JMIR康复和辅助技术

脑瘫儿童的远程保健和远程干预:范围综述

2022 - 10 - 17 - t09:15:03内

背景:2020年前，远程治疗或远程保健已显示出对脑瘫(CP)儿童的希望;然而，全球COVID-19大流行的开始限制了人们前往医院进行面对面治疗，这推动了远程医疗的需求，并导致远程医疗的发展激增。由于最近的发展，对患有CP的儿童远程医疗的现有证据的综合有限。本研究旨在分析和总结用于治疗CP儿童的远程医疗干预的现有证据，并确定任何需要进一步研究的领域。方法: A范围回顾。2021年7月，对MEDLINE和PubMed的现有文献进行了系统检索。文章的纳入标准是调查远程医疗的初步研究和系统综述，包括患有CP的儿童，发表于2010-2021年，并用英语撰写。排除标准为系统综述以外的二次研究;不符合世界卫生组织远程保健定义的干预措施;或所有参与者年龄均为18岁的研究，没有单独报道儿童的结果，或没有报道患有CP的儿童的结果。由于参与者的预期异质性，以及预期的小样本量和测量结果的不一致性，选择了范围审查;因此，以叙述性的方式报告结果被认为是适当的。 Results: In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions: The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth.

COVID-19大流行期间康复医院卒中患者家属基于互联网的信息共享:病例对照研究

2022 - 09 - 20 - t09:00:03内

背景: COVID-19的传播影响了卒中康复。鉴于大多数机构的住院探访受到限制，向家庭成员提供信息的其他方式是必要的。透过网络让家属了解病人的康复进度，有助家属参与康复过程，增强病人继续康复的动力，并对改善病人的日常生活活动(ADL)作出整体贡献。目的:我们旨在探讨基于互联网的康复信息共享(IRIS)干预在康复医院中风患者家庭的可行性，并研究IRIS对患者ADL改善的影响。在这项病例对照研究中，参与者是2020年3月至2021年4月期间在一家康复医院住院的患者。干预组(信息和通信技术[ICT]组)包括要求IRIS的患者和家属，其中包括一份使用文字、照片和视频的患者康复进展报告。那些没有接受基于互联网的信息的人被包括在非ict组。对照组从非ICT组中选取，按照1:1倾向评分与ICT组匹配。计算倾向评分的协变量为患者的年龄、性别以及入院时功能独立性量表的运动和认知评分。主要结果是住院期间ADL的改善程度。 Multiple regression analysis (forced entry method) was performed to confirm the impact of ICT use on ADL improvement. The independent variables were the presence of intervention, length of hospital stay, and number of days from onset to hospitalization. Results: In total, 16 groups of patients and families participated in the IRIS. The mean age of patients was 78.6 (SD 7.2) and 78.6 (SD 8.2) years in the ICT and control groups, respectively. The median total Functional Independence Measure difference was 28.5 (IQR 20.3-53.0) and 11.0 (IQR 2.8-30.0) in the ICT and control groups, respectively, and the ICT group showed significant improvement in ADL function (P=.02). In the multiple regression analysis of the ICT and control groups, the unstandardized regression coefficient was 11.97 (95% CI 0.09-23.84) for ICT use. These results indicate that ICT use was independently and significantly associated with improvement in ADL. Conclusions: This study examined the effect of IRIS on family members to improve ADL in patients with stroke who are hospitalized. The results showed that IRIS promotes the improvement of patients’ ADL regardless of age, sex, motor and cognitive functions at admission, and the length of hospital stay.

