Publications by authors named "Birthe Dinesen"

45 Publications

Motivating patients in cardiac rehabilitation programs: A multicenter randomized controlled trial.

Int J Telerehabil 2021 22;13(1):e6365. Epub 2021 Jun 22.

Laboratory for Welfare Technology - Telehealth & Telerehabilitation, Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Denmark.

Concerns have been raised about motivation and psychological distress when implementing telerehabilitation in patients with heart failure. The current study compared conventional and telerehabilitation in two groups (n=67; n=70) of patients with heart failure at 0, 6, and 12 months on measures of motivation (Self-Determination Theory measures) and psychological distress (Hospital Anxiety and Depression scale). We found no significant changes in motivation across groups, although our telerehabilitation group had a slightly lower level of controlled motivation and higher levels of relatedness. In addition, there were no differences between groups with regard to psychological distress. This study demonstrates that telerehabilitation motivates patients with heart failure to the same degree as conventional rehabilitation, and that telerehabilitation is not associated with increased psychological distress. As such, telerehabilitation offers an alternative to conventional rehabilitation and addresses some of the barriers for participating in rehabilitation identified in the literature.
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http://dx.doi.org/10.5195/ijt.2021.6365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287717PMC
June 2021

The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses.

JMIR Cardio 2021 Jul 19;5(2):e27321. Epub 2021 Jul 19.

Department of Cardiology, Viborg and Skive Regional Hospital, Viborg, Denmark.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules.

Objective: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF.

Methods: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients' perspectives. Secondary outcomes were the development of patients' knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0.

Results: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups.

Conclusions: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient-TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial.

Trial Registration: ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437.
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http://dx.doi.org/10.2196/27321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8329756PMC
July 2021

Patient-Reported Outcomes From Patients With Heart Failure Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial.

JMIR Cardio 2021 Jul 2;5(2):e26544. Epub 2021 Jul 2.

Laboratory for Welfare Technology - Telehealth & Telerehabilitation, Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark.

Background: More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients' recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year.

Objective: The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year.

Methods: In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients' sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group.

Results: The changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P<.05).

Conclusions: There was a significant increase in clinical and social well-being and quality of life during the 1-year period of participating in a telerehabilitation program. These results suggest that patient-reported outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide patients in mastering their own symptoms.

Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918.
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http://dx.doi.org/10.2196/26544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285740PMC
July 2021

Non-Contact Respiratory Measurement Using a Depth Camera for Elderly People.

Sensors (Basel) 2020 Dec 3;20(23). Epub 2020 Dec 3.

Laboratory of Welfare Technology-Telehealth and Telerehabilitation, Department of Health Science and Technology, Aalborg University, 9220 Aalborg Ost, Denmark.

Measuring respiration at home for cardiac patients, a simple method that can detect the patient's natural respiration, is needed. The purpose of this study was to develop an algorithm for estimating the tidal volume (TV) and respiratory rate (RR) from the depth value of the chest and/or abdomen, which were captured using a depth camera. The data of two different breathing patterns (normal and deep) were acquired from both the depth camera and the spirometer. The experiment was performed under two different clothing conditions (undressed and wearing a T-shirt). Thirty-nine elderly volunteers (male = 14) were enrolled in the experiment. The TV estimation algorithm for each condition was determined by regression analysis using the volume data from the spirometer as the objective variable and the depth motion data from the depth camera as the explanatory variable. The RR estimation was calculated from the peak interval. The mean absolute relative errors of the estimated TV for males were 14.0% under undressed conditions and 10.7% under T-shirt-wearing conditions; meanwhile, the relative errors for females were 14.7% and 15.5%, respectively. The estimation error for the RR was zero out of a total of 206 breaths under undressed conditions and two out of a total of 218 breaths under T-shirt-wearing conditions for males. Concerning females, the error was three out of a total of 329 breaths under undressed conditions and five out of a total of 344 breaths under T-shirt-wearing conditions. The developed algorithm for RR estimation was accurate enough, but the estimated occasionally TV had large errors, especially in deep breathing. The cause of such errors in TV estimation is presumed to be a result of the whole-body motion and inadequate setting of the measurement area.
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http://dx.doi.org/10.3390/s20236901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730632PMC
December 2020

EEG Headset Evaluation for Detection of Single-Trial Movement Intention for Brain-Computer Interfaces.

Sensors (Basel) 2020 May 14;20(10). Epub 2020 May 14.

Department of Engineering-Electrical and Computer Engineering, Aarhus University, 8200 Aarhus, Denmark.

Brain-computer interfaces (BCIs) can be used in neurorehabilitation; however, the literature about transferring the technology to rehabilitation clinics is limited. A key component of a BCI is the headset, for which several options are available. The aim of this study was to test four commercially available headsets' ability to record and classify movement intentions (movement-related cortical potentials-MRCPs). Twelve healthy participants performed 100 movements, while continuous EEG was recorded from the headsets on two different days to establish the reliability of the measures: classification accuracies of single-trials, number of rejected epochs, and signal-to-noise ratio. MRCPs could be recorded with the headsets covering the motor cortex, and they obtained the best classification accuracies (73%-77%). The reliability was moderate to good for the best headset (a gel-based headset covering the motor cortex). The results demonstrate that, among the evaluated headsets, reliable recordings of MRCPs require channels located close to the motor cortex and potentially a gel-based headset.
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http://dx.doi.org/10.3390/s20102804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287803PMC
May 2020

Development of an individualized asynchronous sensor-based telerehabilitation program for patients undergoing total knee replacement: Participatory design.

Health Informatics J 2020 12 16;26(4):2492-2511. Epub 2020 Mar 16.

Aalborg University, Denmark.

