Search Results (144)

This study aimed to evaluate the feasibility of using serious games for the (tele)rehabilitation of children with disabilities affected by the Ukrainian war. Additionally, it provides requirements for technologies that can be used in war-affected areas. Structured interviews and Likert scale assessments were conducted on-site and remotely with patients of the tertiary care facility in Ukraine. All participants used the telerehabilitation platform for motor and cognitive training. Nine serious games were employed, involving trunk tilts, upper limb movements, and head control. By mid-September 2023, 186 positive user experiences were evident, with 89% expressing interest in continued engagement. The platform’s accessibility, affordability, and therapeutic benefits were highlighted. The recommendations from user feedback informed potential enhancements, showcasing the platform’s potential to provide uninterrupted rehabilitation care amid conflict-related challenges. This study suggests that serious games solutions that suit the sociopolitical and economic context offer a promising solution to rehabilitation challenges in conflict zones. The positive user experiences towards using the platform with serious games indicate its potential in emergency healthcare provision. The findings emphasize the role of technology, particularly serious gaming, in mitigating the impact of armed conflicts on children’s well-being, thereby contributing valuable insights to healthcare strategies in conflict-affected regions. Requirements for technologies tailored to the context of challenging settings were defined. Full article

Background and Objectives: Specialized nurses play an essential role in managing pulmonary fibrosis. While tele-nursing has the potential to optimize disease management, current evidence regarding its impact remains limited. This study aimed to evaluate a tele-nursing intervention that provided unscheduled access to a specialized nurse via phone or email for both patients and caregivers. Materials and Methods: This was a prospective, single-center, open-label, and pre–post pilot study. Participants and their caregivers were provided with direct access to a specialized nurse, by phone and email, for unscheduled consultations. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) were collected at baseline and after three months of tele-nursing access. PREMs were assessed using a 10-point Likert scale questionnaire, and PROMs were evaluated using the King’s Brief Interstitial Lung Disease (K-BILD) and the Living with Pulmonary Fibrosis (L-PF) questionnaires. Results: A total of 47 patients with pulmonary fibrosis receiving antifibrotic drugs were enrolled. At three months, 44 patients and 34 caregivers completed the questionnaires. Four patients did not complete the study due to death, lung transplantation, or transition to end-of-life care. No significant changes were observed in PROMs. However, PREMs showed significant improvements, with most scores exceeding 9/10. Patient satisfaction increased by 28% (p < 0.001), and caregiver satisfaction by 30% (p < 0.001). Caregivers of patients who did not complete the study also reported high satisfaction, comparable to that of other caregivers. Conclusions: A pragmatic and affordable tele-nursing program, based on direct phone and email consultations, may enhance patient and caregiver satisfaction in the management of pulmonary fibrosis. Full article

This study assesses whether the rise in water level—following three years of reservoir filling at the Teles Pires Hydroelectric Plant (135.6 km² water surface) in Southern Amazonia—has affected the floristic composition, structure, and dynamics of adjacent forests. We established 62 permanent plots (2000 m² each) across a topographic gradient from the reservoir margin and conducted annual tree inventories for individuals with DBH ≥ 10 cm from 2014 to 2017. A total of 6322 individuals were recorded, representing 322 species, 210 genera, and 61 families. Fabaceae was the most abundant family, and the ten species with the highest importance value index (IVI) before reservoir filling remained dominant afterward. The forests exhibited high species richness and were characterized by a few common and many rare species. Mortality rates were highest within 10 m of elevation from the maximum reservoir level, indicating possible hydrological impacts, although no abnormal dieback or sharp shifts in floristic structure were observed. These results suggest limited short-term effects on species composition, but subtle changes in vegetation dynamics underscore the importance of long-term monitoring. Full article

Background/Objectives: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine. Methods: We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end. Results: The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical–legal aspects (e.g., data security, privacy, informed consent); clinician–patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up. Conclusions: This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas. Full article

