Smartphone- and Paper-Based Delivery of Balance Intervention for Older Adults Are Equally Effective, Enjoyable, and of High Fidelity: A Randomized Controlled Trial.

Home-based rehabilitation programs for older adults have demonstrated effectiveness, desirability, and reduced burden. However, the feasibility and effectiveness of balance-intervention training delivered through traditional paper-versus novel smartphone-based methods is unknown. Therefore, the purpose of this study was to evaluate if a home-based balance-intervention program could equally improve balance performance when delivered via smartphone or paper among adults over the age of 65. A total of 31 older adults were randomized into either a paper or phone group and completed a 4-week asynchronous self-guided balance intervention across 12 sessions for approximately 30 min per session. Baseline, 4-week, and 8-week walking and standing balance evaluations were performed, with exercise duration and adherence recorded. Additional self-reported measures were collected regarding the enjoyment, usability, difficulty, and length of the exercise program. Twenty-nine participants completed the balance program and three assessments, with no group differences found for any outcome measure. Older adults demonstrated an approximately 0.06 m/s faster gait velocity and modified balance strategies during walking and standing conditions following the intervention protocol. Participants further self-reported similar enjoyment, difficulty, and exercise effectiveness. Results of this study demonstrated the potential to safely deliver home-based interventions as well as the feasibility and effectiveness of delivering balance intervention through a smartphone-based application.

Ambulatory and successive home-based heart rate targeted aerobic training improves arterial parameters: a follow-up study in people with metabolic syndrome.

BACKGROUND: Studies demonstrated that outpatient aerobic exercise programs (aEP) can significantly decrease aortic stiffness in people with metabolic syndrome (MetS). There is some limited data that remotely supervised home-based aEP can also improve arterial stiffness in this population. We aimed to evaluate the changes in the arterial wall parameters after the 2-month ambulatory supervised aEP followed by the 6-month home-based aEP with and without targeting of heart rate (HR) by electrocardiogram (ECG) in people with MetS. METHODS: In this prospective study (ClinicalTrials.gov identifier: NCT05592704) 132 MetS subjects (mean age 52.44 ± 6.26 years, 54.55% female) were evaluated. At first, all subjects participated in the 2-month ambulatory supervised aEP, which consisted of 40 individual aerobic training sessions on a cycle ergometer 5 times/week for 40 min and received the recommendations for home-based training. Then the study (n = 66) and the control (n = 66) groups participated in the 6-month home-based aEP, but only the study group subjects targeted their HR using ECG monitor connected to the smartphone during workouts. Arterial stiffness parameters and carotid artery intima-media thickness (cIMT) were evaluated in all participants at baseline and after 8 months. RESULTS: After 8 months, carotid-femoral pulse wave velocity (c-f PWV) significantly reduced in both groups (-12.22% in the study group vs. -7.85% in the control group, all p < .001) without a significant between-group difference (p = 0.144). A significant improvement of carotid-radial pulse wave velocity (c-r PWV) was observed only in the study group (-11.37%, p < .001, d = -0.671) with significant between-group difference (p < .001). The reduction of c-r PWV after 8 months of aEP occurred when c-r PWV at baseline was in the 2nd quartile (>7.90 m/s). A significant decrease of 3.32% in cIMT was present only in the study group (p = .032, d = -0.288). CONCLUSIONS: The combination of 2-month ambulatory supervised aEP and successive 6-month home-based aEP targeted by HR monitoring using ECG improved arterial properties in MetS subjects more than the same combination without HR targeting, leading to the greater reduction of c-r PWV and cIMT.

The combination of 2-month ambulatory supervised aEP and successive 6-month home-based aEP targeted by HR monitoring using ECG improved arterial properties in MetS subjects more than the same combination without HR targeting, leading to the greater reduction of c-r PWV and cIMT.This study foregrounds the importance of home-based training with HR targeting using ECG in people with MetS.

Home-based exercise training by using a smartphone app in patients with Parkinson's disease: a feasibility study.