Telerehabilitation programs can be employed to establish communication between patients and healthcare professionals and empower patients performing their training remotely. This study aimed to identify patients' requirements after a total knee replacement following a self-training rehabilitation program, leading to the design and development of a telerehabilitation program that can meet the stakeholders' actual needs. System design, development, and testing were conducted in five iterations based on a participatory design approach. Data collection was performed using interviews, observations, prototyping, and questionnaires. It was found that the main barriers facing the existing rehabilitation program were a lack of clear communication, lack of relevant information, and healthcare professional's feedback. The participants emphasized the main themes of communication, information, training, and motivation in the process of design and development. In using the telerehabilitation program, the patients reported a high level of user-friendliness, flexibility, and a sense of security. This study has identified obstacles in the current rehabilitation program and revealed the potential effectiveness of using asynchronous communication and sensor-based technologies by employing participatory design and development. A higher level of portability and flexibility were observed. However, future studies and development are required to investigate the overall usability and reliability of the telerehabilitation program.
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http://dx.doi.org/10.1177/1460458220909779DOI Listing
December 2020

Evaluation of EEG Headset Mounting for Brain-Computer Interface-Based Stroke Rehabilitation by Patients, Therapists, and Relatives.

Front Hum Neurosci 2020 14;14:13. Epub 2020 Feb 14.

Laboratory of Welfare Technologies, Telehealth and Telerehabilitation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

Brain-computer interfaces (BCIs) have successfully been used for motor recovery training in stroke patients. However, the setup of BCI systems is complex and may be divided into (1) mounting the headset and (2) calibration of the BCI. One of the major problems is mounting the headset for recording brain activity in a stroke rehabilitation context, and usability testing of this is limited. In this study, the aim was to compare the translational aspects of mounting five different commercially available headsets from a user perspective and investigate the design considerations associated with technology transfer to rehabilitation clinics and home use. No EEG signals were recorded, so the effectiveness of the systems have not been evaluated. Three out of five headsets covered the motor cortex which is needed to pick up movement intentions of attempted movements. The other two were as control and reference for potential design considerations. As primary stakeholders, nine stroke patients, eight therapists and two relatives participated; the stroke patients mounted the headsets themselves. The setup time was recorded, and participants filled in questionnaires related to comfort, aesthetics, setup complexity, overall satisfaction, and general design considerations. The patients had difficulties in mounting all headsets except for a headband with a dry electrode located on the forehead (control). The therapists and relatives were able to mount all headsets. The fastest headset to mount was the headband, and the most preferred headsets were the headband and a behind-ear headset (control). The most preferred headset that covered the motor cortex used water-based electrodes. The patients reported that it was important that they could mount the headset themselves for them to use it every day at home. These results have implications for design considerations for the development of BCI systems to be used in rehabilitation clinics and in the patient's home.
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http://dx.doi.org/10.3389/fnhum.2020.00013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033449PMC
February 2020

Video communication as a tool for psychosocial support for people recovering from severe mental disorder: social workers' experiences.

Mhealth 2019 23;5:38. Epub 2019 Sep 23.

Laboratory for Welfare Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technologies, Aalborg University, Aalborg, Denmark.

Background: This paper focuses on a Danish social tele-rehabilitation project, which uses video technologies to support mentally ill citizens in their recovery process in their homes. The aim of the study is to explore how social workers experience using video communication as part of a tele-social-rehabilitation program aimed at citizens discharged from a psychiatric hospital and lives in their own home with mental disorders recovering from a mental illness.

Methods: The research strategy in this study is the case study method. Data collection techniques for the case study were based on triangulation of several data sources, such as analysis of relevant documents, participant observation and qualitative interviews with clients and with social workers assisting citizens in their recovery process.

Results: The social workers stated that video technology gave them the opportunity to make changes in their working practices with the citizens. They also felt they were better able to meet the citizens' need to improve their everyday lives. The social workers found that video technology was less intrusive than a physical visit to the citizen's home. The technology helps to promote the client's recovery process.

Conclusions: The social workers who used video technology in a tele-social-rehabilitation program experienced a community of practice, changes in their work routine and changes in the way they carried out social rehabilitation for clients in their recovery following discharge from mental hospital.
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http://dx.doi.org/10.21037/mhealth.2019.08.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789197PMC
September 2019

Listening to the patients: using participatory design in the development of a cardiac telerehabilitation web portal.

Mhealth 2019 16;5:33. Epub 2019 Sep 16.

Laboratory of Welfare Technologies-Telehealth & Telerehabilitation, SMI, Aalborg University, Aalborg, Denmark.

Background: Cardiovascular disease is the leading cause of all deaths worldwide. Cardiac rehabilitation is an effective approach for preventing secondary complications, but it remains a complex intervention because of the need for lifestyle changes. One solution is to employ interactive telerehabilitation or eHealth web portals. However, these have not been implemented as intended by developers. The aim of this study was to evaluate the design and usability of a cardiac telerehabilitation web portal, called the 'HeartPortal', for use among heart failure (HF) patients.

Methods: The HeartPortal was designed using participatory design (PD). The design process involved HF patients, their relatives, healthcare professionals (HCP), healthcare company specialists and researchers. Self-determination theory (SDT) was used to enable the design to elicit intrinsic motivation within the patients. With eHealth literacy skills in mind, the goal of the HeartPortal was to successfully target the end-users. The PD process and data collection techniques included cultural probes, workshops, participant-observation, questionnaires, and problem-solving tasks.

Results: The PD process helped us design an interactive web portal, the HeartPortal. Based on participants' feedback, the design incorporated features such as being able to make notes and to communicate with HCP, view data from self-tracking devices in a graphic form, and to obtain information on rehabilitation in the form of text, audio, and video. More than half of those testing the HeartPortal found that it was easy to navigate, and most of the users stated that it had an excellent structure and that using it could possibly improve their condition.

