Search Results (124)

Background: Despite strong guideline recommendations, participation in cardiac rehabilitation (CR) among patients with chronic heart failure (CHF) remains low due to logistical, geographical, and psychosocial barriers. Telerehabilitation may help overcome these limitations by offering remote, structured exercise programs supported by digital technologies. Objective: The TELEREHAB-HF study aims to evaluate the efficacy of an 8-week, home-based cardiac telerehabilitation program compared to standard in-person rehabilitation in patients with CHF. Methods: This is a prospective, controlled cohort study involving 220 adult patients with CHF (NYHA class I–III) clinically stable and on optimized therapy. Participants are assigned to either a telerehabilitation group (remote CR via a digital platform with wearable sensors and real-time physiotherapist supervision) or a standard in-person rehabilitation group. The primary outcome is the change in peak oxygen uptake (VO₂max) at 8 weeks. Secondary outcomes include quality of life, functional performance, biochemical and echocardiographic parameters, and cognitive function, assessed at baseline and at 4, 8, 16, and 24 weeks. Expected Results: We hypothesize that telerehabilitation will be non-inferior to standard CR in improving functional capacity and secondary outcomes, with additional benefits in accessibility and adherence. Data from remote monitoring may also support a translational “rehabilomics” approach to exploring exercise-induced biomarker changes. Conclusions: This study seeks to assess the clinical effectiveness, safety, and feasibility of a home-based telerehabilitation model for CHF, with the goal of informing future strategies for broader implementation and personalized rehabilitation. Trial Registration: ClinicalTrials.gov Identifier: NCT07023536 Full article

This study reviews how technology-based interventions have been designed and implemented to promote lung cancer screening (LCS), support shared decision-making, and enhance patient engagement. A systematic search of six databases in February 2025 identified 28 eligible studies published between 2014 and 2025. Most interventions were home-based and self-guided, including videos, websites, mobile apps, telehealth, and patient portal messages. Common features included risk calculators, multimedia content, simplified navigation, and integration with electronic medical records. These tools aim to raise awareness, improve informed decision-making, and support smoking cessation. While 82% of studies reported positive effects on knowledge and decision-making confidence, only some showed an increased screening uptake. Key barriers included limited internet access, low digital literacy, provider time constraints, fear or anxiety, and concerns about radiation or cost. Despite these challenges, digital tools show promise in advancing LCS promotion. Their effectiveness, however, depends on thoughtful design, integration into clinical workflows, and equitable access. Future work should address structural and contextual challenges to scale digital health solutions and reduce disparities in screening participation. This review identifies both the potential and limitations of current interventions and offers guidance for enhancing impact through targeted, accessible, and user-informed approaches. Full article

Hospital in the Home (HITH) programs are emerging as a key pillar of smart city healthcare infrastructure, leveraging technology to extend care beyond traditional hospital walls. The global healthcare sector has been conceptualizing the notion of a care without walls hospital, also called HITH, where virtual care takes precedence to address the multifaceted needs of an increasingly aging population grappling with a substantial burden of chronic disease. HITH programs have the potential to significantly reduce hospital bed occupancy, enabling hospitals to better manage the ever-increasing demand for inpatient care. Although many health providers and hospitals have established their own HITH programs, there is a lack of research that provides healthcare executives and HITH program managers with management models and frameworks for such initiatives. There is also a lack of research that provides strategies for improving HITH management in the health sector. To fill this gap, the current study ran a systematic literature review to explore state-of-the-art with regard to this topic. Out of 2631 articles in the pool of this systematic review, 20 articles were deemed to meet the eligibility criteria for the study. After analyzing these studies, nine management models were extracted, which were then categorized into three categories, namely, governance models, general models, and virtual models. Moreover, this study found 23 strategies and categorized them into five groups, namely, referral support, external support, care model support, technical support, and clinical team support. Finally, implications of findings for practitioners are carefully provided. These findings provide healthcare executives and HITH managers with practical frameworks for selecting appropriate management models and implementing evidence-based strategies to optimize program effectiveness, reduce costs, and improve patient outcomes while addressing the growing demand for home-based care. Full article

