Psychological therapy using virtual reality for treatment of driving phobia: a systematic review.

PURPOSE: Driving phobia is prevalent in injured individuals following motor vehicle crashes (MVCs). The evidence for virtual reality (VR) based psychological treatments for driving phobia is unknown. This systematic review synthesized the available evidence on the effectiveness, feasibility, and user experience of psychological treatments for driving phobia using VR. METHODS: Three databases (PsycINFO, SCOPUS, and PubMed) were searched. Eligibility criteria included adults with clinical or sub-clinical levels of driving phobia manifesting as part of an anxiety disorder or post-traumatic stress disorder (PTSD). Primary outcomes were driving-related anxiety/fear or avoidance, PTSD symptoms and driving frequency/intensity, as well as treatment feasibility including recruitment, treatment completion and retention rates, user experience and immersion/presence in the VR program. Secondary outcomes were other health outcomes (e.g., depression) and VR technological features. RESULTS: The 14 included studies were of low methodological quality. Clinical and methodological heterogeneity prevented quantitative pooling of data. The evidence provided in this review is limited by trials with small sample sizes, and lack of diagnostic clarity, controlled designs, and long-term assessment. The evidence did suggest that VR-based psychological interventions could be feasible and acceptable in this population. CONCLUSIONS: For VR-based psychological interventions to be recommended for driving phobia, more high-quality trials are needed. Implications for rehabilitationVirtual reality (VR) based psychological treatments may be feasible and acceptable to patients with driving phobia.There is potential to increase accessibility to psychological therapies in patients with driving phobia following motor vehicle crashes through the use of digital psychiatry such as VR.

A comparison of prospective observations and chart audits for measuring quality of care of musculoskeletal injuries in the emergency department.

BACKGROUND: Accurate and efficient data collection is crucial for effective evaluation of quality of care. The objective of this study is to compare two methods of data collection used to score quality indicators for musculoskeletal injury management in Emergency departments: prospective observation, and chart audit. METHODS: An analysis was undertaken of data collected from 633 patients who presented with a musculoskeletal injury to eight emergency departments in Queensland, Australia in 2016-17. Twenty-two quality indicators were scored using both prospective observation and chart audit data for each occasion of service. Quality indicators were included if they were originally published with both collection methods. Analyses were performed to compare firstly, the quality indicator denominators, and secondly, the quality indicator trigger rates, scored using each collection method. Chi Square statistics were used to identify significant differences. RESULTS: Prospectively collected data scored quality indicator denominators significantly (p value<0.05) more often than chart audit data for five (22.7 %) of the 22 quality indicators. The remaining 17 quality indicators (77.3 %) showed no statistical differences. When comparing quality indicator trigger rates, 16 (72.7 %) had significantly different results between methods with 12 (54.5 %) scoring higher using prospective data and four (18.2 %) with chart audit data. The remaining six quality indicators (27.3 %) in this comparison showed no significant difference between chart and prospective data. CONCLUSION: Quality indicators including aspects of care associated with patient safety, and those relying on clinician written orders or forms were adequately scored using either prospective observation or chart audit data. Whereas quality indicators relying on time-sensitive information, elements of a social history, general physical exams and patient education and advice scored higher using prospective observation data collection.

Implementation of physiotherapy telerehabilitation before and post Covid-19 outbreak: A comparative narrative between South American countries and Australia.

The continuous development in telecommunication tech-nologies has created opportunities for health professionals to optimise healthcare delivery by adopting digital tools into rehabilitation programs (i.e., telerehabilitation). These tech-nological advances, along with the demographic and social characteristics of each country, have made the implementa-tion of telerehabilitation a disparate process across regions. We have gathered the experience of four countries (Australia, Chile, Brazil, and Colombia) in two different regions (Ocea-nia and South America) to recompile the history pre- and post-Covid-19 outbreak until January of 2021, the barriers to, and facilitators of telerehabilitation, and outline the future challenges for these countries.

Cost analysis of home telerehabilitation for speech treatment in people with Parkinson's disease.

