Research

@article{Auger2023,

title = {Implementation of Telerehabilitation in an Early Supported Discharge Stroke Rehabilitation Program before and during COVID-19: An Exploration of Influencing Factors},

author = {Louis-Pierre Auger and Emmanuelle Moreau and Odile Côté and Rosalba Guerrera and Annie Rochette and Dahlia Kairy},

doi = {10.3390/disabilities3010007},

issn = {2673-7272},

year  = {2023},

date = {2023-03-00},

journal = {Disabilities},

volume = {3},

number = {1},

pages = {87--104},

publisher = {MDPI AG},

abstract = {Objective: To identify the factors influencing the implementation of telerehabilitation (TR) in a post-stroke early supported discharge (ESD) rehabilitation program as perceived by clinicians and managers. Methods: A descriptive qualitative design was used in collaboration with a Canadian ESD stroke rehabilitation program. After 15 months of pre-COVID-19 implementation and 4 months of COVID-19 implementation, 9 stakeholders (7 clinicians, 1 coordinator and 1 manager) from an ESD program participated in 2 focus groups online or an individual interview. Qualitative data were coded and analyzed semi-deductively for the pre-COVID-19 and COVID-19 phases using the Consolidated Framework for Implementation Research (CFIR). Results: Four categories emerged related to the CFIR, each with themes: (1) Telerehabilitation, which included “Technology” and “Clinical activities”; (2) Telerehabilitation users, which included: “Clients’ characteristics” and “Clinicians’ characteristics”; (3) Society and healthcare system, which included “Changes related to COVID-19” and “ESD program”; and (4) TR implementation process, which included “Planning” and “Factors that influenced practice change”. Conclusions: Factors impacting TR implementation in the ESD program were found to be numerous and varied according to the pre-COVID-19 or COVID-19 phases. Clinicians’ motivation regarding potential gains for them in using TR was key in its implementation during the COVID-19 period.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Létourneau2023,

title = {OpenTera: A Framework for Telehealth Applications},

author = {Dominic Létourneau and Simon Brière and Marc-Antoine Maheux and Cédric Godin and Philippe Warren and Gabriel Lauzier and Ian-Mathieu Joly and Jérémie Bourque and Philippe Arsenault and Cynthia Vilanova and Michel Tousignant and François Michaud},

url = {https://doi.org/10.21105/joss.05497},

doi = {10.21105/joss.05497},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Open Source Software},

volume = {8},

number = {91},

pages = {5497},

publisher = {The Open Journal},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35142425,

title = {The acceptability of two remote monitoring modalities for patients waiting for services in a physiotherapy outpatient clinic},

author = {Marianne Renard and Isabelle Gaboury and François Michaud and Michel Tousignant},

doi = {10.1002/msc.1622},

issn = {1557-0681},

year  = {2022},

date = {2022-01-01},

journal = {Musculoskeletal Care},

volume = {20},

number = {3},

pages = {616--624},

abstract = {INTRODUCTION: Access to public rehabilitation services for patients with non-urgent conditions - which suffer mainly from musculoskeletal disorders - is problematic around the world. Remote rehabilitation services are recognized as effective means to increase accessibility. Patient acceptability is an important element in the successful implementation of such clinical innovations and has not yet been studied thoroughly in this context. Thus, the aim of this study was to evaluate and compare the acceptability of two remote consultation modalities - phone and teleconsultation - for patients waiting for public outpatient non-urgent rehabilitation services.



METHODS: We conducted a qualitative descriptive study nested within a randomized clinical trial in which participants received either phone or teleconsultation follow-ups with a physiotherapist after a first systematic face-to-face evaluation. Semi-structured interviews were conducted with participants of both groups selected with purposive sampling. Sekhon's acceptability metaframework was used and interviews were transcribed and coded with thematic analysis.



ETHIC APPROVAL: The research protocol was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS) (#2019-2919).



RESULTS: Twenty participants were recruited. Results show both follow-up modalities have a good level of acceptability for participants; however, teleconsultation stands out because its visual dimension offers higher quality human contact and satisfactorily meets greater needs for support.



CONCLUSION: Systematic in-person assessment and advice combined with telephone or teleconsultation follow-up can contribute to diversifying the services offered in physiotherapy outpatient clinics. Offering a range of service modalities with different resource requirements may shorten wait times. Such an approach seems to be well accepted by patients, especially with teleconsultation.



CLINICALTRIALS: gov ID: NCT03991858.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35223361,

title = {OpenTera: A microservice architecture solution for rapid prototyping of robotic solutions to COVID-19 challenges in care facilities},

author = {Adina M Panchea and Dominic Létourneau and Simon Brière and Mathieu Hamel and Marc-Antoine Maheux and Cédric Godin and Michel Tousignant and Mathieu Labbé and François Ferland and François Grondin and François Michaud},

doi = {10.1007/s12553-021-00636-5},

issn = {2190-7188},

year  = {2022},

date = {2022-01-01},

journal = {Health Technol (Berl)},

volume = {12},

number = {2},

pages = {583--596},

abstract = {As telecommunications technology progresses, telehealth frameworks are becoming more widely adopted in the context of long-term care (LTC) for older adults, both in care facilities and in homes. Today, robots could assist healthcare workers when they provide care to elderly patients, who constitute a particularly vulnerable population during the COVID-19 pandemic. Previous work on user-centered design of assistive technologies in LTC facilities for seniors has identified positive impacts. The need to deal with the effects of the COVID-19 pandemic emphasizes the benefits of this approach, but also highlights some new challenges for which robots could be interesting solutions to be deployed in LTC facilities. This requires customization of telecommunication and audio/video/data processing to address specific clinical requirements and needs. This paper presents OpenTera, an open source telehealth framework, aiming to facilitate prototyping of such solutions by software and robotic designers. Designed as a microservice-oriented platform, OpenTera is an end-to-end solution that employs a series of independent modules for tasks such as data and session management, telehealth, daily assistive tasks/actions, together with smart devices and environments, all connected through the framework. After explaining the framework, we illustrate how OpenTera can be used to implement robotic solutions for different applications identified in LTC facilities and homes, and we describe how we plan to validate them through field trials.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Allegue2022,

