Team-based digital communication reduced patient-initiated phone calls to the hospital and improved patient satisfaction after orthopedic surgery: a randomized controlled trial in 70 patients.

BACKGROUND AND PURPOSE: Post-discharge inquiries to the hospital are predominantly conducted through phone calls. The rigid timing of these calls is inconvenient for patients and disrupts the workflows of healthcare professionals. The aim of this study was to investigate the effect of a team-based digital communication intervention (eDialogue) facilitated through a messenger-like commercial solution on patient-initiated phone calls to the hospital after discharge. Secondarily, we investigated other patient-initiated contacts, patients' perception of continuity of care, and their perception of feeling safe and satisfied after hospital discharge. METHODS: On the day of discharge, 70 surgically treated orthopedic patients were randomized to the intervention group with access to eDialogue (n = 35) or the control group with standard communication pathways by phone call (n = 35) for the following 8 weeks. Through eDialogue, the intervention group had access to team-based asynchronous digital communication in text and photos with healthcare professionals across disciplines and sectors. Inclusion criteria were discharge to own home and receipt of rehabilitation services from both hospital and primary care after discharge. RESULTS: We found a significant reduction in the mean number of patient-initiated phone calls to the hospital from 2.3 (95% confidence interval [CI] 1.4-4.1) in the control group to 0.5 (CI 0.3-1.0) in the intervention group (P = 0.004). Across groups, patients reported similar perceptions of continuity of care; however, the participants in the intervention group expressed significantly improved perceptions of, and satisfaction with, access to healthcare after discharge. CONCLUSION: Access to eDialogue reduced patient-initiated phone calls to the hospital, enhanced patient satisfaction with healthcare accessibility, and did not compromise patients' perception of continuity of care after discharge compared with standard communication pathways.

A Digital Platform (Telepalliation) for Patients in Palliative Care and Their Relatives: Protocol for a Multimethod Randomized Controlled Trial.

BACKGROUND: The World Health Organization defines end-of-life palliative care as "prevention and relief of suffering, by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." Over 20 million people worldwide are in need of palliative care. In Denmark, palliative care is given at a general and a specialist level. The general level comprises health care professionals (HCPs) who do not perform palliative care full-time. The specialist level comprises specialized palliative care (SPC), where HCPs perform palliative care full-time. In total, 20%-30% of patients who need palliative care are referred to SPC. Challenges with SPC include a short time span from referral to end of life, patients who are very ill and may therefore find it hard to travel to an outpatient clinic, and the SPC unit having a relatively small staff. The need for SPC is expected to rise, as the number of patients dying from terminal diseases is increasing. Telehealth has been successfully implemented in different home care settings, including palliative care. OBJECTIVE: The aim of the study is to present the research design of the clinical testing of a telepalliation program by the use of a digital platform for patients in palliative care and their relatives. METHODS: The telepalliation program will be conducted as a multimethod randomized controlled trial. The intervention group will follow the telepalliation program, while the control group will follow the traditional standard of care program for palliative care. The primary outcome of the study is increased quality of life. Secondary outcomes include enhanced sense of security; reduced experience of pain; satisfactory experiences of patients and relatives with the TelePal platform and degree of satisfaction in being a part of the program; experiences with the use of the TelePal platform on the part of HCPs and the professionals' experiences of being a part of the program; the use of a cross-sector communication platform and the telepalliation program by patients, relatives, and HCPs; and the projected lower cost of health care services. These outcomes will be assessed using questionnaires, data generated by digital technologies, and semistructured interviews. RESULTS: The collection of data began in May 2021 and will be completed in August 2024. The results of the study will be published in peer-reviewed journals and presented at international conferences. Results from the telepalliation program are expected to be published by fall 2024. CONCLUSIONS: The expected outcomes of the study are increased quality of life and increased sense of security. We also expect that the study will have a clinical impact on future telepalliation for those patients who are referred to a palliative team. TRIAL REGISTRATION: ClinicalTrials.gov NCT04995848; https://clinicaltrials.gov/study/NCT04995848. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49946.

Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study.

