Journal of Telemedicine and Telecare最新文献

Introduction: The aim of this research was to investigate the effects of telerehabilitation-based remote supervised or unsupervised structured exercise therapy on pain, disability, and quality of life related to chronic nonspecific neck pain.

Method: The study was designed as a single-blinded randomized controlled trial. Sixty-six eligible chronic nonspecific neck pain patients were randomized across three groups: remote supervised group (RSG, n = 22), unsupervised group (UG, n = 22), and waitlist control group (CG, n = 22). Progressive structured exercise therapy program was delivered weekly to patients in remote supervised group and unsupervised group to perform four days a week for four weeks. Remote supervised group was supervised by videoconference and text message. Pain, disability, and quality of life of participants were assessed at baseline, week 2, and post-therapy.

Results: Post-therapy pain and disability total change scores were -3.64 (95% CI -4.85 to -2.42) and -7.27 (95% CI -11.05 to -3.50) for remote supervised group compared with a change of -2.44 (95% CI -3.46 to -1.43) and -5.77 (95% CI -8.54 to -3.01) for unsupervised group, respectively. Post-therapy, quality of life improvements were greater for remote supervised group than unsupervised group overall (general health; remote supervised group: 19.01 (95% CI 6.86 to 31.16), unsupervised group: 12.50 (95% CI 4.79 to 20.21), and physical health; remote supervised group: 18.35 (95% CI 10.35 to 26.35), unsupervised group: 7.31 (95% CI 0.01 to 14.60)). Significant improvements in psychological health and environment-telerehabilitation for remote supervised group were not seen for unsupervised group and outcomes differences did not reach significance for control group (p > 0.05) post-therapy, except environment-telerehabilitation.

Discussion: Structured exercise therapy can improve chronic nonspecific neck pain outcomes when remotely supervised or unsupervised. Structured exercise therapy content and frequent communication are important for remote chronic nonspecific neck pain management.

Introduction: Traumatic brain injury (TBI) represents a major cause of death and disability worldwide. Brain damage is associated with physical and psychological difficulties among TBI survivors. Diverse face-to-face and telehealth programs exist to help survivors cope with these burdens. However, the effectiveness of telehealth interventions among TBI survivors remains inconclusive.

Methods: A systematic review and meta-analysis of randomized control trials were conducted. Relevant full-text articles were retrieved from seven databases, from database inception to January 2022, including Academic Search Complete, CINAHL, EMBASE, Cochrane, MEDLINE, PubMed, and Web of Science. Bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was performed using a random-effects model to calculate the pooled effect size of telehealth interventions for TBI survivors. STATA 16.0 was used for statistical analysis.

Results: In total, 17 studies (N = 3158) applying telehealth interventions among TBI survivors were included in the analysis. Telehealth interventions decreased neurobehavioural symptom (standardized mean difference: -0.13; 95% confidence interval [CI]: -0.36 to 0.10), reduce depression (standardized mean difference: -0.32; 95% CI: -0.79 to 0.14), and increase symptom management self-efficacy (standardized mean difference: 0.22; 95% CI: 0.02-0.42).

Discussion: Telehealth interventions are promising avenues for healthcare delivery due to advances in technology and information. Telehealth programs may represent windows of opportunity, combining traditional treatment with rehabilitation to increase symptom management self-efficacy among TBI patients during recovery. Future telehealth programs can focus on developing the contents of telehealth modules based on evidence from this study.

Introduction: Virtual care using videoconference links between urban-based physical therapists and nurse practitioners in rural primary care may overcome access challenges and enhance care for rural and remote residents with chronic low back disorders (CBD). The purpose of this study was to evaluate the concordance of this new model of care with two traditional models.

Methods: In this cross-sectional study design, each of 27 participants with CBD were assessed by: 1) a team of a nurse practitioner (NP) located with a patient, joined by a physical therapist (PT) using videoconferencing (NP/PT_team); 2) in-person PT (PT_alone); and 3) in-person NP (NP_alone). Diagnostic and management concordance between the three groups were assessed with percent agreement and kappa.

