Rehabilitation of Upper Extremity by Telerehabilitation Combined With Exergames in Survivors of Chronic Stroke: Preliminary Findings From a Feasibility Clinical Trial

Allegue, Dorra Rakia; Higgins, Johanne; Sweet, Shane N; Archambault, Philippe; Michaud, François; Miller, William C.; Tousignant, Michel; Kairy, Dahlia

doi:10.2196/33745

Cited by 8 publications

(23 citation statements)

References 58 publications

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“…The majority (86/103, 83%) [ 47 - 51 , 53 - 56 , 58 , 59 , 61 , 63 - 68 , 71 - 86 , 89 - 95 , 97 - 105 , 107 , 109 , 111 , 112 , 114 , 115 , 117 - 126 , 128 - 136 , 138 - 148 ] were published in the past 10 years. Most studies took place in North America (41/103, 40%) [ 46 - 49 , 52 , 55 , 56 , 60 , 64 - 67 , 69 , 70 , 72 , 74 , 76 - 78 , 80 , 85 - 88 , 92 , 93 , 97 , 99 , 101 , 108 - 110 , 126 - 129 , 137 , 138 , 141 , 142 , 145 ] and Europe (35/103, 34%) [ 51 , 53 , 54 , 57 , 58 , 62 , 63 , 68 , ...…”

Section: Resultsmentioning

confidence: 99%

“…Most studies took place in North America (41/103, 40%) [ 46 - 49 , 52 , 55 , 56 , 60 , 64 - 67 , 69 , 70 , 72 , 74 , 76 - 78 , 80 , 85 - 88 , 92 , 93 , 97 , 99 , 101 , 108 - 110 , 126 - 129 , 137 , 138 , 141 , 142 , 145 ] and Europe (35/103, 34%) [ 51 , 53 , 54 , 57 , 58 , 62 , 63 , 68 , 71 , 79 , 81 - 84 , 89 , 111 , 113 - 125 , 132 , 136 , 140 , 143 , 146 , 147 ], with the remainder in Asia (16/103, 16%) [ 50 , 59 , 61 , 91 , 94 , 95 , 98 , 100 , 102 - 104 , 107 , 135 , 139 ,…”

Section: Resultsmentioning

confidence: 99%

“…Over three-quarters (83/103, 81%; 2508 participants) of studies reported the time since the onset of stroke. Of these 83 studies, 1 (1%; 48 participants) study [ 91 ] was conducted in the acute phase, 14 (17%; 504 participants) studies [ 60 , 61 , 68 , 74 , 79 , 92 , 100 , 102 , 109 , 114 , 133 , 144 , 146 , 148 ] were conducted in the early subacute phase, 11 (13%; 316 participants) studies [ 59 , 65 , 66 , 72 , 75 , 76 , 81 , 104 , 107 , 121 , 134 ] were conducted in the late subacute phase, and 57 (69%; 1640 participants) studies [ 46 , 48 , 49 , 51 , 53 , 54 , 57 , 63 , 64 , 67 , 69 , 70 , 73 , 78 , 80 , 82 , 84 , 85 , 88 , 89 , 93 - 99 , 101 , 103 , 105 , 106 , 108 , 111 - 113 , 117 - 120 , 122 - 125 , 127 - 131 , 13...…”

Section: Resultsmentioning

confidence: 99%

“…An overview of study intervention characteristics is provided ( Table 1 ). Interventions were focused on upper limb rehabilitation in almost two-thirds (65/103, 63%) of the studies [ 46 - 49 , 51 , 54 - 59 , 62 - 65 , 68 , 71 , 72 , 74 , 75 , 77 - 81 , 85 - 88 , 92 , 95 , 96 , 99 , 101 - 103 , 105 - 108 , 110 , 112 , 113 , 116 - 118 , 121 , 123 - 125 , 127 , 128 , 132 , 133 , 135 - 137 , 139 - 142 , 144 - 147 ]. Nearly all interventions (96/103, 93%) [ 46 - 80 , 84 - 94 , 96 - 117 , 119 - 121 , 124 - 148 ] were delivered to individual participants, with over half (62/103, 60%) [ 46 - 50 , 53 - 58 , 60 , 61 , 64 - 70 , 72 , 74 -…”