BACKGROUND: The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. OBJECTIVE: This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue). METHODS: A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. RESULTS: Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. CONCLUSIONS: In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery.

Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study.

BACKGROUND: Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. OBJECTIVE: This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). METHODS: We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. RESULTS: HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. CONCLUSIONS: eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.

"Future patient II" telerehabilitation for patients with heart failure: Protocol for a randomized controlled trial.

Background: Heart failure is a global problem affecting millions of people worldwide. Current care of heart failure patients follows standard protocols and often overlooks the patients' specific needs, which leads to low compliance in the rehabilitation phase. Telerehabilitation, where the patients communicate with health care professionals about their rehabilitation program and monitor their vital signs, aims to increase the degree of compliance as well as enhancing their quality of life. Objective: The aim of this study is to investigate whether application of the Future Patient Telerehabilitation Program II can improve the health-related quality of life for patients with heart failure. Methods: A randomized controlled trial will be conducted. A total of 70 patients will be enrolled, 35 in the intervention group, 35 in the control group. The intervention group will follow an add-on to traditional care, while the control group will follow the conventional Danish cardiac rehabilitation program, which is based on periodic visits to the clinic. The patients will be followed for a period of six months. The intervention group will have access to an online HeartPortal and will use various home-based devices for self-monitoring. The primary outcome to be investigated is health-related quality of life as measured by the EuroQol-5 Dimension. Secondary outcomes are the number of visits to the outpatient clinic, number of readmissions and number of tele-communications contacts (phone and video) with health care professionals. The primary and secondary outcomes will be assessed using questionnaires and through the data generated by digital technologies for self-monitoring. Results: Enrolment began in August 2020. The results will be published in peer-reviewed journals. Results from the Future Patient II Telerehabilitation program are expected to be published in 2024. Discussion: This study is a further development of the Future Patient Telerehabilitation I study, and it is expected to explore the use of video consultation and a weight calculator in relation to telerehabilitation as well as the quality of life for heart failure patients. Conclusion: The expected outcomes are increased quality of life, increased number of phone- and video-consultations with health-care professionals, and the enhanced ability of patients to manage their own disease with the use of a calculator for weight.

Chronic post-thoracotomy pain after lung cancer surgery: a prospective study of preoperative risk factors.

OBJECTIVES: The objective of this longitudinal cohort study was to investigate if preoperative pain mechanisms, anxiety, and depression increase risk of developing chronic post-thoracotomy pain (CPTP) after lung cancer surgery. METHODS: Patients with suspected or confirmed lung cancer undergoing surgery by either video-assisted thoracoscopic surgery or anterior thoracotomy were recruited consecutively. Preoperative assessments were conducted by: quantitative sensory testing (QST) (brush, pinprick, cuff pressure pain detection threshold, cuff pressure tolerance pain threshold, temporal summation and conditioned pain modulation), neuropathic pain symptom inventory (NPSI), and the Hospital Anxiety and Depression Scale (HADS). Clinical parameters in relation to surgery were also collected. Presence of CPTP was determined after six months and defined as pain of any intensity in relation to the operation area on a numeric rating scale form 0 (no pain) to 10 (worst pain imaginable). RESULTS: A total of 121 patients (60.2 %) completed follow-up and 56 patients (46.3 %) reported CPTP. Development of CPTP was associated with higher preoperative HADS score (p=0.025), higher preoperative NPSI score (p=0.009) and acute postoperative pain (p=0.042). No differences were observed in relation to preoperative QST assessment by cuff algometry and HADS anxiety and depression sub-scores. CONCLUSIONS: High preoperative HADS score preoperative pain, acute postoperative pain intensity, and preoperative neuropathic symptoms were was associated with CPTP after lung cancer surgery. No differences in values of preoperative QST assessments were found. Preoperative assessment and identification of patients at higher risk of postoperative pain will offer opportunity for further exploration and development of preventive measures and individualised pain management depending on patient risk profile.

Long-term Telerehabilitation or Unsupervised Training at Home for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.