Background: Parkinson's disease (PD) patients experience deterioration in mobility with consequent inactivity and worsened health and social status. Physical activity and physiotherapy can improve motor impairments, but several barriers dishearten PD patients to exercise regularly. Home-based approaches (e.g., via mobile apps) and remote monitoring, could help in facing this issue. Objective: This study aimed at testing the feasibility, usability and training effects of a home-based exercise program using a customized version of Parkinson Rehab® application. Methods: Twenty PD subjects participated in a two-month minimally supervised home-based training. Daily session consisted in performing PD-specific exercises plus a walking training. We measured: (i) feasibility (training adherence), usability and satisfaction (via an online survey); (ii) safety; (iii) training effects on PD severity, mobility, cognition, and mood. Evaluations were performed at: baseline, after 1-month of training, at the end of training (T2), and at 1-month follow-up (T3). Results: Eighteen out of twenty participants completed the study without important adverse events. Participants' adherence was 91% ± 11.8 for exercise and 105.9% ± 30.6 for walking training. Usability and satisfaction survey scored 70.9 ± 7.7 out of 80. Improvements in PD severity, mobility and cognition were found at T2 and maintained at follow-up. Conclusion: The home-based training was feasible, safe and seems to positively act on PD-related symptoms, mobility, and cognition in patients with mild to moderate stage of PD disease. Additionally, the results suggest that the use of a mobile app might increase the amount of daily physical activity in our study population. Remote monitoring and tailored exercise programs appear to be key elements for promoting exercise. Future studies in a large cohort of PD participants at different stages of disease are needed to confirm these findings.

Can the supplementation of vitamin D, sun exposure, and isolation during the COVID-19 pandemic affect the seasonal concentration of 25(OH)D and selected blood parameters among young soccer players in a one-year training season?

OBJECTIVE: This study examined the effect of vitamin D supplementation, sunlight radiationradiation, and home isolation during the COVID-19 pandemic on the seasonal changes in 25(OH)D concentration and selected biomarkers in young soccer players along a one-year training cycle. METHOD: Forty elite young soccer players (age: 17.2 ± 1.16 years, body mass: 70.2 ± 5.84, and body height: 179.1 ± 4.26 cm) participated in the research. Only 24 players completed the measurements during all four time- points (T1-: September 2019, T2-: December 2019, T3-: May 2020, and T4-: August 2020) and were divided into two subgroups: supplemented group (GS) and placebo group (GP). Players from GS received 5,000 IU of vitamin D for 8 weeks (January-MarchJanuary-March 2020). Several biomarkers such as 25(OH)D, white blood cells (WBC), red blood cells (RBC), hemoglobin (HGB), muscle damage markersmarkers, and lipid profile were measured. RESULTS: AnalysisThe analysis of the total group demonstrated significant seasonal changes in 25(OH)D, HGB, asparagine aminotransferaseaminotransferase, and creatine kinase along the one1-year training cycle. The level of 25(OH)D concentrationinconcentration in T4 was significantly (p < 0.001, pη [ = 0.82) higher in both subgroups in comparison to T2 and T3. Moreover, the significant (p = 0.023) but poor (r = -0.23) correlation between 25(OH)D and WBC was calculated. CONCLUSION: Current research confirmed the significant seasonal changes in 25(OH)D concentration during four seasons. 8-weekEight-week vitamin D supplementation had no extended effect on the level of 25(OH)D concentration.

Feasibility and usability of a new home-based immersive virtual reality headset-based dexterity training in multiple sclerosis.

BACKGROUND: Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living and quality of life. OBJECTIVE: The aim of this study was to evaluate the feasibility, usability and patient engagement/satisfaction of a home-based immersive virtual reality (VR) headset-based dexterity training in persons with multiple sclerosis (pwMS). In addition, preliminary efficacy data on the impact of this new training on manual dexterity were collected. METHODS: Single arm prospective study. After a waiting period of two weeks, pwMS performed a specifically developed home-based VR headset-based dexterity training using the Oculus quest 2 for two weeks with five training sessions/week, each session for approximately 20 minutes. Primary endpoints were feasibility (measured by the adherence rate), usability (System Usability Scale, SUS) and patient engagement/satisfaction (Custom User Engagement Questionnaire, CUEQ). Secondary exploratory efficacy endpoints, measured before and after the waiting period as well as after the training intervention, were the Nine-hole-Peg-Test (9HPT), Coin rotation task (CRT), Handheld JAMAR dynamometer, Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and the Multiple Sclerosis Impact Scale 29 (MSIS 29). RESULTS: Eleven pwMS (mean age 49 ± 10.87 SD, mean EDSS 4.28 ± 1.48 SD) participated in the study. Feasibility (adherence rate: 81.8%), usability (median SUS score 94 (IQR = 78-96)) and patient engagement/satisfaction (median 8 on scale of 1-10) of the VR training was very high. In addition, the CRT for the dominant hand improved significantly after training (p = 0.03). CONCLUSIONS: The good results on feasibility, usability, and patient engagement/satisfaction qualify this home-based immersive VR headset-based dexterity training approach for the use in home-based neurorehabilitation in pwMS. Improved fine motor skills for the dominant hand suggest preliminary efficacy, but this needs to be proven in a future randomized-controlled trials.

