Telemedicine and Remote Management of Patients with Heart Failure: From Theory to Daily Practice.

Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

A Sustainable Approach to Telerehabilitation in Europe: Patients Are Ready, but Caregivers Are Essential.

BACKGROUND: Several studies have demonstrated the effectiveness of telerehabilitation. However, it remains unclear what proportion of people in need of rehabilitation can confidently use telecommunications networks and related devices. OBJECTIVES: The aim of this study is to estimate the proportion of patients who possess either the requisite digital literacy to perform telerehabilitation independently or have a family caregiver capable of providing effective support. METHODS: Synthetic populations with a realistic kinship network (i.e. family trees) representative of European countries are built. Age, sex, and location-specific prevalence rates of rehabilitation needs and digital skills are combined to estimate the percentage of digitally literate patients and patients with digitally literate relatives. RESULTS: In Europe, 86% of people in need of rehabilitation are potentially eligible for telerehabilitation. However, in four out of five cases, eligible patients over the age of 65 require caregiver support. CONCLUSION: Telerehabilitation has the potential to spread in Europe. Caregivers have an essential social role in ensuring sustainable access to telerehabilitation.

Motion acquisition of gait characteristics one week after total hip arthroplasty: a factor analysis.

INTRODUCTION: Clinical gait analysis can be used to evaluate the recovery process of patients undergoing total hip arthroplasty (THA). The postoperative walking patterns of these patients can be significantly influenced by the choice of surgical approach, as each procedure alters distinct anatomical structures. The aim of this study is twofold. The first objective is to develop a gait model to describe the change in ambulation one week after THA. The secondary goal is to describe the differences associated with the surgical approach. MATERIALS AND METHODS: Thirty-six patients undergoing THA with lateral (n = 9), anterior (n = 15), and posterior (n = 12) approaches were included in the study. Walking before and 7 days after surgery was recorded using a markerless motion capture system. Exploratory Factor Analysis (EFA), a data reduction technique, condensed 21 spatiotemporal gait parameters to a smaller set of dominant variables. The EFA-derived gait domains were utilized to study post-surgical gait variations and to compare the post-surgical gait among the three groups. RESULTS: Four distinct gait domains were identified. The most pronounced variation one week after surgery is in the Rhythm (gait cycle time: + 32.9 % ), followed by Postural control (step width: + 27.0 % ), Phases (stance time: + 11.0 % ), and Pace (stride length: -  9.3 % ). In postsurgical walking, Phases is statistically significantly different in patients operated with the posterior approach compared to lateral (p-value = 0.017) and anterior (p-value = 0.002) approaches. Furthermore, stance time in the posterior approach group is significantly lower than in healthy individuals (p-value < 0.001). CONCLUSIONS: This study identified a four-component gait model specific to THA patients. The results showed that patients after THA have longer stride time but shorter stride length, wider base of support, and longer stance time, although the posterior group had a statistically significant shorter stance time than the others. The findings of this research have the potential to simplify the reporting of gait outcomes, reduce redundancy, and inform targeted interventions in regards to specific gait domains.

A virtual environment to evaluate the arm volume for lymphedema affected patients.

BACKGROUND AND OBJECTIVE: The paper presents a novel procedure based on 3D scanning and 3D modelling to automatically assess linear and volumetric measurements of an arm and to be further applied to patients affected by post breast cancer lymphedema. The aim is the creation of a virtual platform easily usable by medical personnel to get more objective evaluations during the lymphedema treatment. METHODS: The procedure is based on the 3D scanning of the arm using the Occipital Structure Sensor and an ad-hoc developed application, named Lym 3DLab. Lym 3DLab emulates the traditional measurement methods, which consist in taking manual circumference measurements or using the water displacement method. These measurements are also used to design the compression stockings, the typical orthopaedic device used for lymphedema treatment. A validation test has been performed to compare the measurements computed by Lym 3DLab with both water displacement and manual circumference measurements. Eight volunteers have been involved who are not affected by lymphedema. Furthermore, a specific usability test has been performed to evaluate the 3D scanning procedure by involving four physiotherapists. RESULTS: The comparison between the volumes has highlighted how all the 3D acquired models have their volumes inside a range of acceptability. This range has been defined by considering the sensitivity error of the tape measure used to measure the water displacement. The comparison between the perimeters of cross sections computed with Lym 3DLab and the circumference measurements has shown results that are very accurate with an average difference of 2 mm. The measure errors have been considered negligible by the medical personnel who have evaluated the proposed procedure more accurate than the traditional ones. The test with physiotherapists has shown a high level of usability of the whole virtual environment, but the 3D scanning procedure requires an appropriate training of the personnel to make the 3D acquisition as fast and efficient as possible. CONCLUSIONS: The achieved results and the physiotherapists' feedback allow planning a future test with patients affected by lymphedema in collaboration with the hospital. A further test has been planned to use the computed measurements to design orthopaedic compression stockings.

Tracking and Characterization of Spinal Cord-Injured Patients by Means of RGB-D Sensors.

In physical rehabilitation, motion capture solutions are well-known but not as widespread as they could be. The main limit to their diffusion is not related to cost or usability but to the fact that the data generated when tracking a person must be elaborated according to the specific context and aim. This paper proposes a solution including customized motion capture and data elaboration with the aim of supporting medical personnel in the assessment of spinal cord-injured (SCI) patients using a wheelchair. The configuration of the full-body motion capturing system is based on an asymmetric 3 Microsoft Kinect v2 sensor layout that provides a path of up to 6 m, which is required to properly track the wheelchair. Data elaboration is focused on the automatic recognition of the pushing cycles and on plotting any kinematic parameter that may be interesting in the assessment. Five movements have been considered to evaluate the wheelchair propulsion: the humeral elevation, the horizontal abduction of the humerus, the humeral rotation, the elbow flexion and the trunk extension along the sagittal plane. More than 60 volunteers with a spinal cord injury were enrolled for testing the solution. To evaluate the reliability of the data computed with SCI APPlication (APP) for the pushing cycle analysis, the patients were subdivided in four groups according to the level of the spinal cord injury (i.e., high paraplegia, low paraplegia, C7 tetraplegia and C6 tetraplegia). For each group, the average value and the standard deviation were computed and a comparison with similar acquisitions performed with a high-end solution is shown. The measurements computed by the SCI-APP show a good reliability for analyzing the movements of SCI patients' propulsion wheelchair.