JMIR Rehabilitation and Assistive Technologies最新文献

Background: Wearable sensor systems maximize visual and clinical feedback for physical therapists to enhance patient outcomes in rehabilitation medicine. However, physical therapists must adopt and accept new technologies for full integration into routine care to advance the use of technology in clinical care. Their role in technology design is critical in adopting and implementing technology. Interprofessional collaboration should be supported in the design of rehabilitation-assisted technologies.

Objective: We used the established tenets of the Technology Acceptance Model to describe physical therapists' expectations and experiences before and after using a novel wearable system in outpatient physical therapy.

Methods: This multiple methods pilot study used a comparative pre-post survey and a qualitative semistructured focus group study design. Using purposive sampling, we recruited outpatient physical therapists to pilot the novel wearable technology, describe their expectations and experiences, and participate in a semistructured focus group discussion conducted to gather training and user experience information.

Results: The study sample consisted of 5 physical therapists with an average age of 38.8 (SD 6.9) years and a work experience average of 12 (SD 7.7) years. Presurvey data show favorable expectations for usefulness and ease of use; however, favorability in both factors decreased after use. For perceived usefulness, all responses moved in the less favorable direction; mean difference -4.4 (SD 3.21); P=.04. All but 2 responses moved in the less favorable direction for overall perceived ease of use; mean difference -4.8 (SD 1.79); P=.04. Themed responses to open-ended questions in the postsurvey were feedback, setup time, accuracy, performance, and enhanced functional activities. Inductive content analysis of the focus group responses resulted in the following themes: system training, system benefits, system challenges, physical therapist perception of patients, and suggestions for improvement. The expectation for frequency of use decreased pre- to postexperience by 53% (mean -22, SD 14.40; P=.04).

Conclusions: The Technology Acceptance Model-based survey responses and focus group themes outcomes demonstrated that physical therapists' expectations for using new technology were not met. Engaging physical therapists in piloting novel wearable technology highlights the importance of physical therapist engagement in developing, refining, and implementing wearable devices for rehabilitation.

Background: Telerehabilitation has become increasingly important worldwide, as the COVID-19 pandemic forced many rehabilitation centers to change their daily care routine and find new ways to provide medical rehabilitation and aftercare.

Objective: This study aims to investigate the acceptance and implementation conditions of telerehabilitation in Germany, particularly following the COVID-19 pandemic.

Methods: We conducted qualitative semistructured interviews with patients (n=9) and health care professionals (n=8) between September 2023 and January 2024. To explore individual and structural barriers to and facilitators of telerehabilitation adoption, we used the extended unified theory of acceptance and use of technology and the Consolidated Framework for Implementation Research.

Results: Patients and health care professionals perceived telerehabilitation as positive, mainly due to its flexibility and accessibility. Patients expressed high acceptance levels, anticipating health benefits, although they found it challenging to familiarize themselves with the technology and establish routines. Health care professionals highlighted the need for adequate resources (financial, time, and personnel) and management support to implement telerehabilitation successfully. Both groups saw higher acceptance and cost coverage of telerehabilitation services as essential for successful implementation and use in Germany.

Conclusions: This study identified institutional barriers, such as concerns about resource availability, team communication, and initial resistance among health care staff to the introduction of new technologies. At an individual level, we found that patients struggled with routine establishment and that digital and in-person support from institutions and peers could mitigate this challenge. Implementing a hybrid approach and improving funding and approval processes would enhance telerehabilitation integration in the German health care sector.

Background: The quantification of gait parameters in amputees facilitates the assessment of their performance with prosthetic devices. These parameters often depend on measurements based on anatomical aspects that vary across different types of lower limb amputations.

Objective: This study aimed to investigate body weight distribution, and gait symmetry, quality, and propulsion, as well as pelvic kinematics in the amputee population.

Methods: The EcoWalk baropodometry platform was used to measure plantar pressure, and the G-Walk inertial sensor was used for accelerometry measurements in 29 unilateral lower limb amputees.