Effect of Online Home-Based Resistance Exercise Training on Physical Fitness, Depression, Stress, and Well-Being in Middle-Aged Persons: A Pilot Study.

PURPOSE: This study investigated the effect of online home-based resistance exercise training on fitness, depression, stress, and well-being. A total of 67 individuals participated. Of them, 28 participants (13 men and 15 women, average age: 45.1 ± 12.2 years) performed the same exercise training online (n = 17), using Zoom, or in person (n = 11) in 2020 (Study 1). In addition, 39 participants (15 men and 24 women; average age: 47.6 ± 10.8 years) performed eight weeks of online home-based resistance exercise training in 2021 (Study 2). The participants performed low-load resistance exercises twice a week for eight weeks (16 sessions). Muscle strength, thigh muscle cross-sectional area, fitness parameters, blood pressure, mental health (Center for Epidemiologic Studies-Depression Scale-CES-D; and Kessler Psychological Distress scale-K6), and well-being (Well-Being Index-WHO-5) were measured pre-and post-resistance training. In Study 1, eight weeks of online home-based resistance training improved CES-D (p = 0.003), and a similar tendency was observed in resistance training (RT) with the in-person group (p = 0.06). There was a significant improvement in CES-D symptoms after the online home-based resistance training in Study 2 (p = 0.009). However, there were no significant changes in the WHO-5 and K6. Our results suggest that online low-load resistance training improves fitness parameters and curbs depressive status.

Effects of early home-based strength and sensory-motor training after total hip arthroplasty: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Total hip arthroplasty (THA) is very effective in alleviating pain, but functional deficits persist up to a year following surgery. Regardless of standard physiotherapy programs, significant additional muscular atrophy and weakness occur. Deficits in strength have serious adverse consequences for these patients with respect to physical function, the maintenance of independence, and the requirement for revision surgery. Progressive resistance training in rehabilitation following THA has been shown to significantly enhance muscle strength and function. The fundamental principle is to progressively overload the exercised muscle as it becomes stronger. Different strength training protocols have been used at different times in the postoperative phase, in group or individual practices, with major differences being in center-based and home-based programs with or without supervision. The primary objective of our study is to evaluate whether an early postoperative home-based strength training protocol can improve patient functional outcomes at 3 months and 1 year following surgery. Secondary objectives are the feasibility of the presented protocol for all elective THA patients and its safety. METHODS/DESIGN: This study is a prospective multicenter randomized clinical trial to be conducted in the orthopedic departments of two Slovenian hospitals. In each hospital, 124 patients aged 60 or older with unilateral osteoarthritis, an ASA score between 1 and 3, a signed informed consent form, and no terminal illness disabling rehabilitation participation will be randomly assigned to the intervention or control group. THA with an anterior approach will be performed. All patients will receive current standard physiotherapy during hospitalization. Patients in the intervention group will also learn strength and sensory-motor training exercises. Upon discharge, all will receive USB drives with exercise videos, written exercise instructions, and a training diary. Physiotherapists will perform the assessments (physical tests and the maximal voluntary isometric contraction assessment), and patients will fill out outcome assessment questionnaires (the Harris Hip Score and 36-Item Short Form Health Survey) at baseline and 1, 3, and 12 months after surgery. DISCUSSION: The main purpose of our study is to design a new standardized rehabilitation protocol with videos that will be effective, safe, and accessible to all Slovenian THA patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061993 . Registered on 07 November 2019. Protocol ID: PRT_PhD. Version 1.

