Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review (Preprint)

Abstract

BACKGROUND Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. OBJECTIVE This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes. METHODS The search strategy used Medical Subject Headings and text words related to the terms <i>upper extremity</i>, <i>exercises</i>, and <i>information and communication technologies</i>. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included. RESULTS Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various <i>software</i>, <i>sensor hardware</i>, and <i>hardware</i> for output are in use. The most common <i>hardware</i> for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related <i>software</i> are frequently used as <i>sensor hardware</i> (in 27 HETs). The identified HETs provide direct or indirect <i>instruction</i>, <i>monitoring</i>, <i>correction</i>, <i>assessment</i>, <i>information</i>, or a <i>reminder to exercise</i>. Common parameters for exercise instructions are a patient’s <i>range of motion</i> (in 43 HETs), <i>starting and final position</i> (in 32 HETs), and <i>exercise intensity</i> (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on <i>telerehabilitation</i> aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients’ evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs. CONCLUSIONS There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects.