The iMHere 2.0 System for Family Caregivers of Older Adults: A Focus Group.

Background: Family caregivers with continuous caregiving responsibilities are at increased risk for adverse physical and mental health outcomes. In response to the challenges of caregiving, a mobile health system (iMHere 2.0) was developed to support caregivers. The study's objective was to gather feedback from family caregivers of older adults on the current features of iMHere 2.0 and to formulate design criteria for future iterations of the system. Methods: An exploratory qualitative study with thematic analyses of focus group feedback. Findings: A total of 10 caregivers of older adults participated in a focus group. Five themes emerged: (1) Monitoring health data, (2) Setting up customized reminders, (3) Supporting care coordination, (4) Balancing security and multiple user access, and (5) Disseminating iMHere 2.0 into the community, along with some potential barriers to implementation. Conclusions: Design criteria were developed to provide a framework for iterative design and development of the iMHere system to support caregivers of older adults.

ReDWINE: A clinical datamart with text analytical capabilities to facilitate rehabilitation research.

Rehabilitation research focuses on determining the components of a treatment intervention, the mechanism of how these components lead to recovery and rehabilitation, and ultimately the optimal intervention strategies to maximize patients' physical, psychologic, and social functioning. Traditional randomized clinical trials that study and establish new interventions face challenges, such as high cost and time commitment. Observational studies that use existing clinical data to observe the effect of an intervention have shown several advantages over RCTs. Electronic Health Records (EHRs) have become an increasingly important resource for conducting observational studies. To support these studies, we developed a clinical research datamart, called ReDWINE (Rehabilitation Datamart With Informatics iNfrastructure for rEsearch), that transforms the rehabilitation-related EHR data collected from the UPMC health care system to the Observational Health Data Sciences and Informatics (OHDSI) Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to facilitate rehabilitation research. The standardized EHR data stored in ReDWINE will further reduce the time and effort required by investigators to pool, harmonize, clean, and analyze data from multiple sources, leading to more robust and comprehensive research findings. ReDWINE also includes deployment of data visualization and data analytics tools to facilitate cohort definition and clinical data analysis. These include among others the Open Health Natural Language Processing (OHNLP) toolkit, a high-throughput NLP pipeline, to provide text analytical capabilities at scale in ReDWINE. Using this comprehensive representation of patient data in ReDWINE for rehabilitation research will facilitate real-world evidence for health interventions and outcomes.

Formative Development of ClockWork for the Postpartum Period: A Theory-Based Intervention to Harness the Circadian Timing System to Address Cardiometabolic Health-Related Behaviors.

Individuals with body mass index (BMI) ≥ 25 kg/m2 before pregnancy have greater difficulty losing the weight gained during pregnancy, and this postpartum weight retention predicts higher risk for cardiometabolic disease. The postpartum period involves substantial disruptions in circadian rhythms, including rhythms related to eating, physical activity, sleep, and light/dark exposure, each of which are linked to obesity and cardiometabolic disease in non-pregnant adult humans and animals. We posit that a multi-component, circadian timing system-based behavioral intervention that uses digital tools-ClockWork-will be feasible and acceptable to postpartum individuals and help promote weight- and cardiometabolic health-related behaviors. We provide data from stakeholder interviews with postpartum individuals (pre-pregnancy BMI ≥ 25; n = 7), which were conducted to obtain feedback on and improve the relevance and utility of digital self-monitoring tools for health behaviors and weight during the postpartum period. Participants perceived the ClockWork intervention and digital monitoring app to be helpful for management of postpartum weight-related health behaviors. They provided specific recommendations for increasing the feasibility intervention goals and improving app features for monitoring behaviors. Personalized, easily accessible interventions are needed to promote gestational weight loss after delivery; addressing circadian behaviors is an essential component of such interventions. Future studies will evaluate the efficacy of the ClockWork intervention and associated digital tools for improving cardiometabolic health-related behaviors linked to the circadian timing system during the postpartum period.

EVALUATION OF A TELEHEALTH APPLICATION (SEHHA) USED DURING THE COVID-19 PANDEMIC IN SAUDI ARABIA: PROVIDER EXPERIENCE AND SATISFACTION.