Conclusions: Overall, the HeartPortal was found to be logical and easy to navigate and will now be tested in a clinical trial within the Future Patient Telerehabilitation Program.
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http://dx.doi.org/10.21037/mhealth.2019.08.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789193PMC
September 2019

"Future Patient" Telerehabilitation for Patients With Heart Failure: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2019 Sep 19;8(9):e14517. Epub 2019 Sep 19.

Cardiology Ward, Regional Hospital in Viborg, Viborg, Denmark.

Background: Cardiovascular disease is the leading cause of mortality worldwide, accounting for 13%-15% of all deaths. Cardiac rehabilitation has poor compliance and adherence. Telerehabilitation has been introduced to increase patients' participation, access, and adherence with the help of digital technologies. The target group is patients with heart failure. A telerehabilitation program called "Future Patient" has been developed and consists of three phases: (1) titration of medicine (0-3 months), (2) implementation of the telerehabilitation protocols (3 months), and (3) follow-up with rehabilitation in everyday life (6 months). Patients in the Future Patient program measure their blood pressure, pulse, weight, number of steps taken, sleep, and respiration and answer questions online regarding their well-being. All data are transmitted and accessed in the HeartPortal by patients and health care professionals.

Objective: The aim of this paper is to describe the research design, outcome measures, and data collection techniques in the clinical test of the Future Patient Telerehabilitation Program for patients with heart failure.

Methods: A randomized controlled study will be performed. The intervention group will follow the Future Patient Telerehabilitation program, and the control group will follow the traditional cardiac rehabilitation program. The primary outcome is quality of life measured by the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes are development of clinical data; illness perception; motivation; anxiety and depression; health and electronic health literacy; qualitative exploration of patients', spouses', and health care professionals' experiences of participating in the telerehabilitation program; and a health economy evaluation of the program. Outcomes were assessed using questionnaires and through the data generated by digital technologies.

Results: Data collection began in December 2016 and will be completed in October 2019. The study results will be published in peer-reviewed journals and presented at international conferences. Results from the Future Patient Telerehabilitation program are expected to be published by the spring of 2020.

Conclusions: The expected outcomes are increased quality of life, increased motivation and illness perception, reduced anxiety and depressions, improved electronic health literacy, and health economics benefits. We expect the study to have a clinical impact for future telerehabilitation of patients with heart failure.

Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918.

International Registered Report Identifier (irrid): DERR1-10.2196/14517.
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http://dx.doi.org/10.2196/14517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754679PMC
September 2019

Seasonal variations in objectively assessed physical activity among people with COPD in two Nordic countries and Australia: a cross-sectional study.

Int J Chron Obstruct Pulmon Dis 2019 5;14:1219-1228. Epub 2019 Jun 5.

Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.

Seasons and weather conditions might influence participation in physical activity and contribute to differences between countries. This study aimed at investigating whether there were differences in physical activity levels between Norwegian, Danish and Australian people with chronic obstructive pulmonary disease (COPD), and establishing if any variations in physical activity were attributable to seasons. A cross-sectional study where study subjects were people with COPD who participated in two separate clinical trials: the iTrain study (Norway, Denmark, and Australia) and the HomeBase study (Australia). Physical activity was objectively assessed with an activity monitor; variables were total energy expenditure, number of daily steps, awake sedentary time, light, and moderate-to-vigorous intensity physical activity. Differences in physical activity between countries and seasons were compared, with adjustment for disease severity. In total, 168 participants were included from Norway (N=38), Denmark (N=36) and Australia (N=94). After controlling for disease severity, time spent in awake sedentary time was greater in Danish participants compared to the other countries (median 784 minutes/day [660-952] vs 775 minutes/day [626-877] for Norwegians vs 703 minutes/day [613-802] for Australians, =0.013), whilst time spent in moderate to vigorous physical activity was lower (median 21 minutes/day [4-73] vs 30 minutes/day [7-93] for Norwegians vs 48 minutes/day [19-98] for Australians, =0.024). Participants walked more during summer (median 3502 [1253-5407] steps/day) than in spring (median 2698 [1613-5207] steps/day), winter (median 2373 [1145-4206] steps/day) and autumn (median 1603 [738-4040] steps/day), regardless of geography. The median difference between summer and other seasons exceeded the minimal clinically important difference of 600 steps/day. However, the differences were not statistically significant (=0.101). After controlling for disease severity, Danish participants spent more time in an awake sedentary state and less time in moderate to vigorous physical activity than their counterparts in Norway and Australia. People with COPD increased their physical activity in summer compared to other seasons. Weather conditions and seasonal variations may influence outcomes in clinical trials and health registries measuring physical activity over time, irrespective of the interventions delivered, and should be taken into account when interpreting results.
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http://dx.doi.org/10.2147/COPD.S194622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556464PMC
January 2020

Developing a telerehabilitation programme for postoperative recovery from knee surgery: specifications and requirements.

BMJ Health Care Inform 2019 Apr;26(1)

Laboratory for Cardio-Technology, Medical Informatics Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

Introduction: Telerehabilitation programmes have been attracting increasing attention as a potential alternative to conventional rehabilitation. Video conferencing can facilitate communication between healthcare professionals and patients. However, in certain cases, video conferencing may face practical limitations. As an alternative to real-time conferencing, sensor-based technologies can transmit the acquired data to healthcare providers. This study aimed to design and develop a sensor-based telerehabilitation programme and to outline the corresponding requirements for such a system.

Development: The development of the sensor-based telerehabilitation programme was carried out based on user needs. The programme includes a portable platform for the patient as well as a web-based platform for the healthcare professional, thus allowing for an individualised rehabilitation programme. Communication, training, reporting, and information services were provided for the patients. Moreover, the portability and usability of the programme were enhanced by utilising the system in offline mode as well.