Results: Values were estimated for each variable under analysis, and the findings were categorized by the level of amputation. All variables exhibited normal distribution within each group under analysis , except for the symmetry index in above-knee (AK) amputees (P=.03). Regarding the body weight distribution (P=.11), velocity (P≥.99), propulsion (P=.38), and quality index (P=.10) of the amputated limb; no significant differences were observed between the AK and below-knee (BK) amputees. The most significant deviation was noted in pelvic obliquity, which was greater in AK amputees compared to BK amputees.

Conclusions: The values reported for the variables under analysis may enable the establishment of more precise reference levels for the amputee population, thereby contributing to a more accurate diagnostic process and aiding prosthetic fitting.

Background: Despite the abundance of assistive devices available, the accomplishment of many everyday tasks remains complex for people with visual impairments. While several studies have been conducted to identify the obstacles encountered when moving around outdoors, current knowledge is less abundant when it comes to the difficulties encountered in complex, indoor environments.

Objective: This study aimed to identify the most important obstacles and facilitators encountered in everyday indoor travel environments outside the home for people with low vision and blindness.

Methods: Data were collected from 20 participants with varying levels of vision from several cities across Canada in 2 web-based focus groups in both English and French. Using open-ended questions, participants shared obstacles and facilitators experienced or imagined during independent navigation in the following scenarios: coffee shop, hospital, big-box store, party with friends, and bus rides. Thematic analysis was conducted, and responses were either categorized as barriers or facilitators for each scenario. These were ranked by all participants via email according to their perceived importance in completing each scenario.

Results: Across scenarios, the principal barriers to perceived success were inaccessible signage, difficulties walking around, problems finding a specific location, and unsuccessful interactions with others. The main facilitators across scenarios were helpful interactions with others, planning, accessible signage, and websites. The use of mobile apps was discussed but ranked as less important by participants. Though similar among the French and English groups, the rankings of the different facilitators and barriers were largely scenario-specific. The most barriers were mentioned in the coffee shop (n=8), followed by the department store (n=7) and bus or metro (n=7) for the English group, whereas the most barriers were in the department store (n=9), followed by the hospital or clinic (n=7) and coffee shop (n=6) for the French group.

Conclusions: Though promising technologies have been developed to resolve some of the issues surrounding indoor navigation for people with visual impairments, they were not perceived as helpful as some other traditional methods of assistance, such as asking for help, by our participants. For the successful incorporation of indoor navigation technologies, it is important to understand how they integrate into the experience of people as they move in these dynamic environments. The successful use of technology is only possible if the physical environment permits and facilitates independent navigation.

Background: Both rehabilitation practice and rehabilitation professionals' work have been transformed by the adoption of different technological solutions. Sociotechnical theory can be used to analyze the adoption of technologies in rehabilitation practice.

Objective: This study aimed to enhance the understanding of the sociotechnical perspective of telerehabilitation (TR) in rehabilitation practice, as well as the understanding of how sociotechnical frameworks can be used to examine the implementation of telerehabilitation in outpatient rehabilitation.

Methods: A survey of rehabilitation professionals (N=629) was conducted in a Finnish outpatient rehabilitation setting. Data from 5 open-ended questions were analyzed using inductive, deductive, and abductive qualitative content analysis. An analysis matrix formed from the Fit between Individuals, Tasks, and Technology (FITT) and the Fit between Individuals, Tasks, Technology, and Environment (FITTE) frameworks was used.

Results: Deductive analysis revealed that in individual-task fit, professionals' and clients' adequate skills, support for participation, and a positive attitude were essential. The task-technology fit highlighted the need for the professionals' familiarization, changes in methods and materials, and collaboration with clients and their close associates and networks. The individual-task fit revealed that professionals found TR tasks to be more complex than those in in-person practice and that TR increased professionals' perceived workload and clients' need for personal contact, especially during the familiarization phase. Our findings suggest that certain dimensions of the FITTE framework need to be specified in order to better understand the sociotechnical adaptation of TR.