INTRODUCTION: Geographical barriers and impaired physical mobility among people with Parkinson's disease (PD) hinder their timely access to speech pathology services. We compared the costs of delivering a speech treatment via in-person consultation versus telerehabilitation. METHODS: We used data from a non-inferiority randomised controlled trial delivering the Lee Silverman Voice Treatment (LSVT LOUD®), where patients with dysarthria associated with PD were assigned to either the urban in-person group (N = 16) or the urban online group (N = 15), supplemented with a non-randomised group (regional online; N = 21). We compared costs over a one-month treatment period from a health-system perspective and a patient perspective. RESULTS: The mean treatment costs of both urban online ($1076) and regional ($1206) treatments tended to be slightly higher than urban in-person ($1020) from a health-system perspective. From a patient perspective, the mean treatment cost was $831 in the urban in-person group, $247 in the urban online group and $200 in the regional group. DISCUSSION: LSVT LOUD® may be delivered via telerehabilitation at a slightly higher cost than in-person delivery from a health-system perspective, but it is cost saving from a patient perspective. Telerehabilitation is an economically beneficial alternative for the delivery of the LSVT LOUD® programme in PD patients with speech disorders.

Does telerehabilitation result in inferior clinical outcomes compared with in-person care for the management of chronic musculoskeletal spinal conditions in the tertiary hospital setting? A non-randomised pilot clinical trial.

INTRODUCTION: Clinical guidelines recommend multidisciplinary non-surgical management for most musculoskeletal spinal conditions. Access to such services continues to be a barrier for many individuals residing outside metropolitan regions. The primary aim of this study was to determine whether clinical outcomes achieved via telerehabilitation are as good as those achieved via in-person care. METHODS: A non-randomised pilot clinical trial was undertaken where eligible patients chose to access treatment either via telerehabilitation or in-person (control group). Outcome measures for pain-related disability, pain severity and health-related quality of life were recorded at baseline, 3-, 6- and 9-months. Secondary outcomes included patient satisfaction and technical disruptions. RESULTS: Seventy-one patients were recruited (telerehabilitation, n = 51; control group, n = 20). Patient characteristics did not differ at baseline and clinically meaningful improvements for pain-related disability and health-related quality of life were observed in both groups. Non-inferiority of telerehabilitation could not be claimed for any clinical outcome measure. There were no significant group-by-time interactions observed for either pain-related disability (p = 0.706), pain severity (p = 0.187) or health-related quality of life (p = 0.425) measures. The telerehabilitation group reported significantly higher levels of treatment satisfaction (median: 97 vs. 76.5; p = 0.021); 7.9% of telerehabilitation appointments were not completed due to technical disruptions. DISCUSSION: Findings indicate patients with chronic musculoskeletal spinal conditions can achieve clinically meaningful improvements in their condition when accessing care via telerehabilitation. Telerehabilitation should be considered for individuals unable to access relevant in-person services; however non-inferiority remains inconclusive and requires further exploration.

Telehealth for musculoskeletal physiotherapy.

INTRODUCTION: Musculoskeletal conditions are a leading cause of global morbidity. Access to traditional in-person healthcare can be difficult for some under usual conditions and has become a ubiquitous barrier throughout the COVID-19 pandemic. Telehealth, defined as the 'delivery of healthcare at a distance using information and communication technology' is a solution to many access barriers and has been rapidly adopted by many healthcare professions throughout the crisis. While significant advancements in technology has made the widespread adoption of telehealth feasible, there are many factors to be considered when implementing a telehealth service. PURPOSE: The aims of this masterclass are to (i) introduce telehealth and outline the current research within the context of musculoskeletal physiotherapy; (ii) provide insights into some of the broader challenges in the wide-scale adoption of telehealth; and (iii) to describe a systematic approach to implementing telehealth into existing healthcare settings, along with some practical considerations. IMPLICATIONS: Telehealth is a broad concept and should be implemented to meet the specific needs of a healthcare service. This masterclass offers a structured approach to the implementation of a musculoskeletal physiotherapy telehealth service, and highlights practical considerations required by both clinicians and healthcare organisations throughout all stages of the implementation process.