Background/Objectives: Telemedicine has emerged as a valuable tool for overcoming access barriers in healthcare, particularly in rehabilitation. However, the validity and reliability of remotely conducted physical capacity assessments remain unclear. This study evaluated the agreement and intra-rater reliability between in-person and tele-assessment administration of the one-minute sit-to-stand test (1 min-STST) in individuals with chronic respiratory diseases (CRDs). Methods: In this cross-sectional study, forty adults (55% female; mean age 59.8 ± 15.9 years) diagnosed with CRDs—including chronic obstructive pulmonary disease (52.5%), asthma (20%), and pulmonary fibrosis (20%)—completed the 1 min-STST in two conditions: in person and via tele-assessment. The primary outcome was the number of repetitions completed in each condition. Intra-rater reliability was analyzed using the intraclass correlation coefficient (ICC), and agreement between methods was evaluated with Bland–Altman analysis. Results: The mean number of repetitions was 24.4 ± 8.0 in person and 24.3 ± 8.1 via tele-assessment, with no significant difference (p = 0.78). Excellent reliability was observed (ICC = 0.978, p < 0.001), and Bland–Altman analysis showed good agreement with a mean difference of 0.08 ± 1.7 repetitions and limits of agreement from −3.26 to 3.41. No adverse events were reported. Conclusions: Tele-assessment of the 1 min-STST shows excellent agreement and reliability compared to in-person assessment in individuals with CRDs. These findings support tele-assessment as a valid and practical alternative for evaluating functional capacity remotely. Further research is needed to confirm its implementation in home-based or less-controlled settings. Full article

Identifying correspondences of road segments in different road networks, namely road-network matching, is an essential task for road network-centric data processing such as data integration of road networks and data quality assessment of crowd-sourced road networks. Traditional road-network matching usually relies on feature engineering and parameter selection of the geometry and topology of road networks for similarity measurement, resulting in poor performance when dealing with dense and irregular road network structures. Recent development of graph neural networks (GNNs) has demonstrated unsupervised modeling power on road network data, which learn the embedded vector representation of road networks through spatial feature induction and topology-based neighbor aggregation. However, weighting spatial information on the node feature alone fails to give full play to the expressive power of GNNs. To this end, this paper proposes a Spatial Pattern-aware Graph EMbedding learning method for road-network matching, named SP-GEM, which explores the idea of spatially-explicit modeling by identifying spatial patterns in neighbor aggregation. Firstly, a road graph is constructed from the road network data, and geometric, topological features are extracted as node features of the road graph. Then, four spatial patterns, including grid, high branching degree, irregular grid, and circuitous, are modelled in a sector-based road neighborhood for road embedding. Finally, the similarity of road embedding is used to find data correspondences between road networks. We conduct an algorithmic accuracy test to verify the effectiveness of SP-GEM on OSM and Tele Atlas data. The algorithmic accuracy experiments show that SP-GEM improves the matching accuracy and recall by at least 6.7% and 10.2% among the baselines, with high matching success rate (>70%), and improves the matching accuracy and recall by at least 17.7% and 17.0%, compared to the baseline GNNs, without spatially-explicit modeling. Further embedding analysis also verifies the effectiveness of the induction of spatial patterns. This study not only provides an effective and practical algorithm for road-network matching, but also serves as a test bed in exploring the role of spatially-explicit modeling in GNN-based road network modeling. The experimental performances of SP-GEM illuminate the path to develop GeoEmbedding services for geospatial applications. Full article

