Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial

Hassett, Leanne; Berg, Maayken van den; Lindley, Richard I.; Crotty, Maria; McCluskey, Annie; Ploeg, Hidde P. van der; Smith, Susan L.; Schurr, Karl; Howard, Kirsten; Hackett, Maree L.; Killington, Maggie; Bongers, Bert; Togher, Leanne; Treacy, Daniel; Dorsch, Simone; Wong, Siobhan; Scrivener, Katharine; Chagpar, Sakina; Weber, Heather; Pinheiro, Marina B.; Héritier, Stéphane; Sherrington, Catherine

doi:10.1371/journal.pmed.1003029

Cited by 29 publications

(61 citation statements)

References 40 publications

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“…Mobility (SPPB) performance (the chair rise scores in particular) and the number of steps per day were in the markedly low/impaired range, while the percent time spent in sedentary activity was high. These results are similar to those in rehabilitation patients provided with telehealth modalities post-hospital discharge (22).…”

Section: Extent Of Cohort Impairmentsupporting

confidence: 86%

“…A key issue is how to handle timed performance, which, assuming a stable WiFi connection with su cient bandwidth, should be possible, but might require additional cues in the event of a time delay for start and stop times. Note however that the SPPB data from this post-hospital VVC cohort is remarkably similar to a cohort identi ed to undergo rehabilitation for mobility and physical activity, both inpatient and outpatient via telehealth devices, and whose SPPB was evaluated in person (22). Note also that participants were enrolling in an intervention, thus serving as their own control, and VVC assessment modi cations were planned to be continued throughout the 6 month follow-up.…”

Section: Videoconference Connectivity Issuesmentioning

confidence: 81%

“…Approximately 1/3 (n = 14) were enrolled over 3 weeks post discharge. Overall, the mean (SD) days from discharge to enrollment was 17 (14) days and the median [25th, 75th percentile] days were 12 [7,22].…”

Section: Recruitmentmentioning

confidence: 99%

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Team VA Video Connect (VVC) to Optimize Mobility and Physical Activity in Post-Hospital Discharge Older Veterans: Baseline Assessment

Alexander

Phillips

Wagner-Felkey

et al. 2021

Preprint

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Background Telehealth is increasingly used for rehabilitation and exercise but few studies include older adult participants with comorbidities and impairment, particularly cognitive. Using Veterans Administration Video Connect (VVC), the aim of the present study is to present the screening, recruitment, baseline assessment, and initial telehealth utilization of post-hospital discharge Veterans in a VVC home-telehealth based program to enhance mobility and physical activity.Methods Older adult Veterans (n = 45, mean age 73), recently discharged from the hospital with physical therapy goals, were VVC-assessed in self-report and performance-based measures, using test adaptations as necessary, by a clinical pharmacy specialist and social worker team.Results Basic and instrumental ADL disabilities were common as were low mobility (Short Portable Performance Battery) and physical activity levels (measured by actigraphy). Half had Montreal Cognitive Assessment (MoCA) scores in the mild cognitive impairment range (< 24). Over 2/3 of the participants used VA-supplied tablets. While half of the Veterans were fully successful in VVC, 1/3 of these and an additional group with at least one failed connection requested in-person visits for assistance. One-quarter had no VVC success and sought help for tablet troubleshooting, and half of these eventually “gave up” trying to connect; computer literacy issues and physical impairment (particularly dexterity) were described prominently in this group. On the other hand, Veterans with at least mild cognitive impairment (based on MoCA scores) were present in all connectivity groups and most of these used caregiver support to facilitate VVC.Conclusion Disabled older post-hospital discharged Veterans with physical therapy goals can be VVC-assessed and enrolled into a mobility/physical activity intervention. A substantial proportion required technical support, including in-person support for many. Yet, VVC seems feasible in those with mild cognitive impairment, assuming the presence of an able caregiver. Modifications of assessment tools were needed for the VVC interface, and while appearing feasible, will require further study.ClinicalTrials.gov NCT 04045054 05/08/2019

