RECOVER-E - a mobile app for patients undergoing total knee or hip replacement: study protocol.

BACKGROUND: Total knee replacement (TKR) or total hip replacement (THR) are common and effective procedures in patients with osteoarthritis (OA) to restore physical function and reduce joint related pain. Patient education plays an important role in the treatment process aiming to develop necessary self-management skills to facilitate recovery and ensure long-term success. We have developed a mobile app (RECOVER-E) for iOS and Android smartphones which provides important information on the preoperative phase, surgery and recovery. The concomitant study will determine the efficacy of RECOVER-E on patients' surgical outcomes. METHODS/DESIGN: This study is a non-randomized, multi-centre (4 sites), double-arm, controlled trial with 1:1 assignment. 160 patients undergoing primary TKR or THR will be recruited from January until October 2019 in 4 German hospitals. Both groups will receive standard care. Additionally, the intervention group will use the app RECOVER-E. Measurements will be taken 4-6 weeks before surgery, on the day of admission to the hospital, on the first and 7th postoperative day and 3 months post-surgery. Primary outcome will be self-reported physical function measured on the activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) for patients with knee and hip osteoarthritis, respectively. Secondary outcomes include the subscales for pain, symptoms, function in sport and recreation and knee/hip-related quality of life of the HOOS and KOOS, preoperative anxiety, measured by the Hospital Anxiety and Depression Scale (HADS), as well as, pain at rest and pain during activity measured by a numerical rating scale (NRS). Primary endpoint is 3 months post-surgery. DISCUSSION: Mobile Health (mHealth) has become increasingly important in patient-centred health care aiming to enhance patient involvement and self-management capabilities. To our knowledge this is the first study to investigate the effect of an evidence-based mobile app on patient reported outcomes after joint replacement. This study should provide evidence supporting the use of mHealth to facilitate recovery and open up new possibilities for patient care in joint replacement. TRIAL REGISTRATION: DRKS Data Management retrospectively registered. DRKS-ID: DRKS00012744.

[Online therapy for depressive disorders : An acceptance-based analysis from the perspective of therapists]. / Onlinetherapie bei depressiven Störungen : Eine Akzeptanzanalyse aus der Perspektive der Behandelnden.

BACKGROUND: The supply of online therapy options for mild to moderate depressive disorders has substantially risen both nationally and internationally in the past years. While the efficacy and efficiency of specific online-based therapeutic services were indicated within the framework of scientific evaluations, little is known about the acceptance of these new therapy options. METHODS: In a nationwide online survey of online-based therapy options for mild to moderate depressive disorders, the attitude and stance as well as the use intention and the subjectively perceived knowledge of 657 medical practitioners and therapists, active in psychotherapeutic and psychiatric treatment were collated. The impact of the potential predictors on the use intention of online-based therapies, based on the unified theory of acceptance and use of technology, was analyzed by means of a binary logistic regression model. RESULTS: Besides the perceived performance and expense expectations, the supportive framework conditions, the influence of the cooperative environment, the individual technical affinity as well as the evaluation of the prospective significance of online-based therapy proved to be significantly influential predictors on the user intention. Special predictability for a positive user intention was shown related to the perceived potential of online therapy. CONCLUSION: The results underline the relevance of further evidence-basing of online therapy for mild to moderate depressive disorders. A user-oriented, participatory technology development proves to be just as relevant as a comprehensive sensitization, elucidation and education of potential users for a successful implementation.

[Telematics in ambulatory care: Exploring the nurses' perspective]. / Telematische Anwendungen in der ambulanten Pflege: Die Perspektive von Pflegekräften.

Telematics in ambulatory care: Exploring the nurses' perspective Abstract. BACKGROUND: In the context of demographic change, the use of information and communications technology in home care has the aim of ensuring the quality of nursing care in the future. The acceptance of telematic applications by all users is crucial in this regard. AIM: The aim of this study was to assess the subjective attitudes and intentions of nursing staff on telematic applications in home care. METHODS: Based on the "Unified Theory of Acceptance and Use of Technology" (UTAUT), an online survey was conducted in which nursing staff as well as nursing students throughout Germany were surveyed. 371 questionnaires have been included in the analysis. RESULTS: Nursing students as well as nurses stated inadequate information and insufficient technical competence. Referring to performance expectations, both groups hope for improving care process transparency and communication inside and outside sectors. For effort expectancy, higher costs, training efforts and technology dependency were named. CONCLUSIONS: The results show the relevance of the attitudes and demands of users for a successful implementation. In the future, training and further education should increasingly promote the technological competence of nursing staff.

Technology-Assisted Home Care for People With Dementia and Their Relatives: Scoping Review.

BACKGROUND: Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research field has become complex. OBJECTIVE: The goal of this scoping review was to provide an overview of the research on technology-assisted home care for people with dementia and their relatives in order to guide further research and technology development. METHODS: A scoping review was conducted following a published framework and by searching 4 databases (MEDLINE, CINAHL, PsycInfo, and CENTRAL) for studies published between 2013 and 2018. We included qualitative and quantitative studies in English or German focusing on technologies that support people with dementia or their informal carers in the home care setting. Studies that targeted exclusively people with mild cognitive impairment, delirium, or health professionals were excluded as well as studies that solely consisted of assessments without implication for the people with dementia or their relatives and prototype developments. We mapped the research field regarding study design, study aim, setting, sample size, technology type, and technology aim, and we report relative and absolute frequencies. RESULTS: From an initial 5328 records, we included 175 studies. We identified a variety of technology types including computers, telephones, smartphones, televisions, gaming consoles, monitoring devices, ambient assisted living, and robots. Assistive technologies were most commonly used by people with dementia (77/175, 44.0%), followed by relatives (68/175, 38.9%), and both target groups (30/175, 17.1%). Their most frequent goals were to enable or improve care, provide therapy, or positively influence symptoms of people with dementia (eg, disorientation). The greatest proportions of studies were case studies and case series (72/175, 41.1%) and randomized controlled trials (44/175, 25.1%). The majority of studies reported small sample sizes of between 1 and 50 participants (122/175, 69.7%). Furthermore, most of the studies analyzed the effectiveness (85/233, 36.5%) of the technology, while others targeted feasibility or usability or were explorative. CONCLUSIONS: This review demonstrated the variety of technologies that support people with dementia and their relatives in the home care setting. Whereas this diversity provides the opportunity for needs-oriented technical solutions that fit individual care arrangements, it complicates the choice of the right technology. Therefore, research on the users' informational needs is required. Moreover, there is a need for larger studies on the technologies' effectiveness that could contribute to a higher acceptance and thus to a transition of technologies from research into the daily lives of people with dementia and their relatives.