiology department in Sweden. This understanding is essential for developing strategies to address potential challenges in AI integration and optimize the use of AI applications in radiology practice.
Methods: This qualitative case study was conducted in a single radiology department with 40 employees in 1 hospital in southwestern Sweden. The study concerned the integration of an AI-powered medical imaging software designed to assist radiologists in analyzing and interpreting medical images. Using a qualitative design, interviews were conducted with 7 radiologists (physicians), 4 radiologic technologists, and 1 physician assistant. Their experience within radiology varied between 13 months and 38 years. The data were analyzed using qualitative content analysis.
Results: Participants cited numerous strengths and advantages of significant value in integrating AI into radiology practice. Numerous challenges were also revealed in terms of difficulties associated with choosing, acquiring, and deploying the AI application and operational issues in radiology practice. They discussed experiences with diverse strategies to facilitate the integration of AI in radiology and to address various challenges and problems.
Conclusions: The findings illustrate how AI integration was experienced in 1 hospital. While not generalizable, the study provides insights that may be useful for similar settings. Radiology staff believed AI integration enhanced decision-making and quality of care, but they encountered challenges from preadoption to routine use of AI in radiology practice. Strategies such as internal training and workflow adaptation facilitated the successful integration of AI in radiology.
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