Stroke survivors' experiences with home-based telerehabilitation using an assistive device to improve upper limb function: a qualitative study.

PURPOSE: Patients in the chronic phase after stroke often lack the possibility to intensively train their upper limb function. Assistive devices can be a solution to training intensively at home. This qualitative study investigated stroke survivors' experiences regarding training using the hoMEcare aRm rehabiLItatioN (MERLIN) system, an assistive device and telecare platform. We investigated patients' perspectives regarding the home-based training with the MERLIN system, on the International Classification of Functioning, Disability and Health (ICF) domains and the facilitators and barriers of the MERLIN system. METHODS: Eleven patients in the chronic phase of stroke who completed the MERLIN trial took part in semi-structured interviews. Interviews were analysed using the framework method. RESULTS: Participants were in general positive about the device and the training. Several experienced positive effects on ICF body functions, such as joint range of motion and self-confidence. Some experienced improvements in activities, but not on participation level. Home training had advantages: flexibility in training time and duration and no need to travel. The major barriers were technical hard- and software issues and ergonomic complaints. A list of recommendations regarding assistive devices and home-based rehabilitation was created. CONCLUSIONS: Homebased training using an assistive device was well received by stroke patients to train their upper limb function. Future device developers should take patients' feedback into account to overcome the barriers related to the introduction of new assistive devices at home. Our recommendations may be the first step to implementing patients' perspectives during the early stages of device development. Implications for rehabilitationTraining at home was a well-received and convenient solution to improve the upper limb functionBarriers regarding hard- and software and device ergonomics need to be addressed in future assistive devicesRecommendations are provided for more successful implementation of assistive devices and home-based telerehabilitation programs.

A feasibility trial of prehabilitation before oesophagogastric cancer surgery using a multi-component home-based exercise programme: the ChemoFit study.

BACKGROUND: Treatment for locally advanced oesophagogastric adenocarcinoma involves neoadjuvant chemotherapy which has a negative impact on patient fitness. Using 'prehabilitation' to increase activity levels and fitness may affect physiology, postoperative outcomes and improve patient wellbeing and quality of life. The aims of the trial were to address the feasibility and acceptability of recruiting participants to a home-based prehabilitation programme and provide data to allow design of future studies. METHODS: We recruited patients to a single-arm feasibility trial of home-based exercise prehabilitation. Eligible patients were aged ≥18years, had operable oesophageal or gastric adenocarcinoma and were receiving neoadjuvant chemotherapy at our tertiary referral hospital. All participants commenced a home-based exercise programme utilising pedometers and step counting to target daily aerobic exercise sessions alongside daily strengthening exercises. A weekly telephone consultation directed the exercise programme and facilitated weekly data collection. The primary (feasibility) outcomes for the trial were (a) recruitment rate, (b) completion rate, (c) engagement with the programme (use of pedometers, recording step counts, telephone consultations) and (d) compliance with exercise sessions, exercise intensity and strengthening exercises. RESULTS: There were 42 patients recruited, and the recruitment rate was 72.4% (42/58). 92.3% (36/39) of patients completed the exercise programme. There was 98.7% (IQR 93.2-100.0%) compliance with wearing a pedometer and recording data, and 100.0% (IQR 93.1-100.0%) compliance with a weekly telephone consultation. Exercise sessions and strengthening exercises were completed 70.2% (IQR 53.1-88.9%) and 69.4% (IQR 52.1-84.3%) of the time, respectively. Appropriate exercise intensity was recorded 96% (IQR 85.4-99.4%) of the time. There were no adverse events. Participants were enrolled in the exercise programme for a median of 91 days (IQR 84 to 105 days). CONCLUSIONS: The results of this trial support the feasibility and acceptability of recruiting participants to an appropriately powered randomised controlled trial of prehabilitation. TRIAL REGISTRATION: Clinicaltrials.gov NCT04194463 . Registered on 11th December 2019-retrospectively registered.

Effects of balance exercises during daily tooth brushing on balance performance in healthy children.