Background/Objectives: This study evaluates the effects of a personalized exercise program on symptoms (pain, fatigue, sleep, cognitive function, physical function), resilience, and health-related quality of life (HRQOL) and compares the effectiveness of in-person versus telehealth delivery. Methods: A secondary data analysis was conducted on two 12-week randomized control pilot studies for solid tumor cancer survivors. One study involved in-person home visits with telephone follow-ups. The second utilized weekly exercise recommendations via a smartphone app. Both studies had control participants who received the standard care. Symptoms, resilience, and HRQOL were measured at baseline and after 12 weeks. Paired t-tests were conducted for intervention effects and ANCOVA for group differences, adjusting for age and education. Results: The analysis included 75 program completers: 15 in-person (iHBE), 38 telehealth (TEHE), and 22 who received standard care. Those receiving exercise interventions reported improvements in physical (t = 3.0, p < 0.01) and mental fatigability (t = 3.1, p < 0.01) at program completion compared to baseline. Comparing the mean changes between participants receiving exercise interventions in-person and via telehealth, there were no significant differences between the two delivery methods except perceived visuo-perceptual cognitive difficulty (F = 3.55, p = 0.027), where telehealth showed a slight advantage. Conclusions: The study provides initial evidence of the effectiveness of a telehealth personalized exercise on fatigability and cognitive difficulty, suggesting it is a potential viable alternative to in-person intervention. Further research with a larger cohort is essential to ascertain the effects of these interventional modalities on cancer-related health outcomes. Full article

Background/Objectives: Telehealth enhances access to specialty care, but stakeholder perspectives are often overlooked. The objective was to evaluate participant and provider satisfaction with a novel telehealth-enabled home safety program. Methods: This is a sub-investigation of a non-randomized pilot study of a novel telehealth-enabled home safety program that enrolled 23 persons with Parkinson’s Disease (PwPs) at risk for falls and their respective care partners (CPs). Dyads participated in four to six televisits over three months, where they performed “virtual home tours” using a mobile platform (tablet mounted on a rolling stand) with a physical therapist to identify and mitigate environmental fall hazards. Satisfaction was assessed using PI-developed surveys and open feedback. Mobile platform usability was assessed with the System Usability Scale (SUS). Results: A total of 95.65% of dyads were very to extremely satisfied with the entire program overall, and the therapist indicated the same for 73.91% of the dyads. Additionally, 95.65% of dyads reported gaining new awareness of home fall hazards. Difficulties maneuvering the mobile platform, using a tablet, and connectivity issues were common challenges noted. The mean score on SUS for the mobile platform was 65, indicating poor perceived usability, and most dyads indicated they would have preferred using a smartphone for the program. Other priorities, including competing health and personal obligations, along with resistance to change, were the primary barriers to implementing program recommendations. Conclusions: Our novel telehealth-enabled home safety program was well-received by patients and the study therapist. Using a smartphone and troubleshooting connectivity issues might help further improve the usability and accessibility of this program. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with rural populations experiencing higher prevalence and worse outcomes. This paper explores the transformative potential of nurse-led palliative care models in addressing the unique challenges faced by rural patients with COPD and their informal caregivers and synthesizes current evidence on nurse-led palliative care interventions, highlighting their impact on symptom management, advance care planning, and psychosocial support. Methods: This is a comprehensive synthesis of nurse-led palliative care programs, focusing on home-based care, telehealth, community outreach, and primary care integration. Results: Nurse-led interventions significantly improve patient satisfaction, reduce symptom burden, and enhance the likelihood of advance care planning discussions. Home-based care models and telehealth are particularly effective in rural settings, offering accessible and continuous support. Conclusions: Nurses have a critical role in bridging the palliative care gap for rural patients with COPD and their informal caregivers. Expanding nurse-led palliative care services can improve quality of life, reduce healthcare utilization, and promote health equity. Future research should focus on long-term outcomes, cost-effectiveness, and strategies for scaling nurse-led palliative care programs in rural contexts. Full article