Application: The programme is currently being tested in the North Denmark Region to assess the feasibility and acceptance of a telerehabilitation programme as an alternative solution to the self-training programme for patients who have been discharged from knee surgery. The preliminary results of our assessment showed a high level of acceptance among the users.

Discussion: In this study, a semi-online sensor-based telerehabilitation programme was tested. It is argued that a similar sensor-based telerehabilitation programme can be utilised as an alternative solution for self-training rehabilitation in the future; however; further studies and development are required to ensure the quality and reliability of sensor-based services.
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http://dx.doi.org/10.1136/bmjhci-2019-000022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062323PMC
April 2019

Integration of Rehabilitation Activities Into Everyday Life Through Telerehabilitation: Qualitative Study of Cardiac Patients and Their Partners.

J Med Internet Res 2019 04 15;21(4):e13281. Epub 2019 Apr 15.

Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.

Background: Implementation of cardiac rehabilitation has not been optimal, with patient participation rates below 50%. Factors that contribute to cardiac patients' lack of participation in rehabilitation programs are patient motivation, logistical difficulties in getting to the rehabilitation facilities, lack of psychosocial elements, and individualization of activities in the rehabilitation programs. Telerehabilitation has been proposed as a new way to address the challenge of engaging and motivating cardiac patients and their partners to participate in rehabilitation.

Objective: The aim of this study was to explore the experiences of cardiac patients and their partners of participating in the Teledialog Telerehabilitation Program (TTP). The Teledialog program consisted of a digital rehabilitation plan, transmission of health data from patient's home to hospital and health care center, and an interactive Web portal with information and training videos.

Methods: This case study used a theoretical approach combining the "community of practice" approach and self-determination theory. A triangulation of data collection techniques was used, including documents, participant observation (72 hours), and qualitative interviews with cardiac patients and their partners enrolled in the telerehabilitation group. A total of 14 cardiac patients, 12 patient spouses/partners, and 1 son participated in the study. The participants were interviewed at enrollment in the telerehabilitation program and after 12 weeks of participation in the program. Interview data were analyzed using NVivo 11.0.

Results: Patients and their partners found the Web portal ActiveHeart.dk and the electronic rehabilitation (e-rehabilitation) plan to be helpful tools for health education, coordinating rehabilitation goals, creating an overview of the data, and ensuring continuity in the rehabilitation process. The patients felt that the TTP treated them as individuals, gave them a sense of autonomy, and provided enhanced relatedness to health care professionals and partners and a sense of competence as active participants in their own rehabilitation process. Some patients missed being part of a community of practice with other cardiac patients and did not use the Web forum. Patients' partners found that the telerehabilitation program gave them a sense of security and helped them balance their involvement as a partner to the patient and not push the patient too hard.

Conclusions: Cardiac patients and their partners found telerehabilitation technologies a useful digital toolbox in the rehabilitation process. Telerehabilitation motivated the patients to integrate rehabilitation activities into their work schedule and everyday life and made them feel like unique individuals. Participating in the Teledialog Telerehabilitation Program might not be a suitable strategy for all cardiac patients. Being a patient's partner in the telerehabilitation program was associated with a heightened sense of security, navigation between active involvement in the rehabilitation process, being an equal partner, and not pushing the patient too hard.
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http://dx.doi.org/10.2196/13281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487348PMC
April 2019

Conventional Rehabilitation Therapy Versus Telerehabilitation in Cardiac Patients: A Comparison of Motivation, Psychological Distress, and Quality of Life.

Int J Environ Res Public Health 2019 02 12;16(3). Epub 2019 Feb 12.

Laboratory of Welfare Technologies - Telehealth and Telerehabilitation, Department of Health Science and Technology, Aalborg University, 9200 Aalborg East, Denmark.

Telerehabilitation (TR) has gained attention as a promising rehabilitation format. Our study examined how patients responded to TR and whether it provided adequate support for their lifestyle changes and self-care efforts when compared to conventional rehabilitation (CR). Cardiac patients ( = 136) were randomly assigned to a TR or CR group. The TR group was provided with relevant health care technology for a period of three months, and both groups filled in questionnaires on their motivation for lifestyle changes and self-care psychological distress, and quality of life at 0, 3, 6, and 12 months. Patients in both groups were found to be equally motivated for lifestyle changes and self-care ( < 0.05) and they experienced similar levels of psychological distress and quality of life. TR is comparable to conventional rehabilitation in motivating patients, preventing psychological distress and improving quality of life. Although we observed an initial increase in autonomous motivation in the telerehabilitation group, this positive difference in motivation does not last over time. As such, neither rehabilitation format seems able to ensure long-term motivation. Therefore, TR may serve as a viable replacement for conventional rehabilitation when considered relevant. Further research is needed to enhance long-term motivation, and maybe telerehabilitation can help to achieve this.
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http://dx.doi.org/10.3390/ijerph16030512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388222PMC
February 2019

The Use of Telerehabilitation Technologies for Cardiac Patients to Improve Rehabilitation Activities and Unify Organizations: Qualitative Study.

JMIR Rehabil Assist Technol 2018 Nov 19;5(2):e10758. Epub 2018 Nov 19.

Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.

Background: Cardiovascular disease is a leading cause of death globally causing 31% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals.

Objective: This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program.

Methods: Theories of networks between organizations, the sociology of professions, and the "community of practice" approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0.

Results: The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals.

Conclusions: The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs.

Trial Registration: ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb).
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http://dx.doi.org/10.2196/10758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277831PMC
November 2018

Investigating the impact of a motion capture system on Microsoft Kinect v2 recordings: A caution for using the technologies together.

PLoS One 2018 14;13(9):e0204052. Epub 2018 Sep 14.

Laboratory for Cardio-Technology, Medical Informatics Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.