临床医生和中风幸存者关于使用远程康复结合锻炼游戏的经验教训:多案例研究

2022 - 09 - 15 - t09:15:02内

背景:在加拿大，由于缺乏资源，中风幸存者很难获得基于社区的康复服务。VirTele是一个结合了虚拟现实运动游戏和远程康复的个性化远程康复项目，旨在为中风幸存者提供一个机会，让他们在家中进行慢性上肢(UE)缺损的康复，同时接受临床医生的持续随访。目的:我们旨在确定临床医生在VirTele干预期间使用的行为和动机技术，探索中风幸存者的赋权指标，并调查中风幸存者和临床医生使用VirTele的决定因素。这项多病例研究涉及3名患有慢性UE缺陷的中风幸存者及其各自的临床医生(物理治疗师)，他们参与了VirTele干预，这是一项为期2个月的远程康复干预，使用非沉浸式虚拟现实运动游戏和远程康复，旨在改善中风幸存者的UE缺陷。研究参与者可以自主使用Jintronix运动游戏，并被要求每周使用5次，每次30分钟。VirTele干预包括每周与临床医生进行1- 3次1小时的视频会议，在此期间，临床医生进行动机性访谈，监督中风幸存者对运动游戏的使用，并通过日常生活活动监测他们对受影响UE的使用。在VirTele干预结束4至5周后，对临床医生和中风幸存者进行了半定向访谈。所有采访都进行了录音和逐字转录。通过数据和理论之间的动态互动，进行了溯因主题分析，以产生新的想法。3名中风幸存者(n=2, 67%，女性，n=1, 33%，男性)，平均年龄58.8岁(SD 19.4)， 2名物理治疗师参与了这项研究。 Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors’ safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts. Conclusions: This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions.

长冠肺炎职业康复后重返工作:描述性队列研究

2022 - 09 - 14 - t09:15:23内

新出现的证据表明，在全球范围内，30%至50%的COVID-19感染者出现长时间COVID症状。这些症状在高比例LC患者中对重返工作(RTW)造成挑战。为了针对LC后遗症量身定制康复方案，并帮助改善RTW的结果，需要对LC康复方案的结果进行更多的研究。目的:本研究描述了参加LC职业康复计划的工人的特征和结果。方法:进行队列研究。描述性变量包括人口统计学和职业因素以及患者报告的结果测量(PROMs，即疲劳严重程度量表[FSS]、covid后功能量表[PCFS]、36项简短健康调查[SF-36]、疼痛残疾指数[PDI]、疼痛视觉模拟量表[VAS]、9项患者健康问卷[PHQ-9]、7项广泛性焦虑障碍问卷[GAD-7]、以及精神疾病诊断与统计手册第五版[DSM-5]创伤后应激障碍[PTSD]检查表[PCL-5])。主要结果变量是出院时的RTW状态。计算描述性统计。Logistic回归检验了RTW的预测因子。 Results: The sample consisted of 81 workers. Most workers were female (n=52, 64%) and from health-related occupations (n=43, 53%). Only 43 (53%) individuals returned to work at program discharge, with 40 (93%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t₃₁=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t₃₂=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t₃₈=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t₃₈=–3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t₃₁=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t₂₂=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95% CI 0.99-1.00) predicted RTW even when controlling for age and gender. Conclusions: Workers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation.

老年人肌肉骨骼疾病的实时远程康复:系统回顾和元分析

2022 - 09 - 01 - t09:45:02内

背景:实时远程康复(TR)是一种为患有肌肉骨骼疾病的老年人提供康复干预的新策略，以提供传统服务的连续性并减轻与旅行相关的障碍。目的:我们旨在研究在患有肌肉骨骼疾病的老年人中，与传统服务相比，通过实时TR服务提供的治疗在身体表现、治疗依从性和成本效益方面的有效性。在6个在线数据库:Cochrane Library、PubMed(即MEDLINE)、PEDro、ClinicalKey、EBSCO和ProQuest中进行了2000年1月至2022年4月发表的随机对照试验(rct)的文献检索。文章的主要合格标准是在患有肌肉骨骼疾病的老年人中使用实时TR来改善身体表现。两名审稿人筛选了2108篇摘要，发现10篇研究(n=851)符合资格标准。质量评估基于Cochrane rct偏倚风险工具第2版，以评估所选文章的方法学质量。基于主要结局指标，将结果汇总进行荟萃分析，并以95% ci的标准化平均差异(SMDs)报告。采用固定模型，根据不同的治疗、对照和结局指标，进行亚组分析，以检查影响TR疗效的可能因素。结果:搜索和筛选过程确定了10篇论文，它们共同报道了老年人的三种肌肉骨骼疾病和三种类型的TR计划。综合结果表明，与常规治疗相比，实时TR在改善平衡方面的身体表现方面更有效(SMD 0.63, 95% CI 0.36-0.9; I²=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I²=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I²=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I²=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI –0.16 to 0.66; I²=0%) had no effect on improving balance and was comparable to conventional treatment. Conclusions: We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care. Trial Registration: PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289