title = {Rehabilitation of Upper Extremity by Telerehabilitation Combined With Exergames in Survivors of Chronic Stroke: Preliminary Findings From a Feasibility Clinical Trial},

author = {Dorra Rakia Allegue and Johanne Higgins and Shane N Sweet and Philippe S Archambault and Francois Michaud and William Miller and Michel Tousignant and Dahlia Kairy},

doi = {10.2196/33745},

issn = {2369-2529},

year  = {2022},

date = {2022-00-00},

journal = {JMIR Rehabil Assist Technol},

volume = {9},

number = {2},

publisher = {JMIR Publications Inc.},

abstract = {

            Background

            Exergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician.

          

          

            Objective

            This study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy.

          

          

            Methods

            This study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention).

          

          

            Results

            A total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants.

          

          

            Conclusions

            The VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae.

          

          

            International Registered Report Identifier (IRRID)

            RR2-10.2196/14629

          },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Allegue2022b,

title = {Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study},

author = {Dorra Rakia Allegue and Shane Norman Sweet and Johanne Higgins and Philippe S Archambault and Francois Michaud and William C Miller and Michel Tousignant and Dahlia Kairy},

doi = {10.2196/31305},

issn = {2369-2529},

year  = {2022},

date = {2022-00-00},

journal = {JMIR Rehabil Assist Technol},

volume = {9},

number = {3},

publisher = {JMIR Publications Inc.},

abstract = {

            Background

            In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician.

          

          

            Objective

            We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians.

          

          

            Methods

            This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors’ use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory.

          

          

            Results

            Three stroke survivors (n=2, 67%, women and n=1, 33%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors’ safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts.

          

          

            Conclusions

            This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions.

          

          

            International Registered Report Identifier (IRRID)

            RR2-10.2196/14629

          },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Tanguay2021,

title = {Telerehabilitation for Post-Hospitalized COVID-19 Patients: A Proof-of-Concept Study During a Pandemic},

author = {Pamela Tanguay and Nicole Marquis and Isabelle Gaboury and Dahlia Kairy and Matthieu Touchette and Michel Tousignant and Simon Décary},

doi = {10.5195/ijt.2021.6383},

issn = {1945-2020},

year  = {2021},

date = {2021-06-22},

journal = {Int J Telerehab},

volume = {13},

number = {1},

publisher = {University Library System, University of Pittsburgh},

abstract = {Purpose: Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life. Methods: We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participants’ attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health. Results: We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance. Conclusion: We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lambert2021,

title = {Patient and Parent Experiences with Group Telerehabilitation for Child Survivors of Acute Lymphoblastic Leukemia},

author = {Genevieve Lambert and Nathalie Alos and Pascal Bernier and Caroline Laverdière and Kenneth Drummond and Noémi Dahan-Oliel and Martin Lemay and Louis-Nicolas Veilleux and Dahlia Kairy},

doi = {10.3390/ijerph18073610},

issn = {1660-4601},

year  = {2021},

date = {2021-04-00},

journal = {IJERPH},

volume = {18},

number = {7},

publisher = {MDPI AG},

abstract = {Background: Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. ALL and its treatment cause altered bone-mineral homeostasis, which can contribute to musculoskeletal late adverse effects (LAEs). With the increasing number of childhood cancer survivors, LAEs are reported often, and are aggravated by inactive lifestyles. A telerehabilitation program is proposed to strengthen the muscle–bone complex and prevent future impairment. Objective: This study aimed to explore and better understand patient and parent experience of a telerehabilitation program after completion of ALL treatment. Methods: ALL survivors (n = 12), 75% girls, 7.9 to 14.7 years old, within six months to five years of treatment, were recruited to participate in the proposed study, along with a parent. The 16-week group program included 40 potential home-based physical activities, with monthly progression, supervised by a kinesiologist, through an online telerehabilitation platform. Patients could be included in the study if they joined during the first month of intervention of their group (minimum 12 weeks of intervention). A semi-structured post-intervention interview was conducted with the patients and their parent during the final assessment, along with a review of the kinesiologist’s clinical notes, to obtain a portrait of the participants’ experience with the telerehabilitation program. Overarching themes were identified by one author and confirmed by two senior authors before extracting the various aspects of each theme. Results: Of the 12 patients recruited, three were excluded from the analysis because they did not complete the minimum 12 weeks of intervention (one = relapse, one = failure to meet technical requirements, and one = abandoned due to parent’s disinterest). The nine patients who completed the program (six girls; 10.93 ± 2.83 years) had a mean adherence of 89%. The overarching themes identified were the program modalities (group approach with patient–parent paired training, supervised by a kinesiologist), the telerehabilitation system, the participants’ perception of the benefits, and recommendations and suggestions from the families. Both patients and parents expressed very high satisfaction with the program and perceived benefits. Conclusion: Participants appreciated the program and reported they would all recommend it to other families in similar situations. The telerehabilitation method of service delivery was perceived by some as decisive in choosing to participate, while the supervision and intra- and inter-family interactions were the motivating factors that were key to program adherence.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Allegue2021,

title = {A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study},

author = {Dorra Rakia Allegue and Dahlia Kairy and Johanne Higgins and Philippe S Archambault and Francois Michaud and William C Miller and Shane N Sweet and Michel Tousignant},

doi = {10.2196/26153},

issn = {2291-9279},

year  = {2021},

date = {2021-00-00},

journal = {JMIR Serious Games},

volume = {9},

number = {3},

publisher = {JMIR Publications Inc.},

abstract = {

            Background

            In Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program.

