How to Prevent the Drop-Out: Understanding Why Adults Participate in Summative eHealth Evaluations.

The aim of this study was to investigate why adults participate in summative eHealth evaluations, and whether their reasons for participating affect their (non-)use of eHealth. A questionnaire was distributed among adults (aged ≥ 18 years) who participated in a summative eHealth evaluation. This questionnaire focused on participants' reason to enroll, their expectations, and on whether the study met their expectations. Answers to open-ended questions were coded by two researchers independently. With the generalized estimating equations method we tested whether there is a difference between the type of reasons in use of the eHealth service. One hundred and thirty-one adults participated (64.9% female; mean age 62.5 years (SD = 10.5)). Their reasons for participating were mainly health-related (e.g., being more active). Between two types of motivations there was a difference in the use of the eHealth service: Participants with an intellectual motivation were more likely to drop out, compared to participants with an altruistic motivation. The most prevalent expectations when joining a summative eHealth evaluation were health-related (like expecting to improve one's health). 38.6% of the participants said their expectation was fulfilled by the study. In conclusion, We encourage eHealth evaluators to learn about adults' motivation to participate in their summative evaluation, as this motivation is very likely to affect their results. Including altruistically motivated participants biases the results by their tendency to continue participating in a study.

Time to act mature-Gearing eHealth evaluations towards technology readiness levels.

It is challenging to design a proper eHealth evaluation. In our opinion, the evaluation of eHealth should be a continuous process, wherein increasingly mature versions of the technology are put to the test. In this article, we present a model for continuous eHealth evaluation, geared towards technology maturity. Technology maturity can be determined best via Technology Readiness Levels, of which there are nine, divided into three phases: the research, development, and deployment phases. For each phase, we list and discuss applicable activities and outcomes on the end-user, clinical, and societal front. Instead of focusing on a single perspective, we recommend to blend the end-user, health and societal perspective. With this article we aim to contribute to the methodological debate on how to create the optimal eHealth evaluation design.

Game not over: Explaining older adults' use and intention to continue using a gamified eHealth service.

BACKGROUND: Gamification within eHealth services can increase eHealth adoption. However, little is known about factors affecting adoption of gamified eHealth among older adults. In this study, we sought to explain the (continued) use of a gamified eHealth service among older adults (55+). METHODS: Participants used a gamified eHealth service, focusing on falls prevention, for 4 weeks and completed a post-test questionnaire based on the Technology Acceptance Model. We used Partial Least Squares Structural Equation Modeling to analyse our data. RESULTS: Seventy-two older adults participated with a mean age of 65.1 years (SD = 7.0). Our results show that first, perceived ease of use affected use of the service (use duration: ß = 0.303, R2 = 0.130, and use frequency: ß = 0.304, R2 = 0.107). Second, perceived usefulness affected the intention to continue using the service (ß = 0.754, R2 = 0.640). Third, use of the service did not predict the intention to continue using it. Furthermore, enjoyment affected perceived usefulness (ß = 0.783, R2 = 0.563) and aesthetics affected perceived ease of use (ß = 0.634, R2 = 0.652). CONCLUSIONS: This study refutes the expected relation between use and intention to continue use a gamified eHealth service. Additionally, we learned that using theoretical approaches focusing on technology acceptance, are not suitable for explaining (continued) use of gamified eHealth services.

The First Introduction of Social Robotics in Rehabilitation Care.

Can you imagine to receive treatment through a robot? When talking about the future of healthcare, this is the vision many people have. Currently, the predominant role of social robots in care is entertaining patients. However, this does not have an impact on care process itself. In this paper, we focus on defining use cases other than merely keeping patients' company by implementing a Pepper robot in inpatient rehabilitation setting, and expand upon usability testing the use cases. Our findings showed that, to ensure sustainable implementation of social robots in care organizations, we need excessive collaboration with the target population.

Evaluation of a virtual coaching system eHealth intervention: A mixed methods observational cohort study in the Netherlands.