Conclusions: We propose an extension to create the Fit between Individual, Task, Technology, Interactive Sociotechnical Environment, and Organizational and Sociopolitical Context (FITTIO) framework, which provides conceptual tools for making contextual interpretations of the adoption of TR in rehabilitation settings. This study increases understanding of the sociotechnical nature of TR, which can be used in the adoption of technological solutions in rehabilitation practice.

Background: Neck pain is a common musculoskeletal disorder, often linked to forward head posture (FHP). Studies have shown that exercise interventions can improve pain, craniovertebral angle (CVA), range of motion, and function in individuals with FHP. While telerehabilitation exercise has proven effective for other musculoskeletal conditions, its effectiveness in addressing neck pain and FHP is still being investigated.

Objective: This study aimed to evaluate and compare the effectiveness of an internet-based telerehabilitation therapeutic exercise program with an in-person supervised program in improving clinical outcomes among young adult females with chronic nonspecific neck pain and FHP. The study hypothesized that there would be no significant differences in outcomes between the 2 groups.

Methods: A randomized controlled trial was conducted with 50 participants experiencing chronic neck pain and FHP, recruited through public announcement and voluntary sign-up. Participants were randomly assigned to either a telerehabilitation group or an in-person supervision group. Both groups completed the same 6-week, physiotherapist-supervised therapeutic exercise program, delivered via Zoom (Zoom Video Communications) or in the physiotherapy department laboratory, respectively. Outcome assessments were conducted face-to-face by blinded assessors at baseline, after 4 and 6 weeks of intervention, and at a 2-week follow-up. Outcome measures included pain intensity (assessed using the Visual Analog Scale [VAS]), CVA, neck disability (assessed using the Neck Disability Index [NDI]), and cervical range of motion (CROM). Adherence was monitored using attendance logs.

Results: Of the 50 participants, 48 completed the intervention with 1 dropout from each group. Adherence among completers was 100 percent in both groups. All 50 participants were included in the analysis using the intention-to-treat principle. No differences in effectiveness were found between the telerehabilitation and in-person groups, as no significant interaction effect between group and time was observed across all outcome measures including VAS, CVA, NDI, and CROM (P values ranged .07-.61). However, improvements were observed in all outcomes across time, including a 2.2- to 4.1-cm reduction in VAS, 5°-8.8° increase in CVA, 3.3- to 7.1-point reduction in NDI (P<.001 for all), and 3.5°-22.7° increase in CROM (P<.001 to P=.04).

Conclusions: Both telerehabilitation and in-person supervision were similarly effective in improving pain, posture, neck disability, and CROM in young adult females with chronic neck pain and FHP. These findings suggest that telerehabilitation may be a feasible and accessible alternative to conventional in-person therapeutic exercise programs for managing chronic neck pain with FHP.

Background: Grab bars are a multi-function bathing tool. While grab bars are commonly recommended by rehabilitation professionals, existing literature regarding optimal grab bar locations is focused on preference rather than function.

Objective: This study aimed to evaluate grab bar grasp location on 8 grab bar configurations during bathtub exit, with and without balance loss, and sit-to-stand (STS) from a bath seat.

Methods: Motion capture was used to evaluate grasp location during bathing activities in 28 older (65+ years) and 37 younger (18-35 years) adults. Grasp location was compared between age groups and balance loss conditions using ANOVA, and correlated with body height.

Results: Vertical grasp location varied from close to the bathtub rim to more than 1 meter above the bathtub rim (maximum 22.4 cm), while horizontal grasp location was close to the bathtub rim during bathtub exit, and close to the bath seat during STS. Young adult participants grasped 9.4% lower on vertical grab bars during perturbation trials than nonperturbation trials (P<.01). Body height was positively correlated with grasp height on a vertical grab bar during nonperturbation trials (r=0.67, P<.01), and negatively correlated with grasp distance on a low horizontal grab bar during STS (r=-0.37, P=.03).

Conclusions: Grab bar grasp location varied between proactive and reactive grasp scenarios and was linked to user height for some situations. These findings may be used to guide the selection of a grab bar installation location to support multiple bathing tasks.

