%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68479 %T The Use of Digital Devices to Monitor Physical Behavior in Motor Neuron Disease: Systematic Review %A Musson,Lucy Samantha %A Mitic,Nina %A Leigh-Valero,Victoria %A Onambele-Pearson,Gladys %A Knox,Liam %A Steyn,Frederik J %A Holdom,Cory J %A Dick,Taylor JM %A van Eijk,Ruben PA %A van Unnik,Jordi WJ %A Botman,Lianne CM %A Beswick,Emily %A Murray,Deirdre %A Griffiths,Alys %A McDermott,Christopher %A Hobson,Esther %A Chaouch,Amina %A Hodson-Tole,Emma %+ Sheffield Institute for Translational Neuroscience, Division of Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, United Kingdom, 44 01142222230, l.s.musson@sheffield.ac.uk %K motor neuron disease %K amyotrophic lateral sclerosis %K physical behavior %K digital devices %K remote monitoring %K wearable technology %D 2025 %7 17.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Motor neuron disease (MND) is a progressive and incurable neurodegenerative disease. The Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is the primary clinical tool for assessing disease severity and progression in MND. However, despite its widespread use, it does not adequately capture the extent of physical function decline. There is an urgent need for sensitive measures of disease progression that can be used to robustly evaluate new treatments. Measures of physical function derived from digital devices are beginning to be used to assess disease progression. There is value in establishing a consensus approach to standardizing the use of such devices. Objective: We aimed to explore how digital devices are being used to quantify free-living physical behavior in MND. We evaluated the feasibility and assessed the implications for monitoring physical behavior for future clinical trials and clinical practice. Methods: Systematic searches of 4 databases were performed in October 2023 and June 2024. Peer-reviewed English-language articles (including preprints) that examined how people living with MND used digital devices to assess their free-living physical behavior were included. Study reporting quality was assessed using a 22-item checklist (maximum possible score=44 points). Results: In total, 12 articles met the inclusion criteria for data extraction. All studies were longitudinal and observational in design, but data collection, analysis, and reporting protocols varied. Quality assessment scores ranged between 19 and 40 points. Sample sizes ranged between 10 and 376 people living with MND at baseline, declining over the course of the study. Most studies used an accelerometer device worn on the wrist, chest, hip, or ankle. Participants were typically asked to continuously wear devices for 1 to 8 days at 1- to 4-month intervals, with studies running for 12 weeks to 24 months. Some studies asked participants to wear the device continuously for the full duration. Studies derived traditional end points focusing on duration, intensity, and frequency of physical activity or nontraditional end points focusing on features of an individual’s movement patterns. The correlation coefficients (r) between physical behavior end points and ALSFRS-R ranged from 0.31 to 0.78. Greater monitoring frequencies and improved end point sensitivity were shown to provide smaller sample size requirements and shorter durations for hypothetical clinical trials. People living with MND found using devices acceptable and reported a low burden. Adherence assessed in 8 (67%) studies was good, ranging from approximately 86% to 96%, with differences evident between wear locations. The perspectives of other end users and implications on clinical practice were not explored. Conclusions: Remote monitoring of free-living physical behavior in MND is in its infancy but has the potential to quantify physical function. It is essential to develop a consensus statement, working toward agreed and standardized methods for data collection, analysis, and reporting. %M 40245393 %R 10.2196/68479 %U https://www.jmir.org/2025/1/e68479 %U https://doi.org/10.2196/68479 %U http://www.ncbi.nlm.nih.gov/pubmed/40245393 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e59172 %T Determining the Prioritization of Behavior Change Techniques for Long-Term Stroke Rehabilitation: Delphi Survey Study %A Wróbel,Agata Ewa %A Cash,Philip %A Maier,Anja %A Paulin Hansen,John %K behavior change %K behavior change techniques %K BCT %K neuroscience %K neurology %K stroke %K rehabilitation %K adherence %K Delphi method %K Delphi %K intervention design %K intervention mapping %D 2025 %7 7.4.2025 %9 %J Interact J Med Res %G English %X Background: Stroke results in both physical disability and psychological distress. The impact can be minimized through rehabilitation, but it is a long-term process, making it difficult for patients to adhere to treatment. Thus, a better understanding of long-term behavior change interventions for patients with stroke is needed as well as how such interventions can support not only rehabilitation of motoric functions but also mental well-being. Objective: The aim of this study is to understand both the most important behavior change technique (BCT) clusters for long-term