Developing and Validating an Intelligent Mouth-Opening Training Device: A New Solution for Restricted Mouth Opening.

Restricted mouth opening (trismus) is one of the most common complications following head and neck cancer treatment. Early initiation of mouth-opening exercises is crucial for preventing or minimizing trismus. Current methods for these exercises predominantly involve finger exercises and traditional mouth-opening training devices. Our research group successfully designed an intelligent mouth-opening training device (IMOTD) that addresses the limitations of traditional home training methods, including the inability to quantify mouth-opening exercises, a lack of guided training resulting in temporomandibular joint injuries, and poor training continuity leading to poor training effect. For this device, an interactive remote guidance mode is introduced to address these concerns. The device was designed with a focus on the safety and effectiveness of medical devices. The accuracy of the training data was verified through piezoelectric sensor calibration. Through mechanical analysis, the stress points of the structure were identified, and finite element analysis of the connecting rod and the occlusal plate connection structure was conducted to ensure the safety of the device. The findings support the effectiveness of the intelligent device in rehabilitation through preclinical experiments when compared with conventional mouth-opening training methods. This intelligent device facilitates the quantification and visualization of mouth-opening training indicators, ensuring both the comfort and safety of the training process. Additionally, it enables remote supervision and guidance for patient training, thereby enhancing patient compliance and ultimately ensuring the effectiveness of mouth-opening exercises.

The use of physically constraining tools for grip-specific skill development in racket, stick and club sports: A scoping review.

Coaches use physically constraining tools to supplement their coaching when developing sport-specific skills, however, their effectiveness is unknown. This scoping review aimed to understand the efficacy of physically constraining tools used in racket, stick, and club sports for grip-specific skill development. This scoping review followed the Joanna Briggs Institute methodology and PRISMA guidelines. Peer-reviewed research, including quasi-experimental, true-experimental, case studies, and grey literature were considered. Peer-reviewed sources were searched on Web of Science, Medline, and SPORTDiscus until October 6th, 2022. Exclusion criteria were (1) not original peer-reviewed research; (2) disabled participants or used for rehabilitation; or (3) not available in English. Data extracted were the type of tool, research foci, measures, and outcomes of the tool's efficacy. Zero peer-reviewed sources were identified on the efficacy of using physically constraining tools for grip-specific skill development. Common trends identified from the excluded sources were explored to provide a basis for the importance of using physically constraining tools for grip-specific skill development. Many tools are used in coaching despite their unclear efficacy, however, the current results can guide future work to assess the acute and longitudinal effects of using these tools, specifically within the development and performance of sport-specific skills.

The Ability to Use Epinephrine Autoinjector in Patients Who Receive Prescription Immediately after Anaphylaxis.

BACKGROUND: Epinephrine autoinjector (EAI) is prescribed to prevent a fatal outcome in the case of a repeated anaphylactic reactions. We wanted to determine how adult patients who received their first prescription as part of an urgent treatment of an anaphylactic reaction or at their family physician were instructed on the use of EAI. METHODS: Nurses assessing patients' knowledge asked the patient to demonstrate how to use the EAI training device. Patients who performed the critical steps correctly in 1 min were labelled as competent. RESULTS: Forty-one patients (24% women, 46 ± 5 years) came for the allergy examination 116 ± 145 days after receiving a prescription for EAI. When prescribing, the doctor or nurse explained the instructions for the use of EAI to 63.4% patients, and 31.7 patients practiced the use of EAI using a training device. At the pharmacy, 22% received explanation and 7% also practiced using a training device. Fifty-four percent of patients were able to effectively administer EAI adrenaline within 1 min. Higher education level was associated with sufficient knowledge about the use of EAI (p = 0.026). At the time of the visit to the allergy specialist clinic, 61% of patients had EAI with them. The shelf life of EAI was known to 63% of patients. CONCLUSIONS: The activities to increase the prescription rate of EAI immediately after treatment of anaphylactic episode are not sufficient to prevent severe outcome after the repeated episodes of anaphylaxis as nearly a half of patients are not able to use EAI correctly.

Endoscopic part-task training box scores correlate with endoscopic outcomes.

