scholarly journals Exploratory Study for Using the mobile Hudl App with Telehealth: A Randomized Controlled Trial Shows Positive Impact on Home Exercise Program Adherence in People with Chronic Diseases and in Financial Distress (Preprint)

2020 ◽  
Author(s):  
Ann Van de Winckel ◽  
Tanjila Nawshin ◽  
Casey Byron
Keyword(s):  
Chronic Diseases ◽  
Financial Distress ◽  
Controlled Trial ◽  
Exercise Program ◽  
Home Exercise ◽  
Control Group ◽  
Home Exercise Program ◽  
Randomized Controlled ◽  
Experimental Group

BACKGROUND Patients with chronic diseases often must adhere to a long-term individualized home exercise program (HEP) to manage their symptoms, and improve or maintain their cardiovascular health, flexibility and/or strength. Those exercises are provided and updated during physical therapy (PT) visits. Limited adherence (ie, perform the required number of HEP/week) to long-term exercise reduces the capacity of exercise to improve or stabilize impairments related to chronic disease. Lower socio-economic status is an additional factor that negatively impacts exercise adherence. To mitigate this, online apps available to motivate people to exercise could be a viable option. Using an app through telehealth may benefit adults with chronic diseases achieve long-term home exercise program (HEP) adherence. However, because using apps for rehabilitation is an emerging field, the app’s feasibility needs to be evaluated. OBJECTIVE To address HEP adherence in participants with chronic diseases and in financial distress, defined by people being on Medicaid or similar programs, we evaluated HEP adherence, compliance (ie, percentage of participant-recorded videos sent), as well as satisfaction with the PT care and with the Hudl Technique® app and telehealth in terms of feasibility, compared to standard HEP on paper. METHODS We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial where the experimental group received weekly HEP demonstrations through app videos on a tablet and received feedback on their self-recorded HEP video performance from the telehealth-physical therapist. The control group received HEP on paper without feedback as is custom in PT practice. The treating therapist and data analyst were blinded to the allocation. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on satisfaction with PT care and, for the experimental group, also satisfaction with the app/telehealth use. RESULTS Forty-five adults with chronic diseases and financial distress were randomized into an experimental (n=23) and a control group (n=22), with respectively 17 and 19 participants completing the 24-week HEP. The experimental group maintained a HEP adherence frequency of 4±2 times/week at 8 and 24 weeks (P=.29), whereas in the control group HEP adherence decreased from 4±2 to 3±2 times/week (P=.07), with a significant difference (P=.04) between groups at 24 weeks. Sixty-eight percent of participants sent videos. They sent on average 68% of the requested number of videos. The average score for satisfaction with PT care was maintained at 87% in the experimental group (P=1.00) whereas it dropped from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. There were no app-related adverse events. CONCLUSIONS The Hudl app/telehealth is feasible for delivering HEP and helps participants with chronic diseases and financial distress maintain HEP adherence. CLINICALTRIAL The full trial protocol is available at ClinicalTrials.gov (NCT02659280).

scholarly journals Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial

10.2196/22659 ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. e22659
Author(s):  
Ann Van de Winckel ◽  
Tanjila Nawshin ◽  
Casey Byron
Keyword(s):  
Randomized Controlled Trial ◽  
Chronic Diseases ◽  
Financial Distress ◽  
Controlled Trial ◽  
Exercise Adherence ◽  
Home Exercise ◽  
Control Group ◽  
Randomized Controlled ◽  
Experimental Group

Background Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51%) and control (22/45, 49%) groups, with 74% (17/23) and 86% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68% (15/22) sent videos. They sent 68% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=.99), whereas it decreased from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280

scholarly journals Effectiveness of a Targeted Exercise Intervention in Reversing Older People's Mild Balance Dysfunction: A Randomized Controlled Trial

2012 ◽  
Vol 92 (1) ◽  
pp. 24-37 ◽  
Author(s):  
Xiao Jing Yang ◽  
Keith Hill ◽  
Kirsten Moore ◽  
Susan Williams ◽  
Leslie Dowson ◽  
...  
Keyword(s):  
Older People ◽  
Exercise Intervention ◽  
Physical Therapist ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Program ◽  
Home Exercise ◽  
Control Group ◽  
Home Exercise Program ◽  
Randomized Controlled

