Lessons learned from investigating patients' and physiotherapists' perspectives on the design of a telerehabilitation platform.

PURPOSE: Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings. METHODS: The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews. RESULTS: Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs. CONCLUSIONS: Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

This work makes three important contributions, in which it extends existing research:Presents insights into the requirements of effective remote physiotherapy sessions;Highlights the challenges and concerns of patients and physiotherapists regarding telerehabilitation;Provides guidance for developing telerehabilitation platforms.

The robot eyes don't have it. The presence of eyes on collaborative robots yields marginally higher user trust but lower performance.

Eye gaze is a prominent feature of human social lives, but little is known on whether fitting eyes on machines makes humans trust them more. In this study we compared subjective and objective markers of human trust when collaborating with eyed and non-eyed robots of the same type. We used virtual reality scenes in which we manipulated distance and the presence of eyes on a robot's display during simple collaboration scenes. We found that while collaboration with eyed cobots resulted in slightly higher subjective trust ratings, the objective markers such as pupil size and task completion time indicated it was in fact less comfortable to collaborate with eyed robots. These findings are in line with recent suggestions that anthropomorphism may be actually a detrimental feature of collaborative robots. These findings also show the complex relationship between human objective and subjective markers of trust when collaborating with artificial agents.

An opinion mining methodology to analyse games for health.

Despite the positive impact of games for health on players' health, users tend to stop playing them after a short period of time, leading benefits to fade. It is therefore important to understand how to sustain interest and, in this way, preserve the health benefits of games for health. This could be achieved by continuously reviewing user feedback after product launch and using this information to inform (re)design and better address user needs. With the growth of social media, user opinions became widely available in public forums. This abundance of information affords us the possibility of, through the application of natural language processing and sentiment analysis techniques, tapping into user opinions and automatically analysing and extracting knowledge from them. This paper introduces a methodology that analyses user comments posted on YouTube about the Just Dance game, to automatically extract information about Usability, User Experience (UX), and Perceived Health Impacts related to Quality of Life (H-QoL). In doing so, the methodology uses a pre-established vocabulary, based on the English lexicon and its semantic relations, to annotate the presence of 38 concepts (five of Usability, 18 of UX, and 15 of H-QoL) and to analyse sentiment. The results of the information extraction and processing are displayed on a dashboard that allows for the exploration and browsing of the results, which can be useful to better understand the opinions and impacts perceived by users and to inform the (re)design of games for health. The methodology proposed builds upon over 500,000 user comments collected from over 32,000 videos.

A Commentary on Blue Zones®: A Critical Review of Age-Friendly Environments in the 21st Century and Beyond.

This paper explores the intersection of the World Health Organization's (WHO) concepts of age-friendly communities and The Blue Zones® checklists and how the potential of integrating the two frameworks for the development of a contemporary framework can address the current gaps in the literature as well as consider the inclusion of technology and environmental press. The commentary presented here sets out initial thoughts and explorations that have the potential to impact societies on a global scale and provides recommendations for a roadmap to consider new ways to think about the impact of health and wellbeing of older adults and their families. Additionally, this paper highlights both the strengths and the weaknesses of the aforementioned checklists and frameworks by examining the literature including the WHO age-friendly framework, the smart age-friendly ecosystem (SAfE) framework and the Blue Zones® checklists. We argue that gaps exist in the current literature and take a critical approach as a way to be inclusive of technology and the environments in which older adults live. This commentary contributes to the fields of gerontology, gerontechnology, anthropology, and geography, because we are proposing a roadmap which sets out the need for future work which requires multi- and interdisciplinary research to be conducted for the respective checklists to evolve.

A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study.