          

          

            Objective

            This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment.

          

          

            Methods

            A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment–upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week.

          

          

            Results

            The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels.

          

          

            Conclusions

            VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. 

          

          

            International Registered Report Identifier (IRRID)

            RR2-10.2196/14629

          },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Caughlin2020,

title = {Implementing Telerehabilitation After Stroke: Lessons Learned from Canadian Trials},

author = {Sarah Caughlin and Swati Mehta and Hélène Corriveau and Janice J. Eng and Gail Eskes and Dahlia Kairy and Jed Meltzer and Brodie M. Sakakibara and Robert Teasell},

doi = {10.1089/tmj.2019.0097},

issn = {1556-3669},

year  = {2020},

date = {2020-06-01},

journal = {Telemedicine and e-Health},

volume = {26},

number = {6},

pages = {710--719},

publisher = {Mary Ann Liebert Inc},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Doiron-Cadrin2019,

title = {Feasibility and preliminary effects of a tele-prehabilitation program and an in-person prehablitation program compared to usual care for total hip or knee arthroplasty candidates: a pilot randomized controlled trial},

author = {Patrick Doiron-Cadrin and Dahlia Kairy and Pascal-André Vendittoli and Véronique Lowry and Stéphane Poitras and François Desmeules},

doi = {10.1080/09638288.2018.1515992},

issn = {1464-5165},

year  = {2020},

date = {2020-03-26},

journal = {Disability and Rehabilitation},

volume = {42},

number = {7},

pages = {989--998},

publisher = {Informa UK Limited},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Allegue2020,

title = {Optimization of Upper Extremity Rehabilitation by Combining Telerehabilitation With an Exergame in People With Chronic Stroke: Protocol for a Mixed Methods Study},

author = {Dorra Rakia Allegue and Dahlia Kairy and Johanne Higgins and Philippe Archambault and Francois Michaud and William Miller and Shane Norman Sweet and Michel Tousignant},

doi = {10.2196/14629},

issn = {1929-0748},

year  = {2020},

date = {2020-00-00},

journal = {JMIR Res Protoc},

volume = {9},

number = {5},

publisher = {JMIR Publications Inc.},

abstract = {

            Background

            Exergames have the potential to provide an accessible, remote approach for poststroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed, and lack of motivation to pursue exercise programs, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant’s completion and adherence. At present, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation.

          

          

            Objective

            This study aims to (1) determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life, and motivation in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program; GRASP); (2) examine the feasibility of using the technology with participants diagnosed with stroke at home; and (3) identify the obstacles and facilitators for its use by participants diagnosed with stroke and stroke therapists and understand the shared decision-making process.

          

          

            Methods

            A mixed methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct videoconferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 participants diagnosed with stroke, randomly assigned to a control group (n=26; 2-month on-paper home exercise program: the GRASP with no supervision) and an experimental group (n=26; 2-month home program using the technology). The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE), Stroke Impact Scale-16 (the quality of life), and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process, resources, management, and scientific outcomes. Qualitative data will be collected by interviews with both participants and therapists.

          

          

            Results

            At present, data collection was ongoing with one participant who had completed the exergame- telerehabilitation based intervention. We expect to collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke; collect feasibility data with users at home (adherence, safety, and technical difficulties); and identify the obstacles and facilitators for the technology use and understand the shared decision-making process.

          

          

            Conclusions

            This paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation.

          

          

            Trial Registration

            ClinicalTrials.gov NCT03759106; http://clinicaltrials.gov/show/NCT03759106.

          

          

            International Registered Report Identifier (IRRID)

            DERR1-10.2196/14629

          },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kairy2017,

title = {Evaluating the implementation process of a new telerehabilitation modality in three rehabilitation settings using the normalization process theory: study protocol},

author = {Dahlia Kairy and Frédéric Messier and Diana Zidarov and Sara Ahmed and Lise Poissant and Paula W. Rushton and Claude Vincent and Brigitte Fillion and Véronique Lavoie},

doi = {10.1080/20479700.2017.1314119},

issn = {2047-9719},

year  = {2019},

date = {2019-10-02},

journal = {International Journal of Healthcare Management},

volume = {12},

number = {4},

pages = {348--355},

publisher = {Informa UK Limited},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Chemtob2019,

title = {Using tele-health to enhance motivation, leisure time physical activity, and quality of life in adults with spinal cord injury: A self-determination theory-based pilot randomized control trial},

author = {K. Chemtob and M. Rocchi and K. Arbour-Nicitopoulos and D. Kairy and B. Fillion and S.N. Sweet},

doi = {10.1016/j.psychsport.2019.03.008},

issn = {1469-0292},

year  = {2019},

date = {2019-07-00},

journal = {Psychology of Sport and Exercise},

volume = {43},

pages = {243--252},

publisher = {Elsevier BV},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27279467,