BACKGROUND: With the rise in human life expectancy, the prevalence of chronic disease has increased significantly. Adopting a healthy lifestyle can decrease the risk of chronic disease. Virtual coaching systems can help older adults adopt a healthy lifestyle.AimThe primary objective of this study was to assess the use, user experience and potential health effects of a conversational agent-based eHealth platform (Council of Coaches) implemented in a real-world setting among older adults. METHODS: An observational cohort study was conducted with older adults aged 55 years or older in the Netherlands. Participants were enrolled for 5-9 weeks during which they had access to Council of Coaches. They completed three questionnaires: pre-test, post-test, and at follow-up. After five weeks, an interview was conducted, and participants chose whether they wanted to use the eHealth intervention for another four weeks during the facultative phase. RESULTS: The study population consisted of 51 older adults (70.6% female) with a mean age of 65.3 years (SD = 7.4). Of these, 94.1% started interacting with Council of Coaches, and most participants interacted once per week. During the facultative phase, 21 participants were still interacting with Council of Coaches. Minimal clinical important differences in quality of life were found among the study population after interacting with Council of Coaches. CONCLUSION: Our results demonstrate that eHealth interventions with virtual coaching can be used among older adults. This may increase quality of life for older adults, and decrease their healthcare needs. Future research into such eHealth interventions should take into account the inclusion of sufficient personalised content and the use of a mixed methods study for assessing the eHealth intervention.

Automatic topic selection for long-term interaction with embodied conversational agents in health coaching: A micro-randomized trial.

INTRODUCTION: Embodied Conversational Agents (ECAs) can be included in health coaching applications as virtual coaches. The engagement with these virtual coaches could be improved by presenting users with tailored coaching dialogues. In this article, we investigate if the suggestion of an automatically tailored topic by an ECA leads to higher engagement by the user and thus longer sessions of interaction. METHODS: A Micro-Randomized Trial (MRT) was conducted in which two types of interaction with an ECA were compared: (a) the coach suggests a relevant topic to discuss, and (b) the coach asks the user to select a topic from a set of options. Every time the user would interact with the ECA, one of those conditions would be randomly selected. Participants interacted in their daily life with the ECA that was part of a multi-agent health coaching application for 4-8 weeks. RESULTS: In two rounds, 82 participants interacted with the micro-randomized coach a total of 1011 times. Interactions in which the coach took the initiative were found to be of equal length as interactions in which the user was allowed to choose the topic, and the acceptance of topic suggestions was high (71.1% overall, 75.8% for coaching topics). CONCLUSION: Tailoring coaching conversations with ECAs by letting the coach automatically suggest a topic that is tailored to the user is perceived as a natural variation in the flow of interaction. Future research could focus on improving the novel coaching engine component that supports the topic selection process for these suggestions or on investigating how the amount of initiative and coaching approach by the ECA could be tailored.

Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens.

BACKGROUND: eHealth apps have been recognized as a valuable tool to reduce COVID-19's effective reproduction number. The factors that determine the acceptance of COVID-19 apps remain unknown. The exception here is privacy. OBJECTIVE: The aim of this article was to identify antecedents of acceptance of (1) a mobile app for COVID-19 symptom recognition and monitoring and (2) a mobile app for contact tracing, both by means of an online survey among Dutch citizens. METHODS: Next to the demographics, the online survey contained questions focusing on perceived health, fear of COVID-19, and intention to use. We used snowball sampling via posts on social media and personal connections. To identify antecedents of the model for acceptance of the 2 mobile apps, we conducted multiple linear regression analyses. RESULTS: In total, 238 Dutch adults completed the survey; 59.2% (n=141) of the responders were female and the average age was 45.6 years (SD 17.4 years). For the symptom app, the final model included the predictors age, attitude toward technology, and fear of COVID-19. The model had an r2 of 0.141. The final model for the tracing app included the same predictors and had an r2 of 0.156. The main reason to use both mobile apps was to control the spread of the COVID-19 virus. Concerns about privacy was mentioned as the main reason to not use the mobile apps. CONCLUSIONS: Age, attitude toward technology, and fear of COVID-19 are important predictors of the acceptance of COVID-19 mobile apps for symptom recognition and monitoring and for contact tracing. These predictors should be taken into account during the development and implementation of these mobile apps to secure acceptance.

Clinician acceptance of complex clinical decision support systems for treatment allocation of patients with chronic low back pain.

