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E000022.Full.Pdf Open access Original research BMJ Health Care Inform: first published as 10.1136/bmjhci-2019-000022 on 20 April 2019. Downloaded from Developing a telerehabilitation programme for postoperative recovery from knee surgery: specifications and requirements MReza Naeemabadi,1 Birthe Dinesen,1 Ole Kæseler Andersen,2 Niels Kragh Madsen,3 Ole Højgaard Simonsen,4 John Hansen5 To cite: Naeemabadi MR, ABSTRACT Summary Dinesen B, Andersen OK, et al. Introduction Telerehabilitation programmes have been Developing a telerehabilitation attracting increasing attention as a potential alternative What is already known? programme for postoperative to conventional rehabilitation. Video conferencing recovery from knee surgery: Video conferencing system are widely being used can facilitate communication between healthcare ► specifications and requirements. to deliver telerehabilitation services over a distance. professionals and patients. However, in certain cases, BMJ Health Care Inform Although, real-time video communication over- video conferencing may face practical limitations. As ► 2019;26:e000022. doi:10.1136/ comes the limitations on providing services re- an alternative to real-time conferencing, sensor-based bmjhci-2019-000022 motely; several limitations such as portability and technologies can transmit the acquired data to healthcare flexibility are unresolved. Received 27 November 2018 providers. This study aimed to design and develop a Revised 20 January 2019 sensor-based telerehabilitation programme and to outline What does this paper add? Accepted 20 January 2019 the corresponding requirements for such a system. ► Requirements for providing communication, training, Development The development of the sensor-based reporting, and information services were discussed. copyright. telerehabilitation programme was carried out based on ► Sensor-based telerehabilitation programs can be user needs. The programme includes a portable platform considered as an alternative solution introducing for the patient as well as a web-based platform for the telerehabilitation programs for the patients. healthcare professional, thus allowing for an individualised ► Dependency on continuous and stable internet con- rehabilitation programme. Communication, training, nection can be resolved by employing a semi-online reporting, and information services were provided for telerehabilitation program. Biometric authentication the patients. Moreover, the portability and usability of the methods can be used to improve users’ experience. programme were enhanced by utilising the system in offline mode as well. http://informatics.bmj.com/ Application The programme is currently being tested improve patients’ adherence as well as facili- in the North Denmark Region to assess the feasibility 3 4 and acceptance of a telerehabilitation programme as an tate health recovery. Hall et al have shown alternative solution to the self-training programme for that a therapist–patient relationship may have patients who have been discharged from knee surgery. a positive influence on the observed clinical 5 The preliminary results of our assessment showed a high outcomes. Baker et al also showed that an level of acceptance among the users. in-home training programme accelerates the Discussion In this study, a semi-online sensor-based rehabilitation process and generates signifi- telerehabilitation programme was tested. It is argued cant improvements in patients’ quality of life. on September 25, 2021 by guest. Protected that a similar sensor-based telerehabilitation programme More comprehensive healthcare services, as can be utilised as an alternative solution for self-training well as higher accessibility, can be introduced rehabilitation in the future; however; further studies using a comprehensive telerehabilitation and development are required to ensure the quality and programme (TRP).6–8 It has been shown that reliability of sensor-based services. © Author(s) (or their patients will experience a higher level of satis- employer(s)) 2019. Re-use faction along with the practical convenience permitted under CC BY-NC. No 9 10 commercial re-use. See rights INTRODUCTION of a home-based TeleHomeCare solution. 