Stevens Timothy, McGinnis Ryan S, Hewgill Blake, Choquette Rebecca H, Tourville Timothy W, Harvey Jean, Lachapelle Richard, Beynnon Bruce D, Toth Michael J, Skalka Christian
Department of Computer Science, University of Vermont, Burlington, VT, United States.
Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States.
JMIR Hum Factors. 2020 May 11;7(2):e16605. doi: 10.2196/16605.
Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions.
This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time.
The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System-based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity.
Compared with the NMES device software-tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed.
RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing.
下肢创伤和骨科手术干预后，膝关节伸肌功能会下降。在家使用神经肌肉电刺激（NMES）可能会改善功能恢复，但在家干预的依从性较低。通过更密切地监测在家治疗方案的依从性以及更频繁的患者与医护人员互动，可能会从NMES中获得更大的益处。
本研究旨在开发一种信息物理系统，以监测在家对NMES治疗方案的依从性，并促进患者与医护人员的沟通，以近乎实时地提高依从性。
开发了RehabTracker信息物理系统来实现这一目标，该系统包括四个组件：（1）对市售NMES治疗设备进行硬件改造，以监测设备使用情况并提供蓝牙功能；（2）基于iPhone操作系统的移动健康（mHealth）应用程序，可实现患者与医护人员近乎实时的沟通；（3）临床医生门户，以便监督患者对设备使用的依从性；（4）后端服务器，用于存储数据、进行依从性分析并向患者发送自动推送通知。这四个要素的设计完全符合《健康保险流通与责任法案》。该系统在前交叉韧带断裂患者队列（n = 7）中进行了形成性测试，以开始评估表面效度。
与NMES设备软件跟踪的设备使用情况相比，RehabTracker系统记录了83%（40/48）的康复疗程，7名患者中有4名患者的所有疗程中有100%（32/32）被系统记录。在启用自动推送通知跟踪的患者中，患者接收了后端服务器发送的100%（29/29）的推送通知。详细介绍了导致这些不准确情况的流程、硬件和软件问题。
RehabTracker是一款很有前景的mHealth应用程序，可用于跟踪和提高在家NMES康复计划的依从性，值得进一步完善和测试。