Section: Resultsmentioning

confidence: 99%

“…Of the 103 studies, over half (n=57, 55%) of the studies [ 46 , 47 , 51 - 54 , 57 , 61 , 63 , 67 , 68 , 70 , 71 , 73 , 75 - 78 , 81 , 84 - 86 , 88 - 91 , 93 , 95 , 96 , 98 , 100 , 102 - 104 , 106 , 109 , 112 , 114 , 115 , 123 - 126 , 129 , 130 , 132 , 133 , 135 - 138 , 140 , 143 - 147 ] included 1 type of DHT, 30 (29%) studies [ 48 , 49 , 55 , 56 , 58 - 60 , 62 , 64 , 69 , 83 , 92 , 94 , 97 , 99 , 101 , 105 , 107 , 108 , 110 , 111 , 113 , 116 , 118 , 121 , …”

Section: Resultsunclassified

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Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

Gooch,

Jarvis,

Stockley

2024

J Med Internet Res

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Background Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions. Objective This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT. Methods Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1). Results From a total of 1973 identified sources, 103 (5%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67%). Almost half (45/103, 44%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56%), and almost two-thirds (65/103, 63%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56/103, 54%), goals and planning (33/103, 32%), and shaping knowledge (33/103, 32%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality. Conclusions Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsunclassified

See 3 more Smart Citations

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

Gooch,

Jarvis,

Stockley

2024

J Med Internet Res

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Effectiveness of digital home rehabilitation and supervision for stroke survivors: A systematic review and meta-analysis

Hestetun-Mandrup,

Toh,

et al. 2024

DIGITAL HEALTH

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Objective Stroke survivors often experience residual impairments and motor decline post-discharge. While digital home rehabilitation combined with supervision could be a promising approach for reducing human resources, increasing motor ability, and supporting rehabilitation persistence there is a lack of reviews synthesizing the effects. Thus, this systematic review and meta-analysis aimed to synthesize the effect of digital home rehabilitation and supervision in improving motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function among stroke survivors. Methods Six electronic databases, grey literature, ongoing studies, and reference lists were searched for relevant studies. Two investigators independently reviewed titles, abstracts, screened full texts for eligibility and performed data extraction. Meta-analysis of 13 independent studies were grouped into four separate meta-analyses. The Grading of Recommendations, Assessments, Development and Evaluations (GRADE) tool was used for evaluating the overall quality of the evidence. Results Meta-analyses showed no statistically significant difference between intervention (digital home rehabilitation) and control groups (home training/clinic-based) of all outcomes including motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function. In the sub-group analysis digital home rehabilitation was associated with better quality of arm use (standardized mean difference = 0.68, 95% confidence interval: [0.27, 1.09], p = 0.001). Conclusions This result indicated that digital home rehabilitation has similar effects and could potentially replace home training or clinic-based services. This review highlights better-targeted digital motor interventions to examine the effects of interventions further. The quality of evidence was moderate to high in motor and self-reported arm outcomes, and low for balance and quality of life.

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Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study

Allegue¹,

Sweet²,

Higgins³

et al. 2022

JMIR Rehabil Assist Technol

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Operational definitions of the concepts have been developed based on potential users (clinician and survivor) and are presented below, including concrete examples for a common understanding of the proposed conceptual framework.Performance: the degree to which the user perceives the technology as efficient, in other words, useful and advantageous compared to standard practice. This definition includes both expected and actual performance, as it aims to capture the user's expectations of the technology and the actual experience of the technology, which might have an impact on the user's motivation to continue using the system (same principle applies for the rest of the determinants).Clinicians: This could translate into ease of designing rehabilitation exercises (adapted levels of difficulty, control of the duration and number of repetitions, various exercises, etc), ability to follow up (video conference, secure sharing of documents, images, video), added value to standard practice (playfulness of games, motivation of the survivor, personalization of treatment) and functional results of the survivor.Stroke survivors: This could be reflected in the ability of the technology to improve access to rehabilitation programs (follow-up by a clinician, access to a personalized exercise program, etc.), to facilitate the performance of exercises in terms of duration, frequency, level of difficulty, etc., and to achieve satisfactory results in the motor performance of the arm (eg, use of the arm in activities of daily living).Effort: the degree of ease and / or complexity associated with using the technology.Clinicians and stroke survivors: This could translate into the effort required to use technology including learning or training in the use of exergames and telerehabilitation platforms, ease of interaction with platforms (launch games, start a video conference call, etc), period of familiarization with the technology, management of technical problems (the Internet, system update, forgotten passwords, etc), redefinition of the role and responsibilities.Social influence: the degree of impact that positive or negative feedback from those around you can have on the use of Virtual Reality -Telerehabilitation technology.

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Rehabilitation of Upper Extremity by Telerehabilitation Combined With Exergames in Survivors of Chronic Stroke: Preliminary Findings From a Feasibility Clinical Trial

Cited by 8 publications

References 58 publications

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

Effectiveness of digital home rehabilitation and supervision for stroke survivors: A systematic review and meta-analysis

Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study

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