Microsoft Kinect sensors are considered to be low-cost popular RGB-D sensors and are widely employed in various applications. Consequently, several studies have been conducted to evaluate the reliability and validity of Microsoft Kinect sensors, and noise models have been proposed for the sensors. Several studies utilized motion capture systems as a golden standard to assess the Microsoft Kinect sensors, and none of them reported interference between Kinect sensors and motion capture systems. This study aimed to investigate possible interference between a golden standard (i.e., Qualisys) and Microsoft Kinect v2. The depth recordings of Microsoft Kinect sensors were processed to estimate the intensity of interference. A flat non-reflective surface was utilized, and smoothness of the surface was measured using Microsoft Kinect v2 in absence and presence of an active motion capture system. The recording was repeated in five different distances. The results indicated that Microsoft Kinect v2 is distorted by the motion capture system and the distortion is increasing by increasing distance between Kinect and region of interest. Regarding the results, it can be concluded that the golden standard motion capture system is robust against interference from the Microsoft Kinect sensors.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204052PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157830PMC
March 2019

Cardiac patients' experiences with a telerehabilitation web portal: Implications for eHealth literacy.

Patient Educ Couns 2018 05 30;101(5):854-861. Epub 2017 Dec 30.

Laboratory of Welfare Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.

Objective: The aims of this study are two-fold: 1) To explore how cardiac patients experience their use of a telerehabilitation tool for recuperation from surgery, and 2) To study how the patients' use of the interactive 'Active Heart' web portal affected their eHealth literacy skills.

Methods: The 'Active Heart' telerehabilitation web portal offers patients and their relatives information and exercises for recovery from cardiac surgery. 109 cardiac patients were using the Active Heart web portal for a duration of three months.

Results: 49 patients completed questionnaires that were administered both before and after their use of the portal, resulting in a 45% response rate. Respondents had a mean age of 60.64 ± 10.75 years, and 82% of the respondents were males. The respondents had a positive impression of Active Heart, reporting that it was easy to access, user-friendly, and written in an understandable language. The patients' eHealth literacy skills increased during the trial period.

Conclusion: Use of a cardiac telerehabilitation web portal can be beneficial for patient education and can increase cardiac patients' eHealth literacy skills.

Practice Implications: Online telerehabilitation portals may be used as a tool in patient education and cardiac rehabilitation.
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http://dx.doi.org/10.1016/j.pec.2017.12.017DOI Listing
May 2018

Accuracy of a step counter during treadmill and daily life walking by healthy adults and patients with cardiac disease.

BMJ Open 2017 03 31;7(3):e011742. Epub 2017 Mar 31.

Laboratory for Cardio Technology, Medical Informatics Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.

Background: Step counters have been used to observe activity and support physical activity, but there is limited evidence on their accuracy.

Objective: The purpose was to investigate the step accuracy of the Fitbit Zip (Zip) in healthy adults during treadmill walking and in patients with cardiac disease while hospitalised at home.

Methods: Twenty healthy adults aged 39±13.79 (mean ±SD) wore four Zips while walking on a treadmill at different speeds (1.7-6.1 km/hour), and 24 patients with cardiac disease (age 67±10.03) wore a Zip for 24 hours during hospitalisation and for 4 weeks thereafter at home. A Shimmer3 device was used as a criterion standard.

Results: At a treadmill speed of 3.6 km/hour, the relative error (±SD) for the Zips on the upper body was -0.02±0.67 on the right side and -0.09 (0.67) on the left side. For the Zips on the waist, this was 0.08±0.71 for the right side and -0.08 (0.47) on the left side. At a treadmill speed of 3.6 km/hour and higher, the average per cent of relative error was <3%. The 24-hour test for the hospitalised patients showed a relative error of -47.15±24.11 (interclass correlation coefficient (ICC): 0.60), and for the 24-hour test at home, the relative error was -27.51±28.78 (ICC: 0.87). Thus, none of the 24-hour tests had less than the expected 20% error. In time periods of evident walking during the 24 h test, the Zip had an average per cent relative error of <3% at 3.6 km/hour and higher speeds.

Conclusions: A speed of 3.6 km/hour or higher is required to expect acceptable accuracy in step measurement using a Zip, on a treadmill and in real life. Inaccuracies are directly related to slow speeds, which might be a problem for patients with cardiac disease who walk at a slow pace.
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http://dx.doi.org/10.1136/bmjopen-2016-011742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387973PMC
March 2017

Evaluation of Commercial Self-Monitoring Devices for Clinical Purposes: Results from the Future Patient Trial, Phase I.

Sensors (Basel) 2017 Jan 22;17(1). Epub 2017 Jan 22.

Laboratory of Welfare Technologies-Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Aalborg University, Aalborg 9100, Denmark.

Commercial self-monitoring devices are becoming increasingly popular, and over the last decade, the use of self-monitoring technology has spread widely in both consumer and medical markets. The purpose of this study was to evaluate five commercially available self-monitoring devices for further testing in clinical applications. Four activity trackers and one sleep tracker were evaluated based on step count validity and heart rate validity.

Methods: The study enrolled 22 healthy volunteers in a walking test. Volunteers walked a 100 m track at 2 km/h and 3.5 km/h. Steps were measured by four activity trackers and compared to gyroscope readings. Two trackers were also tested on nine subjects by comparing pulse readings to Holter monitoring.

Results: The lowest average systematic error in the walking tests was -0.2%, recorded on the Garmin Vivofit 2 at 3.5 km/h; the highest error was the Fitbit Charge HR at 2 km/h with an error margin of 26.8%. Comparisons of pulse measurements from the Fitbit Charge HR revealed a margin error of -3.42% ± 7.99% compared to the electrocardiogram. The Beddit sleep tracker measured a systematic error of -3.27% ± 4.60%.