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Section: Extent Of Cohort Impairmentsupporting

confidence: 86%

Section: Videoconference Connectivity Issuesmentioning

confidence: 81%

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Team VA Video Connect (VVC) to Optimize Mobility and Physical Activity in Post-Hospital Discharge Older Veterans: Baseline Assessment

Alexander

Phillips

Wagner-Felkey

et al. 2021

Preprint

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“…Research investigating the effect of wearable devices on outcomes following stroke is in its infancy. Preliminary indications suggest that wearable devices may increase the amount and intensity of physical activity undertaken during rehabilitation [ 26 - 28 ] and potentially contribute to improved functional outcomes [ 29 ]. However, the effect of wearable devices on UL rehabilitation and outcomes has been less well studied [ 30 , 31 ], with much of the research to date focusing on the accuracy and validity of accelerometry measurement of real-world UL movement [ 32 - 34 ].…”

Section: Introductionmentioning

confidence: 99%

Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study

Signal¹,

McLaren²,

Rashid³

et al. 2020

JMIR Mhealth Uhealth

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Background As many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. Objective This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. Methods A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a “Planned Nudge” to the odds of affected limb movement during the observation period following “No Nudge.” Results The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95% CI 0.99-1.29, P=.07). Conclusions Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. Trial Registration Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687&isReview=true

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“…Two recent randomized controlled trials demonstrated clinically meaningful increases in exercise dose and mobility with the use of technology-based exercise in addition to usual care in the geriatric and neurological rehabilitation populations. 10,11 A pilot randomized controlled trial conducted by our team investigated an app-based supplemental exercise programme in addition to usual care in orthopaedic rehabilitation. The intervention was successful in increasing activity levels in a feasible and safe manner.…”

Section: Introductionmentioning

confidence: 99%

App-based supplemental exercise in rehabilitation, adherence, and effect on outcomes: a randomized controlled trial

Bui

Phan

et al. 2020

Clin Rehabil

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Question: To determine the uptake of an app-based supplemental exercise programme in a rehabilitation setting and the effect of such a programme on length of stay and function compared to usual care physiotherapy. Design: Randomized controlled trial with random allocation and assessor blinding. Participants: A total of 144 individuals with mixed diagnoses (orthopaedic, neurological, reconditioning) admitted for inpatient sub-acute rehabilitation. Interventions: Participants were randomly allocated to usual care physiotherapy (control group) or usual care physiotherapy with the addition of an app-based supplemental exercise programme (intervention group). Outcome measures: The primary measure of interest was total supplementary exercise dosage completed by the intervention group. The primary between-group outcome measure was length of stay with secondary measures including walking endurance (Six-Minute Walk Test), walking speed (10-Metre Walk Test), functional mobility (Timed Up and Go Test) and level of disability (Functional Independence Measure). Results: Participants in the intervention group performed 7 minutes (SD: 9) or 49 repetitions (SD: 48) of supplementary exercise using the app each day. There were no differences between the groups for length of stay (mean difference (MD): −0.5 days, 95% confidence interval (CI): −3.2 to 2.2) or change in any secondary functional outcome measures, including walking speed (MD: −0.1 m/s, 95% CI: −0.2 to 0.0) and disability (MD: −0.9, 95% CI: −3.6 to 1.8). Conclusion: A small supplementary exercise dose was achieved by participants in the intervention group. However, such a programme did not affect length of stay or functional outcomes when compared to usual care.

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Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial

Cited by 29 publications

References 40 publications

Team VA Video Connect (VVC) to Optimize Mobility and Physical Activity in Post-Hospital Discharge Older Veterans: Baseline Assessment

Team VA Video Connect (VVC) to Optimize Mobility and Physical Activity in Post-Hospital Discharge Older Veterans: Baseline Assessment

Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study

App-based supplemental exercise in rehabilitation, adherence, and effect on outcomes: a randomized controlled trial

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