Health App Review Tool (HART): content validation through expert panel review.

The Health App Review Tool (HART) is an evaluation tool that is designed to help the users in evaluation of the health apps for Alzheimer's Disease and Related Dementias (ADRD) population. As the development of the HART continues, the domain items that HART addresses require evaluation to determine if they meet the intended required criteria for the users.To complete content validation of the HART 10 health care professions provided content validation of the HART via a content validation form. Specifically, data collection took place virtually through Microsoft Teams and Qualtrics-based content validity index. Following, revisions were made through a consensus process involving 3 rehabilitation experts, minimizing potential conflicts.Findings indicate 76 of 109 items were considered acceptable, 19 items were in need of review and 14 items in need of revision. In sum 30% of the total HART items required either review or revision to improve HART validity. The changes were implemented through consensus revisions.

Historical technology transfer activities and productivity of NIDLRR grantees.

This paper analyzes the technology-related outputs from The National Institute of Disability, Independent Living, and Rehabilitation Research (NIDILRR). We seek to answer the questions: What are the types and frequency of assistive technology (AT) technology transfer (ATTT) outputs from NIDILRR grants? How does NIDILRR's ATTT generation compare to other granting organizations? What types of ATTT outputs occur, how, and what is the relative productivity of the most frequently funded universities and small businesses performing with funding by NIDILRR grants? An online search was conducted for indications of ATTT from grants funded from 1983-2021 through publicly available databases, the National Rehabilitation Information Center (NARIC), and the internet. This data was then categorized across relevant output types and analyzed. NIDILRR funded 662 organizations and 951 different investigators from 1983 to 2021. The NIDILRR-funded portfolio includes 6,996 papers, 438 informational websites, 163 patents, 120 software products, and 29 hardware products. Compared to the National Institutes of Health (NIH), NIDILRR produced slightly more products per dollar. Our results highlight the substantial portfolio of technology-related outputs generated with NIDILRR funding and demonstrate how productivity measures can be calculated to guide future funding strategies.

The Role of Rehabilitation for Early-Stage Alzheimer's Disease and Related Dementias: Practice and Priorities.

The World Health Organization describes rehabilitation as interventions that focus on addressing disability through optimizing functional ability for individuals living with various health challenges in their unique daily life contexts. Rehabilitation services are typically seeking to enhance functional capacity and health, either in concert with, or in place of pharmacologic interventions. These services typically fall into 2 categories, restorative, where the client endeavors to return to a prior level of independent function, and compensatory, where s/he may not. In the latter case, clients might receive, and be trained to use, technology aids or other external supports to enable them to engage in a safe, healthy, and meaningful day-to-day life. For some populations, however, even enhanced functional capacity can present in the form of an insidious, albeit slower decline. So, what is, or should, rehabilitation's role be in progressive neurologic conditions? Specifically, what are the policy and practice implications of rehabilitation for (not in the presence of, but for) the care of persons living with neurodegenerative conditions such as Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD)?

Refinement of Health App Review Tool (HART) through stakeholder interviews: HART 2.0.

The Health App Review Tool (HART) is a novel assessment designed to match users with Alzheimer's disease or related dementias (ADRD) and caregivers to mobile applications that support health and wellness. The objectives of this study were to gather stakeholder feedback on the HART and then to implement revisions. Thirteen participants completed in-depth Think Aloud interviews. Participants shared qualitative feedback on each HART item. Participant feedback was analyzed via in-depth video-audio review. Feedback was implemented as actionable HART revisions. On average, the majority of participants rated items as "adequate"; however, qualitative findings indicated the need for improvement in conciseness, clarity, and understandability. Conciseness was addressed by combining related concepts into multi-items, clarity through the addition of specific examples, and understandability through improved verbiage. The HART has been refined from 106 items to 17 items through extensive revisions to the clarity, conciseness, and explanations provided throughout the assessment.

Wheelchair-mounted robotic arms: a survey of occupational therapists' practices and perspectives.