Conclusion: The measured results revealed the current functionality and limitations of the five self-tracking devices, and point towards a need for future research in this area.
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http://dx.doi.org/10.3390/s17010211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298782PMC
January 2017

Telemedicine in Greenland: Citizens' Perspectives.

Telemed J E Health 2017 05 4;23(5):441-447. Epub 2016 Nov 4.

2 Laboratory of Welfare technologies-Telehealth and Telerehabilitation, SMI, Department of Health Science and Technology, Aalborg University (AAU) , Aalborg, Denmark .

Background: Telemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine.

Objective: The aim of this study has been to explore how citizens living in the Greenlandic settlements experience the possibilities and challenges of telemedicine when receiving healthcare delivery in everyday life.

Materials And Methods: Case study design was chosen as the overall research design. Qualitative interviews (n = 14) were performed and participant observations (n = 80 h) carried out in the local healthcare center in the settlements and towns. A logbook was kept and updated each day during the field research in Greenland. Observations were made of activities in the settlements.

Findings: Data collected on citizens' views about the possibilities of using telemedicine in Greenland revealed the following findings: Greenlandic citizens are positive toward telemedicine, and telemedicine can help facilitate improved access to healthcare for residents in these Greenlandic settlements. Regarding challenges in using telemedicine in Greenland, the geographical and cultural context hinders accessibility to the Greenlandic healthcare system, and telemedicine equipment is not sufficiently mobile.

Conclusion: Greenlandic citizens are positive toward telemedicine and regard telemedicine as a facilitator for improved access for healthcare in the Greenlandic settlements. We have identified challenges, such as geographical and cultural context, that hinder accessibility to the Greenlandic healthcare system.
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http://dx.doi.org/10.1089/tmj.2016.0134DOI Listing
May 2017

Long-term integrated telerehabilitation of COPD Patients: a multicentre randomised controlled trial (iTrain).

BMC Pulm Med 2016 08 22;16(1):126. Epub 2016 Aug 22.

Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.

Background: Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic obstructive pulmonary disease (COPD). However, available resources are often limited, and many patients bear with poor availability of programmes. Sustaining PR benefits and regular exercise over the long term is difficult without any exercise maintenance strategy. In contrast to traditional centre-based PR programmes, telerehabilitation may promote more effective integration of exercise routines into daily life over the longer term and broaden its applicability and availability. A few studies showed promising results for telerehabilitation, but mostly with short-term interventions. The aim of this study is to compare long-term telerehabilitation with unsupervised exercise training at home and with standard care.

Methods/design: An international multicentre randomised controlled trial conducted across sites in three countries will recruit 120 patients with COPD. Participants will be randomly assigned to telerehabilitation, treadmill and control, and followed up for 2 years. The telerehabilitation intervention consists of individualised exercise training at home on a treadmill, telemonitoring by a physiotherapist via videoconferencing using a tablet computer, and self-management via a customised website. Patients in the treadmill arm are provided with a treadmill only to perform unsupervised exercise training at home. Patients in the control arm are offered standard care. The primary outcome is the combined number of hospitalisations and emergency department presentations. Secondary outcomes include changes in health status, quality of life, anxiety and depression, self-efficacy, subjective impression of change, physical performance, level of physical activity, and personal experiences in telerehabilitation.

Discussion: This trial will provide evidence on whether long-term telerehabilitation represents a cost-effective strategy for the follow-up of patients with COPD. The delivery of telerehabilitation services will also broaden the availability of PR and maintenance strategies, especially to those living in remote areas and with no access to centre-based exercise programmes.

Trial Registration: ClinicalTrials.gov: NCT02258646 .
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http://dx.doi.org/10.1186/s12890-016-0288-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994273PMC
August 2016

Pedometer use and self-determined motivation for walking in a cardiac telerehabilitation program: a qualitative study.

BMC Sports Sci Med Rehabil 2016 18;8:24. Epub 2016 Aug 18.

Clinical Nursing Research Unit, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark.

Background: Exercise-based cardiac rehabilitation reduces morbidity and mortality. Walking is a convenient activity suitable for people with cardiac disease. Pedometers count steps, measure walking activity and motivate people to increase physical activity. In this study, patients participating in cardiac telerehabilitation were provided with a pedometer to support motivation for physical activity with the purpose of exploring pedometer use and self-determined motivation for walking experienced by patients and health professionals during a cardiac telerehabilitation program.

Methods: A qualitative research design consisting of observations, individual interviews and patient documents made the basis for a content analysis. Data was analysed deductively using Self Determination Theory as a frame for analysis and discussion, focusing on the psychological needs of autonomy, competence and relatedness. Twelve cardiac patients, 11 health professionals, 6 physiotherapists and 5 registered nurses were included.

Results: The pedometer offered independence from standardised rehabilitation since the pedometer supported tailoring, individualised walking activity based on the patient's choice. This led to an increased autonomy. The patients felt consciously aware of health benefits of walking, and the pedometer provided feedback on walking activity leading to an increased competence to achieve goals for steps. Finally, the pedometer supported relatedness with others. The health professionals' surveillance of patients' steps, made the patients feel observed, yet supported, furthermore, their next of kin appeared to be supportive as walking partners.

Conclusion: Cardiac patients' motivation for walking was evident due to pedometer use. Even though not all aspects of motivation were autonomous and self determined, the patients felt motivated for walking. The visible steps and continuous monitoring of own walking activity made it possible for each individual patient to choose their desired kind of activity and perform ongoing adjustments of walking activity. The immediate feedback on step activity and the expectations of health benefits resulted in motivation for walking. Finally, pedometer supported walking made surveillance possible, giving the patients a feeling of being looked after and supported.