Introduction: Timed Twenty-Five Foot Walk (T25FW) and Patient-Determined Disease Steps (PDDSs) are measures commonly used for people with MS (PwMS). However, there is limited knowledge about the utility of using the measures to customize interventions. Aim: This exploratory study aimed to assess the correlation between T25FW and PDDS among PwMS enrolled in the Tele-Exercise and Multiple Sclerosis (TEAMS) study. Methods: The correlation was examined through a Spearman’s rho statistic for T25FW time and PDDS scores. Associations between TEAMS Intervention levels (T25FW baseline benchmarks: <6 s, 6–7.99 s, >8 s, unable to complete) and the PDDS-modified ranges (0–2, 3–4, 5–6, 7) were examined utilizing a chi-square test with Monte Carlo simulations. Results: The results showed a strong statistically significant positive correlation between the T25FW time and the PDDS scores (r_s = 0.72, p < 0.001). An additional Spearman’s correlation showed strong significant positive correlation between T25FW baseline benchmarks and PDDS-modified ranges used for intervention assignment (r_s = 0.73, p < 0.001). A chi-square with Monte Carlo simulations showed a significant association between the TEAMS Intervention Level and PDDS-modified ranges (p = 0.005). Conclusion: In conclusions, the findings suggest that T25FW, when considered with PDDSs, might offer some utility in supporting clinicians as they develop intervention strategies that consider both subjective and objective aspects. These findings also highlight the potential for integrated use of both tools in clinical decision-making, program design, and tailoring interventions to meet individual functional capabilities and self-reported disability in PwMS. Full article

Background: Tele-practice, as an evidence-based practice, has gained momentum over the last two decades. However, routine clinical adoption is not spontaneous. Implementation science facilitates stakeholder engagement and the assessment of needs and plans. The study aims to assess the needs related to audiology and speech–language pathology services for children under six years of age and readiness for a tele-practice-based model of care for diagnostic and rehabilitation services among parents within the public sector in Tamil Nadu. Methods: A cross-sectional study design was used. The qualitative methods of focus group discussions and semi-structured interviews were conducted for parents of children with disabilities. A quantitative community survey was conducted on parents of children with no known disabilities. A deductive-inductive method of analysis was used. Results: Community survey responses were analyzed using percentage analysis. The results were classified based on the constructs of Bowen’s feasibility framework: demand/need for tele-practice, acceptability of tele-practice, and integration and practicality of tele-practice. Parents considered the existing services to be inadequate. Parents perceived tele-practice as beneficial, yet they felt a hybrid method would be more suitable, with sufficiently interspersed in-person visits. Parents believed that training and community awareness were necessary before implementing a technology-based model of services. Conclusions: The study’s findings guided the fine-tuning of the proposed comprehensive tele-practice model for hearing and speech–language services for children in this rural district. Full article

Background: Despite advances in artificial intelligence (AI) for Diabetic Retinopathy (DR) classification, traditional severity-based approaches often lack interpretability and fail to capture specific lesion-centered characteristics. To address these limitations, we constructed the National Medical Center (NMC) dataset, independently annotated by medical professionals with detailed labels of major DR lesions, including retinal hemorrhages, microaneurysms, and exudates. Methods: This study explores four critical research questions. First, we assess the analytical advantages of lesion-centered labeling compared to traditional severity-based labeling. Second, we investigate the potential complementarity between these labeling approaches through integration experiments. Third, we analyze how various model architectures and classification strategies perform under different labeling schemes. Finally, we evaluate decision-making differences between labeling methods using visualization techniques. We benchmarked the lesion-centered NMC dataset against the severity-based public Asia Pacific Tele-Ophthalmology Society (APTOS) dataset, conducting experiments with EfficientNet—a convolutional neural network architecture—and diverse classification strategies. Results: Our results demonstrate that binary classification effectively identifies severe non-proliferative Diabetic Retinopathy (Severe NPDR) exhibiting complex lesion patterns, while relationship-based learning enhances performance for underrepresented classes. Transfer learning from NMC to APTOS notably improved severity classification, achieving performance gains of 15.2% in mild cases and 66.3% in severe cases through feature fusion using Bidirectional Feature Pyramid Network (BiFPN) and Feature Pyramid Network (FPN). Visualization results confirmed that lesion-centered models focus more precisely on pathological features. Conclusions: Our findings highlight the benefits of integrating lesion-centered and severity-based information to enhance both accuracy and interpretability in DR classification. Future research directions include spatial lesion mapping and the development of clinically grounded learning methodologies. Full article