PURPOSE: Despite the benefits of wheelchair-mounted robotic arms (WMRAs), occupational therapists are not yet widely involved in the recommendation or implementation of these assistive devices. The purpose of this study was to investigate and compare the current practices and perspectives of occupational therapists who had and had not recommended a WMRA on the recommendation, training, and implementation of WMRAs. METHODS: This was a descriptive cross-sectional study. An online survey was sent to Canadian, European, and American occupational therapists who had or had not worked with WMRAs. Respondents were asked close-ended questions about their experience, role, barriers, motivations, and future needs regarding WMRAs. We compared results between respondents who had and had not recommended WMRAs using descriptive statistics. RESULTS: Ninety-three North American and European occupational therapists completed the survey. Of those, 29 (31.2%) had recommended a WMRA, mostly the JACO robotic arm (n = 26, 89.7%) in rehabilitation centres (n = 18, 62.1%). Their perspectives on their role and barriers related to WMRAs were similar to those who had never recommended a WMRA. All respondents recognised the relevance of occupational therapists' contribution, and most reported interest in WMRAs (n = 76, 81.7%). However, many barriers emerged, mainly related to limited funding (n = 49, 76.6%), lack of training and knowledge (n = 38, 59.4%), and resource constraints (n = 37, 54.4%). Future needs identified matched these barriers. CONCLUSION: This survey provides novel insight into occupational therapists' perspectives on WMRAs. It highlights that health professionals need to have easier access to funding, formal training, and resources to support their involvement with WMRAs.Implications for rehabilitationMost occupational therapists are interested in working with WMRAs, considering the potential of these devices to support individuals with upper extremity impairments in their daily activities. They also recognise their unique contribution to the assessment, recommendation, and implementation process among multidisciplinary teams.WMRA recommendation is relevant in various clinical settings and with a wide range of client populations. Nevertheless, it appears that occupational therapists working with adults, in rehabilitation centres or specialised clinics, may have more opportunities to get involved in this process and to attend formal training on this technology, as compared to other settings.Many barriers remain, impeding occupational therapists' role in the recommendation and implementation of WMRAs. Addressing these barriers may increase the number of devices that are successfully adopted and utilised by individuals with upper extremity impairments. In particular, future research and health policies should focus on access to sufficient funding, formal training, and resources for occupational therapists relative to their role in recommending and implementing WMRAs.

Rehabilitation at the Time of Pandemic: Patient Journey Recommendations.

Purpose: The World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic in March 2020, causing almost 3.5 million coronavirus disease (COVID-19) related deaths worldwide. The COVID-19 pandemic has imposed a significant burden on healthcare systems, economies, and social systems in many countries around the world. The access and delivery of rehabilitation care were severely disrupted, and patients have faced several challenges during the COVID-19 outbreak. These challenges include addressing new functional impairments faced by survivors of COVID-19 and infection prevention to avoid the virus spread to healthcare workers and other patients not infected with COVID-19. In this scoping review, we aim to develop rehabilitation recommendations during the COVID-19 pandemic across the continuum of rehabilitation care. Materials and Methods: Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched. Study Selection: We included articles and reports if they were focused on rehabilitation recommendations for COVID-19 survivors or the general population at the time of the COVID-19 pandemic. Data Extraction: Two of our team members used the pre-tested data extraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Results: We retrieved 6,468 citations, of which 2,086 were eligible after removing duplicates. We excluded 1,980 citations based on the title and the abstract. Of the screened full-text articles, we included 106 studies. We present recommendations based on the patient journey at the time of the pandemic. We assessed the evidence to be of overall fair quality and strong for the recommendations. Conclusion: We have combined the latest research results and accumulated expert opinions on rehabilitation to develop acute and post-acute rehabilitation recommendations in response to the global COVID-19 pandemic. Further updates are warranted in order to incorporate the emerging evidence into rehabilitation guidelines.

Evidence of User-Expert Gaps in Health App Ratings and Implications for Practice.