Trial Registration: Current study is a part of The [email protected] project.
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http://dx.doi.org/10.1186/s13102-016-0048-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991060PMC
August 2016

Digital auscultation of the uterine artery: a measure of uteroplacental perfusion.

Physiol Meas 2016 07 21;37(7):1163-71. Epub 2016 Jun 21.

Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, C1-223, Aalborg, 9220, Denmark. Viewcare A/S, Herlev, Denmark.

This observational study investigated digital auscultation for the purpose of assessing the clinical feasibility of monitoring vascular sounds in pregnancy. The study was performed at the Regional Hospital Viborg, Denmark, and included 29 pregnant women, 10 non-pregnant women and 10 male participants. Digital auscultation was performed with an electronic stethoscope bilaterally near the uterine arteries and correlated to the clinical diagnosis of preeclampsia (PE), intrauterine growth restriction (IUGR) or normal pregnancy in the group of pregnant participants. In the group of non-pregnant participants, digital auscultation was performed as control measurements in the same anatomical positions. The auscultations displayed pulse waveforms comprising systolic and diastolic periods in 20 of the 29 pregnant participants. However, in the non-pregnant and male participants, the pulse waveforms were absent. The pulsatile patterns are thus likely to originate from the arteries in relation to the pregnant uterus. In the participants displaying pulse waveforms, the presence of a dicrotic notch appeared with a sensitivity of 89% and a specificity of 100% in the discrimination of normal pregnancies (n  =  11) from pregnancies with PE or IUGR (n  =  9), (p  <  0.001). This preliminary study shows the potential of identifying vascular complications during pregnancy such as preeclampsia and intrauterine growth restriction. The morphology of the derived pulse contour should be investigated and could be further developed to identify pathophysiology.
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http://dx.doi.org/10.1088/0967-3334/37/7/1163DOI Listing
July 2016

Cardiac Patients' Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial.

J Med Internet Res 2016 Apr 4;18(4):e69. Epub 2016 Apr 4.

Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.

Background: Walking represents a large part of daily physical activity. It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients. A step counter measures walking activity and might be a motivational tool to increase and maintain physical activity. There is a lack of knowledge about both cardiac patients' adherence to step counter use in a cardiac telerehabilitation program and how many steps cardiac patients walk up to 1 year after a cardiac event.

Objective: The purpose of this substudy was to explore cardiac patients' walking activity. The walking activity was analyzed in relation to duration of pedometer use to determine correlations between walking activity, demographics, and medical and rehabilitation data.

Methods: A total of 64 patients from a randomized controlled telerehabilitation trial ([email protected]) from Aalborg University Hospital and Hjoerring Hospital, Denmark, from December 2012 to March 2014 were included in this study. Inclusion criteria were patients hospitalized with acute coronary syndrome, heart failure, and coronary artery bypass grafting or valve surgery. In [email protected], the patients received telerehabilitation technology and selected one of three telerehabilitation settings: a call center, a community health care center, or a hospital. Monitoring of steps continued for 12 months and a step counter (Fitbit Zip) was used to monitor daily steps.

Results: Cardiac patients walked a mean 5899 (SD 3274) steps per day, increasing from mean 5191 (SD 3198) steps per day in the first week to mean 7890 (SD 2629) steps per day after 1 year. Adherence to step counter use lasted for a mean 160 (SD 100) days. The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04). Furthermore, less physically active patients weighed more. There were no significant differences in mean steps per day for patients in the three rehabilitation settings or in the disease groups.

Conclusions: This study indicates that cardiac telerehabilitation at a call center can support walking activity just as effectively as telerehabilitation at either a hospital or a health care center. In this study, the patients tended to walk fewer steps per day than cardiac patients in comparable studies, but our study may represent a more realistic picture of walking activity due to the continuation of step counter use. Qualitative studies on patients' behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters.

Trial Registration: ClinicalTrials.gov NCT01752192; https://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6fgigfUyV).
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http://dx.doi.org/10.2196/jmir.5191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835668PMC
April 2016

Personalized Telehealth in the Future: A Global Research Agenda.

J Med Internet Res 2016 Mar 1;18(3):e53. Epub 2016 Mar 1.

Laboratory of Assistive Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.
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http://dx.doi.org/10.2196/jmir.5257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795318PMC
March 2016

Factors associated with telemonitoring use among patients with chronic heart failure.

J Telemed Telecare 2017 Feb 8;23(2):283-291. Epub 2016 Jul 8.

8 Strategic Technologies and Alliances, University of California, Davis and University of California Davis Medical Center, and The Center for Information Technology Research in the Interest of Society, University of California, Berkeley, USA.

Background In adults with chronic heart failure (HF; defined as people with previously diagnosed left ventricular dysfunction) telemonitoring randomized controlled trials (RCTs) failed to consistently demonstrate improved clinical outcomes. We aimed to examine if patient and HF characteristics are associated with device preferences and use. Methods Using a cross-sectional, multicenter, international design, ambulatory and hospitalized adults with HF in Ohio, California, and Denmark viewed a six-minute video of telemonitoring configurations (tablet, smart phone, and key fob) and completed questionnaires. Comparative analyses were performed and when significant, pairwise comparisons were performed using Bonferroni-adjusted significance levels. Results Of 206 participants, 48.2% preferred smart phones for telemonitoring, especially when traveling (54.8%), with new/worsening symptoms (50%), for everyday use (50%), and connecting with doctors (48.5%). Participants preferred two-way communication and a screen with words over voice or number pads. Of device purposes, allowing for nurse communication ranked highest, followed by maintaining overall health. Very few patient and HF factors were associated with device preferences. Patients with higher health literacy ( p = 0.007), previous/current device use history ( p = 0.008), higher education level ( p = 0.035), and married/cohabitating status ( p = 0.023) had higher perceptions of ease of using devices. Those who were asymptomatic or had mild HF had higher self-confidence for health devices ( p = 0.024) and non-white patients perceived devices as more useful ( p = 0.033). Conclusion Telemonitoring use may be enhanced by simple plug-and-play type devices, two-way communication, and features that meet patients' personal learning and use needs.
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http://dx.doi.org/10.1177/1357633X16630444DOI Listing
February 2017

Cost-Utility Analysis of a Cardiac Telerehabilitation Program: The Teledialog Project.

