Methods for human-centered eHealth development : a narrative scoping review (Preprint)

With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR).This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR.In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included.Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively.For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes. 

Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Background: Knee osteoarthritis (OA) is a highly prevalent and debilitating condition. Exercise is a recommended treatment because of its effectiveness at improving pain and function. However, exercise is underutilized in OA management. Difficulty accessing health care has been identified as a key barrier to exercise uptake. Innovative and scalable methods of delivering exercise treatments to people with knee OA are needed. We developed a self-directed eHealth intervention to enable and encourage exercise participation. The effectiveness of this intervention on pain and function in people with knee OA is being evaluated in a randomized clinical trial.
Objective: This study aimed to explore the attitudes and experiences of people with knee OA who accessed the self-directed eHealth intervention and the features perceived as useful to facilitate self-directed exercise.
Methods: This was a qualitative study embedded within a randomized controlled trial. Individual, semistructured phone interviews were conducted with 16 people with knee OA who had accessed a 24-week eHealth intervention (website and behavior change SMS program) designed to support exercise participation. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed using an inductive approach.
Results: Five themes arose: (1) technology easy to use and follow (website ease of use, SMS ease of use), (2) facilitators to exercise participation (credible OA and exercise information, website features, prescribed exercises simple to do unsupervised, freedom to adapt the exercise to suit needs, influence of other health care experiences), (3) sense of support and accountability (SMS good reminder and prompt, accountable, SMS tone and automation could trigger negative emotions [eg, guilt or shame], inability to contact someone when needed), (4) positive outcomes (knee symptom improvements, confidence to self-manage, encouraged active living), (5) suggestions for real-world application (provided by a health professional preferred, should be provided at subsidized or low out-of-pocket cost).
Conclusions: People with knee OA had mostly positive experiences with and attitudes towards the use of an eHealth intervention that supported exercise participation independent of a health professional. A human connection associated with the eHealth intervention appeared important.