title = {Feasibility and effect of in-home physical exercise training delivered via telehealth before bariatric surgery},

author = {Aurélie Baillot and Patrick Boissy and Michel Tousignant and Marie-France Langlois},

doi = {10.1177/1357633X16653511},

issn = {1758-1109},

year  = {2017},

date = {2017-06-01},

journal = {J Telemed Telecare},

volume = {23},

number = {5},

pages = {529--535},

abstract = {Optimal physical activity (PA) interventions are needed to increase PA in individuals with severe obesity, and optimize the results of bariatric surgery (BS). The aim of this study was to assess the feasibility and effect of Pre-Surgical Exercise Training (PreSET) delivered in-home via telehealth (TelePreSET) in subjects awaiting BS. Six women following the TelePreSET were compared to the women from a previous study (12 performing the PreSET in a gymnasium and 11 receiving usual care). In-home TelePreSET (12-weeks of endurance and strength training) was supervised twice weekly using videoconferencing. Physical fitness, quality of life, exercise beliefs, anthropometric measures and telehealth perception were assessed before and after 12-weeks. Satisfaction was evaluated with questionnaires at the end of the intervention. The TelePreSET participants attended 96% of the exercise sessions, and were very satisfied by the TelePreSET. The baseline telehealth perception score was high, and increased significantly after the intervention. The TelePreSET group significantly increased their physical fitness compared to the usual care group. No significant change was noted in other outcomes. The TelePreSET is feasible and seems effective to improve the physical fitness of women awaiting BS. Further studies are needed to confirm beneficial effects of this innovative mode of delivery.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28112589,

title = {In-Home Synchronous Telespeech Therapy to Improve Functional Communication in Chronic Poststroke Aphasia: Results from a Quasi-Experimental Study},

author = {Joël Macoir and Vincent Martel Sauvageau and Patrick Boissy and Marilyn Tousignant and Michel Tousignant},

doi = {10.1089/tmj.2016.0235},

issn = {1556-3669},

year  = {2017},

date = {2017-01-01},

journal = {Telemed J E Health},

volume = {23},

number = {8},

pages = {630--639},

abstract = {BACKGROUND: Although the use of telepractice in speech-language therapy for assessment purposes is well documented, its effectiveness and potential for rehabilitation in poststroke aphasia remain largely unknown. The purpose of this study was to investigate the effectiveness of a remotely delivered synchronous pragmatic telespeech language therapy for improving functional communication in aphasia.



METHODS: A pre-/post-test design was chosen in which each participant was his or her own control. Using a telerehabilitation platform and software (Oralys TeleTherapy) based on the Promoting Aphasics' Communicative Effectiveness (PACE) approach, 20 participants with chronic poststroke aphasia received 9 speech therapy sessions over a 3-week period.



RESULTS: Teletreatment with the PACE pragmatic rehabilitation approach led to improvements in functional communication, marked by (a) an increase in communication effectiveness, reflecting significantly improved autonomy in functional communication; (b) a decrease in communication exchange duration, meaning that the treatment made communication faster and more efficient; (c) a decrease in the number of communication acts, meaning that, after treatment, less information was needed to be efficiently understood by the communication partner; and (d) an increase in the number of different communication strategies used, meaning that the treatment fostered the use of a variety of alternative communication modes.



CONCLUSIONS: This study provides additional arguments about the benefits of telerehabilitation for poststroke patients with aphasia. It showed that multimodal language therapy delivered through synchronous telerehabilitation had positive effects on functional communication in chronic aphasia.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27570627,

title = {Is an in-home telerehabilitation program for people with proximal humerus fracture as effective as a conventional face-to face rehabilitation program? A study protocol for a noninferiority randomized clinical trial},

author = {François Cabana and Catherine Pagé and Amy Svotelis and Samuel Langlois-Michaud and Michel Tousignant},

doi = {10.1186/s13102-016-0051-z},

issn = {2052-1847},

year  = {2016},

date = {2016-01-01},

journal = {BMC Sports Sci Med Rehabil},

volume = {8},

number = {1},

pages = {27},

abstract = {BACKGROUND: Proximal humerus fractures can be treated surgically (eg: pinning, plate and screws) or conservatively by wearing a splint or a cast. Following both of these approaches, rehabilitation has proven effective to prevent functional limitations and to re-establish normal shoulder function. However, access to these rehabilitation services and compliance tends to be limited in elderly patients due to travelling difficulties caused by their precarious health status and, in some cases, social and marital status. Since the majority of patients with a proximal humerus fracture are elderly, it becomes relevant to find a new way to offer quick, simple and suitable rehabilitation service. Thus, the use of promising alternative approaches, as in-home telerehabilitation, can enhance access to rehabilitation services for such population. The main objective of the study is to compare the clinical effects of the innovative telerehabilitation approach (TELE group) compared to face-to-face visits to a clinic (CLINIC group) for patients treated for a proximal humerus fracture.



METHODS/DESIGN: In this randomized controlled trial, individuals who have had a proximal humerus fracture treated conservatively at the Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie CHUS), and who are returning home will be included. Participants will be recruited during their visit to the emergency ward or outpatient clinic by the medical or research team and will then sign the informed consent form if they are interested to participate in the study. We expect to recruit 52 participants (26 per group). Randomization will be done by a random number generator with sealed envelopes. Each patient will be evaluated before the beginning of the rehabilitation (T1), and immediately after the 2-month intervention (T2). The following outcomes will be measured: 1) upper extremity function (Constant Shoulder Score and Disability of the Arm, Shoulder and Hand questionnaire [DASH]); 2) range of motion (conventional goniometer); 3) user satisfaction (Health Care Satisfaction questionnaire); and 4) cost of services to the public healthcare system. The difference between the two groups will be compared using a t-test or a chi-squared test, and through a cost-effectiveness economic analysis.