Telemed J E Health 2016 07 29;22(7):553-63. Epub 2015 Dec 29.

7 Telehealth and Telerehabilitation, Laboratory of Assistive Technologies, SMI ®, Department of Health Science and Technology, Faculty of Medicine, Aalborg University , Aalborg, Denmark .

Background: Cardiac rehabilitation can reduce mortality of patients with cardiovascular disease, but a frequently low participation rate in rehabilitation programs has been found globally. The objective of the Teledialog study was to assess the cost-utility (CU) of a cardiac telerehabilitation (CTR) program. The aim of the intervention was to increase the patients' participation in the CTR program. At discharge, an individualized 3-month rehabilitation plan was formulated for each patient. At home, the patients measured their own blood pressure, pulse, weight, and steps taken for 3 months.

Materials And Methods: The analysis was carried out together with a randomized controlled trial with 151 patients during 2012-2014. Costs of the intervention were estimated with a health sector perspective following international guidelines for CU. Quality of life was assessed using the 36-Item Short Form Health Survey.

Results: The rehabilitation activities were approximately the same in the two groups, but the number of contacts with the physiotherapist was higher among the intervention group. The mean total cost per patient was €1,700 higher in the intervention group. The quality-adjusted life-years (QALYs) gain was higher in the intervention group, but the difference was not statistically significant. The incremental CU ratio was more than €400,000 per QALY gained.

Conclusions: Even though the rehabilitation activities increased, the program does not appear to be cost-effective. The intervention itself was not costly (less than €500), and increasing the number of patients may show reduced costs of the devices and make the CTR more cost-effective. Telerehabilitation can increase participation, but the intervention, in its current form, does not appear to be cost-effective.
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http://dx.doi.org/10.1089/tmj.2015.0194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939376PMC
July 2016

"The Heart Game": Using Gamification as Part of a Telerehabilitation Program for Heart Patients.

Games Health J 2016 Feb 18;5(1):27-33. Epub 2015 Nov 18.

4 Laboratory for Telehealth and Telerehabilitation, Center for Sensory-Motor Interaction, Department for Health Science and Technology, Aalborg University , Aalborg, Denmark .

Objective: The aim of this article is to describe the development and testing of a prototype application ("The Heart Game") using gamification principles to assist heart patients in their telerehabilitation process in the Teledialog project.

Materials And Methods: A prototype game was developed via user-driven innovation and tested on 10 patients 48-89 years of age and their relatives for a period of 2 weeks. The application consisted of a series of daily challenges given to the patients and relatives and was based on several gamification principles. A triangulation of data collection techniques (interviews, participant observations, focus group interviews, and workshop) was used. Interviews with three healthcare professionals and 10 patients were carried out over a period of 2 weeks in order to evaluate the use of the prototype.

Results: The heart patients reported the application to be a useful tool as a part of their telerehabilitation process in everyday life. Gamification and gameful design principles such as leaderboards, relationships, and achievements engaged the patients and relatives. The inclusion of a close relative in the game motivated the patients to perform rehabilitation activities.

Conclusions: "The Heart Game" concept presents a new way to motivate heart patients by using technology as a social and active approach to telerehabilitation. The findings show the potential of using gamification for heart patients as part of a telerehabilitation program. The evaluation indicated that the inclusion of the patient's spouse in the rehabilitation activities could be an effective strategy. A major challenge in using gamification for heart patients is avoiding a sense of defeat while still adjusting the level of difficulty to the individual patient.
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http://dx.doi.org/10.1089/g4h.2015.0001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754508PMC
February 2016

[More research is needed in telemedicine for well-defined patient groups].

Ugeskr Laeger 2015 Apr;177(18):861-5

The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was initiated in 2008 including 3.230 patients from 179 general practices. The objective of this review is to summarize the results from WSD based on publications made so far. Results from five publications show that telehealth reduces mortality (odds ratio 0.54) during 12 months. The use of secondary care is reduced, however, when including costs of telehealth, the total costs are higher for
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April 2015

HEALTH PROFESSIONALS' USER EXPERIENCE OF THE INTELLIGENT BED IN PATIENTS' HOMES.

Int J Technol Assess Health Care 2015 Jan 21;31(4):256-63. Epub 2015 Aug 21.

Telehealth & Telerehabilitation Laboratory,SMI,Department of Health Science and Technology,Aalborg University.

Background: The intelligent bed is a medical bed with several home healthcare functions. It includes, among others, an "out of bed" detector, a moisture detector, and a catheter bag detector. The design purpose of the intelligent bed is to assist patients in their daily living, facilitate the work of clinical staff, and improves the quality of care. The aim of this sub-study of the iCare project was to explore how health professionals (HPs) experience and use the intelligent bed in patients' homes.

Methods: The overall research design is inspired by case study methodology. A triangulation of data collection techniques has been used: log book, documentation study, participant observations (n = 45 hr), and qualitative interviews (n = 23). The data have been analyzed by means of Nvivo 9.0.

Findings: We identified several themes: HP transformation from passive technology recipient to innovator; individualized care; work flow redesign; and sensor technology intruding on patient privacy.

Conclusions: It is suggested that functions of the intelligent bed can result in more individualized care, workflow redesign, and time savings for the health professionals in caring for elderly patients. However, the technology intruded on patients' privacy.
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http://dx.doi.org/10.1017/S0266462315000380DOI Listing
January 2015
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