Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease Low-bandwidth telerehabilitation for patients who have undergone total knee replacement: Preliminary results Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany The effects of in-home rehabilitation on task self-efficacy in mobility-impaired adults: A randomized clinical trial. Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial In-Home Tele-Rehabilitation Improves Tetraplegic Hand Function Satisfaction with care in post-stroke patients undergoing a telerehabilitation programme at home Perception, satisfaction and utilization of the VALUE home telehealth service Effects of Telerehabilitation on Physical Function and Disability for Stroke Patients: A Randomized, Controlled Trial Agreement Between Telerehabilitation and Face-to-Face Clinical Outcome Assessments for Low Back Pain in Primary Care The clinical effectiveness of a myofeedback-based teletreatment service in patients with non-specific neck and shoulder pain: a randomized controlled trial A Randomized Trial of a Telephone-Delivered Exercise Intervention for Non-urban Dwelling Women Newly Diagnosed with Breast Cancer: Exercise for Health Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. MIOTIC study: a prospective, multicenter, randomized study to evaluate the long-term efficacy of mobile phone-based Internet of Things in the management of patients with stable COPD Study protocol of the YOU CALL - WE CALL TRIAL: impact of a multimodal support intervention after a "mild" stroke Effectiveness of an interactive virtual telerehabilitation system in patients after total knee arthoplasty: a randomized controlled trial. Functional and clinical outcomes of telemedicine in patients with spinal cord injury. Increasing access to specialty care: a pilot, randomized controlled trial of telemedicine for Parkinson's disease. Automated Constraint-Induced Therapy Extension (AutoCITE) for movement deficits after stroke. [Internet-based "e-training" as exercise intervention for health promotion: results from 2 intervention studies]. Telerehabilitation Using the Rutgers Master II Glove Following Carpal Tunnel Release Surgery: Proof-of-Concept A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP) Effect of a Home Telecare Program on Oral Health among Adults with Tetraplegia: A Pilot Study Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial 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. Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: Sustainability and secondary outcomes Increases in muscle strength and balance using a resistance training program administered via a telecommunications system in older adults. Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis Study protocol: home-based telehealth stroke care: a randomized trial for veterans Internet-enhanced management of fibromyalgia: A randomized controlled trial Randomized controlled trial of a teleconference fatigue management plus physical activity intervention in adults with multiple sclerosis: rationale and research protocol Stroke Team Remote Evaluation Using a Digital Observation Camera in Arizona: The Initial Mayo Clinic Experience Trial Comparison of Finger Tracking Versus Simple Movement Training via Telerehabilitation to Alter Hand Function and Cortical Reorganization After Stroke Cost analysis of telehomecare. The Rutgers Arm, a Rehabilitation System in Virtual Reality: A Pilot Study Complex Versus Simple Ankle Movement Training in Stroke Using Telerehabilitation: A Randomized Controlled Trial Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study Telerehabilitation Using a Virtual Environment Improves Upper Extremity Function in Patients With Stroke Depression, fatigue, and health-related quality of life among people with advanced multiple sclerosis: results from an exploratory telerehabilitation study. A randomized controlled trial of home telerehabilitation for post-knee arthroplasty Telerehabilitation: managed care's new opportunity. Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden. A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of 'PhysioDirect' telephone assessment and advice services for physiotherapy. Modified constraint-induced therapy extension: using remote technologies to improve function. Telerehabilitation wheeled mobility and seating assessments compared with in person. Pilot study of an energy conservation education program delivered by telephone conference call to people with multiple sclerosis. Effect of physical activity counseling on disability in older people: a 2-year randomized controlled trial. Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis Cognitive and physical rehabilitation of intensive care unit survivors: Results of the RETURN randomized controlled pilot investigation* Randomised controlled trial of a pedometer-based telephone intervention to increase physical activity among cardiac patients not attending cardiac rehabilitation. Home-Based Versus In-Hospital Cardiac Rehabilitation After Cardiac Surgery: A Nonrandomized Controlled Study Internet-based aftercare for patients with back pain-a pilot study. Real-Time Telehealth for COPD Self-Management Using Skype™ A randomized controlled trial of an internet-based treatment for chronic headache. Telehealth: Reaching Out to Newly Injured Spinal Cord Patients Telemedicine as an effective tool for the management of temporomandibular joint disorders. Telehomecare: quality, perception, satisfaction. Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial Relation between Telecare Implementation and Number of Treatment Days in a Japanese Town Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study.
Background : Interstitial lung disease ( ILD ) is characterised by exertional dyspnoea , exercise limitation and reduced quality of life . The role of exercise training in this diverse patient group is unclear . The aims of this study were to establish the safety of exercise training in ILD ; its effects on exercise capacity , dyspnoea and quality of life ; and whether patients with idiopathic pulmonary fibrosis ( IPF ) had similar responses to those with other types of ILD . Methods : 57 subjects with ILD ( 34 IPF ) were r and omised to receive 8 weeks of supervised exercise training or weekly telephone support . The 6 min walk distance ( 6MWD ) , incremental exercise test , modified Medical Research Council ( MRC ) dyspnoea score and Chronic Respiratory Disease Question naire ( CRDQ ) were performed at baseline , following intervention and at 6 months . Results : 80 % of subjects completed the exercise programme and no adverse events were recorded . The 6MWD increased following training ( mean difference to control 35 m , 95 % CI 6 to 64 m ) . A significant reduction in MRC score was observed ( 0.7 points , 95 % CI 0.1 to 1.3 ) along with improvements in dyspnoea ( p = 0.04 ) and fatigue ( p<0.01 ) on the CRDQ . There was no change in peak oxygen uptake ;  however , exercise training  reduced heart rate at maximum isoworkload ( p = 0.01 ) . There were no significant differences in response between those with and without IPF . After 6 months there were no differences between the training and control group for any outcome variable . Conclusions : Exercise training improves exercise capacity and symptoms in patients with ILD , but these benefits are not sustained 6 months following intervention . Trial registration number : summary We have developed a low-b and width , Internet-based telerehabilitation system to provide outpatient rehabilitation to patients who have undergone total knee arthroplasty . The preliminary efficacy of this treatment programme in terms of both physical and functional objective outcome measures was assessed on 21 patients . Subjects receiving a six-week rehabilitation programme were r and omized to the telerehabilitation system or the usual face-to-face method .  The physical and functional improvements in the telerehabilitation group were similar to those in the control group . There was a non-significant trend for greater improvements in the telerehabilitation group for most outcome measurements . The telerehabilitation programme was well received by patients . The results of this study provide evidence for the efficacy of low-b and width telerehabilitation consultations BACKGROUND Telemedical networks are a new approach to improve stroke care in community setting s. We aim ed to assess the effects of a stroke network with telemedical support in Germany on quality of care , according to acute processes and long-term outcome . METHODS Five community hospitals without pre-existing specialised stroke care were included in a network with telemedical support by two academic hospitals . In a non-r and omised , open intervention study , five community hospitals without specialised stroke care  served as the control group , matched individually to the network hospitals by predefined characteristics . Stroke patients admitted consecutively to one of the participating hospitals between July 7 , 2003 , and March 31 , 2005 , were included in the study . Patients in network and control hospitals were assessed in the same manner and were followed up for vital status , living situation , and disability at 3 months . Poor outcome was defined by death , institutional care , or disability ( Barthel index < 60 or modified Rankin scale > 3 ) . Predefined indicators for quality of acute stroke care were achieved . FINDINGS A total of 5696 patients with a sudden , non-convulsive loss of neurological function who were diagnosed with having suspected stroke were admitted to the ten hospitals participating in the study . After exclusion , 3122 were included in the final analysis , of whom 1971 ( 63 % ) were treated in the network hospitals . All indicators related to quality of acute stroke care were more commonly met in the network than in the control hospitals . After 3 months , 44 % of patients treated in network hospitals versus 54 % treated in control hospitals had a poor outcome ( p<0.0001 ) . In multivariate regression analysis , treatment in network hospitals independently reduced the probability of a poor outcome ( odds ratio 0.62 , 95 % CI 0.52 - 0.74 ; p<0.0001 ) . INTERPRETATION Telemedical networks with academic stroke centres offer new and innovative approaches to improve acute stroke care at community level for stroke patients living in non-urban areas OBJECTIVES To examine the effect on mobility self-efficacy of a multifactorial , individualized , occupational/physical therapy ( OT/PT ) intervention delivered via teletechnology or in-home visits . DESIGN R and omized , clinical trial . SETTING One Department of Veterans Affairs and one private rehabilitation hospital . PARTICIPANTS Sixty-five community-dwelling adults with new mobility devices . Thirty-three were r and omized to the control or usual care group ( UCG ) , 32 to the intervention group ( IG ) . INTERVENTION Four , once-weekly , 1-hour OT/PT sessions targeting three mobility and three transfer tasks . A therapist delivered the intervention in the traditional home setting ( trad group n = 16 ) or remotely via teletechnology ( tele group n = 16 ) . MEASUREMENTS Ten-item Likert-scale measure of mobility self-efficacy . RESULTS The IG had a statistically significantly greater increase in overall self-efficacy over the study period than the UCG ( mean change : IG 8.8 , 95 % confidence interval ( CI ) = 3.8 - 13.7 ; UCG 1.2 , 95 % CI = -5.8 - 8.2 ) . Descriptively , the IG exhibited positive changes in self-efficacy for all tasks and greater positive change than the UCG on all items with the exception of getting in and out of a chair . Comparisons of the two treatment delivery methods showed a medium st and ardized effect size ( SES ) in both the tele and trad groups , although it did not reach statistical significance for the tele group ( SES : tele = 0.35 , 95 % CI = -2.5 - 0.95 ; trad = 0.54 , 95 % CI = 0.06 - 1.14 ) . CONCLUSION A multifactorial , individualized , home-based OT/PT intervention can improve self-efficacy in mobility-impaired adults . The trend toward increased self-efficacy irrespective of the mode of rehabilitation delivery suggests that telerehabilitation can be a viable alternative to or can augment traditional in-home therapy Background Breast cancer survivors suffer physical impairment after oncology treatment . This impairment reduces quality of life ( QoL ) and increase the prevalence of h and icaps associated to unhealthy lifestyle ( for example , decreased aerobic capacity and strength , weight gain , and fatigue ) . Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival . Nowadays , technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional . It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective re source to improve fitness and reduce musculoskeletal disorders of these women . Methods / Design This study will use a two-arm , assessor blinded , parallel r and omized controlled trial design . People will be eligible if : their diagnosis is of stages I , II , or IIIA breast cancer ; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program ; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge ; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence ; and they have an interest in improving lifestyle . Participants will be r and omized into e-CUI DATE or usual care groups . E-CUI DATE give participants access to a range of contents : planning exercise arranged in series with breathing exercises , mobility , strength , and stretching . All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs . The control group will be asked to maintain their usual routine . Study endpoints will be assessed after 8 weeks ( immediate effects ) and after 6 months . The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Question naire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life question naire . The secondary outcomes : pain ( algometry , Visual Analogue Scale , Brief Pain Inventory short form ) ; body composition ; physical measurement ( abdominal test , h and grip strength , back muscle strength , and multiple sit-to-st and test ) ; cardiorespiratory fitness ( International Fitness Scale , 6-minute walk test , International Physical Activity Question naire-Short Form ) ; fatigue ( Piper Fatigue Scale and Borg Fatigue Scale ) ; anxiety and depression ( Hospital Anxiety and Depression Scale ) ; cognitive function ( Trail Making Test and Auditory Consonant Trigram ) ; accelerometry ; lymphedema ; and anthropometric perimeters . Discussion This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer . If this treatment option is effective , telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase . Trial registration Clinical Trials.gov Identifier : Background . Spinal cord injury ( SCI ) survivors with tetraplegia have great difficulty performing activities of daily living ( ADLs ) . Functional electrical stimulation ( FES ) combined with exercise therapy ( ET ) can improve h and function , but delivering the treatment is problematic . Objective . To compare 2 ET treatments delivered by in-home tele-therapy ( IHT ) . Methods . Each treatment involved ET , tele-supervised 1 h/d , 5 d/wk for 6 weeks . Treatment 1 : “ conventional ET ” comprised strength training , computer games played with a trackball , and therapeutic electrical stimulation ( TES ) . Treatment 2 : “ ReJoyce ET ” comprised FES-ET on a workstation , the Rehabilitation Joystick for Computerized Exercise ( ReJoyce ) with which participants played computer games associated with ADLs . Participants were block-r and omized into group 1 receiving conventional ET first , followed by 1-month washout , and then ReJoyce ET and group 2 in reverse order . In all , 13 participants took part , 5 completing the study with both h and s , such that both groups had a sample size of 9 . Primary outcome measure : Action Research Arm Test ( ARAT ) . Secondary outcome measures : grasp and pinch forces and the ReJoyce automated h and function test ( RAHFT ) . Results . ARAT scores improved more after ReJoyce ET ( 13.0 % ± 9.8 % ) than after conventional ET ( 4.0 % ± 9.6 % ; F = 10.6 , P < .01 ) . RAHFT scores also improved more after ReJoyce ET ( 16.9 % ± 8.6 % ) than conventional ET ( 3.3 % ± 10.2 % ; F = 20.4 , P < .01 ) . Conclusions . FES-ET on a workstation , supervised over the Internet , is feasible and may be effective for patients who can meet the residual motor function requirements of our study We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment . We compared the degree of satisfaction of patients undergoing a virtual reality ( VR ) therapy programme at home ( Tele-VR group ) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting ( VR-group ) . The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient 's movement was represented . In tele-therapy , the patient equipment was installed in their homes , connected to the hospital by four ISDN lines at a total b and width of 512 kbit/s . Rehabilitation data were transmitted via one line and videoconferencing via the other three . Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke , were r and omized into VR or Tele-VR groups . A question naire was used at the end of treatment to measure each patient 's degree of satisfaction . Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated , except one . In motor performance , the Tele-VR group improved significantly ( P ≤ 0.05 ) , while the VR group showed no significant change . Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required We conducted a r and omized controlled trial to evaluate the perception , satisfaction and utilization of a home telehealth service  for frail elderly people living independently in their home communities .  Control group subjects continued with their usual care and intervention group subjects were able to supplement their usual care with the use of a web portal . The web portal allowed videoconferencing and electronic messaging between home care nurses and clients , ordering health-related and home care services , access to health-related information and general access to the Internet . A total of 99 eligible people ( 59 female , 40 male ) from one urban and one rural study site agreed to participate in the study . Eighty-four subjects were active participants for nine months . There were no significant differences in perception of technology between the two groups at baseline . At 60-day follow-up , the intervention group was significantly more positive towards technology compared to their own baseline ( P < 0.001 ) and compared to the 60-day scores for the controls ( P < 0.001 ) . The intervention group indicated that overall the telehealth service met their expectations ( mean score 9 out of 10 ) and they would recommend it to others ( mean score 9.5 out of 10 ) . All subjects were able to use the portal without difficulty after brief instructions from the nurses . A total of 1054 videoconferences were conducted with the intervention subjects . Fifty-six of these ( 5 % ) had to be discontinued after successful connection because of technical problems . Intervention subjects made fewer emergency department visits than control subjects , more visits to the eye doctor , fewer visits in all categories of home care utilization , and lower use of transportation services .  Frail elderly people are able to adopt home telehealth technologies which may enable them to maintain independent living arrangements Background and Purpose — To determine the effect of a multifaceted stroke telerehabilitation ( STeleR ) intervention on physical function , and secondarily on disability , in veterans poststroke . Methods — We conducted a prospect i ve , r and omized , multisite , single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers . Veterans with a stroke in the preceding 24 months were r and omized to the STeleR intervention or usual care .  The STeleR intervention consisted of 3 home visits , 5 telephone calls , and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies . Usual care participants received routine rehabilitation care as prescribed by their physicians . The primary outcome measures were improvement in function at 6 months , measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument . Results — The 2 complementary primary outcomes ( Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure ) improved at 6 months for the STeleR group and declined for the usual care group , but the differences were not statistically significant ( P=0.25 , Late-Life Function and Disability Instrument ; P=0.316 ) . Several of secondary outcomes were statistically significant . At 6 months , compared with the usual care group , the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P<0.05 ) , and approached significance in 1 of the 3 Function component subscales ( P=0.06 ) . Conclusions — The STeleR intervention significantly improved physical function , with improvements persisting up to 3 months after completing the intervention . STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited re sources available for in-home rehabilitation for stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00384748 Study Design . A descriptive study of repeated measures using a crossover design . Objective . To determine the level of agreement between assessment s obtained via telerehabilitation and those obtained by traditional face-to-face method in a population of individuals with chronic low back pain ( LBP ) in a primary care setting . Summary of Background Data . Musculoskeletal assessment using telerehabilitation has shown adequate inter- and intrarater agreement and concordance with face-to-face clinical assessment in different diseases . There have been no published studies on the reliability of a telerehabilitation system to assess LBP . Methods . Fifteen individuals ( 6 males ; mean age , 37 yr ) with chronic LBP attended a session for a clinical interview , followed by face-to-face and real-time online telerehabilitation evaluations . There was a 30-minute interval between the 2 assessment s , the order of which was r and omly selected for each patient . The telerehabilitation system used an Internet application conducted via Internet connection ( 17 kB/s ) between 2 personal computers . Real-time video connection facilitated communication between the therapist and the subject . Outcome measures included lumbar spine mobility , Sorensen test , anterior straight leg raise test , Oswestry Disability Index , visual analogue scale for pain , 12-Item Short Form Health Survey question naire , and Tampa Kinesiophobia Scale . Results . The & agr ; reliability between face-to-face and telerehabilitation evaluations was more than 0.80 for 7 of the 9 outcome measures . Lowest reliability was for lateral flexion range of motion ( & agr;= 0.75 ) . Very good inter- and intrarater intraclass correlation coefficients ( & rgr ; ) were obtained ( 0.92–0.96 ) . Conclusion . The findings of our pilot study suggest that this telerehabilitation system may be useful to assess individuals with chronic LBP , providing initial support for its implementation in primary care . Level of Evidence : We investigated the effectiveness and efficiency of a four-week myofeedback-based teletreatment service in subjects with non-specific neck and shoulder pain . Subjects were recruited in Belgium , Germany and the Netherl and s and r and omly allocated to the intervention or conventional care . Subjects in the intervention group received four weeks of myofeedback training .  Pain intensity and disability were evaluated by question naires at baseline , immediately after four weeks of treatment and at follow-up 3 months later . To investigate efficiency , the time-investment of both therapists and patients were assessed . Seventy-one subjects were included in the study ( 36 in the intervention group and 35 in the conventional care group ) . Myofeedback-based teletreatment was at least as effective clinical ly as conventional care .  Pain intensity and disability decreased after 4 weeks of treatment in both groups and part of the effect remained at 3 months ' follow-up . The teletreatment also increased efficiency for therapists by almost 20 % and patients experienced the benefits of less travel time and travel costs by remote consultation . Myofeedback-based teletreatment has the potential to ensure more efficient treatment for patients with non-specific neck and shoulder pain Background Physical activity is important following breast cancer . Trials of non-face-to-face interventions are needed to assist in reaching women living outside major metropolitan areas . Purpose This study seeks to evaluate the feasibility and effectiveness of a telephone-delivered , mixed aerobic and resistance exercise intervention for non-urban Australian women with breast cancer . Methods A r and omized controlled trial comparing an 8-month intervention delivered by exercise physiologists ( n = 73 ) to usual care  ( n = 70 ) . Results Sixty-one percent recruitment rate and 96 % retention at 12 months ; 79 % of women in the intervention group received at least 75 % of calls ; odds ( OR , 95 % CI ) of meeting intervention targets favored the intervention group for resistance training ( OR 3.2 ; 1.2 , 8.9 ) and aerobic ( OR 2.1 ; 0.8 , 5.5 ) activity . Conclusions Given the limited availability of physical activity programs for non-urban women with breast cancer , results provide strong support for feasibility and modest support for the efficacy of telephone-delivered interventions BACKGROUND total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee . Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function . Access to high- quality rehabilitation services is not always possible , especially for those who live in rural or remote areas . The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty . METHODS this investigation was a single-blinded , prospect i ve , r and omized , controlled noninferiority trial . Sixty-five participants were r and omized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program . The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) measured at baseline and six weeks by a blinded independent assessor . Secondary outcomes included the Patient-Specific Functional Scale , the timed up- and -go test , pain intensity , knee flexion and extension , quadriceps muscle strength , limb girth measurements , and an assessment of gait . Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics . RESULTS baseline characteristics between groups were similar , and all participants had significant improvement on all outcome measures with the intervention ( p < 0.01 for all ) . After the six-week intervention , participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion , muscle strength , limb girth , pain , timed up- and -go test , quality of life , and clinical gait and WOMAC scores . Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group ( p < 0.05 ) . The telerehabilitation intervention was well received by participants , who reported a high level of satisfaction with this novel technology . CONCLUSIONS the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation . LEVEL OF EVIDENCE therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence Chronic obstructive pulmonary disease ( COPD ) is a common disease that leads to huge economic and social burden . Efficient and effective management of stable COPD is essential to improve quality of life and reduce medical expenditure . The Internet of Things ( IoT ) , a recent breakthrough in communication technology , seems promising in improving health care delivery , but its potential strengths in COPD management remain poorly understood . We have developed a mobile phone-based IoT ( mIoT ) platform and initiated a r and omized , multicenter , controlled trial entitled the ‘ MIOTIC study ’ to investigate the influence of mIoT among stable COPD patients . In the MIOTIC study , at least 600 patients with stable GOLD group C or D COPD and with a history of at least two moderate-to-severe exacerbations within the previous year will be r and omly allocated to the control group , which receives routine follow-up , or the intervention group , which receives mIoT management . Endpoints of the study include ( 1 ) frequency and severity of acute exacerbation ; ( 2 ) symptomatic evaluation ; ( 3 ) pre- and post-bronchodilator forced expiratory volume in 1 second ( FEV1 ) and FEV1/forced vital capacity ( FVC ) measurement ; ( 4 ) exercise capacity ; and ( 5 ) direct medical cost per year . Results from this study should provide direct evidence for the suitability of mIoT in stable COPD patient management Background More than 60 % of new strokes each year are " mild " in severity and this proportion is expected to rise in the years to come . Within our current health care system those with " mild " stroke are typically discharged home within days , without further referral to health or rehabilitation services other than advice to see their family physician . Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention , community reintegration , medication counselling and problem solving with regard to specific concerns that arise . Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization . The purpose of this study is to assess the effectiveness , for individuals who experience a first " mild " stroke , of a sustainable , low cost , multimodal support intervention ( comprising information , education and telephone support ) - " WE CALL " compared to a passive intervention ( providing the name and phone number of a re source person available if they feel the need to ) - " YOU CALL " , on two primary outcomes : unplanned-use of health services for negative events and quality of life . Method / Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites . Baseline measures will be taken within the first month after stroke onset . Participants will be stratified according to comorbidity level and r and omised to one of two groups : YOU CALL or WE CALL . Both interventions will be offered over a six months period . Primary outcomes include unplanned use of heath services for negative event ( frequency calendar ) and quality of life ( EQ-5D and Quality of Life Index ) . Secondary outcomes include participation level ( LIFE-H ) , depression ( Beck Depression Inventory II ) and use of health services for health promotion or prevention ( frequency calendar ) . Blind assessors will gather data at mid-intervention , end of intervention and one year follow up . Discussion If effective , this multimodal intervention could be delivered in both urban and rural environments . For example , existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics , make this intervention , if effective , deliverable and sustainable . Trial Registration IS RCT OBJECTIVE To compare the effectiveness of a new interactive virtual telerehabilitation system and a conventional programme following total knee arthroplasty . DESIGN R and omized , controlled , single-blind clinical trial . PARTICIPANTS A total of 142 total knee arthroplasty patients . METHODS Participants were r and omly assigned to receive either : ( i ) conventional out-patient physical therapy ; or ( ii ) interactive virtual telerehabilitation system . The main outcome was function assessed with active range of knee movement . Other variables , such as muscle strength , walk speed , pain and the Western Ontario and McMaster Universities osteoarthritis index , were also collected . Comparisons were made on the basis of data collected routinely before surgery , at the end of the rehabilitation programme , and at 3 months follow-up . Quantitative variables were compared by Mann-Whitney U test . The agreed alpha risk for all hypothesis testing was 0.05 . RESULTS Baseline characteristics between groups were comparable . All participants improved after the 2-week intervention on all outcome variables ( p < 0.05 ) . Patients in the interactive virtual telerehabilitation group achieved improvements in the functional variables similar to those achieved in the conventional therapy group . CONCLUSION A 2-week interactive virtual telerehabilitation programme is at least as effective as conventional therapy . Telerehabilitation is a promising alternative to traditional face-to-face therapies after discharge from total knee arthroplasty , especially for those patients who have difficulty with transportation to rehabilitation centres OBJECTIVE To compare the 6-month outcomes of telerehabilitation intervention with those of st and ard care for spinal cord injury ( SCI ) . DESIGN Multicenter r and omized controlled trial . SETTING Home , nursing , or unspecialized hospital care provided after discharge from a spinal cord unit . PARTICIPANTS Adult patients with nonprogressive , complete , or incomplete SCI discharged for the first time from the spinal cord unit to their homes ( Belgium and Italy ) or to their homes or another facility ( Engl and ) . INTERVENTIONS All patients received the st and ard care they would have normally received after discharge from the spinal cord unit . In addition , patients in the telemedicine group received 8 telemedicine weekly sessions in the first 2 months , followed by biweekly telemedicine sessions for 4 months . MAIN OUTCOME MEASURES Functional status at 6 months , clinical complications during the postdischarge period , and patient satisfaction . RESULTS No significant differences in the occurrence of clinical complications were found between the study groups . A higher improvement of functional scores in the telemedicine group was found only at the Italian site : FIM total score 3.38+/-4.43 ( controls ) versus 7.69+/-6.88 ( telemedicine group ) , FIM motor score 3.24+/-4.38 ( controls ) versus 7.55+/-7.00 ( telemedicine group ; P<.05 ) . Items contributing to this difference were grooming , dressing upper body , dressing lower body , and bed/chair/wheelchair transfer . Higher satisfaction with care was reported by patients in the telemedicine group across all sites . CONCLUSIONS Our study provides some of the first quantitative evidence , based on results from 1 site , that telerehabilitation may offer benefits to patients discharged from a spinal cord unit compared with st and ard care in terms of functional improvement . Further research is warranted to confirm or disprove this finding We conducted a r and omized , controlled pilot trial to evaluate the feasibility of providing subspecialty care via telemedicine for patients with Parkinson 's disease residing in a remote community located approximately 130 miles from an academic movement disorders clinic . Study participants were r and omized to receive telemedicine care with a movement disorder specialist at the University of Rochester or to receive their usual care .  Participants in the telemedicine group received three telemedicine visits over six months . Feasibility , as measured by the completion of telemedicine visits , was the primary outcome measure . Secondary measures were quality of life , patient satisfaction , and clinical outcomes .  Ten participants residing in the community were r and omized to receive telemedicine care ( n = 6 ) or their usual care ( n = 4 ) . Four nursing home patients were assigned to telemedicine . Those receiving telemedicine completed 97 % ( 29 of 30 ) of their telemedicine visits as scheduled . At the study 's conclusion , 13 of 14 study participants opted to receive specialty care via telemedicine . Compared with usual care , those r and omized to telemedicine had significant improvements in quality of life ( 3.4 point improvement vs. 10.3 point worsening on the Parkinson 's Disease Question naire 39 ; P = 0.04 ) and motor performance ( 0.3 point improvement vs. 6.5 point worsening on the Unified Parkinson 's Disease Rating Scale , motor subscale ; P = 0.03 ) . Relative to baseline , nursing home patients experienced trends toward improvement in quality of life and patient satisfaction . Providing subspecialty care via telemedicine for individuals with Parkinson 's disease living remotely is feasible We report progress in the development of AutoCITE , a workstation that delivers the task practice component of upper-limb Constraint-Induced Movement therapy and that can potentially be used in the clinic or the home without the need for one-on-one supervision from a therapist . AutoCITE incorporates a computer and eight task devices arranged on a modified cabinet . Task performance is automatically recorded , and several types of feedback are provided . In preliminary testing , nine chronic stroke subjects with mild to moderate motor deficits practice d with AutoCITE for 3 h each weekday for 2 weeks . Subjects wore a padded mitt on the less-affected h and for a target of 90 % of their waking hours . In terms of effect sizes , gains were large and significant on the Motor Activity Log , and moderate to large on the Wolf Motor Function Test . These gains were comparable to the gains of a matched group of 12 subjects who received st and ard Constraint-Induced Movement therapy BACKGROUND AND AIMS Internet-based interventions open a chance to improve the sustainability of rehabilitation in general and of exercise therapy in particular . The internet can be the sole intervention component on the one h and as well as a supportive tool for a traditional " Face-to-Face " intervention on the other h and . In this article , 2 studies in the setting of health promotion are outlined . Those studies evaluated an e-Training program in different administration forms . METHODS Study 1 : 90 adults with a sedentary lifestyle were r and omized into 3 treatment groups : Group fitness ( " Face-to-Face " ) , individually supervised training ( " Face-to-Face " ) and e-Training ( internet-based ) . The respective intervention took place across 3 months and each continued for a maintenance phase of 4 months . Muscular fitness , sports activities and health-related quality of life were assessed at 3 points in time : right before the intervention , after the first 3 months , and finally , after the maintenance -phase . Study 2 : 509 adults with a high self-rated risk of recurrent back pain participated in the intervention " Rückengesundheit ERlangen " , which lasted for 6 months : a combined program with its content delivered " Face-to-Face " and via e-Training . The analysis was conducted in a pre-post design without control group . Several psychosocial outcome variables were assessed ( e.g. , fear-avoidance beliefs/FABQ-D ) and the cardio-pulmonary endurance capacity . RESULTS In study 1 and in study 2 , significant improvements over time in all intervention groups were measured in nearly all of the dependent variables , with the exception of the physical component summary of health-related quality of life ( HRQL ) ( SF-36 ) in study 1 , as well as its mental component summary ( SF-36 ) and the endurance capacity in study 2 . In study 1 , the graphical comparison ( confidence interval ) of e-Training with the " Face-to-Face " interventions shows a similar efficacy of both of them . A gender-specific evaluation reveals that the mental component of HRQL in women is significantly more improved by the group fitness intervention than by e-Training . Study 2 shows significant positive changes in the pre-post comparison regarding psychosocial risk factors of the chronification of back pain and for men significant improvements of the endurance capacity . However , no causal link could be established because of the -limitation of the study design Carpal tunnel syndrome is caused by the compression of the median nerve as it transits the carpal tunnel , with an incidence of about 1 % of the population . If surgery is needed , the treatment involves decompression of the median nerve followed sometimes by musculoskeletal outpatient rehabilitation . This paper presents a proof-of-concept pilot clinical trial in which the Rutgers Masters II haptic glove was tested on five subjects , who were two weeks post-h and surgery . Subjects trained for 13 sessions , 30 min per session , three sessions per week , and had no conventional outpatient therapy .  