BACKGROUND: Competency in endoscopy has traditionally been based on number of procedures performed. With movement towards milestone-based accreditation, new standards of establishing competency are required. The Thompson Endoscopic Skills Trainer (TEST) is a training device previously shown to differentiate between novice and expert endoscopists. This study aims to correlate TEST scores to other markers of performance in endoscopy. METHODS: Trainees of a gastroenterology fellowship program were guided through the TEST. Their scores and sub-scores were correlated to their endoscopic metrics of performance, including adenoma detection rate, cecal intubation rate, cecal intubation time, withdrawal time, fentanyl usage, midazolam usage, pain score, overall procedure time, and performance on the ASGE Assessment of Competency in Endoscopy Tool (ACE Tool). RESULTS: The Overall Score positively correlated with the ACE Tool Total Score (r = 0.707, p = 0.010) and sub-scores (Cognitive Skills Score: r = 0.624, p = 0.030; Motor Skills Score: r = 0.756, p = 0.004), and negatively correlated with cecal intubation time (r = - 0.591, p = 0.043). The Gross Motor Score positively correlated with cecal intubation rate (r = 0.593, p = 0.042), ACE Tool Total Score (r = 0.594, p = 0.042) and Motor Skills Score (r = 0.623, p = 0.031), and negatively correlated with cecal intubation time (r = - 0.695, p = 0.012). The Fine Motor Score positively correlated with the ACE Tool Polypectomy Score (r = 0.601, p = 0.039), and negatively correlated with procedure time (r = - 0.640, p = 0.025), cecal intubation time (r = - 0.645, p = 0.024), and withdrawal time (r = - 0.629, p = 0.028). CONCLUSION: This study demonstrates that performance on the TEST correlate to endoscopic measures. Given these results, the TEST may be used in conjunction with existing assessment tools for demonstrating competency in endoscopy.

HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke.

BACKGROUND: HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). METHODS: Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation. RESULTS: Twelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements. CONCLUSION: Patients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/7535 .

HoMEcare aRm rehabiLItatioN (MERLIN): preliminary evidence of long term effects of telerehabilitation using an unactuated training device on upper limb function after stroke.

BACKGROUND: While short term effects on upper limb function of stroke patients after training with robotic devices have been studied extensively, long term effects are often not addressed. HoMEcare aRm rehabiLItatioN (MERLIN) is a combination of an unactuated training device using serious games and a telerehabilitation platform in the patient's home situation. Short term effects showed that upper limb function improved after training with MERLIN. The aim was to determine long term effects on upper limb function and quality of life. METHODS: Six months after cessation of the 6 week MERLIN training program, the upper limb function and quality of life of 11 chronic stroke patients were assessed. Upper limb function was measured using the Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE). EuroQoL-5D (EQ-5D) was used to measure quality of life. RESULTS: The WMFT, ARAT and EQ-5D did not show significant differences 6 months after the training period compared to directly after training. At 6 months follow-up, FMA-UE results were significantly better than at baseline. Time plots showed a decreasing trend in all tests. CONCLUSION: Training effects were still present at 6 months follow-up, since arm function seemed similar to directly after training and FMA-UE results were better than at baseline. However, because of the decreasing trend shown in all tests, it is questionable if improvements will be maintained longer than 6 months. Due to the sample size and study design, results should be interpreted with caution. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/7535.

Development of a Hand Motion-based Assessment System for Endotracheal Intubation Training.

Endotracheal intubation (ETI) is a procedure to manage and secure an unconscious patient's airway. It is one of the most critical skills in emergency or intensive care. Regular training and practice are required for medical providers to maintain proficiency. Currently, ETI training is assessed by human supervisors who may make inconsistent assessments. This study aims at developing an automated assessment system that analyzes ETI skills and classifies a trainee into an experienced or a novice immediately after training. To make the system more available and affordable, we investigate the feasibility of utilizing only hand motion features as determining factors of ETI proficiency. To this end, we extract 18 features from hand motion in time and frequency domains, and also 12 force features for comparison. Subsequently, feature selection algorithms are applied to identify an ideal feature set for developing classification models. Experimental results show that an artificial neural network (ANN) classifier with five hand motion features selected by a correlation-based algorithm achieves the highest accuracy of 91.17% while an ANN with five force features has only 80.06%. This study corroborates that a simple assessment system based on a small number of hand motion features can be effective in assisting ETI training.

Construct validity of the SurgForce system for objective assessment of laparoscopic suturing skills.