BACKGROUND: The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS this study aims to identify the factors that hinder, or alleviate the acceptance of, clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain. METHODS: We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, in turn is influenced by the perceived service benefits and perceived service risks. An online survey was created to test our research model and the data was analysed using Partial Least Squares Structural Equation Modelling. The study population consisted of clinicians. The online questionnaire started with demographic questions and continued with a video animation of the complex CDSS followed by the set of measurement items. The online questionnaire ended with two open questions enquiring the reasons to use and not use, a complex CDSS. RESULTS: Ninety-eight participants (46% general practitioners, 25% primary care physical therapists, and 29% clinicians at a rehabilitation centre) fully completed the questionnaire. Fifty-two percent of the respondents were male. The average age was 48 years (SD ± 12.2). The causal model suggests that perceived usefulness is the main factor contributing to the intention to use a complex CDSS. Perceived service benefits and risks are both significant antecedents of perceived usefulness and perceived service risks are affected by the perceived threat to autonomy and trusting beliefs, particularly benevolence and competence. CONCLUSIONS: To improve the acceptance of complex CDSSs it is important to address the risks, but the main focus during the implementation phase should be on the expected improvements in patient outcomes and the overall gain for clinicians. Our results will help the development of complex CDSSs that fit more into the daily clinical practice of clinicians.

Acceptance and Potential Impact of the eWALL Platform for Health Monitoring and Promotion in Persons with a Chronic Disease or Age-Related Impairment.

Pervasive health technologies can increase the effectiveness of personal health monitoring and training, but more user studies are necessary to understand the interest for these technologies, and how they should be designed and implemented. In the present study, we evaluated eWALL, a user-centered pervasive health technology consisting of a platform that monitors users' physical and cognitive behavior, providing feedback and motivation via an easy-to-use, touch-based user interface. The eWALL was placed for one month in the home of 48 subjects with a chronic condition (chronic obstructive pulmonary disease-COPD or mild cognitive impairment-MCI) or with an age-related impairment. User acceptance, platform use, and potential clinical effects were evaluated using surveys, data logs, and clinical scales. Although some features of the platform need to be improved before reaching technical maturity and making a difference in patients' lives, the real-life evaluation of eWALL has shown how some features may influence patients' intention to use this promising technology. Furthermore, this study made it clear how the free use of different health apps is modulated by the real needs of the patient and by their usefulness in the context of the patient's clinical status.

User Experience and Potential Health Effects of a Conversational Agent-Based Electronic Health Intervention: Protocol for an Observational Cohort Study.

BACKGROUND: While the average human life expectancy has increased remarkably, the length of life with chronic conditions has also increased. To limit the occurrence of chronic conditions and comorbidities, it is important to adopt a healthy lifestyle. Within the European project "Council of Coaches," a personalized coaching platform was developed that supports developing and maintaining a healthy lifestyle. OBJECTIVE: The primary aim of this study is to assess the user experience with and the use and potential health effects of a fully working Council of Coaches system implemented in a real-world setting among the target population, specifically older adults or adults with type 2 diabetes mellitus or chronic pain. METHODS: An observational cohort study with a pretest-posttest design will be conducted. The study population will be a dynamic cohort consisting of older adults, aged ≥55 years, as well as adults aged ≥18 years with type 2 diabetes mellitus or chronic pain. Each participant will interact in a fully automated manner with Council of Coaches for 5 to 9 weeks. The primary outcomes are user experience, use of the program, and potential effects (health-related factors). Secondary outcomes include demographics, applicability of the virtual coaches, and user interaction with the virtual coaches. RESULTS: Recruitment started in December 2019 and is conducted through mass mailing, snowball sampling, and advertisements in newspapers and social media. This study is expected to conclude in August 2020. CONCLUSIONS: The results of this study will either confirm or reject the hypothesis that a group of virtual embodied conversational coaches can keep users engaged over several weeks of interaction and contribute to positive health outcomes. TRIAL REGISTRATION: The Netherlands Trial Register: NL7911; https://www.trialregister.nl/trial/7911. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/16641.

Challenges and Best Practices in Ethical Review of Human and Organizational Factors Studies in Health Technology: a Synthesis of Testimonies.