Rationale: Despite the benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), many patients do not access or complete pulmonary rehabilitation, and long-term maintenance of exercise is difficult. Objectives: To compare long-term telerehabilitation or unsupervised treadmill training at home with standard care. Methods: In an international randomized controlled trial, patients with COPD were assigned to three groups (telerehabilitation, unsupervised training, or control) and followed up for 2 years. Telerehabilitation consisted of individualized treadmill training at home supervised by a physiotherapist and self-management. The unsupervised training group performed unsupervised treadmill exercise at home. The control group received standard care. The primary outcome was the combined number of hospitalizations and emergency department presentations. Secondary outcomes included time free from the first event; exercise capacity; dyspnea; health status; quality of life; anxiety; depression; self-efficacy; and subjective impression of change. Measurements and Main Results: A total of 120 participants were randomized. The incidence rate of hospitalizations and emergency department presentations was lower in telerehabilitation (1.18 events per person-year; 95% confidence interval [CI], 0.94-1.46) and unsupervised training group (1.14; 95% CI, 0.92-1.41) than in the control group (1.88; 95% CI, 1.58-2.21; P < 0.001 compared with intervention groups). Telerehabilitation and unsupervised training groups experienced better health status for 1 year. Intervention participants reached and maintained clinically significant improvements in exercise capacity. Conclusions: Long-term telerehabilitation and unsupervised training at home in COPD are both successful in reducing hospital readmissions and can broaden the availability of pulmonary rehabilitation and maintenance strategies.

Scoping review protocol to map the use of text-based two-way communication between patients and healthcare professionals after hospital discharge and identify facilitators and barriers to implementation.

INTRODUCTION: After discharge, patients face multiple risks where timely communication with healthcare professionals is required. eHealth has proposed new possibilities for asynchronous text-based two-way communication between patients and healthcare professionals during this time, and studies show positive effects on clinical outcomes, care coordination and patient satisfaction. However, there are challenges to the adoption of text-based two-way communication, potentially undermining the positive effects in clinical practice. Knowledge of these factors may inform future research and implementations. No reviews have provided an overview of the use of text-based two-way communication after discharge and the identified facilitators and barriers. Therefore, the objective of this scoping review is to systematically identify and map available research that assess the use of text-based two-way communication between patients and healthcare professionals after hospital discharge, including facilitators and barriers to implementation. METHODS AND ANALYSIS: We will include all studies describing the use of text-based two-way communication between patients and healthcare professionals after discharge from hospital. A preliminary search of PubMed (PubMed.gov), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), Cochrane Library (Wiley), Web of Science (Clarivate) and Scopus (Elsevier) was undertaken on 9 November 2021. The search will be updated for the full scoping review, and reference lists of relevant papers reviewed. Two reviewers will independently screen the literature for inclusion. Data will be extracted and charted in accordance with a data extraction form developed from the research questions and inspired by Consolidated Framework Implementation Research. Findings will be presented in tabular format and a descriptive summary, and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. ETHICS AND DISSEMINATION: This scoping review will not require ethics approval. The dissemination strategy involves peer review publication and presentation at conferences.

Use of a Social Robot (LOVOT) for Persons With Dementia: Exploratory Study.