The FOOTPATH study: protocol for a multicentre, participant- and assessor-blind, parallel group randomised clinical trial of foot orthoses for patellofemoral osteoarthritis.

INTRODUCTION: Patellofemoral (PF) osteoarthritis (OA) is a common and burdensome subgroup of knee OA, with very little evidence for effective treatments. Prefabricated foot orthoses are an affordable and accessible intervention that have been shown to reduce PF pain in younger adults. Similarities between PF pain and PFOA, as well as our pilot work, suggest that foot orthoses may also be an effective intervention for PFOA. The primary objective of this study is to compare the 3 month efficacy of prefabricated foot orthoses and flat shoe inserts in people with PFOA, on knee pain severity. METHODS AND ANALYSIS: The FOOTPATH Study (FOot OrThoses for PAtellofemoral osteoarTHritis) is a multicentre, randomised, participant- and assessor-blinded superiority trial with two parallel groups, a 3 month observation period (pre-randomisation) and 12 month follow-up. 160 participants with a clinical diagnosis of PFOA will be recruited from three sites in Australia, and randomised to one of two groups (prefabricated foot orthoses or flat shoe inserts). The primary outcome is worst knee pain severity during a self-nominated aggravating activity in the previous week (100 mm visual analogue scale) at 3 months, with a secondary endpoint at 12 months. Secondary outcomes include global rating of change, symptoms, function, health-related quality of life, kinesiophobia, self-efficacy and use of co-interventions for knee pain. Blinded, intention-to-treat analyses of primary and secondary patient-reported outcomes will be performed, as well as economic analyses. ETHICS AND DISSEMINATION: Ethical approval has been granted by La Trobe University's Human Ethics Committee and The University of Queensland's Medical Research Ethics Committee. Study outcomes will be disseminated via peer-reviewed journals, conference presentations targeting a range of healthcare disciplines and an open access website with clinician resources. TRIAL REGISTRATION NUMBER: ANZCTRN12617000385347; Pre-results.

Active Video Games for Rehabilitation in Respiratory Conditions: Systematic Review and Meta-Analysis.

BACKGROUND: Exercise and physical activity are key components of treatment for chronic respiratory diseases. However, the level of physical activity and adherence to exercise programs are low in people with these diseases. Active video games (AVGs) may provide a more engaging alternative to traditional forms of exercise. OBJECTIVE: This review examines the effectiveness of game-based interventions on physiological outcome measures, as well as adherence and enjoyment in subjects with chronic respiratory diseases. METHODS: A systematic search of the literature was conducted, with full texts and abstracts included where they involved an AVG intervention for participants diagnosed with respiratory conditions. A narrative synthesis of included studies was performed. Additionally, meta-analysis comparing AVGs with traditional exercise was undertaken for 4 outcome measures: mean heart rate (HR) during exercise, peripheral blood oxygen saturation (SpO2) during exercise, dyspnea induced by the exercise, and enjoyment of the exercise. RESULTS: A total of 13 full-text papers corresponding to 12 studies were included in the review. Interventions predominantly used games released for the Nintendo Wii (8 studies) and Microsoft Xbox Kinect (3 studies). There were 5 studies that examined the acute effects of a single session of AVGs and 7 studies that examined the long-term effects after multiple sessions of AVGs. Trials conducted over more than 1 session varied in duration between 3 and 12 weeks. In these, AVG interventions were associated with either similar or slightly greater improvements in outcomes such as exercise capacity when compared with a traditional exercise control, and they also generally demonstrated improvements over baseline or nonintervention comparators. There were a few studies of unsupervised AVG interventions, but the reported adherence was high and maintained throughout the intervention period. Additionally, AVGs were generally reported to be well liked and considered feasible by participants. For outcome measures measured during a single exercise session, there was no significant difference between an AVG and traditional exercise for HR (mean difference 1.44 beats per minute, 95% CI -14.31 to 17.18), SpO2 (mean difference 1.12 percentage points, 95% CI -1.91 to 4.16), and dyspnea (mean difference 0.43 Borg units, 95% CI -0.79 to 1.66), but AVGs were significantly more enjoyable than traditional exercise (Hedges g standardized mean difference 1.36, 95% CI 0.04-2.68). CONCLUSIONS: This review provides evidence that AVG interventions, undertaken for several weeks, can provide similar or greater improvements in exercise capacity and other outcomes as traditional exercise. Within a single session of cardiovascular exercise, an AVG can evoke similar physiological responses as traditional exercise modalities but is more enjoyable to subjects with chronic respiratory diseases. However, there is very limited evidence for adherence and effectiveness in long-term unsupervised trials, which should be the focus of future research.