stroke rehabilitation in general as well as which are most relevant for each aspect of stroke rehabilitation: behavioral, cognitive, and emotional. Methods: We applied the 16 BCT clusters. The study used a 2-round Delphi survey, as reliable consensus was obtained among a group of 12 international experts. Experts represented three main backgrounds involved in behavioral intervention in the health context: (1) specialists in behavioral science (n=4), (2) behavioral designers (n=4), and (3) expert health care professionals (n=4). Experts were brought together in this way for the first time. In the first round, web-based questionnaires were used to collect data from the experts. This was followed by a personalized second round. Consensus was determined by statistically aggregating the responses and evaluating IQR and percentage consensus. BCT clusters reaching consensus (IQR ≤1 and percentage ≥50%) were then ranked. Results: In total, 12 of 16 BCT clusters reached consensus for general importance in stroke rehabilitation, with 11, 9, and 6 BCT clusters achieving consensus for, respectively, the behavioral, cognitive, and emotional aspects of rehabilitation. The overall most relevant BCT clusters were repetition and substitution, social support, feedback and monitoring, and self-belief, with similar outcomes for behavioral and cognitive rehabilitation. For emotional rehabilitation, social support and identity were emphasized. The least relevant BCT clusters were natural consequences, covert learning, and comparison of behavior. Conclusions: This expert panel study using a 2-round Delphi survey ranked the importance of BCT clusters for long-term stroke rehabilitation. The process yielded a number of novel insights highlighting differences in importance between general rehabilitation and that specifically focused on the behavioral, cognitive, and emotional aspects of stroke recovery. This provides a first but important step toward unlocking the prioritization of BCT clusters for long-term intervention contexts such as stroke rehabilitation and enables effective intervention mapping addressing long-term behavior change and treatment adherence. %R 10.2196/59172 %U https://www.i-jmr.org/2025/1/e59172 %U https://doi.org/10.2196/59172 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60587 %T Racial Disparities in Parkinson Disease Clinical Phenotype, Management, and Genetics: Protocol for a Prospective Observational Study %A Hall,Deborah A %A Shulman,Josh M %A Singleton,Andrew %A Bandres Ciga,Sara %A S Tosin,Michelle Hyczy %A Ouyang,Bichun %A Shulman,Lisa %+ Department of Neurological Sciences, Rush University, 1725 West Harrison St, Suite 755, Chicago, IL, 60612, United States, 1 312 563 2900, deborah_a_hall@rush.edu %K Parkinson disease %K racial disparities %K clinical protocol %K health disparities %K genetic risk factors %K quality of life %K quality of care %D 2025 %7 7.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) has been described and studied extensively in White populations, with little known about how the disease manifests and progresses in patients from the Black community. Studies investigating disease features in Black populations are uncommon, with some suggesting that the Black population with PD is more disabled and has greater disease severity and different clinical features compared with the White population with PD. These health disparities are likely to influence the quality of care for Black patients with PD. Objective: This study aimed to investigate the motor and nonmotor symptoms and quality of life in Black and White participants with PD in a case-case design. Methods: This is an observational, prospective, multicenter, case-case design study. Other aims will investigate the management of PD in Black individuals and the presence of shared or unique genetic risk factors among the Black PD population. A total of 400 Black and 200 White participants with PD will be recruited. Data will be collected at 7 US sites and entered into a Research Electronic Data Capture database. Linear multivariate regression analysis will be used, except for comparing PD management, which will be analyzed using the chi-square test or Fisher exact test. Bonferroni correction will be applied. This protocol also describes plans for educational programming for clinicians and patients at the end of the study in partnership with national PD organizations. Results: The Rush Institutional Review Board approved the project as the single-site institutional review board in February 2022, and it was funded by the National Institute of Neurological Disorders and Stroke in April 2022. Recruitment began in July 2022. At the time of submission of this manuscript, 131 participants had been recruited. Conclusions: To our knowledge, this is the largest study of PD phenotype and management in Black patients in the United States. The planned collaboration with the Global Parkinson’s Genetics Program and PD GENEration will enhance our understanding of genetic risk factors for PD in this understudied population. International Registered Report Identifier (IRRID): DERR1-10.2196/60587 %M 40193190 %R 10.2196/60587 %U