Background: Rehabilitation technologies can support recovery and rehabilitation outside clinical settings. However, their adoption remains challenging. Factors such as ease of use, perceived benefits, and social influence play a role, but little is known about how rehabilitation patients perceive their relative importance.
Objective: This study aimed to systematically explore the viewpoints of rehabilitation patients regarding the adoption of home-based rehabilitation technology.
Methods: Between May and September 2024, this study examined the viewpoints of rehabilitation patients with acquired brain injury regarding the adoption of home-based rehabilitation technology using Q-methodology. A purposive sample of 21 participants ranked 34 opinion statements based on perceived importance and explained their choices during follow-up interviews. By-person factor analysis identified common patterns in how participants ranked the statements. These patterns, referred to as factors or viewpoints, were further interpreted using qualitative interview data.
Results: Three viewpoints were identified, each highlighting different factors important for adopting home-based rehabilitation technology: (1) technology supporting rapid recovery, (2) technology supporting independence and self-control, and (3) technology as a supporting partner. Participants consistently emphasized the importance of regaining independence, receiving feedback during exercises, simple and easy-to-use designs, and approval from therapists, while positive reports in mainstream media, support from friends, and reducing travel to rehabilitation centers were considered less important.
Conclusions: The findings suggest that rehabilitation patients with acquired brain injury prioritize different factors when adopting home-based rehabilitation technology. While some factors are commonly valued, the diversity in patient viewpoints underscores the need for tailored, user-centered approaches in the design and implementation of these technologies. A one-size-fits-all approach would likely be ineffective in meeting their varying needs.
Background: People with disabilities are a priority population for health services research. People who are blind or have low vision (B/LV) are a segment of this priority population, who experience difficulty in accessing health care facilities due to architectural and navigational barriers. These barriers persist despite disability civil rights law in the United States.
Objective: The purpose of this study is to report on a program that was developed to train way finders in human guide technique for people who are B/LV.
Methods: This study took place at Michigan Medicine, an academic medical center in southeast Michigan. We conducted a needs assessment through cohort discovery and soliciting expert feedback. The human guide training program was developed using the PRECEDE-PROCEED health promotion program development model and targeted health care volunteers and staff. The intended components included in-person training, a web-based module, and tip sheets. Due to COVID-19, the in-person training was not implemented. We report findings from a process evaluation, measuring reach, knowledge, behavioral capability, and satisfaction pre- and postprogram.
Results: In total, 87 participants completed the training, and most of them were Michigan Medicine volunteers. There were significant improvements in behavioral capability related to the human guide technique. Participants were satisfied with the training and provided recommendations for more detailed demonstrations and scenarios in future training sessions.
Conclusions: The training improves participants' knowledge and confidence in providing wayfinding assistance to patients who are B/LV. However, further in-person training is recommended to provide hands-on experience and detailed feedback. Addressing architectural barriers and providing accessible patient education materials is crucial for improving health care accessibility for patients who are B/LV.
Background: COVID-19 has given impetus to an already growing trend around the use of ambient assisted living (AAL) technologies to support frail older adults who live alone. However, the challenge is that systematic research on the long-term use of AAL technologies remains in its nascent stages, leaving gaps in the understanding of the predictors that contribute to the routine embedding of AAL technologies in older adults' care.
Objective: This paper aims to share key lessons from a longitudinal study on the routine embedding of AAL technologies in older adults' care within a hitherto under-studied Southeast Asian context. Our objective was to design and deploy an AAL system termed Ubiquitous Service Management and Reasoning Architecture (Ubismart), evaluate its impact on older adults' quality of life (QOL), and distill lessons to inform the sustainable and culturally sensitive adoption of AAL technologies in similar settings.
Methods: We conducted an in-depth case study using a mixed methods design. First, we designed and deployed Ubismart to unobtrusively monitor and visualize older adults' activities of daily living. To assess changes in QOL, we administered a simplified, gamified version of the validated Older People's Quality of Life Questionnaire. Finally, we conducted semistructured interviews with older adults and their caregivers to triangulate the quantitative findings and explore evolving perceptions of the technology and its integration into daily routines.