BACKGROUND: Laparoscopic surgery requires a new set of skill to be learned by the surgeons, of which the most relevant is tissue manipulation. Excessive forces applied to the tissue can cause rupture during manipulation or ischemia when confronting both sides of the tissue. The aim of this study is to establish the construct validity of the SurgForce system for objective assessment of advanced laparoscopic skills, based on the force signal generated during suture tasks, and the development of force parameters for evaluating tissue handling interaction. METHODS: The SurgForce system, a tissue handling training device that measures dynamic force, was used to capture the force generated by surgeons with different levels of laparoscopic experience. For construct validity, 37 participants were enrolled in this study: 19 medical students, 12 residents of surgical specialties and 6 expert surgeons. All participants performed an intracorporeal knotting suture task over a synthetic tissue pad with a laparoscopic box-trainer. The force performance of the participants was analyzed using 11 force-based parameters with the application of the SurgForce system. Statistical analysis was performed between novice, intermediate, and expert groups using a Kruskal-Wallis test, and between the pairs of groups using a Mann-Whitney U-test. RESULTS: Overall, 9 of the 11 force-related parameters showed significant differences between the three study groups. Results between the pairs of groups presented significant differences in 5 force parameters proposed. Construct validity results demonstrated that the SurgForce system was able to differentiate force performance between surgeons with different levels of laparoscopic experience. CONCLUSION: The SurgForce system was successfully validated. This force system showed its potential to measure the force exerted on tissue for objective assessment of tissue handling skills in suturing tasks. Furthermore, its compact design allows the use of this device in conventional laparoscopic box-trainers.

Learning to stand tall: Idiopathic scoliosis, behavioral electronics, and technologically-assisted patient participation in treatment, c. 1969-1992.

Drawing on the archives of American learning psychologist Neal E. Miller, this article investigates the role of instrumentation in the expansion and diversification of the behavior therapy domain from the late 1960s to the early 1990s. Through the case of Miller's research on the use of biofeedback to treat idiopathic scoliosis, it argues that the post-World War II adoption of electronic technology by behavioral psychologists contributed to extending their subject matter to include physiological processes and somatic conditions. It also enabled a technologically-instrumented move outside the laboratory through the development of portable ambulatory treatment devices. Using the example of the Posture-Training Device that Miller and his collaborators invented for the behavioral treatment of idiopathic scoliosis, this paper considers how electromechanical psychological instrumentation illustrated a larger and ambiguous strategic shift in behavior therapy from an orientation toward external control to one of self-control.

[The use of the visuo-motor reaction training device for the improvement of the coordination in the eye-hand system of the children and adolescents following the completion of the antineoplastic treatment of brain tumours]. / Primenenie trenazhera zritel'no-motornoi korrektsii dlia uluchsheniia koordinatsii v sisteme glaz-ruka u detei i podrostkov posle zaversheniia protivoopukholevoi terapii novoobrazovanii golovnogo mozga.

The survivors among the children and adolescents with a brain tumour are likely to show evidence of the impairment of the most important cognitive functions, such as attention, visual-motor integration, and working memory, following the completion of the antineoplastic treatment. The basic characteristics of these functions compromised in the patients presenting with the most serious cognitive deficiency are the information processing rate and the time needed for carrying out any cognitive activity in the patients experiencing deficit of white matter in the brain. AIM: The objective of the present study was to demonstrate the possibility and the effectiveness of the application of the new method for the stimulation of the information processing activity of the brain, the enhancement of its effectiveness, and the improvement of the quality of the visual-motor coordination in the children and adolescents following the completion of the antineoplastic treatment of brain tumours. This paper reports the first experience of the application of the Dynavision d2 visuo-motor reaction training device which has been used for the visual-motor integration and the increase of the information processing speed. MATERIAL AND METHODS: The sample included in the study was comprised of a total of 46 children at the mean age of 10.6±3.34 years that had undergone the treatment of the brain neoplasm. Each patient participated in 5 to 8 sessions of exercises with the use of the the Dynavision d2 visuo-motor reaction training device during 21 days. RESULTS: All the treated patients exhibited the stable reduction of the mean time of the reaction from the first session to the last one. The comparison of the outcomes of the treatment between the children of different sexes has demonstrated better results (in absolute terms and in dynamics) in the girls in comparison with the boys. The exercises with the use of the Dynavision d2 visuo-motor reaction training device were not accompanied by any negative subjective sensations in the treated patients, nor did they induce the adverse somatic side effects. CONCLUSION: The results of the present study give evidence of both the applicability and the effectiveness of the application of the Dynavision d2 visuo-motor reaction training device for the diagnostics of the disturbances in the motor and visual coordination and the associated cognitive functions and for their correction in the children following the treatment of the neoplasm of the posterior cranial fossa.