Background: The aging population is increasing, leading to a greater need for home care for older adults, often provided by informal caregivers (ICs). These caregivers face numerous challenges, requiring adequate training and support. Objectives: This study aimed to map the main interventions performed by the Rehabilitation Nursing Specialist in empowering ICs of older adults at home. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology. The search included seven articles published between 2019 and 2024, in Portuguese, English, and Spanish, available in the PubMed e CINHAL Ultimate databases. The descriptors used were (Rehabilitation Nursing) AND (Informal Caregivers OR Caregivers) AND (Elderly OR Aged) AND (mentoring OR Training. Results: The RNS interventions focused on training caregivers in technical skills (e.g., positioning, transfers, hygiene care, feeding, medication administration), preventing caregiver burden, managing behavioral and psychological symptoms of dementia, promoting self-care, and emotional support. Educational programs and the use of technologies (telehealth) were identified as effective strategies. Conclusions: RNS interventions are crucial for enhancing the skills and well-being of ICs, improving the quality of care provided to older adults at home, and reducing caregiver burden. Person-centered care, continuous support, and recognizing the caregiver’s role are fundamental aspects of these interventions. Full article

Rotator cuff tears are common in individuals over 40, and physical therapy is often prescribed post-surgery. However, access can be limited by cost, convenience, and insurance coverage. CuffLink is a telehealth rehabilitation system that integrates the Strengthening and Stabilization System mechanical exerciser with the interACTION mobile health platform. The system includes a triple-axis accelerometer (LSM6DSOX + LIS3MDL FeatherWing), a rotary encoder, a VL530X time-of-flight sensor, and two wearable BioMech Health IMUs to capture upper-limb motion. CuffLink is designed to facilitate controlled, home-based exercise while enabling clinicians to remotely monitor joint function. Concurrent validity and test–retest reliability were used to assess device accuracy and repeatability. The results showed moderate to good validity for shoulder rotation (ICC = 0.81), device rotation (ICC = 0.94), and linear tracking (from zero: ICC = 0.75 and RMSE = 2.41; from start: ICC = 0.88 and RMSE = 2.02) and good reliability (e.g., RMSEs as low as 1.66 cm), with greater consistency in linear tracking compared to angular measures. Shoulder rotation and abduction exhibited higher variability in both validity and reliability measures. Future improvements will focus on manufacturability, signal stability, and force sensing. CuffLink supports accessible, data-driven rehabilitation and holds promise for advancing digital health in orthopedic recovery. Full article

Nutritional health is essential for older people with dementia. Their feeding is a challenge for which caregivers are not always ready, and an intervention that supports them may have a significant social impact. The aim of this project is to design and evaluate the impact of systematic nursing intervention with formal caregivers to promote nutritional health for older people with dementia. This is a “Nursing Methodology Research” study conducted with formal caregivers of older people with dementia in four Colombian nursing homes. It includes three consecutive phases: (1) systematic intervention design under Whittemore and Grey’s parameters, (2) intervention validation with seven international experts, and (3) measurement of intervention impact, which included a quasi-experimental pre-test–post-test design. The “Nurturing Neurons—Formal Caregivers” intervention met the criteria of systematic health interventions. In response to the work and personal requirements of formal caregivers, the intervention used a tele-support modality. Its content validity ratio (CVR) ranged from 0.88 to 0.92; its content validity index (CVI) was 0.90. The experience was positive for the participant caregivers (94.9%) and professional providers (92.5%). The overall caregivers’ caring competence changed from the medium, 78.1, to the high category, 91.5 (p < 0.001). Their perceived burden of care changed from 70.4 to 63.6 (p < 0.001). In conclusion, “Nurturing Neurons—Formal Caregivers” achieved a positive impact, with changes in the structure, processes, and outputs to promote the nutritional health of older people with dementia. It led to a significant improvement in formal caregivers’ caring competence and decreased their perceived care burden. Its cost–benefit was favorable; it generated health equity for a vulnerable population and achieved unexpected benefits in the context. Full article