Searching the commercial Google Play Store and App Store is one of the most common strategies for discovering mobile applications for digital health, both among consumers and healthcare professionals. However, several studies have suggested a possible mismatch between this strategy and the objective of finding apps in physical and mental health that are both clinically relevant and reliable from a privacy standpoint. This study provides direct evidence of a gap between the five-star user rating system and expert ratings from a curated library of over 1,200 apps that cover both physical and mental health. An objective metric is derived to assess the strength of the user-expert gap for each app, which in turn allows identifying missed opportunities-low user ratings and high expert ratings-and overrated apps-high user ratings and low expert ratings. Implications for practice and care delivery are discussed.

Mhealth interventions to improve health and quality of life related outcomes for informal dementia caregivers: A scoping review.

BACKGROUND: The devastating effects of dementia extend to the health and well-being of informal dementia caregivers. The physical and mental requirements of serving as a dementia caregiver are evidenced in the negative health effects that this population experiences. There is a present need for effective interventions to improve health and quality of life in informal dementia caregivers. OBJECTIVE: To investigate the health and well-being related outcomes following mHealth use in dementia caregiver and care recipient populations. METHODS: A scoping review was undertaken to investigate mHealth use in dementia caregivers. Searches spanning four databases yielded 172 articles. Following screening procedures, 12 articles were included for data extraction.. RESULTS: Articles were organized into three major themes: social and indirect support, health education, and technology-supported monitoring. Social and indirect support apps may be valuable for caregiver stress relief, confidence, and fatigue. Health education apps were found to 1) assist with the organization of user's health information, and 2) impact depressive symptoms. Monitoring apps provided caregivers with methods of observing both physical and emotional well-being.. CONCLUSION: Currently, the limited evidence on the usability and usefulness of mHealth within dementia caregiver populations indicates that mHealth holds promise as an intervention platform and warrants continued investigation.Abbreviations: AD: Alzheimer's Disease; CANE: Camberwell Assessment of Need for the Elderly; CCS: Caregiver Competence Scale, CDN: COGKNOW Day Navigator; CES-D: Center for Epidemiologic Studies Depression Scale; CG: Caregivers; CQoL-AD: Carer's Overall Quality of Life in Alzheimer's Disease; Dx: Diagnosis; ESM: experience sampling methodology; FB: Facebook; PA: Positive Affect; Pss-14: Perceived Stress Scale; QOL: Quality of Life; RCSS: Revised Caregiving Satisfaction Scale; SSCQ: Short Sense of Competence Questionnaire.

Impact of the TEAM Wheels eHealth manual wheelchair training program: Study protocol for a randomized controlled trial.

BACKGROUND: Variable, and typically inadequate, delivery of skills training following manual wheelchair (MWC) provision has a detrimental impact on user mobility and participation. Traditional in-person delivery of training by rehabilitation therapists has diminished due to cost, travel time, and most recently social distancing restrictions due to COVID-19. Effective alternative training approaches include eHealth home training applications and interactive peer-led training using experienced and proficient MWC users. An innovative TEAM Wheels program integrates app-based self-training and teleconference peer-led training using a computer tablet platform. OBJECTIVE: This protocol outlines implementation and evaluation of the TEAM Wheels training program in a randomized control trial using a wait-list control group. SETTING: The study will be implemented in a community setting in three Canadian cities. PARTICIPANTS: Individuals ≥ 18 years of age within one year of transitioning to use of a MWC. INTERVENTION: Using a computer tablet, participants engage in three peer-led teleconference training sessions and 75-150 minutes of weekly practice using a video-based training application over 4 weeks. Peer trainers individualize the participants' training plans and monitor their tablet-based training activity online. Control group participants also receive the intervention following a 1-month wait-list period and data collection. MEASUREMENTS: Outcomes assessing participation; skill capacity and performance; self-efficacy; mobility; and quality of life will be measured at baseline and post-treatment, and at 6-month follow-up for the treatment group. IMPACT STATEMENT: We anticipate that TEAM Wheels will be successfully carried out at all sites and participants will demonstrate statistically significant improvement in the outcome measures compared with the control group.