DISCUSSION: We hypothesize that in-home telerehabilitation will provide a good alternative to conventional rehabilitation, in terms of its efficacy, simplicity, patient satisfaction, and low associated costs.



TRIAL REGISTRATION: ClinicalTrials.gov: NCT02425267. April 22(nd), 2015.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26075928,

title = {In-Home Pulmonary Telerehabilitation for Patients with Chronic Obstructive Pulmonary Disease: A Pre-experimental Study on Effectiveness, Satisfaction, and Adherence},

author = {Nicole Marquis and Pierre Larivée and Didier Saey and Marie-France Dubois and Michel Tousignant},

doi = {10.1089/tmj.2014.0198},

issn = {1556-3669},

year  = {2015},

date = {2015-11-01},

journal = {Telemed J E Health},

volume = {21},

number = {11},

pages = {870--879},

abstract = {BACKGROUND: Pulmonary rehabilitation (PR) has proven effective in improving exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD). In Canada, however, there are insufficient rehabilitation services. New strategies such as telerehabilitation must be deployed to increase accessibility. This study aims to investigate the effect of telerehabilitation on exercise tolerance and quality of life and to document patient satisfaction and adherence.



MATERIALS AND METHODS: Twenty-six patients with moderate to very severe COPD participated in this pre-/postintervention study. They received 15 in-home teletreatment sessions over 8 weeks via videoconference from a service center to their home. Education was provided via self-learning health capsules. Assessments were carried out twice before (T0 and T1; 8 weeks apart) and immediately after the intervention (T2). Primary outcome measures were changes in exercise tolerance (6-min walk test [6MWT] and cycle endurance test [CET]) and quality of life (Chronic Respiratory Questionnaire [CRQ]).



RESULTS: There were significant improvements between pre- and postintervention (T2-T1) on the 6MWT (32 m; p<0.001), CET (41 s; p=0.005), and three of four CRQ domains (dyspnea [p<0.001], fatigue [p=0.002], and emotion [p=0.002]). Improvements in the CET and fatigue during the 8-week intervention period were greater than changes over 8 weeks of maturation (T1-T0) (p=0.004 and 0.02, respectively). Participants' satisfaction and adherence rate with telerehabilitation were very high.



CONCLUSIONS: Using telehealth technology to deliver in-home PR is a feasible and practical solution for patients with moderate to very severe COPD. The telerehabilitation program was associated with beneficial effects on exercise tolerance and quality of life and was well received by users.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26178888,

title = {In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty: A Noninferiority Randomized Controlled Trial},

author = {Hélène Moffet and Michel Tousignant and Sylvie Nadeau and Chantal Mérette and Patrick Boissy and Hélène Corriveau and François Marquis and François Cabana and Pierre Ranger and Étienne L Belzile and Ronald Dimentberg},

doi = {10.2106/JBJS.N.01066},

issn = {1535-1386},

year  = {2015},

date = {2015-07-01},

journal = {J Bone Joint Surg Am},

volume = {97},

number = {14},

pages = {1129--1141},

abstract = {BACKGROUND: The availability of less resource-intensive alternatives to home visits for rehabilitation following orthopaedic surgeries is important, given the increasing need for home care services and the shortage of health resources. The goal of this trial was to determine whether an in-home telerehabilitation program is not clinically inferior to a face-to-face home visit approach (standard care) after hospital discharge of patients following a total knee arthroplasty.



METHODS: Two hundred and five patients who had a total knee arthroplasty were randomized before hospital discharge to the telerehabilitation group or the face-to-face home visit group. Both groups received the same rehabilitation intervention for two months after hospital discharge. Patients were evaluated at baseline (before total knee arthroplasty), immediately after the rehabilitation intervention (two months after discharge), and two months later (four months after discharge). The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the last follow-up evaluation. Secondary outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, functional and strength tests, and knee range of motion. The noninferiority margin was set at 9% for the WOMAC.



RESULTS: The demographic and clinical characteristics of the two groups of patients were similar at baseline. At the last follow-up evaluation, the mean differences between the groups with regard to the WOMAC gains, adjusted for baseline values, were near zero (for 182 patients in the per-protocol analysis): -1.6% (95% confidence interval [CI]: -5.6%, 2.3%) for the total score, -1.6% (95% CI: -5.9%, 2.8%) for pain, -0.7% (95% CI: -6.8%, 5.4%) for stiffness, and -1.8% (95% CI: -5.9%, 2.3%) for function. The confidence intervals were all within the predetermined zone of noninferiority. The secondary outcomes had similar results, as did the intention-to-treat analysis, which was conducted afterward for 198 patients.



CONCLUSIONS: Our results demonstrated the noninferiority of in-home telerehabilitation and support its use as an effective alternative to face-to-face service delivery after hospital discharge of patients following a total knee arthroplasty.



LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25840501,

title = {Cost analysis of in-home telerehabilitation for post-knee arthroplasty},

author = {Michel Tousignant and Hélène Moffet and Sylvie Nadeau and Chantal Mérette and Patrick Boissy and Hélène Corriveau and François Marquis and François Cabana and Pierre Ranger and Étienne L Belzile and Ronald Dimentberg},

doi = {10.2196/jmir.3844},

issn = {1438-8871},

year  = {2015},

date = {2015-03-01},

journal = {J Med Internet Res},

volume = {17},

number = {3},

pages = {e83},

abstract = {BACKGROUND: Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation.