Clinicians' Perspectives of a Novel Home-Based Multidisciplinary Telehealth Service for Patients with Chronic Spinal Pain.

Chronic spinal pain conditions can often be successfully managed by a non-surgical, multidisciplinary approach, however many individuals are unable to access such specialised services within their local community. A possible solution may be the delivery of care via telerehabilitation. This study aimed to evaluate clinicians' perspectives on providing clinical care via telerehabilitation during the early implementation of a novel spinal telerehabilitation service. Eight clinicians' were recruited, completing surveys at four separate time points. Confidence in providing treatment via telerehabilitation significantly improved with time (χ2(3)=16.22, p=0.001). Clinicians became significantly more accepting of telerehabilitation being a time- (χ2(3)=11.237, p=0.011), and cost-effective (χ2(3)=9.466, p=0.024) platform in which they could deliver care. Overall satisfaction was high, with technology becoming easier to use (p=0.026) and ability to establish rapport significantly improved with experience (p=0.043). Understanding clinicians' perspectives throughout the early implementation phase of a new telerehabilitation service is a critical component in determining long-term sustainability.

Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic.

OBJECTIVE: To determine the level of agreement between a telehealth and in-person assessment of a representative sample of patients with chronic musculoskeletal conditions referred to an advanced-practice physiotherapy screening clinic. DESIGN: Repeated-measures study design. PARTICIPANTS: 42 patients referred to the Neurosurgical & Orthopaedic Physiotherapy Screening Clinic (Queensland, Australia) for assessment of their chronic lumbar spine, knee or shoulder condition. INTERVENTION: Participants underwent two consecutive assessments by different physiotherapists within a single clinic session. In-person assessments were conducted as per standard clinical practice. Telehealth assessments took place remotely via videoconferencing. Six Musculoskeletal Physiotherapists were paired together to perform both assessment types. MAIN OUTCOME MEASURES: Clinical management decisions including (i) recommended management pathways, (ii) referral to allied health professions, (iii) clinical diagnostics, and (iv) requirement for further investigations were compared using reliability and agreement statistics. RESULTS: There was substantial agreement (83.3%; 35/42 cases) between in-person and telehealth assessments for recommended management pathways. Moderate to near perfect agreement (AC1 = 0.58-0.9) was reached for referral to individual allied health professionals. Diagnostic agreement was 83.3% between the two delivery mediums, whilst there was substantial agreement (81%; AC1 = 0.74) when requesting further investigations. Overall, participants were satisfied with the telehealth assessment. CONCLUSION: There is a high level of agreement between telehealth and in-person assessments with respect to clinical management decisions and diagnosis of patients with chronic musculoskeletal conditions managed in an advanced-practice physiotherapy screening clinic. Telehealth can be considered as a viable and effective medium to assess those patients who are unable to attend these services in person.

Patients are willing to use telehealth for the multidisciplinary management of chronic musculoskeletal conditions: A cross-sectional survey.