Background/Objectives: Hearing aids are essential for managing hearing loss, yet their accessibility, consistent use, and maintenance remain challenging in public healthcare systems, particularly in low- and middle-income countries (LMICs) such as South Africa. Despite the availability of these services, many patients struggle with device utilization, resulting in suboptimal rehabilitation outcomes. This study explores patient experiences with hearing aids in South Africa’s public healthcare sector. This study aimed to (1) assess patients’ experiences with hearing aid access, including waiting times and service delivery; (2) identify challenges related to hearing aid maintenance and repairs in the public sector; (3) explore factors influencing consistent hearing aid use, including social, psychological, and practical barriers; and (4) propose strategies to enhance hearing aid provision and aftercare services in South Africa. Methods: This descriptive qualitative study was conducted at two public healthcare facilities in Johannesburg. Purposive sampling was used to recruit 15 adult hearing aid users who had received government-funded hearing aids within the past 12 months. Semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis. Results: Participants reported long waiting periods (up to a year) for hearing aids, with poor communication regarding timelines. Challenges included difficulties adjusting to amplification, discomfort, and battery shortages, leading to inconsistent use or device abandonment. Social stigma and lack of family support further discouraged consistent use. Repair services were slow, with waiting times exceeding three months. Participants recommended decentralized battery distribution, structured follow-up appointments, improved aftercare, awareness campaigns, and mobile audiology services to improve accessibility and usability. Conclusions: While public hearing aid provision is essential for hearing rehabilitation, systemic inefficiencies, maintenance issues, and social barriers limit its impact. Strengthening aftercare services, decentralizing hearing aid distribution, and increasing public awareness could significantly improve hearing aid accessibility and adherence. Furthermore, policy interventions that incorporate tele-audiology, community-based maintenance programs, and integrated healthcare approaches are crucial in ensuring sustainable hearing healthcare outcomes. Full article

Background: Cognitive decline does not always occur; therefore, it is important to recognise the predictors in people over 60. The COVID-19 pandemic led to isolation to limit the spread of the virus, with older people being the most affected. Objectives: To analyse the cognitive variables of older adults in confinement during COVID-19 using tele-neuropsychology for cognitive assessment, comparing online with in-person screening. Methods: In total, 148 subjects took part in the study. Participants were assigned to the in-person or online intervention based on their preferences. A person close to the patient also participated in the study as an informant. Results: The results support the suitability of the protocol used in both modalities (face-to-face/online). Conclusions: Both assessments (face-to-face and online) are equally effective. The findings are consistent with the importance of cognitive measures and the key informant corroboration in identifying indicators of cognitive decline and implementing early intervention strategies. Full article

Introduction: During the COVID-19 pandemic, the availability of cardiac rehabilitation (CR) was limited. On the other hand, during that period of epidemic restrictions, patients with acute coronary syndrome (ACS) required careful control and monitoring after coronary events. The aim of this study was to assess whether CR conducted during the epidemic restrictions in a remote mode ensured similar improvement in physical performance as CR conducted in a centre-based mode before the COVID-19 pandemic. Material and Methods: In this one-centre study, we compared the demographic and clinical profiles of patients after ACS who completed inpatient CR before the COVID-19 era with those of patients who completed telerehabilitation during the COVID-19 pandemic. We assessed the workload on the initial and final exercise tests (ExT) obtained by patients and compared the values of the differences between the final and initial ExT. The study included 359 patients (pts) participating in inpatient CR before October 2020 (the suspension of centre-based CR) and 60 pts who took part in telerehabilitation after July 2021 (the introduction of the tele-CR programme). Both inpatient and tele-CR were performed according to the guidelines of the Working Group for Cardiac Rehabilitation of the National Cardiac Society. A telemedic platform was used to control ECG, blood pressure and body mass of the pts participating in telerehabilitation. Results: The improvement of physical performance did not differ significantly between the two groups. The pts who completed telerehabilitation were significantly older than those who completed inpatient CR. The values of other parameters, such as the percentage of females, BMI, the percentage of pts with arterial hypertension and type 2 diabetes mellitus, as well as left ventricular ejection fraction did not differ significantly between the compared groups. Nor did the results of initial ExT expressed in METs, the results of final ExT and the improvement of workload understood as the difference between the final and initial results of ExT differ significantly—they were 7.7 ± 3.06 vs. 7.89 ± 2.98 with p = 0.82; 9.08 ± 0.29 vs. 8.98 ± 3.48 with p = 0.84, and 1 [0–2.2] vs. 1.2 [0–1.8] with p = 0.17, respectively. Conclusions: In our centre, telerehabilitation after acute coronary syndrome guaranteed an equally good improvement in physical capacity as that observed in inpatient CR patients, regardless of the difference in the age profile of the compared groups. These results encourage the popularization of telerehabilitation with remote monitoring of ECG, blood pressure and body mass. Full article