Background/Objectives: In 2010, approximately 60.5 million people were affected by glaucoma, making it the leading cause of permanent vision impairment globally. With the rise of telehealth tools and technological advancements in glaucoma care, this review aims to provide an up-to-date analysis regarding remote monitoring systems in glaucoma management. Methods: A systematic literature search (in compliance with PRISMA guidelines) was conducted across six databases (CINAHL, MEDLINE, PsycINFO, Web of Science, Scopus, and Cochrane Library) and one grey literature source (Google Scholar), covering the period from 2000 to 2024. Relevant studies meeting predefined inclusion criteria were identified and analyzed. Results: The search identified 21 eligible studies focusing on various glaucoma telemonitoring tools. Several studies demonstrated the potential for continuous remote intraocular pressure (IOP) monitoring and highlighted the effectiveness of home-based visual field-testing technologies (e.g., Melbourne Rapid Fields, Eyecatcher, and VF-Home), which showed results closely matching in-clinic tests. All 21 studies underwent risk of bias assessment with appropriate tools based on study design, and none showed a high overall risk of bias, indicating robust methodology. Conclusions: Glaucoma telemonitoring tools are feasible and cost-effective, helping to reduce patient travel and waiting times and improving patient satisfaction. However, periodic in-person examinations remain necessary to optimally monitor disease progression and adjust treatments. Future directions should focus on interdisciplinary collaboration and the development of advanced algorithms (including artificial intelligence) to further enhance patient outcomes in teleglaucoma care. Full article

China’s rapidly aging population has intensified demand for long-term services and supports (LTSSs), yet geographic disparities in accessibility persist despite policy reforms like long-term care insurance (LTCI). This study evaluates spatial inequities in Chengdu, a megacity piloting LTCI, using an enhanced two-step floating catchment area (2SFCA) method with demand intensity coefficients and a spatial mismatch index (SMI). Results reveal critically low average accessibility: 0.126 LTSS beds and 0.019 formal caregivers per thousand recipients within a 60 min travel threshold. Accessibility declines sharply along urbanization gradients, with urban cores (“first loop”) exceeding suburban “second” and “third loop” by ratios of 1.5–2.1 and 2.0–8.0, respectively. Strong correlations with impervious surface ratios (R² = 0.513–0.643) highlight systemic urban bias in resource allocation. The SMI analysis uncovers divergent spatial mismatches: home care accessibility predominates in western suburbs due to decentralized small-scale providers, while institutional care clusters in eastern suburbs, reflecting government prioritization of facility-based services. Despite LTCI’s broad coverage (67% of Chengdu’s population), rural and peri-urban older adults face compounded barriers, including sparse LTSS facilities, inadequate transportation infrastructure, and reimbursement policies favoring urban institutional care. To address these inequities, this study proposes a multi-stakeholder framework: (1) strategic expansion of LTSS facilities in underserved suburban zones, prioritizing institutional care in the “third loop”; (2) road network optimization to reduce travel barriers in mountainous regions; (3) financial incentives (e.g., subsidies, tax breaks) to attract formal caregivers to suburban areas; (4) cross-regional LTCI coverage to enable access to adjacent district facilities; and (5) integration of informal caregivers into reimbursement systems through training and telehealth support. These interventions aim to reconcile spatial mismatches, align resource distribution with Chengdu’s urban–rural integration goals, and provide scalable insights for aging megacities in developing contexts. By bridging geospatial analytics with policy design, this study underscores the imperative of data-driven governance to ensure equitable aging-in-place for vulnerable populations. Full article

Background/Objectives: Home spirometry allows people with cystic fibrosis (CF) to monitor their lung function from home. However, there are concerns about its feasibility and validity compared to traditional clinic spirometry. The aim of this study was to evaluate the feasibility and validity of telehealth spirometry for patients with CF living in a regional setting. Methods: This retrospective study included forty-eight people with cystic fibrosis (pwCF) aged 6–33 years. Participants performed home spirometry using a portable flow sensor spirometer over a one-year period, without supervision. Spirometry readings from portable spirometers were compared with the nearest in-clinic spirometry using the intra-correlation coefficient (ICC) and Bland–Altman plots. Data were collected over a period of one year, with regular intervals of measurements. Results: In 427 of the 877 (48.6%) attempted sessions, successful spirometry at home was recorded. Although we showed good reliability between at-home and in-clinic measurements using the Bland–Altman plots and intraclass correlation co-efficient (ICC) (values ranged from 0.76 to 0.88), analysis of the 117 pairs of at-home and in-clinic spirometries showed that mean differences of forced expiratory volume in the 1st sec (FEV1) and forced vital capacity (FVC) obtained at home (both in liter and z-score) had, on average, lower values than the corresponding values at the clinic. Conclusions: Home-based telehealth spirometry is feasible among pwCF and provides advantages, especially for those from remote or secluded areas. However, lower values in FVC and FEV1 obtained through home spirometry should not be used interchangeably with clinic values. Full article