Introduction Access to specialised multidisciplinary healthcare services is difficult for many patients with chronic musculoskeletal conditions. A possible solution could be delivery of care via telehealth. This study aims to identify current barriers in accessing healthcare services, and to determine if telehealth is an acceptable mode of healthcare delivery, from the perspective of patients with chronic musculoskeletal conditions. Methods Surveys were distributed to current patients receiving care within the Neurosurgical and Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC & MDS) at six facilities throughout Queensland, Australia. The 48-item survey evaluated five key areas including demographics; current barriers to attendance; satisfaction with current management provided by the N/OPSC & MDS; technology access and literacy; and attitudes and preference towards telehealth. Results In total, 85 patients (71%) completed the survey. The majority of patients were satisfied overall with the N/OPSC & MDS, but almost one-quarter of the patients reported ceasing treatment due to difficulty accessing services. Over half of the respondents were willing to use telehealth if it reduced the costs (53%) and time (57%) associated with attending appointments. Patients in paid employment were more likely (65%) to use telehealth if it reduced work absenteeism. Overall, 78% of patients were identified as having appropriate technology access to enable home telehealth. Specifically, 43% of patients would prefer home telehealth over having to travel to attend their appointments. Discussion The majority of N/OPSC & MDS patients are willing to engage in telehealth for the management of their chronic musculoskeletal condition. These findings justify consideration of telehealth as an additional method of service delivery within the existing N/OPSC & MD service.

Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction.

PURPOSE: Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10-15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. METHODS: Participants (aged 18-50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. RESULTS: Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. CONCLUSIONS: Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. LEVEL OF EVIDENCE: IV.

Telerehabilitation Feasibility in Total Joint Replacement.

Despite documented benefits, many Total Joint Replacement (TJR) patients find it difficult to access rehabilitation following discharge from hospital. One solution to improve access for TJR patients is telerehabilitation. This study aimed to assess the feasibility of introducing a telerehabilitation program for TJR patients. TJR patients at QEII Jubilee Hospital were invited to complete a questionnaire regarding their access, feelings towards and preferences in using technology. Seventy-five patients were recruited. Most patients had computer access (72%) and internet (69%) at home. Sixty-five percent of participants were willing to participate in telerehabilitation. A significant difference was found between older and younger patients. Watching videos on an electronic device was the preferred method for a technology-based home exercise program and phone call the preferred method of communication. Results indicate telerehabilitation in the TJR population is feasible from the perspective of access to, feelings toward, and preferences for technology.

Method-comparison studies in telehealth: Study design and analysis considerations.

When establishing telehealth services, clinicians need to be confident that the examinations, assessments and clinical decisions that they make while using technology are equivalent to conventional best practice. Method-comparison studies are ideally suited to answering these questions, however there is a lack of consistency in the telehealth literature in the study methodologies and data analysis techniques used. Methodologies should closely match clinical practice to maximise external validity and data analysis techniques should match the data types generated in order to be clinically meaningful. In this article we discuss the design, analysis and interpretation of method-comparison studies in the context of telehealth research.

Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study.

BACKGROUND: The Neurosurgical & Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC&MDS) originated as a complementary, non-surgical pathway for patients referred to public neurosurgical and orthopaedic specialist services. Patient access to the N/OPSC&MDS could potentially be improved with the implementation of telerehabilitation as an additional method of service delivery. OBJECTIVE: To evaluate service provider's views on (1) current barriers to patients' accessing N/OPSC & MD services, and (2) the implementation of telerehabilitation within the N/OPSC&MDS. DESIGN: Qualitative descriptive study design. METHODS: Healthcare providers (n = 26) were recruited from six N/OPSC&MD services located throughout Queensland, Australia. Semi-structured interviews were conducted to explore service providers' views with respect to existing barriers to patients accessing the N/OPSC&MDS, and if telerehabilitation could be feasibly adopted to address current barriers. RESULTS: Template analysis resulted in six themes: (1) barriers to some patients' accessing current N/OPSC&MD services are complex & multifaceted; (2) telerehabilitation could improve patient access to appropriate management for their musculoskeletal condition; (3) telerehabilitation may have limitations when compared to face-to-face healthcare; (4) the delivery of telerehabilitation needs to be flexible; (5) perceived barriers, and (6) facilitators to the successful implementation of telerehabilitation within the N/OPSC&MDS. CONCLUSION: This study represents a critical step in determining the readiness of service providers for the implementation of telerehabilitation within the N/OPSC&MDS. Although cautious, service providers are overall accepting of the implementation of telerehabilitation, acknowledging that it could eliminate several current barriers, subsequently achieving more equitable access to the service.