Impact of the COVID-19 Pandemic on Older Adults: Rapid Review.

BACKGROUND: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. OBJECTIVE: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. METHODS: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. RESULTS: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. CONCLUSIONS: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.

Exercise interventions for older adults with Alzheimer's disease: a systematic review and meta-analysis protocol.

BACKGROUND: The growing societal and economic impact of Alzheimer's disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial burden associated with drug therapies. Various forms and regiments of exercise (i.e., strength, aerobic, multicomponent) have been reported in the literature; however, conflicting evidence obscures clear interpretation of the value and impact of exercise as an intervention for older adults with AD. The primary objective of this review will be to evaluate the effects of exercise interventions for older adults with AD. In addition, this review will evaluate the evidence quality and synthesize the exercise training prescriptions for proper clinical practice guidelines and recommendations. METHODS: This systematic review and meta-analysis will be carried out by an interdisciplinary collective representing clinical and research stakeholders with diverse expertise related to neurodegenerative diseases and rehabilitation medicine. Literature sources will include the following: Embase, PsychINFO, OVID Medline, and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily. Inclusion criteria are participants with late onset AD and structured exercise interventions with prescribed duration, frequency, and intensity. The primary outcome of this study will center on improved or sustained cognitive functioning. Secondary outcomes will include institutionalization-related outcomes, ability in activities of daily living, mood and emotional well-being, quality of life, morbidity, and mortality. Analysis procedures to include measurement of bias, data synthesis, sensitivity analysis, and assessment of heterogeneity are described in this protocol. DISCUSSION: This review is anticipated to yield clinically meaningful insight on the specific value of exercise for older adults with AD. Improved understanding of diverse exercise intervention approaches and their specific impact on various health- and function-related outcomes is expected to guide clinicians to more frequently and accurately prescribe meaningful interventions for those affected by AD. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020175016 .

Rehabilitation Care at the Time of Coronavirus Disease-19 (COVID-19) Pandemic: A Scoping Review of Health System Recommendations.

Purpose: The coronavirus disease-19 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. COVID-19, caused by SARS-CoV-2 has imposed a significant burden on health care systems, economies, and social systems in many countries around the world. The provision of rehabilitation services for persons with active COVID-19 infection poses challenges to maintaining a safe environment for patients and treating providers. Materials and Methods: Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched. Study Selection: We included articles and reports if they were focused on rehabilitation related recommendations for COVID-19 patients, treating providers, or the general population. Data Extraction: Pairs of team members used a pre-tested data abstraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: We retrieved 6,468 citations, of which 2,086 were eligible for review, after duplicates were removed. We excluded 1,980 citations based on title and abstract screening. Of the screened full-text articles, we included all 106 studies. A summary of recommendations is presented. We assessed the overall evidence to be strong and of fair quality. Conclusion: The rehabilitation setting, and processes, logistics, and patient and healthcare provider precaution recommendations identified aim to reduce the spread of SARS-CoV-2 infection and ensure adequate and safe rehabilitation services, whether face-to-face or through teleservices. The COVID-19 pandemic is rapidly changing. Further updates will be needed over time in order to incorporate emerging best evidence into rehabilitation guidelines.

Can Technology Abate the Experience of Social Isolation for Those Affected by Dementia?