BACKGROUND: Approximately 50 million people worldwide are living with dementia. Social robots have been developed and tested to determine whether they improve the quality of life for persons with dementia. A new mobile social robot called LOVOT has artificial intelligence and sensor technologies built in. LOVOT, which is manufactured in Japan, has not yet been tested for use by persons with dementia. OBJECTIVE: This study aimed to explore how the social robot LOVOT interacts with persons with dementia and how health care professionals experience working with LOVOT in their interaction with persons with dementia. METHODS: The study was carried out at 3 nursing homes in Denmark, all with specialized units for persons with dementia. The interaction between the persons with dementia and LOVOT was tested in both individual sessions for 4 weeks and group sessions for 12 weeks. A total of 42 persons were included in the study, of which 12 were allocated to the individual sessions. A triangulation of data collection techniques was used: the World Health Organization-5 questionnaire, face scale, participant observation, and semistructured focus group interviews with health care professionals (n=3). RESULTS: There were no clinically significant changes in the well-being of the persons with dementia followed in the individual or group interaction sessions over time. The results from the face scale showed that in both the individual and group sessions, persons with dementia tended to express more positive facial expressions after the sessions. Findings on how persons with dementia experienced their interaction with LOVOT can be stated in terms of the following themes: LOVOT opens up communication and interaction; provides entertainment; creates a breathing space; is accepted and creates joy; induces feelings of care; can create an overstimulation of feelings; is not accepted; is perceived as an animal; is perceived as being nondemanding; and prevents touch deprivation. Findings regarding the health care professionals' experiences using LOVOT were as follows: the artificial behavior seems natural; and it is a communication tool that can stimulate, create feelings of security, and open up communication. Our findings indicate that the social robot is a tool that can be used in interactions with persons with dementia. CONCLUSIONS: The LOVOT robot is the next generation of social robots with advanced artificial intelligence. The vast majority of persons with dementia accepted the social robot LOVOT. LOVOT had positive effects, opened up communication, and facilitated interpersonal interaction. Although LOVOT did not create noticeable effects on social well-being, it gave individual persons a respite from everyday life. Some residents were overstimulated by emotions after interacting with LOVOT. Health care professionals accepted the social robot and view LOVOT as a new tool in the work with persons with dementia.

Increased motivation for and use of digital services in heart failure patients participating in a telerehabilitation program: a randomized controlled trial.

Background: eHealth literacy (eHL) may be an important factor in the adoption of telerehabilitation. However, little is known about how telerehabilitation affects patients' eHL. The current study evaluated changes over time in eHL for heart failure (HF) patients in a telerehabilitation program (the Future Patient Program) compared to a traditional rehabilitation program. Methods: As part of a randomized controlled trial comparing telerehabilitation with traditional rehabilitation, 137 HF patients completed the eHealth Literacy Questionnaire (eHLQ) at 6 and 12 months of their respective rehabilitation programs. Results: At 6 months, the telerehabilitation group indicated higher levels of 'using technology to process health information' and 'motivated to engage with digital services'. This difference was consistent over time, and we found no other differences between groups or over time with regard to eHL. Conclusions: Providing a digital toolbox for processing health information to HF patients may aid in increasing their eHL, motivation, and ability to engage with digital services in HF patients. Especially, if the technology is designed to support patient needs in terms of the educational content of the program. Preferably technology should be provided early on in the rehabilitation process to ensure optimal outcome. Trial Registration: The study was registered in ClinicalTrials.gov (NCT03388918).

The Potential Application of Commercially Available Active Video Games to Cardiac Rehabilitation: Scoping Review.

BACKGROUND: Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. OBJECTIVE: The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. METHODS: Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. RESULTS: Among 120 nonduplicate articles reviewed, 5 (4.2%) were eligible for inclusion, of which 3 (2.5%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. CONCLUSIONS: AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited.

Video and social rehabilitation of persons with mental illness helps to structure everyday life: a qualitative study.

BACKGROUND: Living with a mental disorder has a significant impact on everyday life. In 2018, one out of every six adults, equivalent to 17.3% of the adult population of the European Union, had symptoms of mental disorders. This paper focus on social rehabilitation of patients with mental illness who have been discharged from hospital and who use video communication technologies in their rehabilitation in collaboration with their social worker. The aim of this study has been to explore the experiences of persons with mental illnesses who participated in a long-term video-based tele-social rehabilitation program, the Video Assist. METHODS: The overall research strategy is the case study method. Data collection techniques are based on triangulation. Document analysis has been performed. Participant observation in homes of persons with mental using video with social workers (168 hours). Semi structured qualitative interviews with persons with mental illness (n=13) has been conducted lasting between 30 and 60 minutes. Data were analyzed using NVivo 10.0. RESULTS: Experiences of persons with mental illness participating in the tele-social rehabilitation program are in themes: user friendly video technology, video created a new means of communication between citizen and social worker, feeling of surveillance by having the technology in the home, development of new coping strategies in everyday life and need for psychosocial support and training via the video technology. CONCLUSIONS: Persons with mental illness who are in a recovery process find that participating in a tele-social-rehabilitation program gives them a sense of mobility, security, surveillance but the ability to develop new coping strategies in their everyday lives. Future research is needed on long-term effects of tele-social rehabilitation for persons with mental illness.