用数据驱动评分模型自动评估平衡康复练习:算法开发和验证研究

2022 - 08 - 31 - t09:30:03内

背景:平衡康复计划是平衡障碍最常见的治疗方法。然而，缺乏资源和高度专业的物理治疗师是患者进行个性化康复治疗的障碍。因此，平衡康复项目通常被转移到家庭环境中，有相当大的风险，患者会表现不佳或根本无法遵循该项目。Holobalance是一个有说服力的指导系统，能够在家里提供全面的康复服务。全息平衡包括几个模块，从康复计划管理到增强现实教练演示。目的:本研究的目的是设计、实施、测试和评估一个基于数据驱动技术的平衡康复练习准确评估的评分模型。数据驱动评分模块基于Holobalance试点研究期间收集的大量数据集(约1300次康复训练)。它可以用作训练机器学习(ML)模型的训练和测试数据集，可以推断所有物理康复练习的评分组件。在这个方向上，为了创建数据集，2名独立专家(在诊所)监测了19名患者进行1313次平衡康复练习，并根据预定义的评分标准对他们的表现进行评分。在收集到的数据上，在部署特征选择技术之前应用预处理、数据清理和规范化技术。 Finally, a wide set of ML algorithms, like random forests and neural networks, were used to identify the most suitable model for each scoring component. Results: The results of the trained model improved the performance of the scoring module in terms of more accurate assessment of a performed exercise, when compared with a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9% for sitting exercises, 20.8% for standing exercises, and 26.8% for walking exercises). Finally, the resulting performance of the model resembled the threshold of the interobserver variability, enabling trustworthy usage of the scoring module in the closed-loop chain of the Holobalance coaching system. Conclusions: The proposed set of ML models can effectively score the balance rehabilitation exercises of the Holobalance system. The models had similar accuracy in terms of Cohen kappa analysis, with interobserver variability, enabling the scoring module to infer the score of an exercise based on the collected signals from sensing devices. More specifically, for sitting exercises, the scoring model had high classification accuracy, ranging from 0.86 to 0.90. Similarly, for standing exercises, the classification accuracy ranged from 0.85 to 0.92, while for walking exercises, it ranged from 0.81 to 0.90. Trial Registration: ClinicalTrials.gov NCT04053829; https://clinicaltrials.gov/ct2/show/NCT04053829