Physiotherapy assessment and diagnosis of musculoskeletal disorders of the knee via telerehabilitation.

Introduction Lower limb musculoskeletal disorders place a heavy burden on healthcare systems. Appropriate management of these conditions is critical, however access to appropriate physiotherapy services is difficult for those in geographically remote areas or those with mobility or transport difficulties. The aim of this study was to evaluate the accuracy and reliability of an online musculoskeletal physiotherapy assessment of the knee complex using telerehabilitation compared to traditional face-to-face assessment. Methods In a repeated-measures design, 18 subjects who sought treatment for knee pain underwent a traditional face-to-face assessment and a remote telerehabilitation assessment. Telerehabilitation assessments were conducted with participants performing facilitated self-palpation, self-applied modified orthopaedic tests, active movements and functional tasks. Results Primary pathoanatomical diagnoses were in exact agreement in 67% of cases and were similar in 89% of cases. The system of pathology was found to be in agreement in 17 out of 18 cases (94%). Comparisons of objective findings from the two physical assessments demonstrated substantial agreement (kappa = 0.635) for categorical data and binary data (chi-squared = 400.36; p < 0.001). A high level of intra-rater (89%) and moderate level of inter-rater (67%) reliability was evident for telerehabilitation assessments. Discussion Telerehabilitation assessment of the knee complex appears to be feasible and reliable. This study has implications for clinical practice and the development of physiotherapy services to address the burden of lower limb musculoskeletal pain and disability.

Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of treatment delivered via real-time telerehabilitation for the management of musculoskeletal conditions, and to determine if real-time telerehabilitation is comparable to conventional methods of delivery within this population. DATA SOURCES: Six databases (Medline, Embase, Cochrane CENTRAL, PEDro, psycINFO, CINAHL) were searched from inception to November 2015 for literature which reported on the outcomes of real-time telerehabilitation for musculoskeletal conditions. REVIEW METHODS: Two reviewers screened 5913 abstracts where 13 studies ( n = 1520) met the eligibility criteria. Methodological quality was assessed using the Downs & Black 'Checklist for Measuring Quality' tool. Results were pooled for meta-analysis based upon primary outcome measures and reported as standardised mean differences and 95% confidence intervals (CI). RESULTS: Aggregate results suggest that telerehabilitation is effective in the improvement of physical function (SMD 1.63, 95%CI 0.92-2.33, I2=93%), whilst being slightly more favourable (SMD 0.44, 95%CI 0.19-0.69, I2=58%) than the control cohort following intervention. Sub-group analyses reveals that telerehabilitation in addition to usual care is more favourable (SMD 0.64, 95%CI 0.43-0.85, I2=10%) than usual care alone, whilst treatment delivered solely via telerehabilitation is equivalent to face-to-face intervention (SMD MD 0.14, 95% CI -0.10-0.37, I2 = 0%) for the improvement of physical function. The improvement of pain was also seen to be comparable between cohorts (SMD 0.66, 95%CI -0.27-1.60, I2=96%) following intervention. CONCLUSIONS: Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.

Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial.

PURPOSE: This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated. METHOD: In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures. RESULTS: Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified. CONCLUSIONS: Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.

Assistive technology devices for toileting and showering used in spinal cord injury rehabilitation - a comment on terminology.

A review of assistive technologies, products and devices for toileting and showering identified at least 15 separate terms across all studies, with another two identified in subsequent studies. Terms are often used interchangeably, and are often not defined or described. Inconsistencies in terminology affect the quality of evidence available to policy makers, researchers and clinicians. Researchers are encouraged to provide clear definitions and descriptions of assistive technologies, products and devices for toileting and showering under investigation. Implications for Rehabilitation At least 17 different terms have been identified for assistive technologies, products and devices for toileting and showering. Inconsistencies in terminology make comparisons between studies difficult, and therefore affect the quality of evidence available to policy makers, researchers and clinicians. Providing clear definitions and descriptions of assistive technologies, products and devices for toileting and showering under investigation is encouraged.