https://www.researchprotocols.org/2025/1/e60587 %U https://doi.org/10.2196/60587 %U http://www.ncbi.nlm.nih.gov/pubmed/40193190 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63105 %T Modernizing the Staging of Parkinson Disease Using Digital Health Technology %A Templeton,John Michael %A Poellabauer,Christian %A Schneider,Sandra %A Rahimi,Morteza %A Braimoh,Taofeek %A Tadamarry,Fhaheem %A Margolesky,Jason %A Burke,Shanna %A Al Masry,Zeina %+ , Bellini College of Artificial Intelligence, Cybersecurity, and Computing, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, United States, 1 813 396 0962, jtemplet@usf.edu %K digital health %K Parkinson disease %K disease classification %K wearables %K personalized medicine %K neurocognition %K artificial intelligence %K AI %D 2025 %7 4.4.2025 %9 Viewpoint %J J Med Internet Res %G English %X Due to the complicated nature of Parkinson disease (PD), a number of subjective considerations (eg, staging schemes, clinical assessment tools, or questionnaires) on how best to assess clinical deficits and monitor clinical progression have been published; however, none of these considerations include a comprehensive, objective assessment of all functional areas of neurocognition affected by PD (eg, motor, memory, speech, language, executive function, autonomic function, sensory function, behavior, and sleep). This paper highlights the increasing use of digital health technology (eg, smartphones, tablets, and wearable devices) for the classification, staging, and monitoring of PD. Furthermore, this Viewpoint proposes a foundation for a new staging schema that builds from multiple clinically implemented scales (eg, Hoehn and Yahr Scale and Berg Balance Scale) for ease and homogeneity, while also implementing digital health technology to expand current staging protocols. This proposed staging system foundation aims to provide an objective, symptom-specific assessment of all functional areas of neurocognition via inherent device capabilities (eg, device sensors and human-device interactions). As individuals with PD may manifest different symptoms at different times across the spectrum of neurocognition, the modernization of assessments that include objective, symptom-specific monitoring is imperative for providing personalized medicine and maintaining individual quality of life. %M 40184612 %R 10.2196/63105 %U https://www.jmir.org/2025/1/e63105 %U https://doi.org/10.2196/63105 %U http://www.ncbi.nlm.nih.gov/pubmed/40184612 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e72354 %T Is the Pinball Machine a Blind Spot in Serious Games Research? %A Eckardt,Jens Peter %K serious games %K research %K interventions %K arcade technology %K digital game paradigm %K pinball gaming %K arcade gaming %K executive functions %K neurodiversity %K cognitive training %K therapeutic interventions %D 2025 %7 2.4.2025 %9 %J JMIR Serious Games %G English %X %R 10.2196/72354 %U https://games.jmir.org/2025/1/e72354 %U https://doi.org/10.2196/72354 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e73034 %T Authors’ Reply: Is the Pinball Machine a Blind Spot in Serious Games Research? %A Rodríguez Timaná,Luis Carlos %A Castillo García,Javier Ferney %A Bastos Filho,Teodiano %A Ocampo González,Alvaro Alexander %A Hincapié Monsalve,Nazly Rocio %A Valencia Jimenez,Nicolas Jacobo %K serious games %K research %K interventions %K arcade technology %K digital game paradigm %K pinball gaming %K arcade gaming %K executive functions %K neurodiversity %K cognitive training %K therapeutic interventions %D 2025 %7 2.4.2025 %9 %J JMIR Serious Games %G English %X %R 10.2196/73034 %U https://games.jmir.org/2025/1/e73034 %U https://doi.org/10.2196/73034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62822 %T Effect of the Yon PD App on the Management of Self-Care in People With Parkinson Disease: Randomized Controlled Trial %A Lee,JuHee %A Yoo,Subin %A Kim,Yielin %A Kim,Eunyoung %A Park,Hyeran %A Sohn,Young H %A Kim,Yun Joong %A Chung,Seok Jong %A Baik,Kyoungwon %A Kim,Kiyeon %A Yoo,Jee-Hye %+ College of Nursing, CHA University, 120 Haeryong-ro, Pocheon-si, 11160, Republic of Korea, 82 31 850 9335, jhyoo2@cha.ac.kr %K Parkinson disease %K mHealth %K mobile health %K app %K neurodegenerative disease %K geriatric %K quality of life %K bradykinesia %K nonmotor symptoms %K self-care %K motor symptoms %K cognitive impairment %K autonomic %K monitoring %K management %K randomized controlled trial %D 2025 %7 2.