BACKGROUND: It has been shown that supervised balance training is effective in improving balance performance in children but relatively costly in terms of personnel, materials, and time. Integrating balance exercises into daily routines such as tooth brushing reduces these needs, but its effectiveness is unknown. OBJECTIVE: This study investigated the impact of balance exercises performed during daily tooth brushing on measures of static and dynamic balance in healthy children. METHODS: Fifty-five healthy children were assigned to either an intervention (n = 32, age: 9.5 ± 0.7 years) or a control (n = 23, age: 9.2 ± 0.5 years) group. Participants of the intervention group performed progressive balance exercises while tooth brushing on a daily basis (2 sessions per day × 3 min per session) for eight weeks. Static (i.e., timed one-legged stance test [OLS]) and dynamic (i.e., Lower Quarter Y Balance test [YBT-LQ]) balance were tested before and after the intervention period. RESULTS: The adherence rate to exercise was 98% for the participants of the intervention group. Significant test × group interactions in favor of the intervention group were detected in three out of four OLS stance conditions and for all YBT-LQ reach directions. CONCLUSIONS: Eight weeks of balance exercises while tooth brushing proved to be feasible (i.e., high adherence rate) and effective (i.e., enhanced static and dynamic balance performance) and is thus recommended to improve postural control in healthy children.

Process Evaluation of Home-based Bimanual Training in Children with Unilateral Cerebral Palsy (The COAD-study): A Mixed Methods Study.

PURPOSE: To evaluate the processes and factors that influenced implementation and impact of a home-based bimanual training program in children with unilateral cerebral palsy aged 2 through 7 years. METHODS: The program encompassed bimanual task-specific training (3.5 hours/week for 12 weeks) adopting either implicit or explicit motor learning. A therapist and remedial educationalist coached parents. This mixed methods study included course attendance monitoring, questionnaires, registration form, video analysis, interviews, focus group discussion, and drop-out monitoring. RESULTS: Fourteen families participated. The program was not fully implemented as intended. Parents positively experienced the training and were well able to provide it. The program was demanding for the children and time-consuming for parents. Several components positively contributed to the program: task-analysis, instructional videos, and coaching by a therapist and remedial educationalist. Several modifications to the program were proposed. CONCLUSION: Home-based bimanual training forms a demanding but promising therapeutic approach with potential for optimization.

Effects of home-based occupational therapy telerehabilitation via smartphone for outpatients after hip fracture surgery: A feasibility randomised controlled study.

INTRODUCTION: This study aimed to investigate the effects of a home-based occupational therapy telerehabilitation (TR) via smartphone in enhancing functional and motor performance and fall efficacy for outpatients receiving day hospital rehabilitation after hip fracture surgery in Hong Kong. METHODS: This was a feasibility randomised controlled trial with two groups - an experimental group and a comparison group - and a sample of 31 older adults attending a geriatric day hospital who had undergone hip fracture surgery within 12 weeks of diagnosis. Patients were assessed at baseline, immediately after a three-week intervention and at three-week post-intervention follow-up for motor performance, activities of daily living (ADL) functioning and fall efficacy. The experimental group received a home programme using the Caspar Health e-system and a mobile app for smartphones, while the comparison group received paper-and-pencil instructions for the home programme on a weekly basis for three weeks. RESULTS: Compared to the comparison group, significant improvements in fall efficacy and instrumental ADL performance at post intervention and follow-up were found in the experimental group. However, in the comparison group, inadequate social support was a factor contributing to better muscle strength testing in both the affected and non-affected legs. There were no significant differences between the two groups in regard to the other variables. DISCUSSION: This study supports the potential use of TR via smartphone as an alternative home programme for use in occupational therapy practice with older adults after hip fracture surgery.

COVEPIC (Cognitive and spOrt Virtual EPIC training) investigating the effects of home-based physical exercise and cognitive training on cognitive and physical functions in community-dwelling older adults: study protocol of a randomized single-blinded clinical trial.