Background: People with Parkinson disease (PD) often report low volume and reduced intelligibility of speech. Common household devices that use voice-assisted technology (VAT) require users to speak slowly, clearly, and loudly for the technology to function. For people with PD, this can be challenging, but this also suggests that VAT may have potential as a therapeutic tool. While VAT is an emerging health care technology, it is important to better understand the thoughts and experiences of people with PD who are already using it despite having speech and voice difficulties.

Objective: This study aimed to explore experiences of using VAT to address hypokinetic dysarthria secondary to PD, based on the perspectives of people with PD and family carers.

Methods: People with PD experiencing mild to moderate speech changes who were smart speaker users, and their carers, were invited to participate in 1 of 4 in-person focus groups. Between September and December 2024, focus groups were audiovisually recorded. A semistructured topic guide informed by published evidence was used to guide discussions. Results were transcribed and analyzed through a framework analysis approach (managed using NVivo software).

Results: A total of 15 participants, including 8 (53%) people with PD and 7 (47%) carers, participated in 4 in-person focus groups. Findings revealed shared experiences with VAT that were marked by its therapeutic potential and practical challenges. Five main themes were identified: (1) therapeutic potential for speech and voice, with subthemes of changes in volume, intelligibility, and clarity of speech; the role of VAT feedback; and VAT as an everyday device; (2) distrust of technology, with concerns surrounding data privacy, the listening nature of devices, and measures users take to protect themselves; (3) frustrations with devices, including devices not understanding, devices timing out, and the lack of conversation; (4) support needs, including the impact of a lack of knowledge and the need for education and guidance; and (5) design considerations for a future VAT tool in speech and language therapy (SLT).

Conclusions: This study extends on previous research findings, demonstrating that VAT may be acceptable to people with PD to create changes in volume, clarity, and intelligibility. However, attention must be given to users' privacy concerns and frustrations with devices before VAT can used as a tool in SLT. Future research should design solutions to address current usability challenges with people with PD and professionals in three ways: (1) co-designing education and guidelines for people with PD, describing the use of VAT for speech and voice difficulties; (2) refining commercial VAT for use in SLT; and (3) establishing the feasibility of a therapeutic VAT intervention for people with PD with speech and voice difficulties.

Background: Hearing loss affects 20% of the global population, including 250 million experiencing chronic suppurative otitis media, which can present challenges for conventional hearing aids due to ear discharge. Although assistive technology for hearing is available in high-income settings, provision is poor in low-income settings due to high costs and low availability of audiology services, reaching approximately 3% of those who could benefit from it.

Objective: This study aimed to evaluate the performance of a low-cost self-fitted direct-to-consumer bone-conduction headset for individuals with conductive or mixed hearing loss.

Methods: We conducted a multiple methods study to test the efficacy and acceptability of this device using a purposive sample. Participants with a range of conductive and mixed hearing loss underwent speech-in-quiet speech audiometry with and without the device and took part in feedback interviews exploring their subjective impressions of the device.

Results: In 33 participants, the device improved speech recognition in those with bone conduction thresholds <50 dB by a median of 11%, with larger air-bone gap associated with larger improvement. Participants rated the device positively on weight, style, and ease of use.

Conclusions: This multiple methods study assessed the acceptability and efficacy of a low cost self-fitted bone-conduction device in adults. We found the device provides hearing benefit for those with conductive or mixed hearing loss (with bone conduction thresholds <50dB HL). Those with significant conductive hearing loss were measured to have their speech perception significantly improved. Participants had a mixed response to device aesthetics. Further studies should seek to establish if this type of device has effectiveness in real-world trials and which individuals are most likely to benefit. This low cost device could provide hearing benefits to millions of people without access to other devices. Product designers and clinical researchers should explore device optimization. Given the economic impacts of hearing loss across the globe, this style of self-fitted device could represent a paradigm shift in future assistive technology for hearing loss, in both high and low resource settings.