Web Portals for Patients With Chronic Diseases: Scoping Review of the Functional Features and Theoretical Frameworks of Telerehabilitation Platforms.

BACKGROUND: The COVID-19 pandemic has required an increased need for rehabilitation activities applicable to patients with chronic diseases. Telerehabilitation has several advantages, including reducing clinic visits by patients vulnerable to infectious diseases. Digital platforms are often used to assist rehabilitation services for patients in remote settings. Although web portals for medical use have existed for years, the technology in telerehabilitation remains a novel method. OBJECTIVE: This scoping review investigated the functional features and theoretical approaches of web portals developed for telerehabilitation in patients with chronic diseases. METHODS: PubMed and Web of Science were reviewed to identify articles associated with telerehabilitation. Of the 477 nonduplicate articles reviewed, 35 involving 14 portals were retrieved for the scoping review. The functional features, targeted diseases, and theoretical approaches of these portals were studied. RESULTS: The 14 portals targeted patients with chronic obstructive pulmonary disease, cardiovascular, osteoarthritis, multiple sclerosis, cystic fibrosis diseases, and stroke and breast cancer survivors. Monitoring/data tracking and communication functions were the most common, followed by exercise instructions and diary/self-report features. Several theoretical approaches, behavior change techniques, and motivational techniques were found to be utilized. CONCLUSIONS: The web portals could unify and display multiple types of data and effectively provide various types of information. Asynchronous correspondence was more favorable than synchronous, real-time interactions. Data acquisition often required assistance from other digital tools. Various functions with patient-centered principles, behavior change strategies, and motivational techniques were observed for better support shifting to a healthier lifestyle. These findings suggested that web portals for telerehabilitation not only provided entrance into rehabilitation programs but also reinforced participant-centered treatment, adherence to rehabilitation, and lifestyle changes over time.

Effects of Telerehabilitation Interventions on Heart Failure Management (2015-2020): Scoping Review.

BACKGROUND: Heart failure is one of the world's most frequently diagnosed cardiovascular diseases. An important element of heart failure management is cardiac rehabilitation, the goal of which is to improve patients' recovery, functional capacity, psychosocial well-being, and health-related quality of life. Patients in cardiac rehabilitation may lack sufficient motivation or may feel that the rehabilitation process does not meet their individual needs. One solution to these challenges is the use of telerehabilitation. Although telerehabilitation has been available for several years, it has only recently begun to be utilized in heart failure studies. Especially within the past 5 years, we now have several studies focusing on the effectiveness of telerehabilitation for heart failure management, all with varying results. Based on a review of these studies, this paper offers an assessment of the effectiveness of telerehabilitation as applied to heart failure management. OBJECTIVE: The aim of this scoping review was to assess the effects of telerehabilitation in the management of heart failure by systematically reviewing the available scientific literature within the period from January 1, 2015, to December 31, 2020. METHODS: The literature search was carried out using PubMed and EMBASE. After duplicates were removed, 77 articles were screened and 12 articles were subsequently reviewed. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews) guidelines. As measures of the effectiveness of telerehabilitation, the following outcomes were used: patients' quality of life, physical capacity, depression or anxiety, and adherence to the intervention. RESULTS: A total of 12 articles were included in this review. In reviewing the effects of telerehabilitation for patients with heart failure, it was found that 4 out of 6 randomized controlled trials (RCTs), a single prospective study, and 4 out of 5 reviews reported increased quality of life for patients. For physical capacity, 4 RCTs and 3 systematic reviews revealed increased physical capacity. Depression or depressive symptoms were reported as being reduced in 1 of the 6 RCTs and in 2 of the 5 reviews. Anxiety or anxiety-related symptoms were reported as reduced in only 1 review. High adherence to the telerehabilitation program was reported in 4 RCTs and 4 reviews. It should be mentioned that some of the reviewed articles described the same studies although they employed different outcome measures. CONCLUSIONS: It was found that there is a tendency toward improvement in patients' quality of life and physical capacity when telerehabilitation was used in heart failure management. The outcome measures of depression, anxiety, and adherence to the intervention were found to be positive. Additional research is needed to determine more precise and robust effects of telerehabilitation.