Computerized measures of performance showed group effects in h and mechanical energy ( 1200 % for the virtual ball squeezing and DigiKey exercises and 600 % for the power putty exercise ) . Improvement in their h and function was also observed ( a 38 % reduction in virtual pegboard errors , and 70 % fewer virtual h and ball errors ) . Clinical strength measures showed increases in grip ( by up to 150 % ) and key pinch ( up to 46 % ) strength in three of the subjects , while two subjects had decreased strength following the study . However , all five subjects improved in their tip pinch strength of their affected h and ( between 20%-267 % ) . When asked whether they would recommend the virtual reality exercises to others , four subjects very strongly agreed and one strongly agreed that they Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event , but poor uptake of current programs have been reported globally . Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs . This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies ( ICT ) . Methods / Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation .  Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients ' physiological risk factors and other health information . Video and teleconferencing are used for mentoring sessions aim ing at behavioural modifications through goal setting . The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program . Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on dem and . We have design ed a r and omised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program . The main outcome measure is adherence to physical exercise guidelines . Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients .Trial registration The trial has been registered in the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) with number ACTRN12609000251224 Study design : one group pre- and post-test design . Objectives : The primary aim was to examine both the short- and long-term effects of an oral home telecare program on improving gingival health  among adults with tetraplegia . Methods : Eight adults with tetraplegia participated . The oral home telecare program consisted of individualized oral hygiene training in the use of assistive devices ( powered toothbrush and adapted flosser and /or oral irrigator ) using personal computer-based videoconferencing between each participant and an occupational therapist . Training was conducted on an average of five 15−30 min sessions across 3 months . During these training sessions , supervised practice of oral hygiene , and provision of immediate corrective feedback and positive reinforcement in the use of adaptive oral hygiene devices was emphasized . Gingival health assessment using the Löe-Silness gingival index ( LSGI ) was conducted at baseline , 6 and 12 months . Results : From baseline to 6 months , participants showed statistically significant differences ( that is , improvement with less gingival inflammation ) in their LSGI scores ( z=2.18 , P=.03 ) . From baseline to 12 months , participants also showed a statistically significant difference ( that is , improvement , z=2.03 ; P=0.04 ) in their LSGI scores . Conclusion : This study indicates that preventive oral home telecare with repeated oral hygiene training in the use of adaptive devices improved gingival health at 6 and 12 months among adults with tetraplegia Background In New Zeal and , around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained . Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities . However , on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of re sources and geographical location . Currently most people receive no treatment beyond three months post stroke . The study aims to determine if the Augmented Community Telerehabilitation Intervention ( ACTIV ) results in better physical function for people with stroke than usual care , as measured by the Stroke Impact Scale , physical subcomponent . Methods / design This study will use a multi-site , two-arm , assessor blinded , parallel r and omised controlled trial design . People will be eligible if they have had their first ever stroke , are over 20 and have some physical impairment in either arm or leg , or both . Following discharge from formal physiotherapy services ( inpatient , outpatient or community ) , participants will be r and omised into ACTIV or usual care . ACTIV uses readily available technology , telephone and mobile phones , combined with face-to-face visits from a physiotherapist over a six-month period , to help people with stroke resume activities they enjoyed before the stroke . The impact of stroke on physical function and quality of life will be assessed , measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options . These outcomes will be collected at baseline , six months and 12 months . In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study . Discussion The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation . Best practice guidelines recommend a prolonged period of rehabilitation , however this is expensive and therefore not undertaken in most publicly funded centres . An effective , cost-effective , and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home . Trial registration 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 r and omly 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 Question naire . 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 question naire . 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 Physical activity is associated with many benefits , but persons with multiple sclerosis ( MS ) are less physically active than the general population . There is a critical need for research on methods of increasing and sustaining the physical activity levels of this population . This r and omized controlled trial examined the efficacy of an Internet-delivered and theory-based behavioral intervention that was supplemented with video coaching for increasing and sustaining physical activity over time in persons with MS . Physically inactive , ambulatory persons with MS ( N = 45 ) were r and omly assigned to intervention ( n = 22 ) or control ( n = 23 ) conditions and completed a battery of question naires before , after , and three months after a 12-week intervention period . Data analyses were conducted in PASW 18.0 . Partial eta squared ( ) effect size indicated that there was a large , statistically significant condition-by-time interaction on physical activity ( ) . Cohen 's d effect sizes indicated that the intervention group had a large increase in physical activity after the 12-week trial ( d = .98 ) that was sustained over a three-month follow-up ( d = .79 ) . The current study supports the efficacy of a behavioral intervention for increasing and sustaining physical activity in a sample of persons with MS BACKGROUND Resistance training programs have been found to improve muscle strength , physical function , and depressive symptoms in middle-aged and older adults . These programs have typically been provided in clinical facilities , health clubs , and senior centers , which may be inconvenient and /or cost prohibitive for some older adults . The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention that provides real-time guidance and monitoring of resistance training in the home . METHODS A r and omized clinical trial in 103 middle-aged or older participants . Participants were assigned to use of a theory-driven interactive voice response system design ed to promote resistance training ( Telephone-Linked Computer-based Long-term Interactive Fitness Trainer ; n = 52 ) or to an attention control ( n = 51 ) for a period of 12 months . Measurements of muscle strength , balance , walk distance , and mood were obtained at baseline , 3 , 6 , and 12 months . RESULTS We observed increased strength , improved balance , and fewer depressive symptoms in the intervention group than in the control group . Using generalized estimating equations modeling , group differences were statistically significant for knee flexion strength ( p = .035 ) , single-leg stance time ( p = .029 ) , and Beck Depression Inventory ( p = .030 ) . CONCLUSIONS This computer-based telecommunications exercise intervention led to improvements in participants ' strength , balance , and depressive symptoms . Because of their low cost and easy accessibility , computer-based interventions may be a cost-effective way of promoting exercise in the home Background : Previous studies support the efficacy and effectiveness of face-to-face group-based fatigue management education for people with multiple sclerosis ( MS ) . Nevertheless , many people are unable to access these programs due to environmental barriers . Objectives : To test the efficacy and effectiveness of a group-based , teleconference-delivered fatigue management program for people with MS . Methods : A r and omly allocated two-group time series design with a wait-list control group was used . In total 190 participants were allocated ( 94 intervention , 96 wait-list control ) . Primary outcomes ( fatigue impact , fatigue severity , health-related quality of life ( HRQOL ) ) were measured before , immediately after , at 6 weeks , 3 months , and 6 months post . Secondary outcome ( self-efficacy ) was measured at the same points . Effectiveness ( intent-to-treat ) and efficacy ( per protocol ) analyses were conducted . Results : The program was more effective and efficacious than control for reducing fatigue impact but not fatigue severity . Before and after comparisons with the pooled sample demonstrated efficacy and effectiveness for fatigue impact , fatigue severity , and 6 of 8 HRQOL dimensions . Changes were maintained for 6 months with small to moderate effect sizes . Conclusion : The results offer strong support for the viability of teleconference-delivered fatigue management education for enabling people with MS to manage this disabling symptom Background Stroke is one of the most disabling and costly impairments of adulthood in the United States . Stroke patients clearly benefit from intensive inpatient care , but due to the high cost , there is considerable interest in implementing interventions to reduce hospital lengths of stay . Early discharge rehabilitation programs require coordinated , well-organized home-based rehabilitation , yet lack of sufficient information about the home setting impedes successful rehabilitation . This trial examines a multifaceted telerehabilitation ( TR ) intervention that uses telehealth technology to simultaneously evaluate the home environment , assess the patient 's mobility skills , initiate rehabilitative treatment , prescribe exercises tailored for stroke patients and provide periodic goal oriented re assessment , feedback and encouragement . Methods We describe an ongoing Phase II , 2-arm , 3-site r and omized controlled trial ( RCT ) that determines primarily the effect of TR on physical function and secondarily the effect on disability , falls-related self-efficacy , and patient satisfaction .  Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be r and omly assigned to one of two groups : ( a ) TR ; or ( b ) Usual Care . The TR intervention uses a combination of three videotaped visits and five telephone calls , an in-home messaging device , and additional telephonic contact as needed over a 3-month study period , to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment . Dependent variables will be measured at baseline , 3- , and 6-months and analyzed with a linear mixed-effects model across all time points . Discussion For patients recovering from stroke , the use of TR to provide home assessment s and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services , assist transition to home and increase efficiency . This may be particularly relevant when patients live in remote locations , as is the case for many veterans . Trial Registration Clinical Trials.gov Identifier : & NA ; Both pharmacological and non‐pharmacological interventions have demonstrated efficacy in the management of fibromyalgia ( FM ) .  Non‐pharmacological interventions however are far less likely to be used in clinical setting s , in part due to limited access . This manuscript presents the findings of a r and omized controlled trail of an Internet‐based exercise and behavioral self‐management program for FM design ed for use in the context of a routine clinical care . 118 individuals with FM were r and omly assigned to either ( a ) st and ard care or ( b ) st and ard care plus access to a Web‐Enhanced Behavioral Self‐Management program ( WEB‐SM ) grounded in cognitive and behavioral pain management principles . Individuals were assessed at baseline and again at 6 months for primary endpoints : reduction of pain and an improvement in physical functioning . Secondary outcomes included fatigue , sleep , anxiety and depressive symptoms , and a patient global impression of improvement . Individuals assigned to the WEB‐SM condition reported significantly greater improvement in pain , physical functioning , and overall global improvement . Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period . A no‐contact , Internet‐based , self‐management intervention demonstrated efficacy on key outcomes for FM . While not everyone is expected to benefit from this approach , this study demonstrated that non‐pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis ( MS ) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles . However , no studies to date have systematic ally evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS . This study involves a r and omized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels . Methods / Design A r and omly-allocated , three-parallel group , time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study . Our goal is to recruit 189 ambulatory individuals with MS who will be r and omized into one of three  telehealth interventions : ( 1 ) a contact-control social support intervention , ( 2 ) a physical activity-only intervention , and ( 3 ) a physical activity plus fatigue management intervention . All interventions will last 12 weeks and will be delivered entirely over the phone . Our hypothesis is that , in comparison to the contact-control condition , both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function , with the physical activity plus fatigue management intervention yielding significantly larger improvements . To test this hypothesis , outcome measures will be administered at Weeks 1 , 12 , and 24 . Primary outcomes will be the Fatigue Impact Scale , the Godin Leisure-Time Exercise Question naire ( GLTEQ ) , and Actigraph accelerometers . Secondary outcomes will include the SF-12 Survey , Mental Health Inventory , Multiple Sclerosis Impact Scale , the Community Participation Indicator , and psychosocial constructs ( e.g. , self-efficacy ) . Discussion The proposed study is novel , in that it represents a multi-disciplinary effort to merge two promising lines of research on MS : fatigue management and physical activity promotion . Collectively , the proposed study will be the largest r and omized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS.Trial registration Background and Purpose — Telemedicine techniques can be used to address the rural – metropolitan disparity in acute stroke care . The Stroke Team Remote Evaluation Using a Digital Observation Camera ( STRokE DOC ) trial reported more accurate decision making for telemedicine consultations compared with telephone-only and that the California-based research network facilitated a high rate of thrombolysis use , improved data collection , low risk of complications , low technical complications , and favorable assessment times . The main objective of the STRokE DOC Arizona TIME ( The Initial Mayo Clinic Experience ) trial was to determine the feasibility of establishing , de novo , a single-hub , multirural spoke hospital telestroke research network across a large geographical area in Arizona by replicating the STRokE DOC protocol . Methods — Methods included prospect i ve , single-hub , 2-spoke , r and omized , blinded , controlled trial of a 2-way , site-independent , audiovisual telemedicine system design ed for remote examination of adult patients with acute stroke versus telephone consultation to assess eligibility for treatment with intravenous thrombolysis .  The primary outcome measure was whether the decision to give thrombolysis was correct . Secondary outcomes were rate of thrombolytic use , 90-day functional outcomes , incidence of intracerebral hemorrhages , and technical observations . Results — From December 2007 to October 2008 , 54 patients were assessed , 27 of whom were r and omized to each arm . Mean National Institutes of Health Stroke Scale score at presentation was 7.3 ( SD 6.2 ) points . No consultations were aborted ; however , technical problems ( 74 % ) were prevalent in the telemedicine arm . Overall , the correct treatment decision was established in 87 % of the consultations . Both modalities , telephone ( 89 % correct ) and telemedicine ( 85 % correct ) , performed well . Intravenous thrombolytic treatment was used in 30 % of the telemedicine and telephone consultations . Good functional outcomes at 90 days were not significantly different . There were no statistically significant differences in mortality ( 4 % in telemedicine and 11 % in telephone ) or rates of intracerebral hemorrhage ( 4 % in telemedicine and 0 % in telephone ) . Conclusions — It is feasible to extend the original STRokE DOC trial protocol to a new state and establish an operational single-hub , multispoke rural hospital telestroke research network in Arizona . The trial was not design ed to have sufficient power to detect a difference between the 2 consultative modes : telemedicine and telephone-only . Whether by telemedicine or telephone consultative modalities , there were appropriate treatment decisions , high rates of thrombolysis use , improved data collection , low rates of intracerebral hemorrhage , and equally favorable time requirements . The learning curve was steep for the hub and spoke personnel of the new telestroke network , as reflected by frequent technical problems . Overall , the results support the effectiveness of highly organized and structured stroke telemedicine networks for extending expert stroke care into rural remote communities lacking sufficient neurological expertise Objective . To compare 2 telerehabilitation training strategies , repetitive tracking movements versus repetitive simple movements , to promote brain reorganization and recovery of h and function . Methods . Twenty subjects with chronic stroke and 10 degrees of voluntary finger extension were r and omly assigned to receive 1800 telerehabilitation trials over 2 weeks of either computerized tracking training ( track group ) with the affected finger and wrist involving temporospatial processing to achieve accuracy or movement training ( move group ) with no attention to accuracy . Following movement training , the move group crossed over to receive an additional 2 weeks of tracking training .  Behavioral changes were measured with the Box and Block test , Jebsen Taylor test , and finger range of motion , along with a finger-tracking activation paradigm during fMRI . Results . The track group showed significant improvement in all 4 behavioral tests ; the move group improved in the Box and Block and Jebsen Taylor tests . The improvement for the track group in the Box and Block and Jebsen Taylor tests did not surpass that for the move group . A consistent group pattern of brain reorganization was not evident . The move group , after crossing over , did not show further significant improvements . Conclusion . Telerehabilitation may be effective in improving performance in subjects with chronic stroke .  Tracking training with reinforcement to enhance learning , however , did not produce a clear advantage over the same amount of practice of r and om movements . Two weeks of training may be insufficient to demonstrate a behavioral advantage and associated brain reorganization The dem and for home health care has skyrocketed in recent years . The aging population and the push for more efficient delivery of hospital services have fueled this growing dem and . However , health care financing reforms have constrained the industry 's growth . Home health agencies struggle to deliver high- quality services while staying within the financial limitations imposed by reimbursement changes . Telehomecare is one way to provide cost-effective care in the current environment . Personal computers and video equipment can transmit data over ordinary telephone lines and allow home health providers to monitor patients and provide care at a much lower cost than earlier technologies that required wider b and width telephone lines and more complex equipment . But can telehomecare yield cost-savings for home health agencies ? This article addresses the costs associated with a  telehomecare  intervention  in a large , urban , home health agency . The purpose of the study was two-fold : ( 1 ) to test the effects of telehomecare on clinical outcomes , and ( 2 ) to estimate the financial costs associated with providing telehomecare services . Our results show that , while telehomecare imposes additional expenses for care delivery , it contributes substantial savings without compromising quality . Additionally , we found that the financial benefit increases exponentially as the duration of the patient care episode increases Stroke is one of the leading causes of death and disability worldwide . Its prevalence calls for innovative rehabilitation methods . The Rutgers Arm is a novel upper extremity rehabilitation system consisting of a low-friction table , three-dimensional ( 3D ) tracker , custom forearm support , PC workstation , library of Java 3D virtual reality ( VR ) exercises , clinical data base module , and a tele-rehabilitation extension . The system was tested on a chronic stroke subject , under local and tele-rehabilitation conditions , over 5 weeks of training . Results show improvements in arm motor control and shoulder range of motion , corresponding to improved Fugl-Meyer test scores . Exercise duration , level of difficulty , and patient motivation were maintained under tele-rehabilitaion . A 1-week retention trial showed that gains were maintained Background Telerehabilitation allows rehabilitative training to continue remotely after discharge from acute care and can include complex tasks known to create rich conditions for neural change . Objectives The purpose s of this study were : ( 1 ) to explore the feasibility of using telerehabilitation to improve ankle dorsiflexion during the swing phase of gait in people with stroke and ( 2 ) to compare complex versus simple movements of the ankle in promoting behavioral change and brain reorganization . Design This study was a pilot r and omized controlled trial . Setting Training was done in the participant 's home . Testing was done in separate research labs involving functional magnetic resonance imaging ( fMRI ) and multi-camera gait analysis . Patients Sixteen participants with chronic stroke and impaired ankle dorsiflexion were assigned r and omly to receive 4 weeks of telerehabilitation of the paretic ankle .  Intervention Participants received either computerized complex movement training ( track group ) or simple movement training ( move group ) . Measurements Behavioral changes were measured with the 10-m walk test and gait analysis using a motion capture system . Brain reorganization was measured with ankle tracking during fMRI . Results Dorsiflexion during gait was significantly larger in the track group compared with the move group . For fMRI , although the volume , percent volume , and intensity of cortical activation failed to show significant changes , the frequency count of the number of participants showing an increase versus a decrease in these values from pretest to posttest measurements was significantly different between the 2 groups , with the track group decreasing and the move group increasing . Limitations Limitations of this study were that no follow-up test was conducted and that a small sample size was used . Conclusions The results suggest that telerehabilitation , emphasizing complex task training with the paretic limb , is feasible and can be effective in promoting further dorsiflexion in people with chronic stroke Background Physical training has beneficial effects on exercise capacity , quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation . However , cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period . Home-based training has the potential to increase cardiac rehabilitation uptake , and was shown to be safe and effective in improving short-term exercise capacity . Long-term effects on physical fitness and activity , however , are disappointing . Therefore , we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home . In this way , we aim to improve self-management skills like self-efficacy and action planning for independent exercise and , consequently , improve long-term effectiveness with respect to physical fitness and physical activity . In addition , we aim to compare costs of this strategy with centre-based cardiac rehabilitation . Methods / design This r and omized controlled trial compares a 12-week telemonitoring guided home-based training program with a regular , 12-week centre-based training program of equal duration and training intensity in low to moderate risk patients entering cardiac rehabilitation after an acute coronary syndrome or cardiac intervention . The home-based group receives three supervised training sessions before they commence training with a heart rate monitor in their home environment . Participants are instructed to train at 70 - 85 % of their maximal heart rate for 45–60 minutes , twice a week . Patients receive individual coaching by telephone once a week , based on measured heart rate data that are shared through the internet . Primary endpoints are physical fitness and physical activity , assessed at baseline , after 12 weeks and after one year . Physical fitness is expressed as peak oxygen uptake , assessed by symptom limited exercise testing with gas exchange analysis ; physical activity