Monique Tabak

A telehealth program for self-management of COPD exacerbations and promotion of an active lifestyle: a pilot randomized controlled trial.

The objective of this pilot study was to investigate the use of and satisfaction with a chronic obstructive pulmonary disease (COPD) telehealth program applied in both primary and secondary care. The program consisted of four modules: 1) activity coach for ambulant activity monitoring and real-time coaching of daily activity behavior, 2) web-based exercise program for home exercising, 3) self-management of COPD exacerbations via a triage diary on the web portal, including self-treatment of exacerbations, and 4) teleconsultation. Twenty-nine COPD patients were randomly assigned to either the intervention group (telehealth program for 9 months) or the control group (usual care). Page hits on the web portal showed the use of the program, and the Client Satisfaction Questionnaire showed satisfaction with received care. The telehealth program with decision support showed good satisfaction (mean 26.4, maximum score 32). The program was accessed on 86% of the treatment days, especially the diary. Patient adherence with the exercise scheme was low (21%). Health care providers seem to play an important role in patients’ adherence to telehealth in usual care. Future research should focus on full-scale implementation in daily care and investigating technological advances, like gaming, to increase adherence.

A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial:

Objective: First, to investigate the effects of a telerehabilitation intervention on health status and activity level of patients with Chronic Obstructive Pulmonary Disease (COPD), compared to usual care. Second, to investigate how patients comply with the intervention and whether compliance is related to treatment outcomes. Design: a randomized controlled pilot trial Subjects: Thirty-four patients diagnosed with COPD. Intervention: The telerehabilitation application consists of an activity coach (3D-accelerometer with smartphone) for ambulant activity registration and real-time feedback, complemented by a web portal with a symptom diary for self-treatment of exacerbations. The intervention group used the application for 4 weeks. The control group received usual care. Main measures: Activity level measured by a pedometer (in steps/day), health status by the Clinical COPD Questionnaire at baseline and after intervention. Compliance was expressed as the time the activity coach was worn. Results: Fourteen intervention and 16 control patients completed the study. Activity level (steps/day) was not significantly affected by the intervention over time. There was a non-significant difference in improvement in health status between the intervention (−0.34±0.55) and control group (0.02±0.57, p=0.10). Health status significantly improved within the intervention group (p=0.05). The activity coach was used more than prescribed (108%) and compliance was related to the increase in activity level for the first two feedback weeks (r=0.62, p=0.03). Conclusions: This pilot study shows the potential of the telerehabilitation intervention: compliance with the activity coach was high, which directly related to an improvement in activity levels.

Motivational cues as real-time feedback for changing daily activity behavior of patients with COPD

OBJECTIVE To investigate how COPD patients respond to motivational cues that aim to improve activity behavior and how these responses are related to cue- and context characteristics. In addition, to explore whether activity can be increased and better distributed over the day by providing such cues. METHODS Fifteen COPD patients participated. Patients used an activity sensor with a smartphone for four weeks, at least four days/week. Patients received motivational cues every 2h with advice on how to improve their activity, on top of real-time visual feedback. The response was calculated by the amount of activity 30 min before and after a cue. RESULTS In total, 1488 cues were generated. The amount of activity significantly decreased in the 30 min after a discouraging cue (p<0.001) and significantly increased (p<0.05) in the 10 min after an encouraging cue. The activity level increased with 13% in the intervention period compared to corrected baseline (p=0.008). The activity was not more balanced over the day. CONCLUSIONS COPD patients significantly change their activity level in response to motivational cues, based on continuous ambulatory assessment of activity levels. PRACTICE IMPLICATIONS Motivational cues could be a valuable component of telemedicine interventions that aim to improve activity behavior.

Engaging Elderly People in Telemedicine Through Gamification

Background Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention. Objective This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence. Methods We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content. Results Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great connectivity between these taxonomies. Conclusions Gamification frameworks have been developed from different backgrounds—business and academia—but rarely target the elderly user. The effectiveness of user classifications for tailored game content in this context is not yet known. As a next step, we propose the development of a framework based on the hypothesized existence of a relation between preference for game content and personality.

Trust in telemedicine portals for rehabilitation care: an exploratory focus group study with patients and healthcare professionals

BackgroundFor many eServices, end-user trust is a crucial prerequisite for use. Within the context of Telemedicine, the role of trust has hardly ever been studied. In this study, we explored what determines trust in portals that facilitate rehabilitation therapy, both from the perspective of the patient and the healthcare professional.MethodsWe held two focus groups with patients (total n = 15) and two with healthcare professionals (total n = 13) in which we discussed when trust matters, what makes up trust in a rehabilitation portal, what effect specific design cues have, and how much the participants trust the use of activity sensor data for informing treatment.ResultsTrust in a rehabilitation portal is the sum of trust in different factors. These factors and what makes up these factors differ for patients and healthcare professionals. For example, trust in technology is made up, for patients, mostly by a perceived level of control and privacy, while for healthcare professionals, a larger and different set of issues play a role, including technical reliability and a transparent data storage policy. Healthcare professionals distrust activity sensor data for informing patient treatment, as they think that sensors are unable to record the whole range of movements that patients make (e.g., walking and ironing clothes).ConclusionsThe set of factors that affect trust in a rehabilitation portal are different from the sets that have been found for other contexts, like eCommerce. Trust in telemedicine technology should be studied as a separate subject to inform the design of reliable interventions.

Strategies to improve effectiveness of physical activity coaching systems: Development of personas for providing tailored feedback

Mobile physical activity interventions can be improved by incorporating behavioural change theories. Relations between self-efficacy, stage of change, and physical activity are investigated, enabling development of feedback strategies that can be used to improve their effectiveness. A total of 325 healthy control participants and 82 patients wore an activity monitor. Participants completed a self-efficacy or stage of change questionnaire. Results show that higher self-efficacy is related to higher activity levels. Patients are less active than healthy controls and show a larger drop in physical activity over the day. Patients in the maintenance stage of change are more active than patients in lower stages of change, but show an equally large drop in level of physical activity. Findings suggest that coaching should at least be tailored to level of self-efficacy, stage of change, and physical activity pattern. Tailored coaching strategies are developed, which suggest that increasing self-efficacy of users is most important. Guidelines are provided.

Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service

BACKGROUND For many eServices, end-user trust is a crucial prerequisite for use. For the telemedicine context however, knowledge about the coming about and measurement of end-user trust is scarce. OBJECTIVE To develop and validate the PAtient Trust Assessment Tool (PATAT): a survey instrument to quantitatively assess patient trust in a telemedicine service. METHODS Informed by focus groups, we developed a survey that includes measurement scales for the following factors: trust in the care organization, care professional, treatment, and technology, as well as a scale that assesses a holistic view on trust in the telemedicine service. The survey was completed by 795 patients that use a telemedicine application to manage their anticoagulation treatment. Data were analyzed by means of Partial Least Squares Structural Equation Modeling (PLS-SEM). RESULTS The measurement model yielded good to excellent quality measures, after the removal of one item. The causal model resulted in high explained variance (R2=0.68). Trust in healthcare professionals and the treatment had a small effect on overall trust, while trust in the technology displayed a large effect. Trust in the care organization did not result in a significant effect on overall trust. CONCLUSION The PATAT is a valid means to assess patient trust in a telemedicine service and can be used to benchmark such a service or to elicit redesign input.

Exploring the relation between positive emotions and the functional status of older adults living independently: a systematic review

ABSTRACT Objectives: Literature suggests that positive emotions positively influence physiological parameters but their relation to functioning in the daily life of older adults living independently remains unclear. The present work aims to investigate the relation between positive emotions and functional status in daily life of older people living independently. Method: A systematic literature review was conducted using the PubMed, PsycINFO and Scopus electronic databases. Included works were peer-reviewed empirical studies that analysed the relation between positive emotions and ability to perform activities of daily living with older adults living independently. Results: After removal of duplicates, 10 out of 963 papers met the inclusion criteria. Cross-sectional studies (n = 6) provided limited evidence about a relation between positive emotions and functioning in daily life. However, longitudinal studies (n = 4) provide significant evidence for an interaction between the two factors, suggesting that time influences this interaction. Conclusion: The variety on the design and samples of the studies included in this review does not allow a cohesive conclusion of the results. Nevertheless, limited evidence suggests that higher frequency in the experience of positive emotions might be associated with lower functional limitations. The issue of causality in emotions-functioning remains unclear from the review. Further observational studies are highly recommended, supported by innovative technologies.

From telemedicine technology to telemedicine services

The aim of this study was to design and pilot test ICT-supported rehabilitation services across twelve health care institutions and four different diagnosis groups (i.e. acute hip, arthritis, cancer and chronic obstructive pulmonary disease) starting from a multimodal service platform that offers four different telemedicine technologies: 1) teleconsultation, 2) activity coaching, 3) web-based exercising and 4) health monitoring. Results showed that using the same technologies, different telemedicine services can be developed with different clinical purposes. Results also show that different implementation strategies are needed for different patient groups, or even within different patient groups, to get the services implemented in everyday care. Evaluation of the ICT-supported rehabilitation services in everyday care showed that the ICT support is being accepted and highly used by the patient. However, the use of the ICT support by care professionals was dramatically low. Future studies should focus on full-scale implementation in clinical practice, on education of the health care professionals as well as large-scale trials.

Exploring Determinants of Patient Adherence to a Portal-Supported Oncology Rehabilitation Program: Interview and Data Log Analyses

Background Telemedicine applications often do not live up to their expectations and often fail once they have reached the operational phase. Objective The objective of this study was to explore the determinants of patient adherence to a blended care rehabilitation program, which includes a Web portal, from a patient’s perspective. Methods Patients were enrolled in a 12-week oncology rehabilitation treatment supported by a Web portal that was developed in cooperation with patients and care professionals. Semistructured interviews were used to analyze thought processes and behavior concerning patient adherence and portal use. Interviews were conducted with patients close to the start and the end of the treatment. Besides, usage data from the portal were analyzed to gain insights into actual usage of the portal. Results A total of 12 patients participated in the first interview, whereas 10 participated in the second round of interviews. Furthermore, portal usage of 31 patients was monitored. On average, 11 persons used the portal each week, with a maximum of 20 in the seventh week and a drop toward just one person in the weeks in the follow-up period of the treatment. From the interviews, it was derived that patients’ behavior in the treatment and use of the portal was primarily determined by extrinsic motivation cues (eg, stimulation by care professionals and patient group), perceived severity of the disease (eg, physical and mental condition), perceived ease of use (eg, accessibility of the portal and the ease with which information is found), and perceived usefulness (eg, fit with the treatment). Conclusions The results emphasized the impact that care professionals and fellow patients have on patient adherence and portal usage. For this reason, the success of blended care telemedicine interventions seems highly dependent on the willingness of care professionals to include the technology in their treatment and stimulate usage among patients.