Background: The widespread social isolation measures recently utilized to mitigate the spread of COVID-19 to older adults may have exuded unexpected consequences. Social isolation among older adults is a risk factor for poor health outcomes. Innovative solutions to balancing public safety and health maintenance for those with dementia and their caregivers are needed. Methods: A sample of N = 82 dementia caregivers participated in a web-based survey to investigate their perceptions on (1) changes in personal mental health due to isolation from their loved one, and (2) the perceived need for use of smart mobile device app use in these situations. Results: The majority of our sample (87%) reported experiencing negative mental health outcomes beyond those experienced in typical situations. Furthermore, over 70% of caregivers were concerned with the care their loved on received during social isolation. Finally, 67% reported perceived need to use SMD apps in these times of social isolation. Conclusion: Our findings provide preliminary insight into troubling consequences occurring when individuals with dementia are socially isolated from their caregivers. An inverse relationship between SMD app use and poor mental health points to the potential for communication technology to lessen the negative impacts of social isolation, when it becomes necessary to public safety.

Health App Review Tool: Matching mobile apps to Alzheimer's populations (HART Match).

Aim: This brief report provides an overview of the development and structure of the Health App Review Tool. Methods: The Health App Review Tool has been designed to assess smart phone health apps according to their compatibility to individuals within the Alzheimer's disease community. Specifically, app features and functions are characterized according to their appropriateness to the needs, abilities, and preferences of potential users. The Health App Review Tool is comprised of two components, the App and User Assessment; each component includes four complementary domains. Items in these domains can be compared between App and User assessments using a scoring key that will produce a match score. The score indicates the level of appropriateness in reference to the app's ability to meet the user's needs. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations.

Evidence-Based Practice Implementation in Stroke Rehabilitation: A Scoping Review of Barriers and Facilitators.

IMPORTANCE: Despite advancements in stroke rehabilitation research, occupational therapy practitioners still face challenges with implementing research into routine practice. Although the development of evidence-based practices (EBPs) is one critical step along the knowledge translation continuum for the population of people with stroke, research is also needed to identify the most effective strategies for implementing EBPs with stroke survivors who are receiving occupational therapy services. OBJECTIVE: To synthesize research related to occupational therapy practitioners' implementation of EBPs in adult stroke rehabilitation. DATA SOURCES: We searched four electronic databases-CINAHL, MEDLINE, PubMed, and Academic Search Complete-and the peer-reviewed journal Implementation Science to identify relevant research studies. STUDY SELECTION AND DATA COLLECTION: Studies that met the following inclusion criteria were included in the scoping review: published between January 2003 and January 2018, addressed the adult stroke population, and examined the implementation of occupational therapy interventions. Data were abstracted on the basis of recommendations from the seminal review framework established by Arksey and O'Malley (2005). Thematic analysis identified themes that emerged from the included studies. FINDINGS: Twenty-five articles satisfied our inclusion parameters. Our analyses yielded three overarching themes: barriers to implementation, facilitators of implementation, and implementation strategies. Implementation strategies often consisted of multimodal knowledge translation training programs. CONCLUSION AND RELEVANCE: Although the stroke rehabilitation literature appears to have established the barriers to and facilitators of EBP implementation, greater attention to the identification of effective implementation strategies that promote the uptake of EBPs by occupational therapy practitioners is needed. WHAT THIS ARTICLE ADDS: This article summarizes the contextual factors and effective strategies that may influence practitioners' implementation of stroke research findings in real-world practice.

Scoping Review of Self-Advocacy Education Interventions to Improve Care.

Self-advocacy is a client's ability to represent one's interests when managing disease or disability. Self-advocacy may increase one's ability to seek, evaluate, and use information to promote health, yet little is known about the role of occupational therapy in promoting self-advocacy. This scoping review aims to identify interventions within occupational therapists' scope of practice to improve self-advocacy. A literature search was conducted through Academic Search Complete to identify interventions within the scope of occupational therapy that promote self-advocacy. All levels of evidence were included, and articles were reviewed for inclusion by two authors. Included articles were charted for level of evidence, objectives, participants, and results. Fourteen articles met the criteria. Interventions included interactive multimedia interventions, peer-led educational groups, writing interventions, job counseling and advocacy, and disease-specific advocacy programs. Occupational therapists are well-equipped to intervene and promote self-advocacy through workplace modification, utilizing assistive technologies, and facilitating peer-led educational groups.