Performance analysis in sport: contributions from a joint analysis of athletes' experience and biomechanical indicators.

The purpose of this study was to test the usefulness of combining two types of analysis to investigate sports performance with the aim of optimizing it. These two types of analysis correspond to two levels of athletes' activity: (a) their experiences during performance and (b) the biomechanical characteristics of their movements. Rowing served as an illustration, and the activity of one female crew member was studied during a race. Three types of data were collected: (a) audiovisual data recorded during the race; (b) verbalization data obtained in interviews conducted afterward; and (c) biomechanical data. The courses of experience of the two rowers during the race were reconstructed on the basis of the audiovisual and verbalization data. This paper presents a detailed analysis of a single phenomenon of the race experienced by one of the rowers. According to the coaches, it reflected a dysfunction in crew coordination. The aim of this analysis was to identify the biomechanical characteristics of the rowers' movements that might explain it. The results showed that the phenomenon could be explained principally by an amplitude differential between the two rowers' strokes. On this basis, the coaches defined new training objectives to remedy the dysfunction in crew coordination.

Biomechanical comparison of walking with a new, wearable rehabilitation training device to Nordic walking and regular walking in people with chronic low back pain.

Physical activity, particularly walking, is commonly used for the treatment of diseases such as low back pain. In this study, the effects of walking wearing the new ToneFit Reha training belt (TFR) were compared to both Nordic walking and regular walking. The TFR is intended to intensify the effects of walking through the integration of two adjustable resistance handles. Ten patients with low back pain performed regular walking, Nordic walking, and walking with the TFR in a movement laboratory. The kinematics of the trunk, upper extremities, and lower extremities were measured, and the activity of the trunk and upper extremity muscles recorded. Data were analyzed by repeated-measures ANOVA and paired t-test. Kinematics indicated that walking with the TFR introduces instability that was mitigated by a delayed peak trunk rotation (peak at 63.3% gait cycle, vs. 52.8% in walking (p = .001) and 51.0% in NW (p = .007)). Upper extremity kinematics (constrained elbow flexion, high peak shoulder abduction) showed movement patterns that need to be considered when training over a longer period. Increased muscle activity was observed especially for upper extremity muscles, when training with TFR. Overall, walking with the TFR was found to be a suitable therapy for use in a rehabilitation setting.

Electro-localization method using a muscle conductive phantom for needle position detection towards medical training.

Simulation in healthcare can help train, improve, and evaluate medical personnel's skills. In the case of needle insertion/manipulation inside the muscle during an nEMG examination, a training simulator Requires estimating the position of the needle to output the electrical muscle activity in real time according to the training plan. External cameras can be used to estimate the needle location; however, different error sources can make its implementation difficult and new medical sensing technologies are needed. This study introduces and demonstrates the feasibility of a conductive phantom that serves as the medium for needle insertion and senses the 3D needle position based on a technique named electro-localization for the first time. The proposed conductive phantom is designed so that different voltage distributions are generated in the phantom using electrodes placed on its borders. The needle is inserted in the phantom, and the recorded voltages are mapped to spatial coordinates using a finite element method (FEM)-based computational model of the conductive phantom to estimate the 3D needle tip position. Experimental and simulation results of phantom voltage distributions agreed. In 2D mapping (no depth consideration), the needle position error was 1.7 mm, which was marginally reduced if only the central area of the phantom was used (1.5 mm). In 3D mapping, the error was 4 mm. This study showed the feasibility of using a conductive muscle phantom as a new embedded sensor that estimates needle position for medical training of nEMG without relying on external sensors.

Influence of a special training process on the psychomotor skills of cadet pilots - Pilot study.