Introduction: COVID-19 has drastically transformed healthcare delivery and forced many to utilize telehealth. This study aimed to comprehensively evaluate the telehealth service "Sehha" used during COVID-19 in Saudi Arabia and assess the provider experience and satisfaction with Sehha. Methods: A questionnaire was distributed by the Ministry of Health (MoH) to 362 physicians using Sehha. The questionnaire items were adapted from previous studies and then tested for content validity and reliability (α = 0.88). Results: The findings showed that most of the physicians improved their experience in telehealth because of COVID-19. The majority of the physicians (67.6 percent) reported being satisfied with Sehha. However, the most commonly perceived challenge by the physicians was difficulty in providing accurate medical assessments. Conclusion: COVID-19 has remarkably uncovered numerous benefits of telehealth. Therefore, telehealth should remain a permanent model of healthcare delivery with consideration of further telehealth development initiatives.

Making Self-Management Mobile Health Apps Accessible to People With Disabilities: Qualitative Single-Subject Study.

BACKGROUND: Over the past decade, a large number of mobile health (mHealth) apps have been created to help individuals to better manage their own health. However, very few of these mHealth apps were specifically designed for people with disabilities, and only a few of them have been assessed for accessibility for people with disabilities. As a result, people with disabilities have difficulties using many of these mHealth apps. OBJECTIVE: The objective of this study was to identify an approach that can be generally applied to improve the accessibility of mHealth apps. METHODS: We recruited 5 study participants with a primary diagnosis of cerebral palsy or spinal cord injury. All the participants had fine motor impairment or lack of dexterity, and hence, they had difficulties using some mHealth apps. These 5 study participants were first asked to use multiple modules in the client app of a novel mHealth system (iMHere 2.0), during which their performance was observed. Interviews were conducted post use to collect study participants' desired accessibility features. These accessibility features were then implemented into the iMHere 2.0 client app as customizable options. The 5 participants were asked to use the same modules in the app again, and their performance was compared with that in the first round. A brief interview and a questionnaire were then performed at the end of the study to collect the 5 participants' comments and impression of the iMHere 2.0 app in general and of the customizable accessibility features. RESULTS: Study results indicate that the study participants on their first use of the iMHere 2.0 client app experienced various levels of difficulty consistent with the severity of their lack of dexterity. Their performance was improved after their desired accessibility features were added into the app, and they liked the customizable accessibility features. These participants also expressed an interest in using this mHealth system for their health self-management tasks. CONCLUSIONS: The accessibility features identified in this study improved the accessibility of the mHealth app for people with dexterity issues. Our approach for improving mHealth app accessibility may also be applied to other mHealth apps to make those apps accessible to people with disabilities.

Veteran and Provider Satisfaction with a Home-Based Telerehabilitation Assessment for Wheelchair Seating and Mobility.

The objective of this project was to measure Veteran and provider satisfaction with a home-based telerehabilitation assessment for wheelchair seating and mobility. Forty-three Veterans were seen remotely at their place of residence by a provider, using a VA Video Connect synchronous videoconferencing system. Veteran and provider satisfaction were collected using the Telerehabilitation Questionnaire (TRQ). Mean individual TRQ scores for both Veterans and providers were significantly higher than the scale midpoint of 3.5. Veterans had higher scores than providers for five individual items on the TRQ. Higher scores by Veterans on the technology and quality and clarity of the video and audio likely correspond to the differences in environmental settings in which the visit occurred for the Veteran compared with the provider. High satisfaction scores with the telerehabilitation assessments are likely attributed to the positive working relationship between the provider and the rehabilitation technician, who provided in-person technical support to the Veteran in the home during the wheeled mobility evaluation. Overall, the results indicate a high level of Veteran and provider satisfaction using telerehabilitation for wheelchair seating and mobility evaluations.

Evaluation of Service Delivery Effectiveness Through Patient-Reported Outcome Measures.