BACKGROUND: In the context of the COVID-19 pandemic, lockdown and social distancing measures are applied to prevent the spread of the virus. It is well known that confinement and social isolation can have a negative impact on physical and mental health, including cognition. Physical activity and cognitive training can help enhance older adults' cognitive and physical health and prevent the negative collateral impacts of social isolation and physical inactivity. The COVEPIC study aims to document the effects of 6 months of home-based physical exercise alone versus home-based physical exercise combined with cognitive training on cognitive and physical functions in adults 50 years and older. METHODS: One hundred twenty-two healthy older adults (> 50 years old) will be recruited from the community and randomized to one of the two arms for 6 months: (1) home-based physical exercises monitoring alone and (2) combined physical exercises monitoring with home-based cognitive training. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as executive functions, processing speed, and episodic memory (composite Z-scores based on validated neuropsychological tests and computerized tasks). The secondary outcome is physical functions, including balance (one-leg stance test), gait and mobility performance (Timed Up and Go, 4-meter walk test), leg muscle strength (5-time sit-to-stand), and estimated cardiorespiratory fitness (Matthews' questionnaire). Exploratory outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported questionnaires (i.e., Geriatric depression scale-30 items, Perceived stress scale, State-trait anxiety inventory-36 items, Perseverative thinking questionnaire, Connor-Davidson Resilience Scale 10, and 12-item Short Form Survey). DISCUSSION: This trial will document the remote monitoring of home-based physical exercise alone and home-based physical combined with cognitive training to enhance cognitive and physical health of older adults during the COVID-19 pandemic period. Remote interventions represent a promising strategy to help maintain or enhance health and cognition in seniors, and potentially an opportunity to reach older adults in remote areas, where access to such interventions is limited. TRIAL REGISTRATION: Clinical trial Identifier NCT04635462 . COVEPIC was retrospectively registered on November 19, 2020.

Effect of Home-based Bimanual Training in Children with Unilateral Cerebral Palsy (The COAD-study): A Case Series.

Purpose: To explore the child- and parent-related effects of home-based bimanual training in children with unilateral cerebral palsy.Methods: Case series of 14 children (2-7 years) who completed goal-oriented task-specific training for 3.5 hours/week for 12 weeks by a program adopting implicit (n = 5) or explicit (n = 9) motor learning. A therapist and remedial educationalist coached parents. Progression on bimanual goals (Canadian Occupational Performance Measure (COPM)) and therapy-related parental stress (interviews) were of primary interest. Data were collected at baseline (T0), halfway through and at the end of training (T1 and T2), and after 12 weeks (T3).Results: On the COPM performance scale a clinically relevant change was seen in 50% (7/14), 86% (12/14), and 85% (11/13) of the children, at T1, T2, and T3, respectively. Some parents indicated that they had experienced stress because of the training intensity.Conclusion: The child- and parent-related effects of the home-based bimanual training programs are encouraging.

Initial Evaluation of the Concept-2 Rowing Ergometer's Accuracy Using a Motorized Test Rig.

INTRODUCTION: The Concept 2 (C2) rowing ergometer is used worldwide for home-based training, official competitions, and performance assessment in sports and science. Previous studies reported a disparate underestimation of mechanical power output positively related to an unclearly defined stroke variability. The aim of this study was to quantify the accuracy of the C2 while controlling for the potentially influencing variables of the rowing stroke by using a test rig for air-braked rowing ergometers and thus excluding biological variability. METHODS: A unique motorized test rig for rowing ergometers was employed. Accuracy was assessed as the difference in mechanical power output between C2 and a reference system during steady (i.e., minimal variations of stroke power within a series of 50 spacemark, no -strokes) and unsteady simulated rowing (i.e., persistent variations during measurement series) while manipulating the stroke variables shape, force, or rate. RESULTS: During steady simulated rowing, differences between C2 and the reference system ranged 2.9-4.3%. Differences were not significantly affected by stroke shapes (P = 0.153), but by stroke rates ranging 22-28 min-1 (P < 0.001). During unsteady simulated rowing with alterations of stroke force and rate, mean differences of 2.5-3.9% were similar as during steady simulated rowing, but the random error increased up to 18-fold. C2 underestimated mechanical power output of the first five strokes by 10-70%. Their exclusion reduced mean differences to 0.2-1.9%. CONCLUSION: Due to the enormous underestimation of the start strokes, the nominal accuracy of the C2 depends on the total number of strokes considered. It ranges 0.2-1.9%, once the flywheel has been sufficiently accelerated. Inaccuracy increases with uneven rowing, but the stroke shape has a marginal impact. Hence, rowers should row as even as possible and prefer higher stroke rates to optimize C2 readings. We recommend external reference systems for scientific and high-performance assessments, especially for short tests designs where the start strokes will have a major impact.