Background Previous research has mainly targeted older people with high risk of falling. The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored. Objective This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematically screened as having mild balance dysfunction. Design This was a community-based, randomized controlled trial with assessors blinded to group allocation. Participants Study participants were older people who reported concerns about their balance but remained community ambulant (n=225). After a comprehensive balance assessment, those classified as having mild balance dysfunction (n=165) were randomized into the trial. Intervention Participants in the intervention group (n=83) received a 6-month physical therapist–prescribed balance and strength home exercise program, based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. Participants in the control group (n=82) continued with their usual activities. Outcome Measures Laboratory and clinical measures of balance, mobility, and strength were assessed at baseline and at a 6-month reassessment. Results After 6 months, the intervention group (n=59) significantly improved relative to the control group (n=62) for: the Functional Reach Test (mean difference=2.95 cm, 95% confidence interval [CI]=1.75 to 4.15), the Step Test (2.10 steps/15 seconds, 95% CI=1.17 to 3.02), hip abductor strength (0.02, 95% CI=0.01 to 0.03), and gait step width (2.17 cm, 95% CI=1.23 to 3.11). There were nonsignificant trends for improvement on most other measures. Fourteen participants in the intervention group (23.7%) achieved balance performance within the normative range following the exercise program, compared with 3 participants (4.8%) in the control group. Limitations Loss to follow-up (26.6%) was slightly higher than in some similar studies but was unlikely to have biased the results. Conclusions A physical therapist–prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment.

Long-term Effectiveness and Adoption of a Cellphone Augmented Reality System for Stroke Rehabilitation: Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Jie Jia ◽  
Chong Li ◽  
Xinyu Song ◽  
Shugeng Chen ◽  
Chuankai Wang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Function ◽  
Controlled Trial ◽  
Control Group ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Augmented Reality System ◽  
Home Based ◽  
Experimental Group

BACKGROUND A serious game-based Cellphone Augmented Reality System (CARS) was developed for rehabilitation of stroke patients, which is portable, convenient, and suitable for self-training. OBJECTIVE The present research aimed to study the effectiveness of CARS in improving upper limb motor function and cognition function of stroke patients via conducting a long-term randomized controlled trial and analyze the patient’s acceptance of the proposed system. METHODS A randomized, double-blind, controlled trial was performed with 30 post-stroke, sub-acute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week, for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment-Upper Extremity subscale (FMA-UE), Action Research Arm Test (ARAT), Manual Muscle Test (MMT), Brunnstrom Stage (BS), and Barthel Index (BI) were used to assess motor function, and the Mini-Mental State Examination (MMSE), Add VS Sub (AVS), and Stroop Game (SG) were used to assess cognitive function before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire (USEQ) was used to reflect the patients’ acceptance of the system in the experimental group after the final intervention. RESULTS All the assessment scores of the experimental group and control group were significantly improved after intervention (p＜0.05). The experimental group’s score of FMA-UE and ARAT increased by 11.47 and 5.86 respectively after intervention, which were both significantly higher than the increase of the control group (p＜0.01). Similarly, the score of AVS and SG in the experimental group increased by 7.53 and 6.83 respectively after the intervention, which was also higher than the control group (p＜0.01). The evaluation of the adoption of this system has three sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27±0.704 for the enjoyment of their experience with the system, 4.33±0.816 for success to use the system, 4.67±0.617 for the ability to control the system. In terms of comfort, the patients reported 4.40±0.737 for clear information provided by the system, 4.40±0.632 for comfort. In terms of acceptability, the patients reported 4.27±0.884 for usefulness in their rehabilitation, 4.67±0.617 for agreeing with CARS as a suitable tool for home-based rehabilitation. CONCLUSIONS CARS and conventional OT together-based rehabilitation were more effective in improving both upper limb motor function and cognition function as compared with conventional OT. Due to the low cost, and ease of use, CARS is also potentially suitable for home-based rehabilitation. CLINICALTRIAL The Chinese Clinical Trial Registry (ChiCTR1800017568).

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