Results: Overall diagnostic categorization was compared for PT_alone versus NP_alone and NP/PT_team: percent agreement was 77.8% (k = 0.474, p = 0.001) and 74.1% (k = 0.359, p = 0.004), respectively. In terms of management recommendations, the PT_alone and NP_alone demonstrated strong agreement on "need for urgent surgical referral" (92.6%, k = 0.649 (p < 0.00) and slight agreement for "refer to primary physician for pharmacology, lab or imaging" (81.5%, k = 0.372 (p = 0.013). The PT_alone and NP/PT_team demonstrated strong agreement on "need for urgent surgical referral" (96.3%, k = 0.649, p = 0.000) and "recommendation for PT follow up" (88.9%, k = 0.664, p = 0.000).

Discussion: The diagnostic categorization and management recommendations of the team using videoconferencing for CBD were similar to decisions made by an in-person PT. This model of care may provide a method for enhancing access to PT for CBD assessment and initial management in underserved areas.

Background: Total knee replacement is a commonly adopted surgical intervention to reduce physical limitations and pain in advanced-stage knee osteoarthritis. However, these patients may experience physical dysfunction to limit their access during conventional rehabilitation after total knee replacement. The use of telemedicine may be the promising solution. This study aims to compare the effectiveness of telerehabilitation with conventional in-person rehabilitation in patients who underwent a total knee replacement.

Methods: For this systematic review on randomized controlled trials, PubMed, Medline, EMBASE, Cochrane Library, ScienceDirect and CINAHL databases were searched for eligible articles published between 1 January 2003 and 28 February 2022. The eligibility criteria were patients who underwent total knee replacement, randomized controlled trials and publications in English. The main outcome measures were focused on pain and physical function. Reference lists of relevant studies were also manually checked to find additional studies. Two independent reviewers conducted study selection separately. PEDro scale was used to assess the methodological quality of the included randomized controlled trials. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses.

Results: A total of 11 studies met the eligibility criteria and included 1825 participants in the systematic review. Overall, the results revealed that the effectiveness of telerehabilitation is comparable to conventional in-person rehabilitation in improving various pain and functional outcomes in patients who underwent a total knee replacement. In the meta-analysis with the fixed-effects model, no significant difference was found in the improvement of pain and physical function in patients with knee osteoarthritis compared with conventional rehabilitation (Standardized Mean Difference (SMD)  -0.15, 95% CI  -0.47 to 0.16, P = 0.34 and SMD -0.04, 95% CI -0.19 to 0.12, P = 0.62, respectively). In addition, the utilization of hospital resources and costs were significantly lower in telerehabilitation when compared with in-person rehabilitation.

Conclusion: Telerehabilitation was comparable to conventional in-person rehabilitation in improving clinical outcomes following total knee replacement. However, it might be a more preferable alternative rehabilitation intervention for patients following total knee replacement given the significantly lower cost of telerehabilitation.

Introduction: The impact of depressed mood in daily life is difficult to investigate using traditional retrospective assessments, given daily or even within-day mood fluctuations in various contexts. This study aimed to use a smartphone-based ambulatory assessment to examine real-time relationships between depressed mood and functional behaviors among individuals with stroke.

Methods: A total of 202 participants with mild-to-moderate stroke (90% ischemic, 45% female, 44% Black) completed an ecological momentary assessment five times per day for 2 weeks by reporting their depressed mood and functional behaviors regarding where, with whom, and what activity was spent.

Results: Participants spent 28% of their wake-up time participating in passive leisure activities but spent the least time in physical (4%) and vocational (9%) activities. Depressed mood was concurrently lower when participants engaged in social activities (β = -0.023 ± 0.011) and instrumental activities of daily living (β = -0.061 ± 0.013); spent time with family members (β = -0.061 ± 0.014), spouses (β = -0.043, ± 0.016), friends (β = -0.094, ± 0.021), and coworkers (β = -0.050 ± 0.021); and were located in restaurants (β = -0.068 ± 0.029), and homes of family members (β = -0.039 ± 0.020) or friends (β = -0.069 ± 0.031). Greater depressed mood was associated with worse ratings in satisfaction, performance, and engagement of activities in concurrent (βs = -0.036 ± 0.003, -0.053 ± 0.003, -0.044 ± 0.003) and time-lagged models (βs = -0.011 ± 0.004, -0.012 ± 0.004, -0.013 ± 0.004).

Discussion: Smartphone-based ambulatory assessment can elucidate functional behaviors and associated mood after stroke. Findings support behavioral activation treatments to schedule social and instrumental activities for stroke survivors to reduce their depressed mood.