OBJECTIVE: The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits.



METHODS: The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student's t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs).



RESULTS: The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient's home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P=.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P=.002; ≥50 km: $90<$152, P<.001).



CONCLUSIONS: To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient's home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient's home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic.



TRIAL REGISTRATION: International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25840501b,

title = {Cost analysis of in-home telerehabilitation for post-knee arthroplasty},

author = {Michel Tousignant and Hélène Moffet and Sylvie Nadeau and Chantal Mérette and Patrick Boissy and Hélène Corriveau and François Marquis and François Cabana and Pierre Ranger and Étienne L Belzile and Ronald Dimentberg},

doi = {10.2196/jmir.3844},

issn = {1438-8871},

year  = {2015},

date = {2015-03-01},

journal = {J Med Internet Res},

volume = {17},

number = {3},

pages = {e83},

abstract = {BACKGROUND: Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation.



OBJECTIVE: The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits.



METHODS: The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student's t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs).



RESULTS: The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient's home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant (P=.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P=.002; ≥50 km: $90<$152, P<.001).



CONCLUSIONS: To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient's home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient's home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic.



TRIAL REGISTRATION: International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25945227,

title = {In-home telerehabilitation for proximal humerus fractures: a pilot study},

author = {Michel Tousignant and Anne-Marie Giguère and Marilène Morin and Julie Pelletier and Annie Sheehy and François Cabana},

doi = {10.5195/ijt.2014.6158},

issn = {1945-2020},

year  = {2014},

date = {2014-01-01},

journal = {Int J Telerehabil},

volume = {6},

number = {2},

pages = {31--37},

abstract = {The objective of this study was to investigate the feasibility of an in-home telerehabilitation program for proximal humerus fractures. Seventeen patients with proximal humerus fractures were recruited by an orthopedic specialist during emergency room visits. Telerehabilitation treatments were given at the patient's home over an 8-week period using a videoconferencing system. Pain (Short-Form McGill Pain Questionnaire [SF-MPQ]), disabilities including shoulder range of motion (flexion, extension, internal rotation, external rotation, abduction), and upper limb function (Disability of the Arm, Shoulder and Hand questionnaire [DASH]) were measured in face-to-face evaluations before (T1) and immediately after (T2) the program. Participant satisfaction with the health care received was also evaluated at T2 with the Health care satisfaction questionnaire. All the clinical outcomes improved post-intervention (p < 0.05). Also, patient satisfaction was high (overall score of 82 ± 7%). Therefore, in-home teletreatment seems to be a promising way to dispense rehabilitation services for this population. },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25945226,

title = {Are improvements maintained after in-home pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease?},

author = {Nicole Marquis and Pierre Larivée and Marie-France Dubois and Michel Tousignant},

doi = {10.5195/ijt.2014.6156},

issn = {1945-2020},

year  = {2014},

date = {2014-01-01},

journal = {Int J Telerehabil},

volume = {6},

number = {2},

pages = {21--30},

abstract = {This study investigated if improvements can be maintained over 24 weeks when in-home pulmonary telerehabilitation is combined with asynchronous self-management education for Chronic Obstructive Pulmonary Disease (COPD). Twenty-three community-living elders with moderate to very severe COPD participated in a pre/post-intervention study. Over 8 weeks, they had access to self-learning capsules on self-management, received 15 in-home teletreatment sessions and were encouraged to gradually engage in unsupervised sessions. Participants were assessed before the intervention (T1), immediately after the intervention (T2), and 6 months later (T3). Outcome measures were (1) exercise tolerance (6-minute walk test [6MWT]), Cycle Endurance Test [CET]), and (2) quality of life (Chronic Respiratory Questionnaire [CRQ]). Although there were significant improvements after 8 weeks of pulmonary telerehabilitation on the 6MWT, CET and three of four CRQ domains, none of these improvements were maintained after 6 months and scores returned to their baseline values (all p values > 0.05 when comparing T3 with T1). While pulmonary telerehabilitation is possible and has a positive impact on patients with moderate to very severe COPD, improvements were not maintained in the long-term even when physical therapy was accompanied by self-management education. },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid24479760,

title = {Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial},

author = {Michel Tousignant and Hélène Corriveau and Dahlia Kairy and Katherine Berg and Marie-France Dubois and Sylvie Gosselin and Richard H Swartz and Jean-Martin Boulanger and Cynthia Danells},

doi = {10.1186/1745-6215-15-42},

issn = {1745-6215},

year  = {2014},

date = {2014-01-01},

journal = {Trials},

volume = {15},

pages = {42},

abstract = {BACKGROUND: The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home.



METHODS/DESIGN: This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services.