OBJECTIVE: Human and Organizational Factors (HOF) studies in health technology involve human beings and thus require Institutional Review Board (IRB) approval. Yet HOF studies have specific constraints and methods that may not fit standard regulations and IRB practices. Gaining IRB approval may pose difficulties for HOF researchers. This paper aims to provide a first overview of HOF study challenges to get IRB review by exploring differences and best practices across different countries. METHODS: HOF researchers were contacted by email to provide a testimony about their experience with IRB review and approval. Testimonies were thematically analyzed and synthesized to identify and discuss shared themes. RESULTS: Researchers from seven European countries, Argentina, Canada, Australia, and the United States answered the call. Four themes emerged that indicate shared challenges in legislation, IRB inefficiencies and inconsistencies, general regulation and costs, and lack of HOF study knowledge by IRB members. We propose a model for IRB review of HOF studies based on best practices. CONCLUSION: International criteria are needed that define low and high-risk HOF studies, to allow identification of studies that can undergo an expedited (or exempted) process from those that need full IRB review. Enhancing IRB processes in such a way would be beneficial to the conduct of HOF studies. Greater knowledge and promotion of HOF methods and evidence-based HOF study designs may support the evolving discipline. Based on these insights, training and guidance to IRB members may be developed to support them in ensuring that appropriate ethical issues for HOF studies are considered.

Tailoring Persuasive Electronic Health Strategies for Older Adults on the Basis of Personal Motivation: Web-Based Survey Study.

BACKGROUND: Persuasive design, in which the aim is to change attitudes and behaviors by means of technology, is an important aspect of electronic health (eHealth) design. However, selecting the right persuasive feature for an individual is a delicate task and is likely to depend on individual characteristics. Personalization of the persuasive strategy in an eHealth intervention therefore seems to be a promising approach. OBJECTIVE: This study aimed to develop a method that allows us to model motivation in older adults with respect to leading a healthy life and a strategy for personalizing the persuasive strategy of an eHealth intervention, based on this user model. METHODS: We deployed a Web-based survey among older adults (aged >60 years) in the Netherlands. In the first part, we administered an adapted version of the revised Sports Motivation Scale (SMS-II) as input for the user models. Then, we provided each participant with a selection of 5 randomly chosen mock-ups (out of a total of 11), each depicting a different persuasive strategy. After showing each strategy, we asked participants how much they appreciated it. The survey was concluded by addressing demographics. RESULTS: A total of 212 older adults completed the Web-based survey, with a mean age of 68.35 years (SD 5.27 years). Of 212 adults, 45.3% were males (96/212) and 54.7% were female (116/212). Factor analysis did not allow us to replicate the 5-factor structure for motivation, as targeted by the SMS-II. Instead, a 3-factor structure emerged with a total explained variance of 62.79%. These 3 factors are intrinsic motivation, acting to derive satisfaction from the behavior itself (5 items; Cronbach alpha=.90); external regulation, acting because of externally controlled rewards or punishments (4 items; Cronbach alpha=.83); and a-motivation, a situation where there is a lack of intention to act (2 items; r=0.50; P<.001). Persuasive strategies were appreciated differently, depending on the type of personal motivation. In some cases, demographics played a role. CONCLUSIONS: The personal type of motivation of older adults (intrinsic, externally regulated, and/or a-motivation), combined with their educational level or living situation, affects an individual's like or dislike for a persuasive eHealth feature. We provide a practical approach for profiling older adults as well as an overview of which persuasive features should or should not be provided to each profile. Future research should take into account the coexistence of multiple types of motivation within an individual and the presence of a-motivation.

Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands.

BACKGROUND: Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. METHODS: The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. RESULTS: In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. CONCLUSION: Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.

Patient acceptance of a telemedicine service for rehabilitation care: A focus group study.

BACKGROUND AND PURPOSE: Despite positive outcomes, widespread implementation of telemedicine services in rehabilitation care is lacking. This could, for a large part, be attributed to a lack of end-user acceptance. The aim of this article is to look beyond the common theoretical approaches towards end-user acceptance (like the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology), and to explore the factors that contribute to or hinder the acceptance of a telemedicine service for rehabilitation care by patients with a chronic disease. METHODS: A qualitative, exploratory focus group approach was applied. We involved 188 patients in 22 focus groups. A guide was developed to provoke a discussion among participants of a rehabilitation clinic on the topic of using an online portal with a wide range of telemedicine features (e.g., an exercise module and a teleconference module). Three coders, using thematic analysis, coded the focus group transcripts simultaneously. RESULTS: The focus groups resulted in a wide range of factors that drive or hinder patient acceptance. Facilitators included the possibility to exercise from the comfort of home, the ability to work on one's recovery, irrespective of the time schedule of care professionals, and improved quality of exercise instruction, due to the provision of exercise videos on the portal. Barriers included a lack of intrinsically motivation, experiencing portal-mediated communication with care professionals as 'impersonal', and the lack of physical space and rest to properly exercise at home. Generally speaking, participants were enthusiastic about the idea to provide the telemedicine service as a follow-up treatment as they liked to be in contact with their therapist and to continue training. CONCLUSION: Acceptance of telemedicine services depends on many factors that are not part of well-established theories that explain technology acceptance. These factors are more specific than general determinants, such as ease of use and usefulness, and focus mainly on contextual factors, such as a fit between the service configuration and daily life, personal motivation and the associated psychological burden.