The effect of the walk-bike on quality of life and exercise capacity in patients with idiopathic pulmonary fibrosis: a feasibility study.

Idiopathic pulmonary fibrosis (IPF) is characterized by progressive loss of pulmonary function and exercise capacity, leading to loss of quality of life and often social isolation. A new walking aid, the walk-bike, showed an improvement in exercise performance in COPD patients. Aims of this pilot study were to evaluate feasibility of a homebased walk-bike intervention study in IPF patients and to explore the effect of the walk-bike on quality of life (QoL) and exercise capacity. Twenty-three patients with IPF were included in a randomized multicenter crossover study with 8 weeks of standard care and 8 weeks of walk-bike use at home. Ten patients completed both study phases. Study barriers included reluctance to participate and external factors (e.g. weather and road conditions) that hampered adherence. Patients' satisfaction and experience with the walk-bike varied greatly. After training with the walk-bike, health-related QoL (St. George's Respiratory and King's Brief Interstitial Lung Disease questionnaires) demonstrated a tendency towards improvement, exercise capacity did not. A clinically important difference was found between 6-minute walk test with the walk-bike and the standard test; median (range) respectively 602 m (358-684) and 486 m (382-510). Conclusions: Due to practical barriers a larger study with the walk-bike in patients with IPF seems not feasible. Individual patients may benefit from the use of a walk-bike as it improved action radius and showed a tendency towards improvement in QoL. No effect on exercise capacity was observed. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 192-202).

Rationale and protocol of the StayFitLonger study: a multicentre trial to measure efficacy and adherence of a home-based computerised multidomain intervention in healthy older adults.

BACKGROUND: In older adults, multidomain training that includes physical and cognitive activities has been associated with improvement of physical and cognitive health. The goal of the multisite StayFitLonger study is to assess a home-based computerised training programme, which combines physical exercises, stimulating cognitive activities and virtual coaching. METHODS: One hundred twenty-eight cognitively healthy older adults will be recruited from the community in Switzerland, Canada and Belgium. The study will comprise (1) a 26-week double-blind randomized controlled efficacy trial and (2) a 22-week pragmatic adherence sub-study. In the efficacy trial, participants will be randomly assigned to an experimental or an active control intervention. In the experimental intervention, participants will use the StayFitLonger programme, which is computerised on a tablet and provides content that combines physical activities with a focus on strength and balance, as well as divided attention, problem solving and memory training. Outcomes will be measured before and after 26 weeks of training. The primary efficacy outcome will be performance on the "Timed-Up & Go" test. Secondary outcomes will include measures of frailty, cognition, mood, fear of falling, quality of life, and activities of daily living. Age, sex, education, baseline cognition, expectation, and adherence will be used as moderators of efficacy. Following the 26-week efficacy trial, all participants will use the experimental programme meaning that participants in the control group will 'cross over' to receive the StayFitLonger programme for 22 weeks. Adherence will be measured in both groups based on dose, volume and frequency of use. In addition, participants' perception of the programme and its functionalities will be characterised through usability, acceptability and user experience. DISCUSSION: This study will determine the efficacy, adherence and participants' perception of a home-based multidomain intervention programme and its functionalities. This will allow for further development and possible commercialization of a scientifically validated training programme. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04237519 Registered on January 22, 2020 - Retrospectively registered.

Feasibility of a Home-Based Tablet App for Dexterity Training in Multiple Sclerosis: Usability Study.