BACKGROUND: Dementia is a neurodegenerative chronic condition characterized by a progressive decline in a person's memory, thinking, learning skills, and the ability to perform activities of daily living. Previous research has indicated that there are many types of technology interventions available in the literature that have shown promising results in improving disease progression, disease management, and the well-being of people with dementia (PwD) and their informal caregiver, thus facilitating dementia care and living. Technology-driven home care interventions, such as Connected Health (CH), could offer a convenient and low-cost alternative to traditional home care, providing an informal caregiver with the support they may need at home while caring for a PwD, improving their physical and mental well-being. OBJECTIVE: This study aimed (1) to create a multidimensional profile for evaluating the well-being progression of the PwD-informal caregiver dyad for a year during their use of a CH platform, designed for monitoring PwD and supporting their informal caregivers at home, and (2) to conduct a long-term follow-up using the proposed well-being profile at different time-interval evaluations. METHODS: The PwD-informal caregiver well-being profile was created based on the World Health Organization International Classification of Functioning considering the following outcomes: functional status, cognitive status, and quality of life for the PwD and mental well-being, sleeping quality, and burden for the informal caregiver. Over a year, comprehensive assessments of these outcomes were conducted every 3 months to evaluate the well-being of PwD-informal caregivers, using international and standardized validated questionnaires. Participants' demographic information was analyzed using descriptive statistics and presented as means and SDs. A nonparametric Friedman test was used to analyze the outcome changes and the progression in the PwD-caregiver dyads and to determine if those changes were statistically significant. RESULTS: There were no significant changes in the well-being of PwD or their caregivers over the year of follow-up, with the majority of the PwD-caregiver dyads remaining stable. The only instances in which significant changes were observed were the functional status in the PwD and sleep quality in their caregivers. In each of these measures, post hoc pairwise comparisons did not indicate that the changes observed were related to the deployment of the CH platform. CONCLUSIONS: The follow-up of this population of PwD and their informal caregivers has shown that disease progression and physical and mental well-being do not change significantly during the time, being a slow and gradual process. The well-being profile created to analyze the potential impact of the CH platform on the PwD-informal caregiver dyad well-being, once validated, could be used as a future tool to conduct the same analyses with other CH technologies for this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13280.

COVID-19: Technology, Social Connections, Loneliness, and Leisure Activities: An International Study Protocol.

Drawn from the stress process model, the pandemic has imposed substantial stress to individual economic and mental well-being and has brought unprecedented disruptions to social life. In light of social distancing measures, and in particular physical distancing because of lockdown policies, the use of digital technologies has been regarded as the alternative to maintain economic and social activities. This paper aims to describe the design and implementation of an online survey created as an urgent, international response to the COVID-19 pandemic. The online survey described here responds to the need of understanding the effects of the pandemic on social interactions/relations and to provide findings on the extent to which digital technology is being utilized by citizens across different communities and countries around the world. It also aims to analyze the association of use of digital technologies with psychological well-being and levels of loneliness. The data will be based on the ongoing survey (comprised of several existing and validated instruments on digital use, psychological well-being and loneliness), open for 3 months after roll out (ends September) across 11 countries (Austria, France, Germany, India, Malta, Portugal, Romania, Spain, Turkey, and UK). Participants include residents aged 18 years and older in the countries and snowball sampling is employed via social media platforms. We anticipate that the findings of the survey will provide useful and much needed information on the prevalence of use and intensities of digital technologies among different age groups, gender, socioeconomic groups in a comparative perspective. Moreover, we expect that the future analysis of the data collected will show that different types of digital technologies and intensities of use are associated with psychological well-being and loneliness. To conclude, these findings from the study are expected to bring in our understanding the role of digital technologies in affecting individual social and emotional connections during a crisis.

Development of a Caregivers' Support Platform (Connected Health Sustaining Home Stay in Dementia): Protocol for a Longitudinal Observational Mixed Methods Study.

BACKGROUND: Dementia disease is a chronic condition that leads a person with dementia (PwD) into a state of progressive deterioration and a greater dependence in performing their activities of daily living (ADL). It is believed nowadays that PwDs and their informal caregivers can have a better life when provided with the appropriate services and support. Connected Health (CH) is a new technology-enabled model of chronic care delivery where the stakeholders are connected through a health portal, ensuring continuity and efficient flow of information. CH has demonstrated promising results regarding supporting informal home care and Aging in Place, and it has been increasingly considered by researchers and health care providers as a method for dementia home care management. OBJECTIVE: This study aims to describe the development and implementation protocol of a CH platform system to support informal caregivers of PwDs at home. METHODS: This is a longitudinal observational mixed methods study where quantitative and qualitative data will be combined for determining the utility of the CH platform for dementia home care. Dyads, consisting of a PwD and their informal caregiver living in the community, will be divided into 2 groups: the intervention group, which will receive the CH technology package at home, and the usual care group, which will not have any CH technology at all. Dyads will be followed up for 12 months during which they will continue with their traditional care plan, but in addition, the intervention group will receive the CH package for their use at home during 6 months (months 3 to 9 of the yearly follow-up). Further comprehensive assessments related to the caregiver's and PwD's emotional and physical well-being will be performed at the initial assessment and at 3, 6, 9, and 12 months using international and standardized validated questionnaires and semistructured individual interviews. RESULTS: This 3-year funded study (2016-2019) is currently in its implementation phase and is expected to finish by December 2019. We believe that CH can potentially change the PwD current care model, facilitating a proactive and preventive model, utilizing self-management-based strategies, and enhancing caregivers' involvement in the management of health care at home for PwDs. CONCLUSIONS: We foresee that our CH platform will provide knowledge and promote autonomy for the caregivers, which may empower them into greater control of the care for PwDs, and with it, improve the quality of life and well-being for the person they are caring for and for themselves through a physical and cognitive decline predictive model. We also believe that facilitating information sharing between all the PwDs' care stakeholders may enable a stronger relationship between them, facilitate a more coordinated care plan, and increase the feelings of empowerment in the informal caregivers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13280.