is expressed as physical activity energy expenditure , assessed by tri-axial accelerometry and heart rate measurements . Secondary endpoints are training adherence , quality of life , patient satisfaction and cost-effectiveness . Discussion This study will increase insight in long-term effectiveness and costs of home-based cardiac rehabilitation with telemonitoring guidance . This strategy is in line with the trend to shift non-complex healthcare services towards patients ’ home environments . Trial registration Dutch Trial Register : NTR3780 . Clinical trials.gov register : In this paper , we describe our experience in design ing a virtual environment-based ( VE ) telerehabilitation system , and the results of a clinical study of the first 11 subjects with stroke to use the system . Our telerehabilitation system allows a therapist to conduct interactive VE treatment sessions remotely with a patient who is located at home . The system , software architecture , and development experience are described . Results of the clinical study on subjects with stroke showed significant improvements in upper extremity function following 30 1-h VE treatment sessions as measured by three st and ard clinical tests : Fugl-Meyer test of motor recovery ( FM ) ( p<0.0001 ) , Wolf motor test ( WMT ) ( p=0.0097 , and shoulder strength ( ShS ) ( p=0.0027 ) . Grip strength ( GS ) showed a trend toward improvement ( p=0.025 ) . These changes were maintained , for the most part , at four-months follow-up ( FM + 7.6 , WMT -18.4 s , ShS , + 169 % , GS , + 53 % This study reports on secondary data , depression , fatigue and health-related quality of life ( HRQOL ) , collected on people with advanced multiple sclerosis ( MS ) as part of a larger study of the impact of a telerehabilitation intervention on people with severe mobility impairment . People with spinal cord injuries ( SCIs ) ( n=111 ) and the prevention of pressure sores were the primary group of interest of the project . The focus here is on data collected from people with advanced MS ( n=27 ) , who were included as an exploratory cohort , as they experience increased risk of pressure ulcer development as their level of mobility declines . The study consisted of a nine-week intervention with three r and omized groups : video , telephone , and st and ard care . Aside from information on pressure sores , data were also collected on fatigue , depression , and HRQOL for a two-year follow-up period . For the video group HRQOL scores trended higher and fatigue and depression scores lower for 24 months . Fatigue scores were significantly lower for the video group at month six , 12 , and 18 . In the sample overall , fatigue symptoms were far more prominent than depressive symptoms and affected 100 % higher rates of depression than women . At baseline , controlling for Extended Disability Status Score ( EDSS ) , depression and fatigue were correlated . However , contrary to indications from previous cross-sectional studies , no consistent relationship was observed over time between the two . Telerehabilitation interventions for people with advanced MS warrant further investigation . Findings here suggest that such interventions may be beneficial , although the results need affirmation through larger sample s. In addition , the higher prevalence of male depression merits serious attention 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 r and omly 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 st and ardized 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 Recent advances in telecommunications technology are leading to new developments in postacute and rehabilitative care . For about $ 400 per patient and a telephone hookup , physicians and therapists can provide ongoing , direct care to patients at remote clinics or in their homes . The lack of large-scale r and omized controlled trials demonstrating clinical and cost effectiveness in rehabilitation and telemedicine has precluded many payers from reimbursing for services . Guidelines for best use do not currently exist , yet the benefits for payers , providers , and patients could be substantial . Telerehabilitation could become an important modality to MCOs seeking to extend the continuum of postacute care to non clinical setting OBJECTIVE Telerehabilitation enables a remotely controlled programme to be used to treat motor deficits in post-stroke patients . The effects of this telerehabilitation approach were compared with traditional motor rehabilitation methods . DESIGN R and omized single-blind controlled trial . PATIENTS A total of 36 patients with mild arm motor impairments due to ischaemic stroke in the region of the middle cerebral artery . METHODS The experimental treatment was a virtual reality-based system delivered via the Internet , which provided motor tasks to the patients from a remote rehabilitation facility . The control group underwent traditional physical therapy for the upper limb . Both treatments were of 4 weeks duration . All patients were assessed one month prior to therapy , at the commencement and termination of therapies and one month post-therapy , with the Fugl-Meyer Upper Extremity , the ABILH AND and the Ashworth scales . RESULTS Both rehabilitative therapies significantly improved all outcome scores after treatment , but only the Fugl-Meyer Upper Extremity scale showed differences in the comparison between groups . CONCLUSION Both strategies were effective , but the experimental approach induced better outcomes in motor performance . These results may favour early discharge from hospital sustained by a telerehabilitation programme , with potential beneficial effects on the use of available re sources OBJECTIVE Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery ( CABS ) . The study objective was to determine whether a 6-week early recovery telehealth intervention , design ed to improve self-efficacy and management related to symptoms after CABS , was effective in improving outcomes ( physical activity , physiologic , and psychologic functioning ) for older adults ( aged > 65 years ) with higher disease burden . METHODS A descriptive , repeated- measures experimental design was used . Follow-up data were collected at 3 and 6 weeks and 3 months after CABS . Subjects were drawn from a larger r and omized clinical trial . Parent study subjects who had high disease burden preoperatively ( physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6 ) were included ( N = 55 ) , with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group ( n = 31 ) . Subjects ranged in age from 65 to 85 years ( M = 71.6 + 5.1 years ) . RESULTS There was a significant main effect by group ( F[1,209 ] = 4.66 , P < .05 ) . The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer ( Stayhealthy , Inc , Monrovia , CA ) . Both groups had significantly improved physical ( F[2,171 ] = 3.26 , P < .05 ) and role-physical ( F[2,171 ] = 6.64 , P < .005 ) functioning over time . CONCLUSION The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention . Improving patients '  physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events BACKGROUND As a result of long delays for physiotherapy for musculoskeletal problems , several areas in the UK have introduced PhysioDirect services in which patients telephone a physiotherapist for initial assessment and treatment advice . However , there is no robust evidence about the effectiveness , cost-effectiveness or acceptability to patients of PhysioDirect .  OBJECTIVE To investigate whether or not PhysioDirect is equally as clinical ly effective as and more cost-effective than usual care for patients with musculoskeletal ( MSK ) problems in primary care . DESIGN Pragmatic r and omised controlled trial to assess equivalence , incorporating economic evaluation and nested qualitative research . Patients were r and omised in 2 : 1 ratio to PhysioDirect or usual care using a remote automated allocation system at the level of the individual , stratifying by physiotherapy site and minimising by sex , age group and site of MSK problem . For the economic analysis , cost consequences included NHS and patient costs , and the cost of lost production . Cost-effectiveness analysis was carried out from the perspective of the NHS . Interviews were conducted with patients , physiotherapists and their managers . SETTING Four community physiotherapy services in Engl and . PARTICIPANTS Adults referred by general practitioners or self-referred for physiotherapy for a MSK problem . INTERVENTIONS Patients allocated to PhysioDirect  were invited to telephone a senior physiotherapist for initial assessment and advice using a computerised template , followed by face-to-face care when necessary . Patients allocated to usual care were put on to a waiting list for face-to-face care . MAIN OUTCOME MEASURES Primary outcome was the Short Form question naire-36 items , version 2 ( SF-36v2 ) Physical Component Score ( PCS ) at 6 months after r and omisation . Secondary outcomes included other measures of health outcome [ Measure Yourself Medical Outcomes Profile , European Quality of Life-5 Dimensions ( EuroQol health utility measure , EQ-5D ) , global improvement , response to treatment ] , wait for treatment , time lost from work and usual activities , patient satisfaction . Data were collected by postal question naires at baseline , 6 weeks and 6 months , and from routine records by research ers blind to allocation . RESULTS A total of 1506 patients were allocated to PhysioDirect and 743 to usual care .  Patients allocated to PhysioDirect had a shorter wait for treatment than those allocated to usual care [ median 7 days vs 34 days ; arm-time ratio 0.32 , 95 % confidence interval ( CI ) 0.29 to 0.35 ] and had fewer non-attended face-to-face appointments [ incidence rate ratio 0.55 ( 95 % CI 0.41 to 0.73 ) ] . The primary outcome at 6 months ' follow-up was equivalent between PhysioDirect and usual care [ mean PCS 43.50 vs 44.18 , adjusted difference in means -0.01 ( 95 % CI -0.80 to 0.79 ) ] . The secondary measures of health outcome all demonstrated equivalence at 6 months , with slightly greater improvement in the PhysioDirect arm at 6 weeks ' follow-up . Patients were equally satisfied with access to care but slightly less satisfied overall with PhysioDirect compared with usual care . NHS costs ( physiotherapy plus other relevant NHS costs ) per patient were similar in the two arms [ PhysioDirect £ 198.98 vs usual care £ 179.68 , difference in means £ 19.30 ( 95 % CI -£ 37.60 to £ 76.19 ) ] , while QALYs gained were also similar [ difference in means 0.007 ( 95 % CI -0.003 to 0.016 ) ] . Incremental cost per QALY gained was £ 2889 . The probability that PhysioDirect was cost-effective at a £ 20,000 willingness-to-pay threshold was 88 % . These conclusions about cost-effectiveness were robust to sensitivity analyses . There was no evidence of difference between trial arms in cost to patients or value of lost production . No adverse events were detected . CONCLUSIONS Providing physiotherapy via PhysioDirect is equally clinical ly effective compared with usual waiting list-based care , provides faster access to treatment , appears to be safe , and is broadly acceptable to patients . PhysioDirect is probably cost-effective compared with usual care OBJECTIVE To determine efficacy of a modified constraint-induced therapy extension ( mCITE ) protocol , in which persons with stroke participated in therapy sessions via the Internet . DESIGN Pre-post , single-blinded case series . SETTING Outpatient clinic . PARTICIPANTS Four people with stroke who experienced stroke more than 1 year prior to study entry exhibiting upper-limb hemiparesis and nonuse . INTERVENTION Subjects participated in online , 30-minute therapy sessions , 3 times a week for 10 weeks using personal computer-based cameras and free network meeting software . During the same period , subjects ' less affected h and s and wrists were restrained every weekday for 5 hours . Patients completed online logs to document restraint use and activities practice d at home . MAIN OUTCOME MEASURES The Motor Activity Log ( MAL ) and Wolf Motor Function Test ( WMFT ) . We also used a structured interview to ask patients about their satisfaction with the protocol . RESULTS After intervention , subjects exhibited marked improvements in more affected arm use ( + 2.7 , + 2.06 , + 1.7 , + 2,83 , respectively ) , quality of movement ( + 2.1 , + 2.1 , + 2.03 , + 1.9 , respectively ) , as measured by the MAL , and speed increases while performing WMFT tasks . Subjects ' mCITE satisfaction and adherence were high , and motor changes translated to ability to perform valued activities . CONCLUSIONS A home-based , modified constraint-induced movement therapy program is feasible and appears to increase more affected arm use and function using commercially available , inexpensive technologies OBJECTIVE To evaluate the equivalency of wheeled mobility and seating assessment s delivered under 2 conditions : in person ( IP ) at a local clinic and via Telerehabilitation at remotely located clinics . DESIGN The study used a prospect i ve , multicenter controlled nonr and omized design to investigate wheeled mobility and seating assessment s. SETTING Five wheelchair clinics in Western Pennsylvania . PARTICIPANTS Participants ( N=98 ) in need of new wheeled mobility and seating were recruited and consented for IP assessment s at the Center for Assistive Technology ( n=50 ) and Telerehabilitation ( n=48 ) assessment s at remotely located clinics . INTERVENTIONS The telerehabilitation condition used a custom videoconferencing system to connect a wheeled mobility and seating expert at the University of Pittsburgh 's Rehabilitation Engineering Research Center on Telerehabilitation to a remote clinic . MAIN OUTCOME MEASURES Study findings were based on the level of function the participants showed with their new wheeled mobility and seating devices as measured by using the Functioning Everyday with a Wheelchair ( FEW ) outcome tool . RESULTS The results revealed no significant differences between the FEW pretest average or item scores for the 2 conditions or the FEW posttest average or item scores except for the FEW transportation item . The average FEW and FEW item scores reached the established clinical ly relevant pretest-posttest difference of 1.85 , and the change scores were significantly different . The difference between FEW means based on posttest confidence intervals indicated that telerehabilitation was equally effective as IP rehabilitation . CONCLUSIONS An expert practitioner located at least 125 miles away from each of the remote sites used a secured videoconferencing system to consult from a geographic distance on wheeled mobility and seating evaluations via telerehabilitation . Compared with participants receiving st and ard IP care , the telerehabilitation treatment condition was equally effective on all but 1 outcome OBJECTIVE To modify and pilot test a face-to-face group energy conservation education program for delivery by group telephone teleconference to people with multiple sclerosis . PARTICIPANTS 29 community dwelling individuals with multiple sclerosis . METHODS The first phase of the study involved the modification of an existing energy conservation education program to accommo date teleconference delivery . The second phase involved a pilot test of the intervention using a basic pre/post intervention design . Licensed occupational therapists delivered the intervention . OUTCOME MEASURES Fatigue severity , fatigue impact , health related quality of life , self-efficacy for performing energy conservation strategies , and use of energy conservation behaviors . FINDINGS Using an a priori alpha of p = 0.10 , paired t-tests found significant reductions in fatigue severity , fatigue impact , and improvements in the following aspects of quality of life : bodily pain and general health . Average effect size was 0.31 . The most used energy conservation strategies after the course were simplifying activities , adjusting priorities , changing body position , resting , and planning the day to balance work and rest . CONCLUSION The pilot study supports on-going development and testing of energy conservation education delivered by teleconference to people with multiple sclerosis OBJECTIVES To study the effect of a physical activity counseling intervention on instrumental activity of daily living ( IADL ) disability . DESIGN Primary care-based , single-blind , r and omized controlled trial . SETTING City of Jyväskylä , central Finl and . PARTICIPANTS Six hundred thirty-two people aged 75 to 81 who were able to walk 500 meters without assistance , were at most moderately physically active , had a Mini-Mental State Examination score greater than 21 , had no medical contraindications for physical activity , and gave informed consent for participation . INTERVENTION A single individualized physical activity counseling session with supportive phone calls from a physiotherapist every 4 months for 2 years and annual lectures on physical activity . Control group received no intervention . MEASUREMENTS The outcome was IADL disability defined as having difficulties in or inability to perform IADL tasks . Analyses were carried out according to baseline IADL disability , mobility limitation , and cognitive status . RESULTS At the end of the follow-up , IADL disability had increased in both groups ( P<.001 ) and was lower in the intervention group , but the group-by-time interaction effect did not reach statistical significance . Subgroup analyses revealed that the intervention prevented incident disability in subjects without disability at baseline ( risk ratio=0.68 , 95 % confidence interval=0.47 - 0.97 ) but had no effect on recovery from disability . CONCLUSION The physical activity counseling intervention had no effect on older sedentary community-dwelling persons with a wide range of IADL disability , although it prevented incident IADL disability . The results warrant further investigation to explore the benefits of a primary care-based physical activity counseling program on decreasing and postponing IADL disability We conducted a r and omized controlled multicentre trial to investigate the feasibility of a telerehabilitation intervention for arm/h and function ( the Home Care Activity Desk [ HCAD ] training ) in a home setting . Usual care was compared to HCAD training . The hypothesis was that the clinical outcomes of the HCAD intervention would be at least the same as those measured after a period of usual care for patients with stroke , traumatic brain injury ( TBI ) and multiple sclerosis ( MS ) with respect to their arm/h and function . Eighty-one patients with affected arm/h and function result ing from either stroke , MS or TBI were recruited in Italy , Spain and Belgium ; 11 were lost during follow-up ( 14 % ) . The outcome measures were the Action Research Arm Test ( ARAT ) and the Nine Hole Peg Test ( NHPT ) . There were no significant differences between the two groups on the outcome measures ( ARAT and NHPT ) ; in both groups , patients maintained or even improved their arm/h and function . The HCAD training was found to be as feasible as usual care in terms of clinical outcomes , and both therapists and patients were satisfied with the HCAD intervention . A telerehabilitation intervention using HCAD may increase the efficiency of care Background : Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities . To overcome the current reality in which patients receive inadequate rehabilitation , we devised a multifaceted , in-home , telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes . Methods : This was a single-site , feasibility , pilot , r and omized trial of 21 general medical/surgical intensive care unit survivors ( 8 controls and 13 intervention patients ) with either cognitive or functional impairment at hospital discharge . After discharge , study controls received usual care ( sporadic rehabilitation ) , whereas intervention patients received a combination of in-home cognitive , physical , and functional rehabilitation over a 3-month period via a social worker or master ’s level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment . Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation . Outcomes were measured at the completion of the rehabilitation program ( i.e. , at 3 months ) , with cognitive functioning as the primary outcome . Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores . Results : Patients tolerated the program with only one adverse event reported . At baseline both groups were well-matched . At 3-month follow-up , intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test ( for planning and strategic thinking ) vs. controls ( median [ interquartile range ] , 13.0 [ 11.5–14.0 ] vs. 7.5 [ 4.0–8.5 ] ; adjusted p < .01 ) . Intervention group patients also reported better performance ( i.e. , lower score ) on one of the most frequently used measures of functional status ( Functional Activities Question naire at 3 months vs. controls , 1.0 [ 0.0 –3.0 ] vs. 8.0 [ 6.0–11.8 ] , adjusted p = .04 ) . Conclusions : A multicomponent rehabilitation program for intensive care unit survivors combining cognitive , physical , and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months . Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results , as well as to eluci date the elements of rehabilitation contributing most to improved outcomes OBJECTIVE To determine the effectiveness of a pedometer-based telephone intervention on the physical activity levels of cardiac patients who did not attend a CRP . METHODS A r and omised controlled trial was conducted with 215 patients referred to a CRP but who could not or chose not to attend . The 6-week intervention included self-monitoring of physical activity using a pedometer and step calendar ; and behavioural counselling and goal setting sessions . Data were collected at baseline , 6 weeks and 6 months . RESULTS Study groups did not differ significantly at baseline . After 6 weeks , improvements in total physical activity time ( p=0.027 ) , total physical activity sessions ( p=0.003 ) , walking time ( p=0.013 ) and walking sessions ( p=0.002 ) in the intervention group were significantly greater than the control group after adjusting for baseline differences , and remained significant at 6 months . CONCLUSION The findings that the pedometer-based telephone intervention was successful in increasing physical activity levels in cardiac patients who did not attend a CRP could result in major health benefits for this group of people . PRACTICAL IMPLICATION S The pedometer-based telephone intervention could be offered as an effective and accessible option for patients not attending a CRP to increase and maintain their physical activity levels after hospitalisation Background Exercise rehabilitation after cardiac surgery has beneficial effects , especially on a long-term basis . Rehabilitative programs with telemedicine plus appropriate technology might satisfy the needs of performing rehabilitation at home . Objective The purpose of this study was to compare exercise capacity after home-based cardiac rehabilitation ( HBCR ) or in-hospital rehabilitation in patients at low to medium risk for early mortality ( EuroSCORE 0–5 ) following cardiac surgery . Design A quasi-experimental study was conducted . Methods At hospital discharge , patients were given the option to decide whether to enroll in the HBCR program .  Clinical examinations ( electrocardiography , cardiac echo color Doppler , chest radiography , blood sample s ) of patients in the HBCR group were collected during 4 weeks of rehabilitation , and exercise capacity ( assessed using the Six-Minute Walk Test [ 6MWT ] ) was assessed before and after rehabilitation . A group of patients admitted to the in-hospital rehabilitation program was used as a comparison group . Patients in the HBCR group were supervised at home by a medical doctor and telemonitored daily by a nurse and physical therapist by video conference . Periodic home visits by health staff also were performed . Results One hundred patients were recruited into the HBCR group . An equal number of patients was selected for the comparison group . At the end of the 4-week study , the 2 groups showed improvement from their respective baseline values only in the 6MWT . No difference was found in time × group interaction . Limitations Because patients self-selected to enroll in the HBCR program and because they were enrolled from a single clinical center , the results of the study can not be generalized . Conclusions In patients who self-selected HBCR , the program was found to be effective and comparable to the st and ard in-hospital rehabilitative approach , indicating that rehabilitation following cardiac surgery can be implemented effectively at home when coadministered with an integrated telemedicine service OBJECTIVE In order to maintain treatment gains achieved during multidisciplinary treatments for chronic back pain , patients are challenged to implement the behavioral changes they learned during treatment into their daily life . Offering support during the critical time after treatment conclusion helps patients deal with relapses , provides them with practical advice and social support , and helps to master this transfer . As in-person offerings are not always feasible , innovative concepts are needed to enable hospitals to provide aftercare to their patients . SUBJECTS AND METHODS An Internet-based aftercare intervention following multidisciplinary therapy for back pain was constructed , implemented , and evaluated . The aftercare program comprised two modules : ( 1 ) an individualized self-monitoring module and ( 2 ) a weekly , 90-min chat session moderated by a therapist whom participants already knew from treatment . A r and omized controlled trial ( n=75 ) was conducted that compared the post-treatment symptom developments of program participants with symptom developments of controls ( treatment as usual [ TAU ] ) . RESULTS The program was proven to be feasible and well accepted by participants ; on average , 68.2 % of the participants rated the previous chat session as helpful . Intention-to-treat analyses demonstrated significant effects on post-treatment courses of disability . The largest effects were found for pain-related disability : for TAU participants , disability increased an average of 1.25 scale points ( Rol and -Morris Question naire ) per 100 days ; for program participants , disability decreased an