Objectives: The aim of the pilot study was to check the influence of the training process on the Special Aviation Gymnastics Instruments (SAGI) on the improvement of the psychomotor skills, expressed as an increase in the percentage of ability to perform all tasks and the number of reels on a loop. Materials and methods: Cadets - second year pilots (n = 20), male, mean age 20.8 years old, studying at the faculty of a pilot. Cadets were carrying out a 40-h special pilot training program on SAGI. They were subjected to two exercise tests (reels forward on looping), before and after the period of special training. Exercise tests were performed with the use of a diagnostic and training device used to assess psychomotor skills. During two tests, heart rate (HR) and blood pressure were measured. The obtained results were analysed statistically. Results: There was a statistically significant increase in the percentage of ability to perform all tasks (p < 0.01) and a statistically insignificant increase in the number of reels forward on looping, in test II in relation to test I. A significant increase was found in the correct execution of arithmetic operations (p < 0.05) in test II in relation to test I. In the remaining tests, an increase in results in test II was noted, but it was not statistically significant. There was a significant correlation between the percentage ability to perform all tasks and the number of completed reels in test I (p < 0.05) and insignificant in test II. In test II, a statistically insignificant higher level of heart rate and blood pressure before and after the effort was noted, compared to test I. Conclusion: It was found that the training process on SAGI increased the psychomotority level by increasing the percentage of ability to perform all tasks and the number of reels, in test II in relation to test I.

Effect of transcranial direct current stimulation combined with a smart hand joint training device on hand dysfunction in patients with early stroke.

INTRODUCTION: The aim of this study was to investigate the effect of transcranial direct current stimulation (tDCS) combined with a smart hand joint training device on hand dysfunction in patients with early stroke. MATERIAL AND METHODS: This study was a randomized controlled trial, which was conducted in the neurology department in our hospital. From March 2019 to January 2021, 60 patients diagnosed with early stroke hand dysfunction were selected. A random number table method was used to divide patients equally into control group (smart hand joint training device group) and intervention group (tDCS and smart hand joint training device group). Before and after treatment, Brunnstrom six-level staging, Fugl-Meyer motor function score (wrist hand part), hemiplegic finger function examination, and hemiplegic hand function classification evaluation were applied in both groups. Main outcome measures were Brunnstrom motor function staging (hand part), functional evaluation of hemiplegic fingers, and Fugl-Meyer motor function score (wrist hand part). RESULTS: After treatment, compared with control group, the results in intervention group of Brunnstrom six-level staging and hemiplegic hand function classification evaluation showed obvious improvement (p = 0.000), and the result of hemiplegic fingers' functional evaluation also improved (p = 0.026). After treatment, Fugl-Meyer motor function scores were 6.73 ±6.65 (control group) and 9.8 ±6.66 (intervention group). Slight tDCS-related adverse events occurred in one patient (3.33%) in intervention group. None in either group discontinued treatment. CONCLUSIONS: Both the smart hand joint training device alone and tDCS combined with the smart hand joint training device can improve hand function of patients with early stroke to varying degrees, but the treatment effect of tDCS combined with the smart hand joint training device is more significant.

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.

The current paradigm for biologic initiation: a confirmatory quantitative analysis of self-injection training practices.

BACKGROUND: Self-injected biologic therapies have gained significant prevalence across numerous therapeutic areas. A lack of specific guidance on best practices may lead to inadequate biologic initiation and training. We previously conducted a small-sample, qualitative analysis designed to identify gaps in self-injection training. METHODS: A total of 277 HCPs performing routine biologic initiation and 264 patients currently self-injecting biologics completed this quantitative study remotely using an online survey. The primary objective was to validate previous qualitative findings and firmly characterize the current paradigm. As an exploratory objective, the study examined associations that may exist between training experiences and patient-reported outcomes. RESULTS: Most patients (91.7%) reported receiving formal self-injection training, commonly conducted over one or two sessions. The mean overall training time reported was 37.8 and 30.4 minutes by patients and HCPs, respectively. Over one-third of patients reported lacking confidence that they could correctly self-inject during the first 6 months of treatment. CONCLUSION: Current training practices may not be adequate to prepare patients to start their therapies. Considerable attention must be paid to providing patients with multiple opportunities for training sessions, training devices, and medical information for home access. Further studies should prospectively examine the impact of training techniques on patient-reported outcomes.

Cardiac rehabilitation performance predicts 1-year major adverse cardiovascular events.