Results: Quantitative analysis revealed significant improvements in (1) psychological and emotional well-being (P=.01) and (2) leisure and social activities (P=.03) following the AAL intervention. Other QOL dimensions showed no statistically significant change. Qualitative findings reinforced the improvement in psychological and emotional well-being, with many participants describing a heightened sense of safety and peace of mind, often likening the technology to "insurance" or a silent companion. However, the impact on social relationships was paradoxical; some older adults felt more cared for, while others perceived a decline in in-person visits. This paradox highlighted the complexities of technology's role in caregiving, as it might simultaneously enhance feelings of safety while unintentionally diminishing social connection for some older adults.
Conclusions: AAL technologies such as Ubismart enhance older adults' psychological and emotional well-being and sense of safety but may inadvertently reduce social interaction. Sustainable integration requires balancing these benefits with efforts to maintain meaningful caregiver connections, supporting both safety and social engagement for older adults.
Trial registration: ClinicalTrials.gov NCT06486935; https://clinicaltrials.gov/study/NCT06486935.
Background: With the rapid advancement of technology, using wearable devices and mobile health (mHealth) apps to monitor and promote physical activity (PA) has become increasingly popular among individuals with various chronic conditions. However, such work remains limited among individuals with spinal cord injury (SCI), especially those who use a manual wheelchair for mobility.
Objectives: The study aims to describe the development of the WheelFit mHealth app for monitoring and promoting PA in manual wheelchair users (MWUs) with SCI and evaluate its feasibility and usability in free-living conditions.
Methods: The WheelFit app, based on the Fogg Behavioral Model with inputs from stakeholders, including MWUs, physical therapists, and personal trainers, was developed to promote PA in MWUs. It works with two commercial wearable devices, that is, an Android smartwatch and a wheel sensor, which stream users' upper extremity and wheelchair movement to the app to calculate PA variables using custom algorithms. Users can set personal goals, review daily progress and PA history, and access an adaptive workout library within the app. A 4-week single-group pre-post study, consisting of a 1-week baseline and 3-week intervention phase, was conducted to evaluate WheelFit's feasibility and usability. Feasibility was evaluated using the session attendance rate, device and app usage, and implementation of action plans. Usability was assessed using the system usability scale. The preliminary effectiveness was assessed by comparing preintervention and postintervention PA variables and scores from the SCI exercise self-efficacy scale.
Results: A total of 16 participants completed the study protocol with 100% session attendance and maintained 14.2 hours of daily device and app connection. Participants demonstrated varying levels of adherence to their action plans. The excellent usability of WheelFit was indicated by an average system usability scale score of 81.8 (SD 19.2) points. Statistically significant increases between pre-post daily exercise times (preintervention: mean 26.4, SD 16.9 minutes; postintervention: mean 33.3, SD 24.9 minutes; P=.049) and exercise self-efficacy scale scores (preintervention: mean 33.9, SD 4.5 points; postintervention: mean 35.9, SD 3.2 points; P=.043) were observed.
Conclusions: The WheelFit app demonstrated promising feasibility, usability, and a positive impact on promoting PA in MWUs with SCI. Future investigation exploring the potential integration of the WheelFit app into clinical practice is warranted.
Background: The Gloreha (Idrogenet SRL) is a robotic device that enhances conventional rehabilitation for improving upper extremity function after stroke, but comprehensive evidence on its effectiveness is still lacking.
Objective: The objective of this study was to evaluate the effectiveness of the Gloreha device on upper extremity function and activities of daily living (ADLs) in patients with stroke.
Methods: PubMed, Cochrane CENTRAL, CINAHL, Embase, and EBSCO Open Dissertations were searched from January 2013 to January 2024. The inclusion criteria were randomized controlled trials involving adult patients with stroke that compared rehabilitation with the Gloreha device to conventional rehabilitation and reported upper extremity function or ADLs outcomes. All included studies underwent bias risk assessment using the Revised Cochrane risk-of-bias tool for randomized trials.