average of 0.39 scale points ( p<0.01 ) . CONCLUSIONS The aftercare intervention was shown to be feasible and well accepted . Its efficacy should be tested with a larger-scale r and omized controlled trial Abstract The utility of real-time interactive voice and video telehealth for teaching pursed-lips breathing ( PLB ) in chronic obstructive pulmonary disease ( COPD ) is unknown . This was a pilot study to determine its feasibility and efficacy on the key variables of social support and dyspnea . A r and omized control study design with repeated measures ( baseline , 4 and 12 weeks ) was used . All participants in the control and intervention groups received PLB instruction at baseline , but only the intervention group received one weekly PLB reinforcement session for 4 weeks via home computer and Skype ™ software . Outcome measures were Medical Outcomes Study Social Support Survey and dyspnea assessment ( visual analogue scales for intensity and distress , modified Borg after six-minute walk distance , and Shortness of Breath Question naire for activity-associated dyspnea ) . A total of 22 participants with COPD ( mean FEV1 % predicted = 56 ) were r and omized ; 16 ( 9 telehealth , 7 control ) completed the protocol . Intent-to-treat analysis at week 4 , but not week 12 , demonstrated significantly improved total social support ( P = 0.02 ) and emotional/informational subscale ( P = 0.03 ) scores . Dyspnea intensity decreased ( P = 0.08 ) for the intervention group with a minimal clinical important difference of 10.4 units . Analysis of only participants who completed the protocol demonstrated a significant decrease in dyspnea intensity ( P = < 0.01 ) for the intervention group at both week 4 and 12 . Real-time telehealth is a feasible , innovative approach for PLB instruction in the home with outcomes of improved social support and decreased dyspnea Chronic headache is a significant public health problem in Western nations . Although controlled trials demonstrate the efficacy and cost-effectiveness of face-to-face behavioral therapy , most headache sufferers have limited access to these treatments . Delivery of behavioral interventions using Internet technology has the potential to reach a larger number of headache sufferers and reduce the burden of disease . This r and omized controlled study evaluated an Internet-delivered behavioral regimen composed of progressive relaxation , limited biofeedback with autogenic training , and stress management versus a symptom monitoring waitlist control . Treatment led to a significantly greater decrease in headache activity than symptom monitoring alone . Thirty-nine percent of treated individuals showed clinical ly significant improvement on self-report measures of headache symptoms at post-treatment . At two-month follow-up , 47 % of participants maintained improvement . Treatment had a significant impact on general headache symptoms and headache-related disability . There was a 35 % within-group reduction of medication usage among the treated subjects . The Internet program was more time-efficient than traditional clinical treatment . Treatment and follow-up dropout rates , 38.1 % and 64.8 % , respectively , were typical of behavioral self-help studies . This approach to self-management of headache is promising ; however , several method ological and ethical challenges need to be addressed Objectives . The authors present preliminary results on health-related outcomes of a r and omized trial of telehealth interventions design ed to reduce the incidence of secondary conditions among people with mobility impairment result ing from spinal cord injury ( SCI ) . Methods . Patients with spinal cord injuries were recruited during their initial stay at a rehabilitation facility in Atlanta , They received a video-based intervention for nine weeks , a telephone-based intervention for nine weeks , or st and ard follow-up care . Participants are followed for at least one year , to monitor days of hospitalization , depressive symptoms , and health-related quality of life . Results . Health-related quality of life was measured using the Quality of Well-Being ( QWB ) scale . QWB scores ( n = 111 ) did not differ significantly between the three intervention groups at the end of the intervention period . At year one post discharge , however , scores for those completing one year of enrollment ( n = 47 ) were significantly higher for the intervention groups compared to st and ard care . Mean annual hospital days were 3.00 for the video group , 5.22 for the telephone group , and 7.95 for the st and ard care group . Conclusions . Preliminary evidence suggests that in-home telephone or video-based interventions do improve health-related outcomes for newly injured SCI patients .  Telehealth interventions may be cost-saving if program costs are more than offset by a reduction in rehospitalization costs , but differential advantages of video-based interventions versus telephone alone warrant further examination PURPOSE To evaluate the effectiveness of a store- and -forward telemedicine system ( SFTMS ) as an optimal method for the selection , diagnosis and treatment of patients with TMJ disorders ( TMJD ) referred from primary care sites to the Maxillofacial Surgery Unit ( hospital-based ) . MATERIAL S AND METHODS A multicenter , analytical , quasi-experimental , non-r and omized clinical study of a SFTMS aim ed towards the management of patients with TMJD was conducted at the Oral and Maxillofacial Surgery Unit of the Virgen Macarena University Hospital ( Seville , Spain ) and 10 primary care areas of the North area of Seville located between 15 and 180 km from the hospital . The study was carried out between January 2008 and February 2010 including a non-r and om sample consisting of all patients with TMJD treated at primary care sites during the study period . We describe the development and effectiveness of this method based on the rates of diagnosis of myofascial syndrome and /or internal deragement Wilkes Stages I-II-III , internal deragement Wilkes Stages IV-V , other arthropathies , resolved teleconsultations , second teleconsultations , referrals to hospital , mean treatment delay , lost hours working/patient and complaints . The same variables were also described for the TMJD conventional consultation system at hospital ( st and ard system ) . Descriptive statistics ( frequency tables , means and medians , and dispersion measures ) , T-Student test was used to compare the differences in the average quantitative variables ( time ) and Chi2 test was used to compare the differences in the average qualitative variables . RESULTS Over a 24-month period , 710 patients with TMJD were assisted at hospital by conventional consultation from 1 - 1 - 2008 to 2 - 25 - 2010 , of which 587 ( 82.7 % ) were women and 123 ( 17.3 % ) were men with a mean age of 41.08 years . The mean time elapsed until treatment onset was 78.6 days , with a mean cost of 32 lost working hours per patient . In this period , 342 patients with TMJD were assisted by teleconsultation , of which 276 ( 80.7 % ) were women and 66 ( 19.2 % ) were men with a mean age of 38.3 years . Only 35 ( 10 % ) patients presented some other TMJ pathology that required maxillofacial surgery . The remaining 307 ( 89.7 % ) received non-surgical treatment in the primary care center ( high resolutive consultations ) in a mean time of 2.3 days ( p<0.05 ) , and a mean cost of 16 lost working hours/patient ( p<0.05 ) . CONCLUSIONS Telemedicine allows a correct diagnosis and an adequate treatment for the majority of TMJD from primary care sites and shortens the delay in treatment onset , preventing displacement and unnecessary costs for these patients The aim of this study was to demonstrate that telehomecare linking homebound patients with their home health-care nurses over the plain old telephone system ( POTS ) provides high- quality , clinical ly useful , and patient satisfactory interactions . Congestive heart failure , chronic obstructive pulmonary disease , and chronic wound-care patients receiving skilled home nursing care were r and omized into control ( st and ard home health care , HHC )  and two intervention ( st and ard care plus video conferencing/Internet access ; the above plus physiological monitoring ) groups . Virtual visits ( VVs ) , consisting of two-way audio and video interactions between the central site HHC nurse and the subject at home , were compared for technical quality and clinical usefulness by the HHC nurses who performed the VVs . Subject perception of telehomecare and satisfaction with their HHC were assessed over the course of the project . There were a total of 567 virtual and 1,057 actual visits conducted for the 53 subjects completing the study . The technical quality of VVs were rated at 94.7 % . They were considered to be as useful as actual visits in 90.7 % of cases . Subject telehomecare perception increased after experiencing the process . All subjects were satisfied with their HHC ; satisfaction increased with an increasing level of telehomecare intervention . Subjects receiving physiological monitoring and video conferencing/Internet access in addition to st and ard care were most satisfied with their care . VVs can be conducted over POTS . Patients can use telehomecare with moderate levels of training . These programs can provide timely and quality home health nursing care with VVs augmenting traditional home visits OBJECTIVE The study objective was to examine the effect of a symptom management ( SM ) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients ( aged > 65 years ) after coronary artery bypass surgery ( CABS ) by group ( SM intervention group and usual care group ) . METHODS A r and omized clinical trial design was used . The study was conducted in 4 Midwestern tertiary hospitals . The 6-week SM telehealth intervention was delivered by the Health Buddy ( Health Hero Network , Palo Alto , CA ) . Measures included Modified  7-Day Activity Interview , RT3 accelerometer  ( Stayhealthy , Inc , Monrovia , CA ) , physical activity and exercise diary , Medical Outcomes Study Short-Form 36 , and subjects ' self-report and provider records of health care use . Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS . RESULTS Subjects ( N = 232 ) had a mean age of 71.2 ( + 4.7 ) years . There were no significant interactions using repeated- measures analyses of covariance . There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer , with the usual care group having a higher estimated energy expenditure . Both groups had significant improvements over time for role-physical , vitality , and mental functioning . Both groups had similar health care use . CONCLUSION Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity . Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted 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 r and omized 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 Question naire 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 We analysed data on the medical expenditure of 199 telecare users in Nishiaizu Town , Fukushima Prefecture , which has one of the oldest ongoing telecare implementations in Japan . As controls , 450 out of 3528 non-users residents covered by National Health Insurance were r and omly selected in the same age and sex ratios as the telecare users . An analysis by the Generalized Method of Moments ( GMM ) was conducted in order to examine causality , i.e. that telecare use reduces the number of treatment days . To reduce sample selection bias , the presence of chronic diseases , age and education were added as control variables in the estimation . The results show that the treatment days of those who had chronic diseases were greater than those who did not have chronic diseases by 8.7 days per year ( P < 0.10 ) , and they were increased by 5.6 days ( P < 0.01 ) according to their age . Finally ,  telecare use decreased treatment days by 3.1 days ( P < 0.05 ) OBJECTIVE This pilot study investigates the use of telerehabilitation to improve upper limb performance in chronic stages of stroke recovery . DESIGN Intervention study with pre/post/one month follow-up tests . METHODS Seven adults with chronic stroke participated in the study . Tests consisted of lab-based clinical and kinematic assessment s. Participants completed the Upper Limb Training and Assessment ( ULTrA ) program at home . Training was 5 days/week , 60 min/day for 6 weeks with intermittent supervision of participants . RESULTS Participants showed improvements in the training program tasks as well as clinical and kinematic assessment s. Results also suggest there may be auxiliary benefits in cognitive function . CONCLUSIONS A home-based telerehabilitation program is a viable approach to provide rehabilitation in chronic stages of stroke
Summary Recent advances in telecommunication technologies have boosted the possibility to deliver rehabilitation via the internet ( i.e. telerehabilitation ) .
Several studies have shown that telerehabilitation is effective to improve clinical outcomes in disabling conditions .
The aim of this review was to determine whether telerehabilitation was more effective than other modes of delivering rehabilitation to regain motor function , in different population s of patients .