User Experience, Actual Use, and Effectiveness of an Information Communication Technology-Supported Home Exercise Program for Pre-Frail Older Adults.

OBJECTIVE: The main objective of this study was to investigate the use and user experience of an Information Communication Technology-supported home exercise program when offered for independent use to pre-frail older adults. Our secondary aim was to explore whether the program improved quality of life and health status compared to a control group. METHODS: A cohort multiple randomized controlled trail is being performed. Physically pre-frail older adults (65-75 years) living independently at home were included and randomly assigned to a control group or an intervention group. The intervention group received a home exercise program (strength, balance, and flexibility exercises) for a minimal duration of 12 weeks. The control group received usual care. Primary outcomes were: use of the intervention (frequency and duration), adherence to a 3-day exercise protocol and user experience [System Usability Scale (SUS); rating 1-10]. Secondary outcomes were quality of life measured with the SF12 (Physical Component Scale and Mental Component Scale) and health status (EQ-5D), assessed before the study starts and after 12 weeks of exercising. RESULTS: Thirty-seven independently living older adults participated in the study. Sixteen participants were allocated to the intervention group and 21 to the control group. The average score on the SUS was 84.2 (±13.3), almost reaching an excellent score. Participants rated the intervention with an 8.5. Eighty percent of the participants finished the 12 week exercise protocol. The adherence to the 3-day exercise protocol was 68%. Participants in the intervention group trained on average 2.2 times (±1.3) each week. The mean duration of login for each exercise session was 24 min. The Mental Component Scale of the SF12 was significantly higher in the intervention group compared to the control group. A trend was seen in the change over time in the health status between groups. CONCLUSIONS: This study provides evidence that a home-based exercise program is easy to use and has potential in improving quality of life and health status of pre-frail older adults who live at home. However, further refinement of the program is required to improve adherence and maximize the benefits and potential of exercising in the home environment. TRIAL REGISTRATION: Unique Identifier: NTR5304. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5304.

"There Is Something We Need to Tell You ": Communicating Health-Screening Results to Older Adults via the Internet.

BACKGROUND: With the introduction of online health screenings, guidelines describing how to communicate about a person's health need to be adapted for a digital setting. This study aimed to uncover older adults' preferences regarding such online messages. MATERIALS AND METHODS: Thirty older adults (aged 65 to 75 years) viewed four versions of the results message of a screening aimed at identifying frailty: a standard, empathic, tailored, or both empathic and tailored message. After each version, they were interviewed about what they (dis)liked about the message. They also ranked the four versions according to preference. Ranks were analyzed with a Friedman's test and a Wilcoxon's signed-rank test. RESULTS: There was no significant difference for message-type preference when the outcome was positive. For the prefrail or frail outcome, message-type preferences differed (χ2 = 10.51, p = 0.02 and χ2 = 13.56, p < 0.01, respectively). Overall, for the prefrail and frail outcome, the tailored version was appreciated most. Participants commented that the tailored version made them feel appreciated more as a person. Some found the empathic additions comforting, others found these unnecessary. CONCLUSIONS: When communicating the results of an online health screening to older adults via the Internet, one should primarily tailor the message toward personal characteristics. The effect of empathic elements in results messages appeared to be limited. Whether a message should be adapted depends on whether the outcome is positive or negative.

Possibilities of ICT-supported services in the clinical management of older adults.

Services making use of information and communication technology (ICT) are of potential interest to face the challenges of our aging society. Aim of this article is to describe the possible field of application for ICT-supported services in the management of older adults, in particular those with functional impairment. The current status of ICT-supported services is described and examples of how these services can be implemented in everyday practice are given. Upcoming technical solutions and future directions are also addressed. An ICT-supported service is not only the technological tool, but its combination with clinical purposes for which it is used and the way it is implemented in everyday care. Patient's satisfaction with ICT-supported services is moderate to good. Actual use of patients is higher than those of professionals but very variable. Frequency of use is positively related to clinical outcome. ICT offers a variety of opportunities for the treatment and prevention of frailty and functional decline. Future challenges are related to the intelligence of the systems and making the technologies even more unobtrusive and intuitive.