STUDY/TRIAL REGISTRATION: ClinicalTrials.gov: NCT01848080.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid23999548,

title = {The patient's perspective of in-home telerehabilitation physiotherapy services following total knee arthroplasty},

author = {Dahlia Kairy and Michel Tousignant and Nancy Leclerc and Anne-Marie Côté and Mélanie Levasseur and The Telage Researchers},

doi = {10.3390/ijerph10093998},

issn = {1660-4601},

year  = {2013},

date = {2013-08-01},

journal = {Int J Environ Res Public Health},

volume = {10},

number = {9},

pages = {3998--4011},

abstract = {This study aimed at exploring patients' perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients' perceptions: (1) improving access to services with reduced need for transportation; (2) developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3) complementing telerehabilitation with in-person visits; (4) providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5) perceived ease-of-use of telerehabilitation equipment; and (6) feeling an ongoing sense of support. Gaining a better understating of the patient's experience in telerehabilitation will be essential as programs continue to be developed and implemented. },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25945192,

title = {In-home Telerehabilitation for Older Persons with Chronic Obstructive Pulmonary Disease: A Pilot Study},

author = {Michel Tousignant and Nicole Marquis and Catherine Pagé and Ninette Imukuze and Annie Métivier and Valérie St-Onge and Annie Tremblay},

doi = {10.5195/ijt.2012.6083},

issn = {1945-2020},

year  = {2012},

date = {2012-01-01},

journal = {Int J Telerehabil},

volume = {4},

number = {1},

pages = {7--14},

abstract = {The purpose of this pilot study was to investigate the efficacy of in-home telerehabilitation for people with Chronic Obstructive Pulmonary Disease (COPD). Three community-living elders with COPD were recruited in a rehabilitation outpatient group and by direct referrals from pneumologists with outpatients who have COPD. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (15 sessions) were conducted by two trained physiotherapists from a service center to the patient's home. Locomotor function (walking performance) and quality of life were measured in person prior to and at the end of the treatment by an independent assessor. Clinical outcomes improved for all subjects except for locomotor function in the first participant. In-home telerehabilitation for people with COPD is a realistic alternative to dispense rehabilitation services for patients requiring physical therapy follow-up. },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid21492030,

title = {Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial},

author = {Michel Tousignant and Patrick Boissy and Hélène Moffet and Hélène Corriveau and François Cabana and François Marquis and Jessica Simard},

doi = {10.1089/tmj.2010.0198},

issn = {1556-3669},

year  = {2011},

date = {2011-06-01},

journal = {Telemed J E Health},

volume = {17},

number = {5},

pages = {376--382},

abstract = {OBJECTIVE: We measured the satisfaction of both patients and healthcare professionals with the technologies and services provided during in-home telerehabilitation as an alternative to conventional rehabilitation after discharge from total knee arthroplasty surgery.



METHODS: This study was embedded in a larger controlled trial where 48 community-living older adults who received total knee arthroplasty were recruited prior to discharge from acute care following surgery and randomly assigned to treatment arms (Tele and Comparison). The participants' satisfaction with the services was assessed at the end of the intervention for both groups using the Healthcare Satisfaction Questionnaire. For the Tele group, the patients' perception of in-home telehealth was assessed before treatment and after completion of teletreatments. The satisfaction of the healthcare professionals with the technology during the telerehabilitation services was noted at the end of each treatment session using a technical quality subjective appreciation questionnaire.



RESULTS: Both groups of patients (Tele and Comparison) were satisfied with the services received and no significant difference was observed between them. Moreover, the physiotherapists' satisfaction with regard to goal achievement, patient-therapist relationship, overall session satisfaction, and quality and performance of the technological platform was high.



CONCLUSIONS: As patient satisfaction is important in maintaining motivation and treatment compliance and the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid21398389,

title = {A randomized controlled trial of home telerehabilitation for post-knee arthroplasty},

author = {Michel Tousignant and Hélène Moffet and Patrick Boissy and Hélène Corriveau and François Cabana and François Marquis},

doi = {10.1258/jtt.2010.100602},

issn = {1758-1109},

year  = {2011},

date = {2011-01-01},

journal = {J Telemed Telecare},

volume = {17},

number = {4},

pages = {195--198},

abstract = {We compared the effectiveness of home telerehabilitation with conventional rehabilitation following knee replacement surgery (total knee arthroplasty, TKA). Forty-eight patients (mean age 66 years) who received TKA were recruited prior to discharge from hospital after surgery and were randomly assigned to telerehabilitation or usual care. Telerehabilitation sessions (16 per participant over two months) were conducted by trained physiotherapists using videoconferencing to the patient's home via an Internet connection (512 kbit/s upload speed). Disability and function were measured using standardized outcome measures in face-to-face evaluations at three times (prior to and at the end of treatment, and four months after the end of treatment). Clinical outcomes improved significantly for all subjects in both groups between endpoints. Some variables showed larger improvements in the usual care group two months post-discharge from therapy than in the telerehabilitation group. Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25945183,

title = {Simulated in-home teletreatment for anomia},

author = {Lambert Dechêne and Michel Tousignant and Patrick Boissy and Joël Macoir and Serge Héroux and Mathieu Hamel and Simon Brière and Catherine Pagé},

doi = {10.5195/IJT.2011.6075},

issn = {1945-2020},

year  = {2011},

date = {2011-01-01},

journal = {Int J Telerehabil},

volume = {3},

number = {2},

pages = {3--10},

abstract = {This pilot study explored the feasibility of in-home teletreatment for patients with post-stroke anomia. Three participants over 65 years of age suffering from post-stroke anomia were treated in this pre/post-intervention case study. They received 12 speech therapy teletreatments (two sessions/week for 6 weeks) aimed at improving confrontation naming skills. Half of the failed items from a set of 120 preselected stimuli were trained during treatment (Block A-trained stimuli) while the other half served as controls (Block B-untrained stimuli). Variables measured were: 1) efficacy of treatment (performance on Block-A vs. Block B Stimuli), and 2) participants' satisfaction with teletreatment (using a French adaptation of the Telemedicine satisfaction questionnaire). All participants showed a clinically relevant improvement on confrontation naming of trained items and less improvement for untrained items. The researchers also obtained high satisfaction scores on the questionnaire (above 57/60). This pilot study supports the feasibility of speech therapy teletreatments applied to neurological language disorders. },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid20406116,