Motivating patients in cardiac rehabilitation programs: A multicenter randomized controlled trial.

Concerns have been raised about motivation and psychological distress when implementing telerehabilitation in patients with heart failure. The current study compared conventional and telerehabilitation in two groups (n=67; n=70) of patients with heart failure at 0, 6, and 12 months on measures of motivation (Self-Determination Theory measures) and psychological distress (Hospital Anxiety and Depression scale). We found no significant changes in motivation across groups, although our telerehabilitation group had a slightly lower level of controlled motivation and higher levels of relatedness. In addition, there were no differences between groups with regard to psychological distress. This study demonstrates that telerehabilitation motivates patients with heart failure to the same degree as conventional rehabilitation, and that telerehabilitation is not associated with increased psychological distress. As such, telerehabilitation offers an alternative to conventional rehabilitation and addresses some of the barriers for participating in rehabilitation identified in the literature.

Patient-Reported Outcomes From Patients With Heart Failure Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial.

BACKGROUND: More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients' recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year. OBJECTIVE: The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year. METHODS: In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients' sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group. RESULTS: The changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P<.05). CONCLUSIONS: There was a significant increase in clinical and social well-being and quality of life during the 1-year period of participating in a telerehabilitation program. These results suggest that patient-reported outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide patients in mastering their own symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918.

The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules. OBJECTIVE: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF. METHODS: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients' perspectives. Secondary outcomes were the development of patients' knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0. RESULTS: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups. CONCLUSIONS: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient-TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437.

Non-Contact Respiratory Measurement Using a Depth Camera for Elderly People.

Measuring respiration at home for cardiac patients, a simple method that can detect the patient's natural respiration, is needed. The purpose of this study was to develop an algorithm for estimating the tidal volume (TV) and respiratory rate (RR) from the depth value of the chest and/or abdomen, which were captured using a depth camera. The data of two different breathing patterns (normal and deep) were acquired from both the depth camera and the spirometer. The experiment was performed under two different clothing conditions (undressed and wearing a T-shirt). Thirty-nine elderly volunteers (male = 14) were enrolled in the experiment. The TV estimation algorithm for each condition was determined by regression analysis using the volume data from the spirometer as the objective variable and the depth motion data from the depth camera as the explanatory variable. The RR estimation was calculated from the peak interval. The mean absolute relative errors of the estimated TV for males were 14.0% under undressed conditions and 10.7% under T-shirt-wearing conditions; meanwhile, the relative errors for females were 14.7% and 15.5%, respectively. The estimation error for the RR was zero out of a total of 206 breaths under undressed conditions and two out of a total of 218 breaths under T-shirt-wearing conditions for males. Concerning females, the error was three out of a total of 329 breaths under undressed conditions and five out of a total of 344 breaths under T-shirt-wearing conditions. The developed algorithm for RR estimation was accurate enough, but the estimated occasionally TV had large errors, especially in deep breathing. The cause of such errors in TV estimation is presumed to be a result of the whole-body motion and inadequate setting of the measurement area.

EEG Headset Evaluation for Detection of Single-Trial Movement Intention for Brain-Computer Interfaces.

Brain-computer interfaces (BCIs) can be used in neurorehabilitation; however, the literature about transferring the technology to rehabilitation clinics is limited. A key component of a BCI is the headset, for which several options are available. The aim of this study was to test four commercially available headsets' ability to record and classify movement intentions (movement-related cortical potentials-MRCPs). Twelve healthy participants performed 100 movements, while continuous EEG was recorded from the headsets on two different days to establish the reliability of the measures: classification accuracies of single-trials, number of rejected epochs, and signal-to-noise ratio. MRCPs could be recorded with the headsets covering the motor cortex, and they obtained the best classification accuracies (73%-77%). The reliability was moderate to good for the best headset (a gel-based headset covering the motor cortex). The results demonstrate that, among the evaluated headsets, reliable recordings of MRCPs require channels located close to the motor cortex and potentially a gel-based headset.