A Telemedicine Service as Partial Replacement of Face-to-Face Physical Rehabilitation: The Relevance of Use.

BACKGROUND: Different kinds of telemedicine services have made their entry into healthcare. In this article we focus on a telerehabilitation service for physical exercise, designed and implemented as partial replacement of a 3-day outpatient rehabilitation program for chronic disease patients. The aim of this article is to examine the use pattern of this telerehabilitation service by chronic disease patients and to examine the association between actual use and clinical benefit experienced by these patients. MATERIALS AND METHODS: Chronic lower back pain (CLBP) patients and pulmonary disease (PD) patients referred to the physical outpatient rehabilitation programs were asked to participate in and to use the telerehabilitation service. The actual use was expressed as frequency and duration of use, and the measurement of clinical benefit focused on complaints and physical functioning. RESULTS: Sixty-two patients finished the outpatient rehabilitation using the telerehabilitation service. During the weeks of home rehabilitation the majority of the patients used the service. On average the service was used one or two times a week for a total of 35-38 min for both pathologies, with this value being lower than the time that was replaced. Frequency of use was significantly associated with the change in physical functioning outcome for both pathologies (CLBP, r=0.41, p=0.02; PD, r=0.55, p=0.003). CONCLUSIONS: Chronic disease patients used a telerehabilitation service as partial replacement of their face-to-face rehabilitation program, and more frequent use was positively related to higher clinical benefit.

A Community-Based, Technology-Supported Health Service for Detecting and Preventing Frailty among Older Adults: A Participatory Design Development Process.

Frailty is a multifaceted condition that affects many older adults and marks decline on areas such as cognition, physical condition, and nutritional status. Frail individuals are at increased risk for the development of disability, dementia, and falls. There are hardly any health services that enable the identification of prefrail individuals and that focus on prevention of further functional decline. In this paper, we discuss the development of a community-based, technology-supported health service for detecting prefrailty and preventing frailty and further functional decline via participatory design with a wide range of stakeholders. The result is an innovative service model in which an online platform supports the integration of traditional services with novel, Information Communication Technology supported tools. This service is capable of supporting the different phases of screening and offers training services, by also integrating them with community-based services. The service model can be used as a basis for developing similar services within a wide range of healthcare systems. We present the service model, the general functioning of the technology platform, and the different ways in which screening for and prevention of frailty has been localized. Finally, we reflect on the added value of participatory design for creating such health services.

A Serious Exergame for Patients Suffering from Chronic Musculoskeletal Back and Neck Pain: A Pilot Study.

INTRODUCTION: Over recent years, the popularity of videogames has gone beyond youth and gamers and is slowly entering the field of professional healthcare. Exergames are an attractive alternative to physical therapy. The primary aim of this pilot study was to explore the user experience (usability, satisfaction, level of motivation, and game experience) of the patient with the "PlayMancer" exergame. The secondary aim was to explore the progression of the performed motor skills (walking velocity, overhead reach ability, and cervical range of motion) and the clinical changes (to physical condition, disability, and pain intensity) in a group of patients with chronic musculoskeletal pain using an exergame for 4 weeks. MATERIALS AND METHODS: In the European PlayMancer project, an exergame for physical rehabilitation of chronic pain patients was developed. This exergame is controlled by relevant motions of the patient's body captured by a motion suit and several infrared cameras. In three different integrated minigames, the patient can train the following motor skills: Walking velocity, overhead reaching, and neck mobility. RESULTS: Ten patients participated in this study and completed the 4 weeks of gaming. Patients rated the usability of the exergames as good (score of 78.5 [standard deviation 9.7; range, 60.0-97.5]) on the System Usability Scale, and the game motivated all patients to perform their exercises. Patients enjoyed playing and were pleased with both the game environment and the game play. Overall, the patients made a progression in the examined motor skills during the minigames over the 4 weeks of gaming. CONCLUSIONS: The "PlayMancer" exergame is a potential tool for achieving physical rehabilitation because it motivates patients to perform their exercises and as a result increases their motor skills and physical condition.