Results: Out of 1123 studies identified, 3 randomized controlled trials involving 83 participants were included. Of these, 2 trials combined Gloreha training with conventional rehabilitation, while in another trial, patients engaged solely in the training by the Gloreha device. The Gloreha, whether integrated with conventional rehabilitation or used independently, has the potential to enhance motor function and functional ability in survivors of stroke.
Conclusions: Gloreha passive training with conventional rehabilitation improves upper extremity function post stroke, but ADL effects and long-term optimal dosing require further research.
Background: Individuals with spinal cord injury or disease (SCI/D) experience disproportionately high rates of recurrent urinary tract infections, which are often complicated by atypical symptoms and delayed diagnoses. Patient-centered tools, like the Urinary Symptom Questionnaires for Neurogenic Bladder (USQNB), have been developed to support symptom assessment yet remain underused. Generative artificial intelligence tools such as ChatGPT may offer a more usable approach to improving symptom management by providing real-time, tailored health information directly to patients.
Objective: This study explores the role of ChatGPT (version 3.5) in supporting urinary symptom management for individuals with SCI/D, focusing on its perceived accuracy, usefulness, and impact on health care engagement and self-management practices.
Methods: A total of 30 individuals with SCI/D were recruited through advocacy groups and health care networks. Using realistic, scenario-based testing derived from validated tools for symptom management with SCI/D, such as the USQNB, participants interacted with ChatGPT to seek advice for urinary symptoms. Follow-up interviews were conducted remotely to assess individuals' experiences using ChatGPT for urinary symptom management. Data were analyzed using inductive content analysis, with themes refined iteratively through a consensus-based process.
Results: People with SCI/D reported high levels of trust in ChatGPT's recommendations, with all 30 participants agreeing or strongly agreeing with the advice provided. ChatGPT's responses were perceived as clear and comparable to professional medical advice. Participants mentioned concerns about the lack of sources and integration with patient-specific data. ChatGPT influenced individuals' decision-making by supporting symptom assessment and guiding participants on when to seek professional care or pursue self-management strategies.
Conclusions: ChatGPT is a promising tool for symptom assessment and managing chronic conditions such as urinary symptoms in individuals with SCI/D. While ChatGPT enhances accessibility to health information, further research is needed to improve its transparency and integration with personalized health data to be a more usable tool in making informed health decisions.
Background: An accurate tongue strength and endurance assessment is necessary for pediatric dysphagia. TongueFit is a new, portable orofacial manometer for measuring tongue strength and endurance and a game-based training app for children.
Objective: This study aimed to test the validity of TongueFit compared with a standard manometer as the current gold standard for measuring air pressure.
Methods: This laboratory study compared TongueFit and a standard manometer as the gold standard for measuring air pressure. This study was conducted in 3 different experimental conditions. The first experiment compared TongueFit and the standard manometer using a force tester (MCT-2150), with pressure controlled by MSatLite software. The second and third experiments involved 2-cm and 3-cm bulbs between the 2 devices. This study used Lin concordance correlation to measure the level of agreement.
Results: There was a mean absolute difference of 0.005 kilopascals (kPa) between the TongueFit and the standard manometer (n=35, ρC=1). Statistical analysis showed perfect agreement correlation (ρC=1). By using the 2-cm bulb, TongueFit's mean was 0.007 kPa lower, also showing perfect agreement (ρC=1). Furthermore, using the 3-cm bulb, results showed almost perfect agreement (ρC=0.999) with the TongueFit's mean, which was 0.044 kPa lower.
Conclusions: This study confirms the high validity of TongueFit as an orofacial manometer compared with a standard manometer, with negligible mean differences, as well as near-perfect and perfect agreement in the experiments. These results confirm that TongueFit is a valid and accurate tool for assessing tongue strength.
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