用惯性传感器和机器学习检测下背部物理治疗练习:算法开发和验证

2022 - 08 - 23 - t09:15:38内

背景:物理治疗是成功保守治疗腰痛(LBP)的关键因素。定量测量物理治疗参与的金标准对于理解物理治疗依从性管理LBP恢复至关重要。目的:本研究旨在开发和评估一种具有可穿戴惯性传感器的系统，以客观地检测LBP无监督练习的表现，包括多个平面的运动和坐姿。在机器学习框架内使用定量分类设计来检测一组健康参与者的运动表现和姿势。一组8个惯性传感器被放置在参与者身上，并在他们进行7个麦肯齐下腰练习和3个坐姿姿势时获取数据。从数据中提取工程时间序列特征，采用6倍交叉验证方法训练9个模型，从中选择最佳的2个模型进行进一步研究。此外，在时间序列数据上直接训练卷积神经网络。进行了特征重要性分析，以确定对模型贡献最大的传感器位置和通道。最后，将传感器位置和通道的子集包含在超参数网格搜索中，以确定用于运动和姿势分类的最佳传感器配置和最佳性能算法。采用10倍交叉验证方法，使用F₁评分对最终模型进行评估。 Results: In total, 19 healthy adults with no history of LBP each completed at least one full session of exercises and postures. Random forest and XGBoost (extreme gradient boosting) models performed the best out of the initial set of 9 engineered feature models. The optimal hardware configuration was identified as a 3-sensor setup—lower back, left thigh, and right ankle sensors with acceleration, gyroscope, and magnetometer channels. The XGBoost model achieved the highest exercise (F₁ score: mean 0.94, SD 0.03) and posture (F₁ score: mean 0.90, SD 0.11) classification scores. The convolutional neural network achieved similar results with the same sensor locations, using only the accelerometer and gyroscope channels for exercise classification (F₁ score: mean 0.94, SD 0.02) and the accelerometer channel alone for posture classification (F₁ score: mean 0.88, SD 0.07). Conclusions: This study demonstrates the potential of a 3-sensor lower body wearable solution (eg, smart pants) that can identify exercises in multiple planes and proper sitting postures, which is suitable for the treatment of LBP. This technology has the potential to improve the effectiveness of LBP rehabilitation by facilitating quantitative feedback, early problem diagnosis, and possible remote monitoring.

肌萎缩性侧索硬化症患者的辅助机器人:带有早期验证器的探索性任务型评估研究

2022 - 08 - 23 - t09:15:03内

背景:虽然机器人操纵器在促进运动障碍患者的运动独立性方面有很大潜力，但目前只有少数系统可用于商业。除了技术、经济和规范障碍之外，它们的推广面临的一个关键挑战是目前缺乏关于它们的有用性、可接受性和用户特定需求的证据。在此背景下，机器人辅助服务的肌萎缩性侧索硬化症(ROBINA)患者的个性化和资源型强化和姑息治疗(intensive and palliative care)研发项目开发了半自主机器人系统，以支持肌萎缩性侧索硬化症(ALS)患者的各种日常活动。开发的早期验证器在11例ALS患者的任务型实验室研究中进行了评估。在由标准化问卷、开放式问题和观察协议组成的多方法设计的基础上，参与者被问及其与日常生活、可用性和设计要求的相关性。结果:大多数参与者认为该系统在测试场景和他们的日常生活中提供相关支持。在系统可用性量表的基础上，机器人辅助服务对ALS患者个体和面向资源的重症和姑息治疗系统的整体可用性被评为优秀，中位数为90分(IQR 75-95分)。此外，还确定并讨论了开发半自动机械手的3个核心需求领域:半自动人机协作的需求，用户界面的需求，以及机器人适应日常生活能力的需求。结论:机械手有助于增强ALS患者的自主能力。未来研究的一个关键问题是如何平衡现有的能力水平和所需的机器人能力，以确保高用户满意度和有效高效的任务表现。 Trial Registration:

