Correction: Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Students' Perceived Knowledge, Skills, Attitudes, and Experience.

[This corrects the article DOI: 10.2196/51112.].

Should We Better Stick to Pen and Paper? An Empirical Investigation on Functionality, Privacy and Data-Security of Physiotherapy Telehealth Applications.

BACKGROUND: Telehealth and mHealth apps become increasingly popular in health professions such as physiotherapy calling for increased awareness on functionality, privacy, and data security. OBJECTIVES: This work presents a functionality, privacy, and data-security evaluation of four telehealth services commonly used in physiotherapy. METHODS: We examined functionality and features, data protection, privacy implementations and data-security with a questionnaire and performed an in-depth investigation of the services. RESULTS: Privacy and security relevant findings such as use of outdated webservers, problems with certificate renewal as well as questionable GDPR compliance were reported. CONCLUSION: Due to the privacy and security relevant findings in this analysis it can be concluded that there is a need for improvement in design, development, operation as well as regulation of telehealth apps and services.

Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study.

BACKGROUND: The acquisition of handwriting skills is essential for a child's academic success, self-confidence, and general school performance. Nevertheless, an estimated 5% to 27% of children face handwriting challenges, where the ability to modulate pressure on the pencil and lead on the paper is a key motor component. OBJECTIVE: We aimed to investigate the experience with and usability of the SensoGrip system, a pressure-measuring pen system with personalized real-time feedback about pressure modulation, in a clinical setting with children and occupational therapists (OTs). METHODS: A multimethods study was conducted, incorporating qualitative interviews and questionnaires with children, user diaries, focus group discussions, and a usability questionnaire with OTs, along with a questionnaire for parents. RESULTS: The study involved OTs (n=8), children with handwriting difficulties (n=16), and their parents (n=16), each of whom used the SensoGrip system in up to 5 therapy sessions. OTs reported that the SensoGrip system helped to focus the child's awareness on handwriting pressure and to measure it objectively. The system received high acceptance and usability ratings from the OTs-usefulness: median score of 4 out of 7; ease of use and ease of learning: median score of 6 out of 7; and satisfaction: median score of 6 out of 7. Participants appreciated that it fosters pressure awareness and motivation to draw and write. CONCLUSIONS: The SensoGrip pressure-sensing system with real-time feedback is a promising tool for pediatric occupational therapy. It supports children with handwriting difficulties to adjust their pressure application during the task. In the future, controlled quantitative trials are warranted to further examine the system's impact.

Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Students' Perceived Knowledge, Skills, Attitudes, and Experience.

BACKGROUND: The COVID-19 pandemic has highlighted the growing relevance of telehealth in health care. Assessing health care and nursing students' telehealth competencies is crucial for its successful integration into education and practice. OBJECTIVE: We aimed to assess students' perceived telehealth knowledge, skills, attitudes, and experiences. In addition, we aimed to examine students' preferences for telehealth content and teaching methods within their curricula. METHODS: We conducted a cross-sectional web-based study in May 2022. A project-specific questionnaire, developed and refined through iterative feedback and face-validity testing, addressed topics such as demographics, personal perceptions, and professional experience with telehealth and solicited input on potential telehealth course content. Statistical analyses were conducted on surveys with at least a 50% completion rate, including descriptive statistics of categorical variables, graphical representation of results, and Kruskal Wallis tests for central tendencies in subgroup analyses. RESULTS: A total of 261 students from 7 bachelor's and 4 master's health care and nursing programs participated in the study. Most students expressed interest in telehealth (180/261, 69% very or rather interested) and recognized its importance in their education (215/261, 82.4% very or rather important). However, most participants reported limited knowledge of telehealth applications concerning their profession (only 7/261, 2.7% stated profound knowledge) and limited active telehealth experience with various telehealth applications (between 18/261, 6.9% and 63/261, 24.1%). Statistically significant differences were found between study programs regarding telehealth interest (P=.005), knowledge (P<.001), perceived importance in education (P<.001), and perceived relevance after the pandemic (P=.004). Practical training with devices, software, and apps and telehealth case examples with various patient groups were perceived as most important for integration in future curricula. Most students preferred both interdisciplinary and program-specific courses. CONCLUSIONS: This study emphasizes the need to integrate telehealth into health care education curricula, as students state positive telehealth attitudes but seem to be not adequately prepared for its implementation. To optimally prepare future health professionals for the increasing role of telehealth in practice, the results of this study can be considered when designing telehealth curricula.

Barriers to Video Call-Based Telehealth in Allied Health Professions and Nursing: Scoping Review and Mapping Process.

BACKGROUND: Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses. OBJECTIVE: This review aimed to identify and map the perceived barriers to the use of video call-based telehealth interventions among allied health professionals and nurses. METHODS: A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call-based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups. RESULTS: A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication. CONCLUSIONS: This review identified key barriers to video call-based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers.

Handwriting Evaluation Using Deep Learning with SensoGrip.

Handwriting learning disabilities, such as dysgraphia, have a serious negative impact on children's academic results, daily life and overall well-being. Early detection of dysgraphia facilitates an early start of targeted intervention. Several studies have investigated dysgraphia detection using machine learning algorithms with a digital tablet. However, these studies deployed classical machine learning algorithms with manual feature extraction and selection as well as binary classification: either dysgraphia or no dysgraphia. In this work, we investigated the fine grading of handwriting capabilities by predicting the SEMS score (between 0 and 12) with deep learning. Our approach provided a root-mean-square error of less than 1 with automatic instead of manual feature extraction and selection. Furthermore, the SensoGrip smart pen SensoGrip was used, i.e., a pen equipped with sensors to capture handwriting dynamics, instead of a tablet, enabling writing evaluation in more realistic scenarios.