BACKGROUND: Persons with multiple sclerosis (MS) often experience dexterous difficulties during the performance of activities of daily living, such as fastening buttons, handling coins, or writing, therefore impacting their health-related quality of life. Mobile health (mHealth) solutions, such as tablet apps, may be used to train impaired dexterous skills. The feasibility of a tablet app-based dexterity home-based intervention in MS (TAD-MS) has not been explored yet in persons with MS. OBJECTIVE: The aim of this pilot study was to evaluate the feasibility and usability of home-based dexterity training with a tablet app in both persons with MS and healthy subjects. METHODS: A total of 9 persons with MS, aged 35-71 years, with an Expanded Disability Status Scale score between 2 and 7.5, performed the TAD-MS for 4 weeks, five times a week, with each training session lasting approximately 30 minutes. Participants' impaired dexterity was measured by the Nine-Hole Peg Test. A total of 10 age-matched healthy subjects also tested and rated the usability of the app. Outcome measures were the adherence rate as well as usability measured by the System Usability Scale and a Custom User Engagement Questionnaire (CUEQ). RESULTS: High feasibility of the tablet app-based dexterity training program was shown by a 97% adherence rate to the training protocol (ie, mean 19.4/20 sessions completed, SD 0.8). High system usability scores (ie, mean 85.39%, SD 11.67) and overall high scores given in the CUEQ (ie, mean 8.2/10, SD 1.4) further point to high usability of the app. Neither demographic variables nor dexterity levels affected the use of the app. CONCLUSIONS: This pilot study is the first to demonstrate high feasibility and usability of a new tablet app-based dexterity home-based training program among both persons with MS and healthy individuals. Whether this kind of training improves dexterity will need to be evaluated in a randomized controlled trial.

Utilizing multi-user virtual reality to bring clinical therapy into stroke survivors' homes.

INTRODUCTION: Lifespans after the occurrence of a stroke have been lengthening, but most stroke survivors will experience chronic impairment. Directed, repetitive practice may reduce deficits, but clinical access is often limited by a variety of factors, such as transportation. PURPOSE OF THE STUDY: To introduce a multiuser virtual reality platform that can be used to promote therapist-client interactions when the client is at home. METHODS: The Virtual Environment for Rehabilitative Gaming Exercises encourages exploration of the hand workspace by enabling multiple participants, located remotely and colocated virtually, to interact with the same virtual objects in the shared virtual space. Each user controls an avatar by corresponding movement of his or her own body segments. System performance with stroke survivors was evaluated during longitudinal studies in a laboratory environment and in participants' homes. Active arm movement was tracked throughout therapy sessions for both studies. RESULTS: Stroke survivors achieved considerable arm movement while using the system. Mean voluntary hand displacement, after accounting for trunk displacement, was greater than 350 m per therapy session for the Virtual Environment for Rehabilitative Gaming Exercises system. Compliance for home-based therapy was quite high, with 94% of all scheduled sessions completed. Having multiple players led to longer sessions and more arm movement than when the stroke survivors were trained alone. CONCLUSIONS: Multiuser virtual reality offers a relatively inexpensive means of extending clinical therapy into home and enabling family and friends to support rehabilitation efforts, even when physically remote from each other.

Effectiveness of Home-based rehabilitation in improving physical function of persons with Stroke and other physical disability: A systematic review of randomized controlled trials.

BACKGROUND: A significant number of people with physical disabilities in the world, especially in most developing countries face a lot of impediments. There is a dearth of literature describing the consensus of effectiveness of home-based rehabilitation programs designed specifically for people living with different types of physical disabilities resulting from stroke, Parkinson's and other musculoskeletal conditions. OBJECTIVE: To determine if home-based rehabilitation is effective in improving physical function of people with physical disabilities. METHOD: A systematic review of randomized controlled trials was done. An electronic search of the literature was done by PubMed, Cochrane Library, the Physiotherapy Evidence Database and Cumulative Index to Nursing and Allied Health Literature from 1990 to March 2018 to identify full text, peer-reviewed randomized controlled trials, Published in English. Selected randomized controlled trials were critically appraised with 11 items Physiotherapy Evidence Database scale scores extracted from the Physiotherapy Evidence Database and studies were included if the cutoff of 5 points was reached on Physiotherapy Evidence Database scale score. RESULTS: Nine randomized controlled trials met the preset eligibility criteria. This systematic review found that there is the consistency of findings among the included studies which showed that home-based rehabilitation is an effective option for people with physical disabilities. CONCLUSION: Home-based rehabilitation is not superior to hospital-based rehabilitation in improving nearly all patient outcomes assessed. However, home-based exercise programs require patient enthusiasm and regular follow-up to yield positive outcomes.