11 and permissions. Published by Total knee arthroplasty is considered the most Russell has categorised TRP solutions into BMJ. successful and efficient surgical treatment for image-based (audio/video-based communi- For numbered affiliations see patients with degenerative knee arthritis.1 cation), sensor-based, and virtual environ- end of article. Studies have shown that post-surgical physical ment-based TRP. Real-time video-conference Correspondence to rehabilitation improves the physical function communication was frequently employed to 2 MReza Naeemabadi; over the short-term. Moreover, an individual- establish live video communication between reza@ hst. aau. dk ised exercise programme has been shown to patients and healthcare professionals (HPs). Naeemabadi MR, et al. BMJ Health Care Inform 2019;26:e000022. doi:10.1136/bmjhci-2019-000022 1 Open access BMJ Health Care Inform: first published as 10.1136/bmjhci-2019-000022 on 20 April 2019. Downloaded from Figure 1 An overview of the developed telerehabilitation programme. Patients used a tablet to access the programme. copyright. MyKnee application (running on the tablet) was responsible for providing the telerehabilitation services using a user-friendly graphical interface. Healthcare professionals could communicate with patients and individualise the rehabilitation programme using an online web service. A content management system (CMS) interconnects the two platforms. BLE, Bluetooth low energy; HTTPS, hypertext transfer protocol secure. The effectiveness of the solution on the functional perfor- DEVELOPMENT mance of patients,12–14 degree of user satisfaction,15 16 The TRP was developed by the research and develop- http://informatics.bmj.com/ 17–19 and cost-effectiveness of the system have been evalu- ment team at the Laboratory for Welfare Technology, ated. It is reported that in-home telerehabilitation using Aalborg University, with close collaboration with the video-conferencing equipment may improve the acces- university-affiliated Farsø Hospital using a participa- 14 sibility of supervised rehabilitation and can also be tory design method.22 The TRP benefitted from two 13 considered effective as conventional treatment. Bini et different environments, one for patients and one for 20 al demonstrated the advantages of employing asynchro- HPs, and could thus provide various services for each nous (semi-offline) video rehabilitation compared with side. The communication between the two platforms real-time video conferencing. Asynchronous telecommu- (introduced below) was provided using the internet. on September 25, 2021 by guest. Protected nication can be more practical in comparison with real- Figure 1 shows an overview of the developed TRP. time video conferencing and requires fewer resources. Piqueras et al21 introduced a sensor-based TRP by Telerehabilitation services employing two wearable sensors to monitor the patients’ exercises and send data as an alternative solution for a The TRP establishes electronic communication between video conference. patients and HPs by providing four main services: Hence, it is hypothesised that a hybrid (online/offline) 1. Asynchronous messaging service. TRP using sensor technologies can facilitate in-home 2. Training management and HP intervention service rehabilitation as well as enhance the human resource 3. Patient report management. management in the healthcare sector and overcome the 4. A dynamic web portal is providing information and difficulties of accessing services at a distance. Therefore, multimedia for the patient. the primary objective of this study was to develop and test Table 1 shows the detailed sub-services introduced in a semi-offline TRP using telecommunication and wireless each of these four main services in the patient and HP motion sensors. platform of the TRP. 2 Naeemabadi MR, et al. BMJ Health Care Inform 2019;26:e000022. doi:10.1136/bmjhci-2019-000022 Open access BMJ Health Care Inform: first published as 10.1136/bmjhci-2019-000022 on 20 April 2019. Downloaded from Table 1 Providing services and corresponding system task for (a) patient and (b) healthcare professional sides of the telerehabilitation programme Service Patient platform HP platform Messaging Send and receive text messages Send and receive text messages Notify new/unread messages Notify new/unread messages Notify if receiver read the message Notify if receiver read the message Send and receive text messages Send and receive text messages Training Provide a daily virtual training programme (number of repetitions and sets) Personalise training programme Provide video instruction for each exercise Show patients’ adherence Organise performed and remaining exercises and notify the patient Count the repetitions using sensors Send adherence report (exercise, repetitions, sets, overall adherence) Reports Collect and send PRO reports (pain, OKS,33 knee swollen) Show report Instruct how to report Notify the patient to send a report Show a history of reports Information Provide project relevant multimedia/information Modify the information HP, healthcare professional; OKS, Oxford Knee Score; PRO, patient reported outcome. Platforms and hardware (BLE) with the 20 Hz sampling frequency. It should Two different platforms were provided for the HPs be mentioned that the programme was able to track and patients
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