OBJECTIVE: The aims of the study were to report the demographic characteristics and functional mobility for individuals accessing an academic medical center mobility device clinic and to compare functional mobility data across demographic characteristics and mobility device type. DESIGN: This study used a retrospective, cross-sectional design. Demographic, mobility type, and patient-reported outcome measure data for 833 clients were analyzed. The Functional Mobility Assessment was used as the patient-reported outcome measure to determine satisfaction. RESULTS: The mean (SD) baseline Functional Mobility Assessment score was 0.59 (0.25) on a 0-1 scale. Significant differences with the Functional Mobility Assessment scores were found across the mobility device types, with scooter and power wheelchair groups reporting higher satisfaction scores than those in the cane/crutch/walker or manual wheelchair groups. Device type, sex, and age were each found to be significant predictors of satisfaction scores (P < 0.01). CONCLUSIONS: Mobility device type is associated with satisfaction level. Mobility devices that offer higher levels of assistance are associated with increased satisfaction. The Functional Mobility Assessment, mobility device type, and demographic data provide baseline information for evaluating the effectiveness of an academic medical center mobility device clinic.

The mHealth App Usability Questionnaire (MAUQ): Development and Validation Study.

BACKGROUND: After a mobile health (mHealth) app is created, an important step is to evaluate the usability of the app before it is released to the public. There are multiple ways of conducting a usability study, one of which is collecting target users' feedback with a usability questionnaire. Different groups have used different questionnaires for mHealth app usability evaluation: The commonly used questionnaires are the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ). However, the SUS and PSSUQ were not designed to evaluate the usability of mHealth apps. Self-written questionnaires are also commonly used for evaluation of mHealth app usability but they have not been validated. OBJECTIVE: The goal of this project was to develop and validate a new mHealth app usability questionnaire. METHODS: An mHealth app usability questionnaire (MAUQ) was designed by the research team based on a number of existing questionnaires used in previous mobile app usability studies, especially the well-validated questionnaires. MAUQ, SUS, and PSSUQ were then used to evaluate the usability of two mHealth apps: an interactive mHealth app and a standalone mHealth app. The reliability and validity of the new questionnaire were evaluated. The correlation coefficients among MAUQ, SUS, and PSSUQ were calculated. RESULTS: In this study, 128 study participants provided responses to the questionnaire statements. Psychometric analysis indicated that the MAUQ has three subscales and their internal consistency reliability is high. The relevant subscales correlated well with the subscales of the PSSUQ. The overall scale also strongly correlated with the PSSUQ and SUS. Four versions of the MAUQ were created in relation to the type of app (interactive or standalone) and target user of the app (patient or provider). A website has been created to make it convenient for mHealth app developers to use this new questionnaire in order to assess the usability of their mHealth apps. CONCLUSIONS: The newly created mHealth app usability questionnaire-MAUQ-has the reliability and validity required to assess mHealth app usability.

An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies.

BACKGROUND: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs' self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. OBJECTIVE: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. METHODS: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs' evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. RESULTS: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. CONCLUSIONS: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs.

Development and Implementation of a Wheelchair Outcomes Registry.

OBJECTIVE: To describe the development of a patient registry related to wheeled mobility and seating (WMS) device interventions to accumulate large datasets for clinical quality assurance and research purposes. DESIGN: Accepted guidelines for registry development were applied and anchored around the Functional Mobility Assessment (FMA) questionnaire and a uniform dataset (UDS). SETTING: The FMA and UDS were developed under a corporate research agreement between clinical researchers and commercial providers. The questionnaires are administered in rehabilitation clinics to patients at the time of assessment for new device interventions (baseline) and readministered by telephone or other remote strategies periodically thereafter (follow-up). PARTICIPANTS: The FMA and UDS can be administered to any patient with a mobility impairment in need of a WMS device. INTERVENTIONS: WMS interventions include manual wheelchairs, power wheelchairs, scooters, seating, and other accessories. MAIN OUTCOME MEASURES: The FMA is a validated 10-item patient-centered outcome measure that investigates satisfaction in performing common mobility-related activities of daily living. The UDS includes variables related to age, diagnosis, and type of device used, as well as health, participation, and environmental factors. RESULTS: Currently there are over 1500 complete FMA and UDS cases at baseline and more than 600 follow-up datasets from 45 providers nationwide. Feedback indicates use of the FMA and UDS does not add burden to the clinical routine. CONCLUSIONS: A registry in the field of WMS has been developed and shown to be feasible in a clinical setting. This has created an opportunity to collect large datasets to increase sample sizes for future analyses to more scientifically evaluate what types of WMS devices work best for what types of patients under varying circumstances to promote health and participation.