BACKGROUND: Cardiac Rehabilitation is an essential following major adverse cardiovascular events however there is no current data correlating rehab performance to long term outcomes. HYPOTHESIS: Patient exercise performance during cardiac rehabilitation reliably predicts future cardiovascular events. METHODS: We conducted a single-center study of 486 consecutive patients who participated in a CR program between January 2018 and August 2021. We assessed patient performance using a novel index, the CR-score, which integrated duration, speed of work, and workload conducted on each training device (TD). We used a binary recursive partition model to determine the optimal thresholds for cumulative CR score. We used Cox regression analysis to assess the mortality rate among patients who developed MACE ("study group") and those who did not ("control group"). RESULTS: Among 486 eligible patients, 1-year MACE occurred in 27 (5.5%) patients and was more common in patients with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%, p < .001). Age, gender, comorbidities, heart failure, and medical treatment did not significantly affect the outcome. The median cumulative CR score of the study group was significantly lower than the control group (595 ± 185.6 vs. 3500 ± 1104.7, p < .0001). A cumulative CR-score of ≥1132 correlated with the outcome (98.5% sensitivity, 99.6% specificity, 95% CI: 0.985-0.997, area 0.994, p < .0001). Patients older than 55 with a cumulative CR score of <1132 were at particularly high risk (OR: 7.4, 95% CI: 2.84-18.42) for 1-year MACE (log-rank p = .03). CONCLUSION: Our proposed CR-score accurately identifies patients at high risk for 1-year MACE following the rehabilitation program. Multicenter validation is required.

Efficacy of an Integrated Training Device in Improving Muscle Strength, Balance, and Cognitive Ability in Older Adults.

OBJECTIVE: To determine the effects of an integrated training device for strength and balance on extremity muscle strength, postural balance, and cognition in older adults using a combination with various rehabilitation training games, in which balance, strength, and cognitive training were configured in a single device. METHODS: This prospective study included 20 healthy participants aged 65-85 years. Participants trained for 30 minutes daily, 3 days weekly, for 6 weeks with an integrated training device for strength and balance (SBT-120; Man&Tel Inc., Gumi, Korea). Main outcomes were measured using the Korean Mini-Mental State Examination (K-MMSE), Korean version of the Montreal Cognitive Assessment (K-MoCA), Timed Up and Go Test (TUG), Functional Reach Test (FRT), Berg Balance Scale (BBS), and Manual Muscle Test. Measurements were taken at three time points: T0 (pretreatment), T1 (immediately after treatment), and T2 (4 weeks after treatment). RESULTS: All 20 patients completed the training, and TUG, FRT, and BBS scores significantly improved at T1 and T2 compared to T0. Mean TUG scores decreased by 0.99±2.00 at T1 and 1.05±1.55 at T2 compared to T0. Mean FRT scores increased by 6.13±4.26 at T1 and 6.75±4.79 at T2 compared to T0. BBS scores increased by 0.60±0.94 at T1 and 0.45±1.15 at T2 compared to T0. Moreover, muscle strength and cognition (K-MMSE and K-MoCA scores) increased after training. CONCLUSION: Our findings suggest that an integrated training device for strength and balance can be a safe and useful tool for older adults.

The current paradigm for biologic initiation: a mixed-methods exploration of practices, unmet needs, and innovation opportunities in self-injection training.

BACKGROUND: Self-injection, particularly of biologics, has become a mainstay of chronic disease management. Despite labeling requirement for healthcare provider (HCP) training, current injection initiation experiences have been shown to be suboptimal. This study characterizes gaps in training and support during initiation and identifies rationales to inform solutions. METHODS: We enrolled HCPs (n = 18) performing routine biologic initiation and patients (n = 24) currently self-injecting biologics. Participants completed activities through an online, remote ethnography tool. We conducted two focus groups with biologic-naïve patients (n = 5). Data was analyzed using thematic frameworks, Q methodology, and quantitative assessments. RESULTS: Our results suggest considerable gaps exist. Analysis revealed five common themes that could explain these gaps: 1) minimal biologic-specific professional instruction is provided to HCPs; 2) nuanced injection use-steps are not universally understood; 3) no one stakeholder currently 'owns' training; 4) support offered by HCPs and manufacturers is perceived as biased; and 5) emotional burden is not accounted for. CONCLUSIONS: Our study suggests optimizing several elements to facilitate successful initiations, including structured sessions, improved HCP injection device knowledge, demo-device practice, and focus on both emotional and mechanical aspects. Aligning these factors has potential to increase patient confidence, reduce burden on HCPs, and improve probability of success on therapy.