Background: About 15 million people suffer a stroke each year, of which 10–15% occur in people under 50 years of age. The clinical management of neurological disorders depends on reliable diagnostic tools to identify impairments and aid in the early and accurate detection of disease. The objective of this study is to present a systematic review protocol for identifying the scientific evidence on the use of tele-assessment compared with in-person assessment delivery by physiotherapists for stroke patients. This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024613552). Methods: Original studies of any design in which physiotherapy tele-assessment using videoconferencing compared with face-to-face assessment for patients with stroke conditions will be included. The research will be carried out in PubMed/Medline, Cochrane Library, PEDro (Physiotherapy Evidence Database), and NICE. The risk of bias will be assessed using the Quality Appraisal Tool for studies of diagnostic Reliability (QAREL) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Results: The screening, selection, and analysis process will be conducted by two independent researchers and reviewed by a third evaluator to resolve any potential disagreements. The feasibility of conducting a meta-analysis for quantitative data will be evaluated based on the homogeneity analysis of the selected studies. Conclusions: We hope that this systematic review protocol will provide scientific evidence for tele-assessment as a physiotherapeutic assessment strategy for stroke patients and that it will be available as a complementary tool to face-to-face physiotherapeutic assessments for specific situations. Full article

Parkinson’s disease (PD) and multiple sclerosis (MS) are two chronic neurological diseases (CNDs) that have a high demand for early and continuous rehabilitation. However, accessing professional care remains a challenge, making it a key priority to identify sustainable solutions for ensuring early rehabilitation availability. Objective: The FIT4TeleNEURO pragmatic trial proposes to investigate, in real-life care settings, the superiority in terms of the effectiveness of early rehabilitation intervention with harmonized, mix-model telerehabilitation (TR) protocols (TR single approach, task-oriented—TRsA; TR combined approach, task-oriented and impairment-oriented—TRcA) compared to conventional management (control treatment, CeT) in people with PD and MS. Design, and Methods: This multicenter, randomized, three-treatment arm pragmatic trial will involve 300 patients with CNDs (PD, N = 150; MS, N = 150). Each participant will be randomized (1:1:1) to the experimental groups (20 sessions of TRsA or TRcA according to a mix-model—3 asynchronous + 1 synchronous session/week) or the control group (20 sessions of CeT). Primary and secondary outcome measures will be obtained at the baseline (T0), post-intervention (T1, 5 weeks after baseline), and follow-up (T2, 3 months after the end of the treatment). A multidimensional evaluation (cognitive, motor, and quality of life domains) will be conducted at each time point of assessment (T0; T1; T2). The primary outcome measures will be the assessment of change (T0 vs. T1 vs. T2) in static and dynamic balance, measured using the Mini-Balance Evaluation Systems Test. Usability and acceptability assessment will be also investigated. Expected Results: Implementing TR protocols will enable a more targeted and efficient response to the growing demand for rehabilitation in the early stages of CNDs. Both the TRsA and TRcA approaches are expected to be more effective than CeT, with the combined approach likely providing greater benefits in secondary outcome measures. Finally, the acceptability of the asynchronous modality could open the door to scalable solutions, such as digital therapeutics. 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