电信技术(Zoom)中以移动性为重点的物理结果测量:内部和内部评分者可靠性试验

2022 - 08 - 22 - t09:30:03内

背景:通过远程医疗提供的康复为目前有限的面对面医疗保健提供了另一种选择。有效的康复取决于准确和相关的评估，可靠地衡量功能随时间的变化。一套衡量康复对身体功能影响的相关评估的可靠性尚不清楚。目的:我们旨在测量通过Zoom(一种常用的电信平台)提供的以移动为重点的物理结果测量的区域内可靠性，以及评分者之间的可靠性，将Zoom与现场测量进行比较。方法:在本可靠性试验中，招募健康志愿者在远程研究人员的指导下，在笔记本电脑前完成7项以活动为重点的结果测量。研究人员进行了远程评估。一个亲自的研究人员(提供基准分数)同时记录他们的分数。使用类内相关系数(ICC)和Bland-Altman图，评估了握力、功能伸展测试、5次坐到站、3米和4米步行以及计时升降的等级间和等级内可靠性。选择这些测试是因为它们涵盖了广泛的身体流动性、力量和平衡结构;几乎不需要临床医生的帮助;可以在家庭环境的限制下进行; and are likely to be feasible over a telehealth delivery mode. Results: A total of 30 participants (mean age 36.2, SD 12.5 years; n=19, 63% male) completed all assessments. Interrater reliability was excellent for Grip Strength (ICC=0.99) and Functional Reach Test (ICC=0.99), good for 5-Time Sit to Stand (ICC=0.842) and 4-Meter Walk (ICC=0.76), moderate for Timed Up and Go (ICC=0.64), and poor for 3-Meter Walk (ICC=–0.46). Intrarater reliability, accessed by the remote researcher, was excellent for Grip Strength (ICC=0.91); good for Timed Up and Go, 3-Meter Walk, 4-Meter Walk, and Functional Reach (ICC=0.84-0.89); and moderate for 5-Time Sit to Stand (ICC=0.67). Although recorded simultaneously, the following time-based assessments were recorded as significantly longer via Zoom: 5-Time Sit to Stand (1.2 seconds), Timed Up and Go (1.0 seconds), and 3-Meter Walk (1.3 seconds). Conclusions: Untimed mobility-focused physical outcome measures have excellent interrater reliability between in-person and telehealth measurements. Timed outcome measures took approximately 1 second longer via Zoom, reducing the reliability of tests with a shorter duration. Small time differences favoring in-person attendance are of a similar magnitude to clinically important differences, indicating assessments undertaken using telecommunications technology (Zoom) cannot be compared directly with face-to-face delivery. This has implications for clinicians using blended (ie, some face-to-face and some via the internet) assessments. High intrarater reliability of mobility-focused physical outcome measures has been demonstrated in this study.

covid -19后在家进行虚拟现实练习的可行性:队列研究

2022 - 08 - 15 - t09:30:02内

背景: 30%至76%的COVID-19患者有持续的身心症状，有时在急性COVID-19后长达9个月。目前的康复主要集中在身体症状上，而专家们已经同意需要一种生物心理社会方法。在家中进行虚拟现实(VR)康复等新方法可能会使患者和治疗师受益，特别是考虑到covid -19后需要康复的患者预计会大量涌入。目的:本研究的目的是探讨在covid -19后患者家中进行自我管理的VR练习的可行性。方法:这是一项在门诊护理环境中的单臂可行性研究。由治疗物理治疗师确定的因covid -19后病情而需要物理治疗的患者包括在内。参与者在家中进行为期6周的VR体育锻炼，并被允许通过VR平台上可用的应用程序进行VR心理锻炼，以减轻压力和焦虑，促进认知功能。主要结果与可行性(即VR使用的持续时间和频率)、安全性(即不良事件)、患者满意度和退出原因有关。在锻炼前后分别测量了身体表现、日常活动、认知功能、焦虑和抑郁以及生活质量。结果:共纳入48例; 1 (2%) patient did not start VR, and 7 (15%) patients withdrew, mostly due to dizziness. Almost 70% (33/47) of participants reported experiencing any adverse event during VR exercising. However, only 25% (9/36) recalled these events at the end of the intervention period. The majority (27/36, 75%) of the patients described VR as having a positive influence on their recovery, and the global satisfaction score was 67%. The average VR use was 30 minutes per session, 3-4 times a week for 3-6 weeks. The overall use of VR applications was almost equally distributed over the 3 sets of VR exercises (physical, relaxing, and cognitive). However, the use frequency of physical exercises seemed to decrease over time, whereas the use of cognitive and relaxation exercises remained stable. Physical performance and quality of life outcomes were significantly improved after 6 weeks. Conclusions: VR physical exercises at home is feasible and safe with good acceptance in a significant percentage of patient with post–COVID-19 condition. Trial Registration: ClinicalTrials.gov NCT04505761; https://clinicaltrials.gov/ct2/show/NCT04505761