/pdf/exploring-attitudes-and-experiences-of-people-with-knee-5b26onf8if.pdf

Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study

To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve.To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation.We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions. DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members. Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others. Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members. In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services. Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances.This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.پیشینه: برای افزایش دسترسی افراد به خدمات توان‌بخشی، به‌ویژه در زمینه همه‌گیری کووید‐19، باید بررسی کنیم که چگونه می‌توان ارائه این خدمات را با شرایط موجود تطبیق داد. این شامل استفاده از توان‌بخشی در منزل و توان‌بخشی از راه دور (telerehabilitation) است. خدمات توان‌بخشی مبتنی بر منزل ممکن است به گزینه‌های پُر استفاده در روند بهبودی بیماران تبدیل شود، نه تنها به عنوان راه حلی برای غلبه بر موانع دسترسی، بلکه به عنوان مکملی برای ارائه معمول توان‌بخشی حضوری در شرایط بستری. با بهبود قابلیت استفاده و در دسترس بودن فناوری‌های ارتباطی، توان‌بخشی از راه دور نیز قابل اجراتر می‌شود. اهداف: شناسایی عواملی که بر سازماندهی و ارائه توان‌بخشی حضوری در منزل و توان‌بخشی از راه دور منزل‐محور برای افراد نیازمند توان‌بخشی تاثیر می‌گذارد. روش‌های جست‌وجو: ما PubMed؛ Global Health؛ پورتال منطقه‌ای VHL؛ Epistemonikos؛ Health Systems Evidence؛ و EBM Reviews هم‌چنین پیش‌چاپ‌ها (preprints)، مخازن منطقه‌ای، و وب‌سایت‌های سازمان‌های توان‌بخشی را برای یافتن مطالعات واجد شرایط، از زمان آغاز به کار بانک اطلاعاتی تا تاریخ جست‌وجو در جون 2022 بررسی کردیم. معیارهای انتخاب: مطالعاتی را وارد کردیم که از روش‌های کیفی برای جمع‌آوری و آنالیز داده‌ها استفاده کردند؛ و تجربیات، ادراکات و رفتارهای بیماران، مراقبان، ارائه‌دهندگان خدمات مراقبت سلامت و دیگر ذینفعان را در مورد ارائه خدمات توان‌بخشی حضوری در منزل و توان‌بخشی از راه دور مبتنی بر منزل بررسی کردند که به نیازهای بیماران در مراحل مختلف شرایط سلامت آنها پاسخ می‌دهند. گردآوری و تجزیه‌وتحلیل داده‌ها: از یک رویکرد نمونه‌گیری هدفمند استفاده کرده و نمونه‌گیری حداکثر تنوع را در یک چارچوب نمونه‌گیری چهار مرحله‌ای اعمال کردیم. یک آنالیز چارچوب موضوعی را با استفاده از چارچوب CFIR (چارچوب تلفیقی برای تحقیقات پیاده‌سازی (Consolidated Framework for Implementation Research)) به عنوان نقطه شروع انجام دادیم. اعتماد خود را به یافته‌ها با استفاده از رویکرد GRADE‐CERQual (Confidence in the Evidence from Reviews of Qualitative research) ارزیابی کردیم. نتایج اصلی: تعداد 223 مطالعه را در این مرور وارد کرده و 53 مورد از آنها را برای آنالیز خود نمونه‌برداری کردیم. چهل و پنج مطالعه در کشورهایی با درآمد بالا، و هشت مطالعه در کشورهایی با سطح درآمد پائین و متوسط انجام شدند. بیست مطالعه به ارائه توان‌بخشی حضوری در منزل، 28 مطالعه به ارائه خدمات توان‌بخشی از راه دور در منزل و پنج مطالعه به هر دو روش ارائه خدمات پرداختند. مطالعات عمدتا دیدگاه‌های ارائه‌دهندگان خدمات مراقبت سلامت، بیماران را با طیف وسیعی از بیماری‌های مختلف، و مراقبان غیر رسمی و اعضای خانواده‌شان را مورد بررسی قرار دادند. بر اساس ارزیابی‌های GRADE‐CERQual، به هشت مورد از یافته‌ها اطمینان بالایی داشته، و در پنج مورد اعتماد متوسطی داشتیم، که نشان می‌دهد به ترتیب با احتمال بالا یا احتمالا این یافته‌ها بازنمایی معقولی هستند از پدیده مورد نظر. دو یافته با اطمینان پائین وجود داشت. یافته‌هایی با سطح اطمینان بالا و متوسط خدمات توان‌بخشی در منزل که به صورت حضوری یا از طریق توان‌بخشی از راه دور ارائه می‌شوند بیماران، دریافت خدمات را در منزل به صورت راحت و با اختلال کمتر در فعالیت‌های روزمره خود توصیف می‌کنند. بیماران و ارائه‌دهندگان خدمات هم‌چنین پیشنهاد می‌کنند که این خدمات می‌توانند خود‐مدیریتی بیماران را تشویق کرده و باعث شوند در مورد فرآیند توان‌بخشی احساس قدرت کنند. اما بیماران، اعضای خانواده، و ارائه‌دهندگان خدمات، مسائل مربوط به حفظ حریم خصوصی و محرمانگی را، هنگامی که خدمات در منزل ارائه می‌شوند، ذکر می‌کنند. اینها شامل افزایش حریم خصوصی برای ورزش کردن در منزل و هم‌چنین از دست دادن حریم خصوصی زمانی است که زندگی شخصی در منزل برای دیگران قابل مشاهده باشد. بیماران و ارائه‌دهندگان خدمات هم‌چنین عوامل دیگری را توصیف می‌کنند که می‌توانند بر موفقیت ارائه خدمات توان‌بخشی در منزل تاثیر بگذارند. این موارد شامل حمایت از ارائه‌دهندگان خدمات و اعضای خانواده، برقراری ارتباط خوب با ارائه‌دهندگان خدمات، الزامات ایجاد شده از بیماران و محیط اطراف آنها، و انتقال از بیمارستان به خدمات در منزل هستند. توان‌بخشی از راه دور به طور مشخص بیماران، اعضای خانواده و ارائه‌دهندگان خدمات، توان‌بخشی از راه دور را فرصتی برای در دسترس قرار دادن خدمات می‌دانند. اما ارائه‌دهندگان هنگام ارزیابی اینکه بیماران تمرینات خود را به درستی انجام می‌دهند یا خیر، به مشکلات عملی اشاره می‌کنند. ارائه‌دهندگان و بیماران نیز وقفه‌های ایجاد شده را توسط اعضای خانواده توصیف می‌کنند. علاوه بر این، ارائه‌دهندگان خدمات از کمبود تجهیزات، زیرساخت و تعمیر و نگهداری وسایل شکایت داشته و بیماران به مشکلات قابلیت استفاده و ناامیدی از فناوری دیجیتال اشاره می‌کنند. ارائه‌دهندگان خدمات در مورد اینکه توان‌بخشی از راه دور برای آنها مقرون به صرفه است یا خیر، نظرات متفاوتی دارند. اما بسیاری از بیماران توان‌بخشی از راه دور را مقرون به صرفه و با قابلیت صرفه‌جویی در هزینه می‌بینند، اگر تجهیزات و زیرساخت‌ها فراهم شده باشد. بیماران و ارائه‌دهندگان خدمات پیشنهاد می‌کنند که توان‌بخشی از راه دور می‌تواند ماهیت رابطه آنها را تغییر دهد. به عنوان مثال، برخی از بیماران توضیح می‌دهند که چگونه توان‌بخشی از راه دور منجر به برقراری ارتباط راحت‌تر و آسان‌تر می‌شود. دیگر بیماران احساس می‌کنند که هنگام دریافت خدمات توان‌بخشی از راه دور احساس رها شدن دارند. بیماران، اعضای خانواده و ارائه‌دهندگان خدمات به فناوری‌هایی با کاربرد آسان و آموزش و پشتیبانی بیشتر اشاره می‌کنند. آنها هم‌چنین پیشنهاد می‌دهند که حداقل چند جلسه حضوری با ارائه‌دهنده ضروری است. آنها احساس می‌کنند که خدمات توان‌بخشی از راه دور به تنهایی می‌تواند ایجاد ارتباطات معنی‌دار را دشوار کند. هم‌چنین توضیح می‌دهند که برخی از خدمات به دستان فرد ارائه‌دهنده خدمات نیاز دارند. ارائه‌دهندگان خدمات بر اهمیت شخصی‌سازی خدمات بر اساس نیازها و شرایط هر فرد تاکید می‌کنند. نتیجه‌گیری‌های نویسندگان: این ترکیب چندین عامل را شناسایی کرد که می‌توانند بر اجرای موفقیت‌آمیز خدمات توان‌بخشی و توان‌بخشی از راه دور در منزل شخصی فرد بیمار تاثیر بگذارند. اینها شامل عواملی بودند که پیاده‌سازی برنامه‌ها را تسهیل می‌کنند، اما عواملی هم هستند که می‌توانند این فرآیند را به چالش بکشند. ارائه‌دهندگان خدمات مراقبت سلامت، برنامه‌ریزان و سیاست‌گذاران ممکن است از در نظر گرفتن این عوامل هنگام طراحی و اجرای برنامه‌ها سود ببرند. 

Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis

Promoting physical activity (PA) participation in older adults is important for preserving quality of life and functional independence. Co-design has been shown to increase engagement of end-users in health-related policies and interventions. This scoping review aimed to examine how co-design has been used to develop PA interventions for older adults.We searched MEDLINE, EMBASE, AMED, and CINAHL. Peer-reviewed primary research studies that met the following criteria were included: had at least one participant aged ≥60 years involved in the co-design process and the intervention was delivered to individuals whose mean age was ≥60, used co-design methodologies, and any form of PA. After duplicate removal, two or more independent reviewers completed title and abstract and full text screening. Data were extracted from the included studies according to study aims.Of the 29 included studies, 12 different terms were used to describe co-design with variable operational definitions that we consolidated into five proposed components. Fifteen studies engaged users in a consultative way, 13 studies using collaboration, and one study engaged end-users in consumer-control. No studies involved end-users in the dissemination phase. Further, no studies directly measured the effectiveness of the co-design process. Five categories of barriers and facilitators to co-design were identified including frameworks and methodologies, logistics, relationships, participation, and generalizability.There is a large degree of variability in how co-design is used to develop PA interventions for older adults. Our findings can be used by researchers to improve rigor and standardization in this emerging field.osf.io/vsw2m. 

https://bmcgeriatr.biomedcentral.com/counter/pdf/10.1186/s12877-022-03345-4

The use of co-design in developing physical activity interventions for older adults: a scoping review

Background: Osteoarthritis is highly prevalent and has enormous personal and socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain through Exercise (ESCAPE-pain) is an integrated rehabilitation program that helps people understand how exercise can improve physical and psychosocial well-being. Unfortunately, its availability is limited. A Web-based version of the program could increase access for more people. Many Web-based resources are developed without end-user input and result in over-complex, unwanted, ineffective products with limited uptake. Objective: The objective of this study was to codesign a Web-based version of ESCAPE-pain that people with chronic joint pain find engaging, informative, and useful. Methods: To establish older persons' Internet use we conducted a postal survey of 200 people. To establish their opinions, likes or dislikes, and requirements for a Web-based version of the ESCAPE-pain program, we conducted two focus groups with 11 people who had participated in a program based on ESCAPE-pain and two with 13 people who had not. Information from the postal survey and focus groups was used to develop an online prototype website. People's opinions of the prototype website were gauged from thematic analysis of eight semistructured “think aloud” interviews. Results: The survey response rate was 42% (83/200), of whom 67% (56/83) were female and mean age was 67 years. Eighty-three percent of the people had used the Internet, 69% described themselves as either very confident or confident Internet users, and 77% had looked online for health information. With regard to participating online, 34% had read a commentary or watched a video of someone else’s experience of a health problem and 23% had tracked a health issue. Key qualitative themes emerged that included engagement, acceptability and usability, and structure and content of the program. Conclusions: Older people use the Internet as a source of health information but have concerns about safe use and quality of information. Users require a credible website that provides personalized information, support, monitoring, and feedback. [JMIR Res Protoc 2016;5(2):e67]

/pdf/developing-a-web-based-version-of-an-exercise-based-34up816l9p.pdf

Developing a Web-Based Version of An Exercise-Based Rehabilitation Program for People With Chronic Knee and Hip Pain: A Mixed Methods Study.

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Developing a Web-Based Version of An Exercise-Based Rehabilitation Program for People With Chronic Knee and Hip Pain: A Mixed Methods Study.