American Telemedicine Association's Principles for Delivering Telerehabilitation Services.

Telehealth is a broad term used to describe the use of electronic or digital information and communications technologies to support clinical healthcare, patient and professional health related education, and public health and health administration. Telerehabilitation refers to the delivery of rehabilitation and habilitation services via information and communication technologies (ICT), also commonly referred to as" telehealth" technologies. Telerehabilitation services can include evaluation, assessment, monitoring, prevention, intervention, supervision, education, consultation, and coaching. Telerehabilitation services can be deployed across all patient populations and multiple healthcare settings including clinics, homes, schools, or community-based worksites. This document was adapted from the American Telemedicine Association's (ATA) "A Blueprint for Telerehabilitation Guidelines" (2010) and reflects the current utilization of telerehabilitation services. It was developed collaboratively by members of the ATA Telerehabilitation Special Interest Group, with input and guidance from other practitioners in the field, strategic stakeholders, and ATA staff. Its purpose is to inform and assist practitioners in providing effective and secure services that are based on client needs, current empirical evidence, and available technologies. Rehabilitation professionals, in conjunction with professional associations and other organizations are encouraged to use this document as a resource for developing discipline-specific standards, guidelines, and practice requirements.

Delivering an in-Home Exercise Program via Telerehabilitation: A Pilot Study of Lung Transplant Go (LTGO).

We evaluated the feasibility, safety, system usability, and intervention acceptability of Lung Transplant Go (LTGO), an 8-week in-home exercise intervention for lung transplant recipients using a telerehabilitation platform, and described changes in physical function and physical activity from baseline to post-intervention. The intervention was delivered to lung transplant recipients in their home via the Versatile and Integrated System for TeleRehabilitation (VISYTER). The intervention focused on aerobic and strengthening exercises tailored to baseline physical function. Participants improved walk distance (6-minute walk distance), balance (Berg Balance Scale), lower body strength (30-second chair stand test) and steps walked (SenseWear Armband®). No adverse events were reported. Participants rated the program highly positively in regard to the technology and intervention. The telerehabilitation exercise program was feasible, safe, and acceptable. Our findings provide preliminary support for the LTGO intervention to improve physical function and promote physical activity in lung transplant recipients.

Usability and reliability of a remotely administered adult autism assessment, the autism diagnostic observation schedule (ADOS) module 4.

INTRODUCTION: The Autism Diagnostic Observation Schedule (ADOS) Module 4 is an autism assessment designed for verbally fluent adolescents and adults. Because of a shortage of available clinical expertise, it can be difficult for adults to receive a proper autism spectrum disorder (ASD) diagnostic assessment. A potential option to address this shortage is remote assessment. The objective of this study was to examine the feasibility, usability, and reliability of administering the ADOS Module 4 remotely using the Versatile and Integrated System for Telerehabilitation (VISYTER). MATERIALS AND METHODS: VISYTER consists of computer stations at the client site and clinician site for video communication and a Web portal for managing and coordinating the assessment process. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote ADOS and a face-to-face ADOS were administered. After completing the remote ADOS, participants completed a satisfaction survey. RESULTS: Participant satisfaction with the remote ADOS delivery system was high. The kappa value was greater than 0.61 on 21 of 31 ADOS items. There was substantial agreement on ADOS classification (i.e., diagnosis) between assessments delivered face-to-face versus assessments delivered remotely (interclass coefficient=0.92). Non-agreement may have been due to outside factors or practice effect despite a washout period. CONCLUSIONS: The results of this study demonstrate that an autism assessment designed to be delivered face to face can be administered remotely using an integrated Web-based system with high levels of usability and reliability.

An integrated telehealth system for remote administration of an adult autism assessment.