Changing attitudes towards teletherapy in Austrian therapists during the COVID-19 pandemic.

INTRODUCTION: Telehealth and its usage strongly depend on regulatory frameworks and user acceptance. During the COVID-19 pandemic, physiotherapists, occupational therapists, speech-language therapists and their patients experienced restrictions regarding the usual face-to-face therapy. Teletherapy has become a highly discussed medium for providing therapy services. This study aimed at assessing Austrian therapists' attitudes towards teletherapy, including perceived barriers, during and before the COVID-19 lockdown. Further interest referred to therapists' technical affinity and experiences with the application of teletherapy. METHODS: Therapists (n = 325) completed an online survey amid the COVID-19 lockdown in 2020. Retrospective indications referred to the time prior to the lockdown. Ratings were opposed across the three therapeutic professions. Subgroup analyses investigated the role of gender and age regarding technical affinity. Measures included custom-made attitudinal statements towards teletherapy and the standardized TA-EG survey. RESULTS: The COVID-19 lockdown caused attitude changes towards teletherapy - for example, in terms of interest (r = 0.57, p > 0.01), perceived skills for performance of teletherapy (r = 0.33, p > 0.01) and perceived need for physical contact with patients (r = 0.35, p > 0.01). Regarding technical affinity, women reported significantly higher values than men did (r = 0.32, p > 0.01). Nearly half of the participants already applied teletherapy, with mainly positive ratings regarding perceived skills and feasibility. Barriers identified were missing or unstable reimbursement policies by insurance companies and therapeutic software with guaranteed data security. DISCUSSION: Austrian therapists indicate a relatively high level of telehealth positivity, with an improvement in the course of the COVID-19 lockdown. However, therapists outline the need for stable reimbursement policies and secure software solutions.

Participatory design and needs assessment for a pressure-sensitive pen and mobile application (SensoGrip) for children with handwriting problems.

PURPOSE: Problems with handwriting are a common referral to occupational therapy in children and are often associated with inadequate pen grip and tip pressure. Technologies providing immediate feedback on applied forces are currently not available. Therefore, the aim was to identify user's perspectives on the optimal functionality of a pressure-sensitive pen with an integrated feedback system. METHODS: To ensure that the product meets the requirements of the users, user needs of paediatric occupational therapists, elementary or special education teachers and children were collected in two focus groups and a children's workshops before starting the technical development process. Focus group transcripts were analyzed and rephrased as user stories to identify user-centred requirements. In a second step, user stories were merged and ranked regarding importance and feasibility. RESULTS: 120 user story requirements were generated from the focus groups and children's workshops, indicating requirements regarding design and functionality for the pen and mobile application. Visual feedback, appropriate size and weight, customizability, ease of settings and usability of the pen were pivotal. CONCLUSIONS: This study comprehensively researched the requirements for a device that may facilitate children in adjusting their handwriting pressure and can guide further research and evaluation.

Description of a participatory design process for the development of a pressure-sensitive pen.Understand the needs of different stakeholders for an assistive device for children with handwriting difficulties.Inform the further development of a pressure-sensitive pen with immediate pressure-feedback.

Benefits of the Genium microprocessor controlled prosthetic knee on ambulation, mobility, activities of daily living and quality of life: a systematic literature review.

PURPOSE: The benefits of advanced hydraulic microprocessor controlled knee (MPK) joints have been well established and repeatedly confirmed. The Genium knee was introduced in 2011 containing an enhanced control concept including additional sensors and improved algorithms enabling a range of new functions for transfemoral amputees (TFAs). A systematic review was conducted to evaluate the effect of the Genium knee on ambulation, mobility, activities of daily living (ADLs) and quality of life compared to standard MPKs. MATERIALS AND METHODS: The review was conducted according to PRISMA Guidelines and Recommendations of the State-of-Science Evidence Report Guidelines of the American Academy of Orthotists & Prosthetists. RESULTS: Twelve articles were included in the review and reported primarily on active subjects (MFCL-3/4) transitioning from C-Leg to Genium knee systems. The overall validity of the evidence was medium to high with the exception of one article having low validity. Synthesis of biomechanical analyses concludes that gait during level walking, stairs and ramps is more physiological and symmetric following accommodation and use of the Genium in community ambulating TFAs. Further, sound side loading and compensatory motions are reduced. Transitioning from C-Leg to the Genium knee additionally resulted in significant improvements in mobility, quality of life and the performance in activities of daily living (ADLs). CONCLUSION: A high level of evidence was identified when assessing the ability of Genium to improve gait quality and safety and performance in ADLs. While individual studies report significant improvements in terms of quality of life and mobility, additional studies are needed to increase the evidence level.Implications for rehabilitationMicroprocessor controlled prosthetic knees (MPKs) are well-established devices to serve patients with transfemoral amputation. Studies conducted mostly with the C-Leg MPK show that such knees significantly increase patient safety, ambulation, mobility, performance in activities of daily living and quality of life.Genium MPK includes advanced features which enable a range of new functions and functional benefits to patients. Transitioning from conventional MPKs (i.e., C-Leg) to Genium MPK resulted in more physiological gait, more equally distributed loading between the prosthetic and sound limbs, as well as reduced compensatory movements on the sounds side. These outcomes could potentially reduce the long-term risks of secondary physical complications in prosthetic users (i.e., osteoarthritis, osteoporosis). Genium significantly improved mobility, performance in activities of daily living, and quality of life in the patients using a conventional MPK (C-Leg).Different functioning principles of the MPKs presently available are responsible for different performance levels the knees offer to users. The amount of clinical evidence is also knee-dependent, with the C-Leg knee being most extensively tested in clinical studies. This systematic review concludes that Genium offers further advantages to transfemoral patients as compared to conventional MPKs (C-Leg).