Design and development of a gait training system for Parkinson's disease.

BACKGROUND: Rhythmic Auditory Stimulation (RAS) is an effective technique to improve gait and reduce freezing episodes for Persons with Parkinson's Disease (PwPD). The BeatHealth system, which comprises a mobile application, gait sensors, and a website, exploits the potential of the RAS technique. This paper describes the tools used for co-designing and evaluating the system and discusses the results and conclusions. METHODS: Personas, interviews, use cases, and ethnographic observations were used to define the functional requirements of the system. Low fidelity prototypes were created for iterative and incremental evaluation with end-users. Field trials were also performed with the final system. The process followed a user centered design methodology defined for this project with the aim of building a useful, usable, and easy-to-use system. RESULTS: Functional requirements of the system were produced as a result of the initial exploration phase. Building upon these, mock-ups for the BeatHealth system were created. The mobile application was iterated twice, with the second version of it achieving a rating of 75 when assessed by participants through the System Usability Scale (SUS). After another iteration field trials were performed and the mobile application was rated with an average 78.6 using SUS. Participants rated two website mock-ups, one for health professionals and another for end-users, as good except from minor issues related to visual design (e.g. font size), which were resolved in the final version. CONCLUSION: The high ratings obtained in the evaluation of the BeatHealth system demonstrate the benefit of applying a user centered design methodology which involves stakeholders from the very beginning. Other important lessons were learned through the process of design and development of the system, such as the importance of motivational aspects, the techniques which work best, and the extra care that has to be taken when evaluating non-functional mock-ups with end users.

The Effectiveness of Technology-Mediated Dance Interventions and Their Impact on Psychosocial Factors in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Engaging in physical activity contributes to healthy aging; however, adherence to exercise programs is often low among older adults. Technology-mediated dance systems, which can be used at home, and dance as a way of keeping physically active have been receiving attention as a means of not only enabling physical activity among older people but may also address key psychosocial factors that are amenable to change. OBJECTIVES: To assess the effectiveness of technology-mediated dance interventions and their impact on psychosocial factors in older adults (aged 65 or older). METHODS: A systematic review of randomized controlled trials from January 2000 to February 2017 using key search terms. Two independent reviewers screened articles using predetermined selection criteria. Risk of bias of selected articles was assessed in accordance with the Cochrane guidelines. RESULTS: From an overall 264 articles, six articles (five studies) were found, which assessed the impact of technology-mediated dance interventions on psychosocial factors in older adults. Studies' quality ratings were low, with exception of one study that was considered of moderate quality. None of the studies considered psychosocial factors as primary outcomes. Secondary outcomes assessed fear of falling, depression, and training enjoyment, but no study showed evidence of an effective impact on these variables. The meta-analysis revealed low quality evidence that there was little or no difference above that of the comparison groups for fear of falling (standardized mean difference [SMD] -0.02, 95% confidence interval [CI] -0.37 to 0.33; P = 0.91; five trials). Similarly, there was little or no difference on depression (SMD -0.06, 95% CI -0.59 to 0.47; P = 0.83; three trials). CONCLUSION: Existing evidence to support the effectiveness of technology-mediated dance interventions and their impact on psychosocial factors in older adults is weak and with a high risk for bias. The findings of this review may inform future, more rigorous research in the area.

Dance! Don't Fall - preventing falls and promoting exercise at home.

Falling is a serious danger to older adults that is usually only addressed after a person has fallen, when doctors administer clinical tests to determine the patient's risk of falling again. Having the technological capability of performing fall risk assessment tests with a smartphone, the authors set out to design a mobile application that would enable users to monitor their risk themselves and consequently prevent falls from occurring. The authors conducted a literature review and two observation sessions before beginning the iterative design process that resulted in the Dance! Don't Fall (DDF) game, a mobile application that enables users to both monitor their fall risk and actively reduce it through fun and easy exercise.