Background: Healthy cognitive functioning is a primary component of well-being, independence, and successful aging. Cognitive deficits can arise from various conditions, such as brain injury, mental illness, and neurological disorders. Rehabilitation is a highly specialized service limited to patients who have access to institutional settings. In response to this unmet need, telehealth solutions are ideal for triggering the migration of care from clinics to patients’ homes. Objectives: The aim of EARLY-COGN^3 will be threefold: (1) to test the efficacy of a digital health at-home intervention (tele@cognitive protocol) as compared to an unstructured cognitive at-home rehabilitation in a cohort of patients with Chronic Neurological Diseases (CNDs); (2) to investigate its effects on the biomolecular and neurophysiological marker hypothesizing that people with CNDs enrolled in this telerehabilitation program will develop changes in biological markers and cortical and subcortical patterns of connectivity; (3) to analyze potential cognitive, neurobiological, and neurophysiological predictors of response to the tele@cognitive treatment. Method: In this single-blind, randomized, and controlled pilot study, we will assess the short- and long-term efficacy of cognitive telerehabilitation protocol (tele@cognitive) as compared to an unstructured cognitive at-home rehabilitation (Active Control Group—ACG) in a cohort of 60 people with Mild Cognitive Impairment (MCI), Subjective Cognitive Complaints (SCCs), or Parkinson’s Disease (PD). All participants will undergo a clinical, functional, neurocognitive, and quality of life assessment at the baseline (T0), post-treatment (5 weeks, T1), and at the 3-month (T2) follow-up. Neurophysiological markers and biomolecular data will be collected at T0 and T1. Conclusions: EARLY-COGN^3 project could lead to a complete paradigm shift from the traditional therapeutic approach, forcing a reassessment on how CNDs could take advantage of a digital solution. (clinicaltrials.gov database, ID: NCT06657274) Full article

Background: The rapid adoption of telehealth services for youth mental health care necessitates a comprehensive evaluation of its effectiveness. This study aimed to analyze the impact of telehealth on youth mental health outcomes using artificial intelligence techniques applied to large-scale public health data. Methods: We conducted an AI-driven analysis of data from the National Survey on Drug Use and Health (NSDUH) and other SAMHSA datasets. Machine learning techniques, including random forest models, K-means clustering, and time series analysis, were employed to evaluate telehealth adoption patterns, predictors of effectiveness, and comparative outcomes with traditional in-person care. Natural language processing was used to analyze sentiment in user feedback. Results: Telehealth adoption among youth increased significantly, with usage rising from 2.3 sessions per year in 2019 to 8.7 in 2022. Telehealth showed comparable effectiveness to in-person care for depressive disorders and superior effectiveness for anxiety disorders. Session frequency, age, and prior diagnosis were identified as key predictors of telehealth effectiveness. Four distinct user clusters were identified, with socioeconomic status and home environment strongly associated with positive outcomes. States with favorable reimbursement policies saw a 15% greater increase in youth telehealth utilization and 7% greater improvement in mental health outcomes. Conclusions: Telehealth demonstrates significant potential in improving access to and effectiveness of mental health services for youth. However, addressing technological barriers and socioeconomic disparities is crucial to maximize its benefits. Full article

Hypertension remains a critical global health challenge, significantly contributing to cardiovascular morbidity and mortality despite advancements in treatment. The 2024 ESC hypertension guidelines address persistent gaps in hypertension management by emphasizing comprehensive strategies encompassing early detection, socioeconomic barriers, lifestyle interventions, and personalized care. Enhanced screening protocols, including home and ambulatory blood pressure monitoring, aim for accurate diagnosis and risk stratification. Lifestyle recommendations now prioritize reducing sodium intake, increasing potassium consumption, and integrating tailored exercise regimens. Pharmacological updates advocate for single-pill combinations and stringent BP targets (<130/80 mmHg), emphasizing the benefits of sodium-glucose cotransporter-2 inhibitors for specific comorbidities. Minimally invasive therapies like renal denervation are explored for resistant hypertension, while digital tools such as telehealth and mobile applications enhance patient engagement and adherence. This multifaceted, patient-centered approach provides a roadmap for optimizing BP control, reducing cardiovascular risks, and addressing the complexities of hypertension in diverse populations. Full article