Background and objective: Evidence is shown for the benefits of physical activity, for patients with lung cancer, at different times through the course of the disease. Telerehabilitation can overcome some of barriers often met by patients to practice physical activity. The objective of this systematic review is to assess feasibility and safety of telerehabilitation for patients with lung cancer, its effects on physical capacity, quality of life, symptoms severity, depression and anxiety, survival, lung function, post-operative outcomes, dyspnoea and body composition. Secondary aim was to distinguish the telerehabilitation efficacy between the different phases of the disease.

Data source and selection criteria: Pubmed, PEDro, Scopus, ScienceDirect, randomized controlled trials and non-randomized controlled trials, written in French or English, of telerehabilitation among patients with lung cancer.

Results: Eight studies were included. Telerehabilitation is safe but was characterized by a low recruitment and attendance rate (<70%). It enhances quality of life, muscle mass, depression and anxiety but it does not improve physical capacity (except in preoperative period), symptoms severity, survival, lung function or dyspnoea. After surgery, it ameliorates quality of life, depression and anxiety. During systemic treatments of lung cancer, it improves quality of life, symptoms severity and muscle mass.

Conclusion: Telerehabilitation could be proposed in patients with lung cancer as a complementary intervention of hospital-based programme to increase physical activity volume, compliance and self-efficacy. In case the classic programmes are not possible, it could also be an alternative approach for patients unable to participate to a hospital or community-based training programme.

Introduction: Remote assessment creates opportunities for monitoring child development at home. Determining the possible barriers to and facilitators of the quality of telemonitoring motor skills allows for safe and effective practices. We aimed to: (1) determine the quality, barriers and facilitators of Alberta Infant Motor Scale (AIMS) home videos made by mothers; (2) verify interrater reliability; (3) determine the association between contextual factors and the quality of assessments.

Methods: Thirty infants at biological risk aged between three and ten months, of both sexes, and their mothers were included. Assessments were based on asynchronous home videos, where motor skills were evaluated by mothers at home according to AIMS guidelines. The following were analyzed: video quality; stimulus quality; camera position; and physical environment. The video characteristics were analyzed descriptively. The intraclass correlation coefficient was used to calculate interrater reliability and the regression model to determine the influence of contextual factors on the outcome variables. Significance was set at 5%.

Results: Remote assessment of AIMS exhibited high image and stimulus quality, and a suitable physical environment. Interrater reliability was high for all domains: prone (r = 0.976); supine (r = 0.965); sitting (r = 0.987); standing (r = 0.945) and total score (r = 0.980). The contextual factors had no relation with assessment quality.

Discussion: Assessments conducted remotely by the mothers showed high video quality and interrater reliability, and represent a promising assessment tool for telemedicine in at-risk infants in the first year of life.

Background: The COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design.

Methods: A non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed.

Results: Nineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent.

Conclusions: The feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial.

Trial registration: ClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.

Introduction: Since 2021, the world has been facing a cost-of-living crisis which has negatively affected population health. Meanwhile, little is known about its impact on patients' preferences to access care. We aimed to analyse public preference for the modality of consultation (virtual vs face-to-face) before and after the onset of crisis and factors associated with these preferences.

Methods: An online cross-sectional survey was administered to the public in the United Kingdom, Germany, Italy and Sweden. McNemar tests were conducted to analyse pre- and post-crisis differences in preferences; logistic regression was used to examine the demographic factors associated with public preferences.

Results: Since the onset of crisis, the number of people choosing virtual consultations has increased in the United Kingdom (7.0% vs 9.5% P < 0.001), Germany (6.6% vs 8.6%, P < 0.008) and Italy (6.0% vs 9.8%, P < 0.001). Before the crisis, a stronger preference for virtual consultations was observed in people from urban areas (OR 1.28, 95% CI 1.05-1.56), while increasing age was associated with a lower preference for virtual care (OR 0.966, 95% CI 0.961-0.972). Younger people were more likely to switch to virtual care, while change to face-to-face was associated with younger age and lower income (OR 1.34, 95% CI 1.12-1.62). Older adults were less likely to change preference.

Conclusions: Since the onset of the cost-of-living crisis, public preference for virtual consultations has increased, particularly in younger population. This contrasts with older adults and people with lower-than-average incomes. The rationale behind patients' preferences should be investigated to ensure patients can access their preferred modality of care.