We developed a telehealth system to administer an autism assessment remotely. The remote assessment system integrates videoconferencing, stimuli presentation, recording, image and video presentation, and electronic assessment scoring into an intuitive software platform. This is an advancement over existing technologies used in telemental health, which currently require several devices. The number of children, adolescents, and adults with autism spectrum disorders (ASDs) has increased dramatically over the past 20 years and is expected to continue to increase in coming years. In general, there are not many clinicians trained in either the diagnosis or treatment of adults with ASD. Given the number of adults with autism in need, a remote assessment system can potentially provide a solution to the lack of trained clinicians. The goal is to make the remote assessment system as close to face-to-face assessment as possible, yet versatile enough to support deployment in underserved areas. The primary challenge to achieving this goal is that the assessment requires social interaction that appears natural and fluid, so the remote system needs to be able to support fluid natural interaction. For this study we developed components to support this type of interaction and integrated these components into a system capable of supporting the entire autistic assessment protocol. We then implemented the system and evaluated the system on real patients. The results suggest that we have achieved our goal in developing a system with high-quality interaction that is easy to use.

Evaluation of a telerehabilitation system for community-based rehabilitation.

The use of web-based portals, while increasing in popularity in the fields of medicine and research, are rarely reported on in community-based rehabilitation programs. A program within the Pennsylvania Office of Vocational Rehabilitation's Hiram G. Andrews Center, the Cognitive Skills Enhancement Program (CSEP), sought to enhance organization of program and participant information and communication between part- and full-time employees, supervisors and consultants. A telerehabilitation system was developed consisting of (1) a web-based portal to support a variety of clinical activities, and (2) the Versatile Integrated System for Telerehabilitation (VISYTER) video-conferencing system to support the collaboration and delivery of rehabilitation services remotely. This descriptive evaluation examines the usability of the telerehabilitation system incorporating both the portal and VISYTER. Telerehabilitation system users include CSEP staff members from three geographical locations and employed by two institutions. The IBM After-Scenario Questionnaire (ASQ) and Post-Study System Usability Questionnaire (PSSUQ), the Telehealth Usability Questionnaire (TUQ), and two demographic surveys were administered to gather both objective and subjective information. Results showed generally high levels of usability. Users commented that the telerehabilitation system improved communication, increased access to information, improved speed of completing tasks, and had an appealing interface. Areas where users would like to see improvements, including ease of accessing/editing documents and searching for information, are discussed.

Telerehabilitation assessment using the Functioning Everyday with a Wheelchair-Capacity instrument.

This study explored the interrater reliability between a generalist practitioner administering the Functioning Everyday with a Wheelchair-Capacity (FEW-C) in person (IP) and a remote expert practitioner observing via telerehabilitation (TR) from more than 100 miles away. Each of the 46 participants was simultaneously rated by both the IP and TR practitioner, who were masked to each other's results. The IP-TR raters demonstrated excellent interrater reliability, with an intraclass correlation coefficient of 0.91 for the total FEW-C and 0.96, 0.88, and 0.90 for the constructs of independence, safety, and quality, respectively. Internal consistency (Cronbach alpha) was 0.94 for the total FEW-C tool and 0.91, 0.83, and 0.82 for independence, safety, and quality, respectively, indicating good internal consistency without redundancy. Using TR and the FEW-C, an expert practitioner more than 100 miles away was able to accurately assess the functional mobility needs of clients being assessed for new wheeled mobility devices.

VISYTER: versatile and integrated system for telerehabilitation.

The versatile and integrated system for telerehabilitation (VISYTER) is a software platform for developing various telerehabilitation applications. VISYTER has been designed to take into account the environments and requirements of rehabilitation services. The requirements considered in the platform design include minimal equipment beyond what is available in many rehabilitation settings, minimal maintenance, and ease of setup and operation. In addition, the platform has been designed to be able to adjust to different bandwidths, ranging from the very fast new generation of Internet to residential broadband connections. VISYTER is a secure integrated system that combines high-quality videoconferencing with access to electronic health records and other key tools in telerehabilitation such as stimuli presentation, remote multiple camera control, remote control of the display screen, and an eye contact teleprompter. The software platform is suitable for supporting low-volume services to homes, yet scalable to support high-volume enterprise-wide telehealth services. The VISYTER system has been used to develop a number of telerehabilitation applications, including a remote wheelchair prescription, adult autistic assessments, and international physical therapy teleconsultations. An evaluation of VISYTER for delivering a remote wheelchair prescription was conducted on 48 participants. Results of the evaluation indicate a high level of satisfaction from patients with the use of VISYTER. The versatility and cost-effectiveness of the platform has the potential for a wide range of telerehabilitation applications and potentially may lower the technical and economic barriers of telemedicine adoption.