title = {Interrater agreement between telerehabilitation and face-to-face clinical outcome measurements for total knee arthroplasty},

author = {Francois Cabana and Patrick Boissy and Michel Tousignant and Hélène Moffet and Hélène Corriveau and Réjean Dumais},

doi = {10.1089/tmj.2009.0106},

issn = {1556-3669},

year  = {2010},

date = {2010-04-01},

journal = {Telemed J E Health},

volume = {16},

number = {3},

pages = {293--298},

abstract = {Outcome measures in physical therapy provide the basis for determining the patient's rehabilitation needs, developing an individual intervention plan, and reassessing the evolution of the condition after therapeutic intervention. Questions surrounding the validity and reliability of outcome measures obtained in the context of telerehabilitation remain. The goal of this study was to explore which outcome measures can be used reliably in the context of telerehabilitation after discharge from an acute care hospital for lower limb orthopedic surgery. Fifteen patients recently discharged after total knee arthroplasty were evaluated by two experienced therapists. Each therapist evaluated under a given condition (face-to-face assessment, telerehabilitation assessment) eight outcome measures taken from standard clinical tests routinely used in the management of orthopedic rehabilitation after total knee arthroplasty. Evaluations were measured at 1-day intervals. Telerehabilitation evaluations were conducted with a videoconference link (H.264 CoDecs with Pan, Tilt, Zoom cameras) between either the participant's home or a clinical environment and a remote clinical station over residential DSL lines at 512 kbps. Interrater agreement between the two measurement modes was analyzed using the Bland and Altman method and Kripendorff's alpha reliability estimate. The 95% confidence interval for mean difference between evaluation methods varied between -20% and 8% for knee range of motion measures, -85% and 55% for scar management, -33% and 29% for functional evaluations. Five out of the eight outcome measures showed reliability estimates of >0.80, with lowest reliability obtained for the scar assessment scale (0.34) and the highest reliability for the evaluation of the range of motion at the knee (0.87 in flexion and 0.85 in extension). Clinical variables typically measured in face-to-face evaluations can be measured successfully under telerehabilitation conditions with moderate reliability.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25945158,

title = {In-home telerehabilitation for post-knee arthroplasty: a pilot study},

author = {Michel Tousignant and Patrick Boissy and Hélène Corriveau and Hélène Moffet and Francois Cabana},

doi = {10.5195/ijt.2009.5997},

issn = {1945-2020},

year  = {2009},

date = {2009-01-01},

journal = {Int J Telerehabil},

volume = {1},

number = {1},

pages = {9--16},

abstract = {The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alternative to conventional rehabilitation services following knee arthroplasty. Five community-living elders who had knee arthroplasty were recruited prior to discharge from an acute care hospital. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (16) were conducted by two trained physiotherapists from a service center to the patient's home using H264 videoconference CODECs (Tandberg 550 MXP) connected at 512 Kbs. Disability (range of motion, balance and lower body strength) and function (locomotor performance in walking and functional autonomy) were measured in face-to-face evaluations prior to and at the end of the treatments by a neutral evaluator. The satisfaction of the health care professional and patient was measured by questionnaire. Results are as follows. One participant was lost during follow-up. Clinical outcomes improved for all subjects and improvements were sustained two months post-discharge from in-home telerehabilitation. The satisfaction of the participants with in-home telerehabilitation services was very high. The satisfaction of the health care professionals with the technology and the communication experience during the therapy sessions was similar or slightly lower. In conclusion, telerehabilitation for post-knee arthroplasty is a realistic alternative for dispensing rehabilitation services for patients discharged from an acute care hospital. },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid19260168,

title = {In home telerehabilitation for older adults after discharge from an acute hospital or rehabilitation unit: A proof-of-concept study and costs estimation},

author = {M Tousignant and P Boissy and H Corriveau and H Moffet},

doi = {10.1080/17483100600776965},

issn = {1748-3115},

year  = {2006},

date = {2006-09-01},

journal = {Disabil Rehabil Assist Technol},

volume = {1},

number = {4},

pages = {209--216},

abstract = {PURPOSE: The purpose of this study is to investigate rehabilitation through teletreatment as an alternative to a physical homecare visit to deliver services to individuals at home following discharge from an acute hospital or rehabilitation unit.



METHOD: Four community-living elderly people were recruited for telerehabilitation services prior being discharged from an acute-care hospital and a geriatric rehabilitation unit. Once the patient returned home, an appointment was made for the assessing therapist to take the clinical measurements (T1) in a face-to-face session. Four clinical variables were used (functional autonomy, balance, locomotor performance in walking and lower-body strength). Telerehabilitation sessions with the participants were conducted with trained personnel in the individual's home. The system used to support telerehabilitation services for this proof of concept was built around network-attached remotely-controlled pan/tilt/zoom cameras with MJPEG compression, media displays and hands-free phones. Before the patient was discharged from the physiotherapy program, the same assessing therapist visited the subject again to take the T2 measurements in a face-to-face session. The satisfaction of the health-care professional was determined for each session with the homemade questionnaire. Costs related to telerehabilitation were compared to theoretically home visits.



RESULTS: All four subjects improved on the four clinical variables. Mean costs for the telerehabilitation program, comprising 12 sessions over 4 weeks was $487.



CONCLUSION: Telerehabilitation seems to be a practical alternative for dispensing rehabilitation services after patients are discharged from an acute hospital or rehabilitation unit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}