RESUMEN
BACKGROUND: Resource-rich countries are facing the challenge of aging societies, a high risk of dependence, and a high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like gamified physical rehabilitation to achieve functional targets and prevent rehospitalization. OBJECTIVE: The purpose of this study is to assess the effectiveness of a personal mobility device compared with standard care in the rehabilitation treatment of patients with musculoskeletal issues. METHODS: A total of 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to the control group (n=22) receiving usual standard care. Due to dropout, only 41 patients were included in the postintervention analysis. Outcome measures included the short physical performance battery (SPPB), isometric hand grip strength (IHGS), functional independence measure (FIM), and the number of steps. RESULTS: A noninferiority related to the primary outcome (SPPB) was identified during the hospital stay, and no significant differences were found between the control and intervention groups for any of the secondary outcomes (IHGS, FIM, or steps), which demonstrates the potential of the serious game-based intervention to be as effective as the standard physical rehabilitation at the hospital. The analysis by mixed-effects regression on SPPB showed a group×time interaction (SPPB_I_t1=-0.77, 95% CI -2.03 to 0.50, P=.23; SPPB_I_t2=0.21, 95% CI -1.07 to 0.48, P=.75). Although not significant, a positive IHGS improvement of more than 2 kg (Right: 2.52 kg, 95% CI -0.72 to 5.37, P=.13; Left: 2.43 kg, 95% CI -0.18 to 4.23, P=.07) for the patient from the intervention group was observed. CONCLUSIONS: Serious game-based rehabilitation could potentially be an effective alternative for older patients to regain their functional capacities. TRIAL REGISTRATION: ClinicalTrials.gov NCT03847454; https://clinicaltrials.gov/ct2/show/NCT03847454.
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The implementation of digital health technologies has increased globally, producing substantial amounts of information and knowledge. While there are still areas in digital health that are understudied, concurrently there is an exponential increase in published articles, guidelines, methods, projects, and experiences, many of which fail to reach critical mass (pilotitis). Semantically describing and documenting this implementation knowledge and the effectiveness of these tools will help to avoid the duplication of efforts, to reduce preventable implementation obstacles, and to assure that investments are targeted to the most important technological innovations. The RAFT annotation model, presented in this paper, enables to semantically describe all elements of various outputs and implementation projects that were developed, are used, or are part of the RAFT network. This model was initially developed to annotate various implementations and outputs of the RAFT network to facilitate knowledge documentation and sharing, and to be used as a proof of concept for the Implementome. The Implementome will be an interconnected knowledge system that enables the user to navigate on multiple dimensions through metadata annotated projects, people, and information, and can serve as base for consensus building, best practices and guidelines. The RAFT annotation model can be further developed to enable the annotation of outputs, implementations, people, initiatives, and projects of the digital health domain in general.
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This paper presents the evolution and growth of continuous medical education through the Réseau en Afrique Francophone pour la Télémédecine (RAFT) network. RAFT is a telemedicine network present on four continents and built through years of experience, with the goal of supporting isolated healthcare professionals by providing them with the right expertise at the right time using affordable, low-bandwidth technologies. Much more than a platform to share and exchange knowledge, RAFT has put in place a solid local infrastructure to ensure the sustainability and maintenance of the network. From experience gained with South-South collaboration to top-down and bottom-up approaches and various certification models, much know-how has been acquired and different perspectives for improvement have been proposed. The results we have collected from these 15 years of practice are presented in this paper through lessons learned and key takeaways. Perspectives for future development supported by concrete examples conclude the paper.
Asunto(s)
Educación Médica Continua , Telemedicina/métodos , Telemedicina/tendencias , Humanos , Telemedicina/instrumentaciónRESUMEN
Serious games are increasingly used in pediatric care, especially to educate young patients with chronic diseases, to improve their understanding of the disease and develop independence in disease management, as it can ultimately improve clinical results. This is also true for liver transplanted children and adolescents, who are not only challenged by their therapeutic burden, but who need to face transition to adult care, often without remembering their transplantation, which was performed, most of the time, very early in their life. KidsETransplant aims to improve long term outcomes of liver transplanted patients, using the principle of a serious game in 3D.