Telerehabilitation wheeled mobility and seating assessments compared with in person.

OBJECTIVE: To evaluate the equivalency of wheeled mobility and seating assessments delivered under 2 conditions: in person (IP) at a local clinic and via Telerehabilitation at remotely located clinics. DESIGN: The study used a prospective, multicenter controlled nonrandomized design to investigate wheeled mobility and seating assessments. SETTING: Five wheelchair clinics in Western Pennsylvania. PARTICIPANTS: Participants (N=98) in need of new wheeled mobility and seating were recruited and consented for IP assessments at the Center for Assistive Technology (n=50) and Telerehabilitation (n=48) assessments at remotely located clinics. INTERVENTIONS: The telerehabilitation condition used a custom videoconferencing system to connect a wheeled mobility and seating expert at the University of Pittsburgh's Rehabilitation Engineering Research Center on Telerehabilitation to a remote clinic. MAIN OUTCOME MEASURES: Study findings were based on the level of function the participants showed with their new wheeled mobility and seating devices as measured by using the Functioning Everyday with a Wheelchair (FEW) outcome tool. RESULTS: The results revealed no significant differences between the FEW pretest average or item scores for the 2 conditions or the FEW posttest average or item scores except for the FEW transportation item. The average FEW and FEW item scores reached the established clinically relevant pretest-posttest difference of 1.85, and the change scores were significantly different. The difference between FEW means based on posttest confidence intervals indicated that telerehabilitation was equally effective as IP rehabilitation. CONCLUSIONS: An expert practitioner located at least 125 miles away from each of the remote sites used a secured videoconferencing system to consult from a geographic distance on wheeled mobility and seating evaluations via telerehabilitation. Compared with participants receiving standard IP care, the telerehabilitation treatment condition was equally effective on all but 1 outcome.

Patient satisfaction with telerehabilitation assessments for wheeled mobility and seating.

Wheeled mobility and seating assessments for individuals with mobility impairments living in rural or distant locations are problematic due to the lack of expertise and available resources. The objective of this study was to measure satisfaction based on one's evaluation and prescription as well as comfort level when being evaluated by telerehabilitation (TR). Patient satisfaction data from real-time interactive TR clinical consultations between an expert practitioner located at least 125 miles away and four remote wheelchair clinics set up by the research team were collected and evaluated. The results revealed that there was a statistically significant difference between participants' pre- and postevaluation scores, t(39) = -13.92, p < .05, as well as pre- and postprescription scores, t(39) = -13.15, p < .05. In addition, all mean scores were significantly higher than the scale midpoint of3.5 on a TR survey. The study's findings are consistent with those of previous telemedicine satisfaction studies. Overall, the results indicate a high level of patient satisfaction using TR.

Methodology for analyzing and developing information management infrastructure to support telerehabilitation.

The proliferation of advanced technologies led researchers within the Rehabilitation Engineering Research Center on Telerehabilitation (RERC-TR) to devise an integrated infrastructure for clinical services using the University of Pittsburgh (PITT) model. This model describes five required characteristics for a telerehabilitation (TR) infrastructure: openness, extensibility, scalability, cost-effectiveness, and security. The infrastructure is to deliver clinical services over distance to improve access to health services for people living in underserved or remote areas. The methodological approach to design, develop, and employ this infrastructure is explained and detailed for the remote wheelchair prescription project, a research task within the RERC-TR. The availability of this specific clinical service and personnel outside of metropolitan areas is limited due to the lack of specialty expertise and access to resources. The infrastructure is used to deliver expertise in wheeled mobility and seating through teleconsultation to remote clinics, and has been successfully deployed to five rural clinics in Western Pennsylvania.