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: As the percentage of the older population increases, it is accompanied by an increase in the prevalence of Parkinson disease (PD). People with PD experience a range of nonmotor symptoms, including pain, constipation, dysphagia, sleep disturbances, and fatigue. Improving self-care is necessary for people with PD because it is a chronic disease that requires lifelong management. In our previous study, we developed a mobile app (Yon PD app) to monitor nonmotor symptoms of PD. In this study, we investigated the long-term effects of the app in a larger group of people. Objective: This study aimed to examine the effectiveness of a mobile app on the management of self-care in people with PD. Methods: This was a randomized controlled trial. People with PD aged ≥50 years and able to use a smartphone were recruited from the neurology outpatient clinic of a tertiary hospital in South Korea. In total, 102 participants were enrolled in this study. The intervention group was requested to record 5 nonmotor symptoms (pain, constipation, dysphagia, sleep disturbances, and fatigue) for 12 weeks using the mobile app. The control group was requested to record these 5 nonmotor symptoms on a paper questionnaire. General characteristics including age, sex, level of education, disease severity, and comorbidities were examined at baseline. The degree of self-care was examined using the Self-Care of Chronic Illness Inventory at baseline, 6 weeks, and 12 weeks. At 12 weeks, satisfaction with the app was also examined. General characteristics and satisfaction with the app were analyzed using descriptive statistics. The effect of the app on self-care was analyzed using the repeated-measures ANOVA with an α level of .05. Results: In total, 93 participants were included in the analysis. There were 41 and 52 participants in the intervention and control groups, respectively. The general characteristics of the 2 groups were comparable. Monitoring nonmotor symptoms with the app effectively increased self-care maintenance (F2182=4.087; P=.02) and prevented a decrease in self-care monitoring (F2182=3.155; P=.045). However, using the app was ineffective in improving self-care management (F2182=1.348; P=.26). Self-care management gradually decreased over the 12-week period in both groups. The intervention (n=41) adherence rate reached 60.84% at 6 weeks but decreased to 41.87% by 12 weeks. Conclusions: Participants were able to improve the degree of self-care by monitoring their nonmotor symptoms using the app. However, additional strategies that increase motivation and enjoyment are required to improve adherence. Trial Registration: Clinical Research Information Service KCT0006433; https://tinyurl.com/3vmf435m %M 40173440 %R 10.2196/62822 %U https://www.jmir.org/2025/1/e62822 %U https://doi.org/10.2196/62822 %U http://www.ncbi.nlm.nih.gov/pubmed/40173440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59649 %T The Role of Machine Learning in Cognitive Impairment in Parkinson Disease: Systematic Review and Meta-Analysis %A Wu,Yanyun %A Cheng,Yangfan %A Xiao,Yi %A Shang,Huifang %A Ou,Ruwei %+ Department of Neurology, West China Hospital of Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China, 86 18980607525, ouruwei@aliyun.com %K Parkinson disease %K cognitive impairment %K machine learning %K systematic review %K meta-analysis %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Parkinson disease (PD) is a common neurodegenerative disease characterized by both motor and nonmotor symptoms. Cognitive impairment often occurs early in the disease and can persist throughout its progression, severely impacting patients’ quality of life. The utilization of machine learning (ML) has recently shown promise in identifying cognitive impairment in patients with PD. Objective: This study aims to summarize different ML models applied to cognitive impairment in patients with PD and to identify determinants for improving diagnosis and predictive power for early detection of cognitive impairment. Methods: PubMed, Cochrane, Embase, and Web of Science were searched for relevant articles on March 2, 2024. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Bivariate meta-analysis was used to estimate pooled sensitivity and specificity results, presented as odds ratio (OR) and 95% CI. A summary receiver operator characteristic (SROC) curve was used. Results: A total of 38 articles met the criteria, involving 8564 patients with PD and 1134 healthy controls. Overall, 120 models reported sensitivity and specificity, with mean values of 71.07% (SD 13.72%) and 77.01% (SD 14.31%), respectively. Predictors commonly used in ML models included clinical features, neuroimaging features, and other variables. No significant heterogeneity was observed in the bivariate meta-analysis, which included 12 studies. Using sensitivity as the metric, the combined sensitivity and specificity were 0.76 (95% CI 0.67-0.83) and 0.83 (95% CI 0.76-0.88), respectively. When specificity was used, the combined values were 0.77 (95% CI 0.65-0.86) and 0.76 (95% CI 0.63-0.85), respectively. The area under the curves of the SROC were 0.87 (95% CI 0.83-0.89) and 0.83 (95% CI 0.80-0.86) respectively. Conclusions: Our findings provide a comprehensive summary of various ML models and demonstrate the effectiveness of ML as a tool for diagnosing and predicting cognitive impairment in patients with PD. Trial Registration: PROSPERO CRD42023480196; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023480196 %M 40153789 %R 10.2196/59649 %U https://www.jmir.org/2025/1/e59649/ %U https://doi.org/10.2196/59649 %U http://www.ncbi.nlm.nih.gov/pubmed/40153789 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67658 %T The Lived Experience of Participating in Online Peer-To-Peer Groups After Acquired Brain Injury: Phenomenological Study %A Tistad,Malin %A Hultman,Lill %A Wohlin Wottrich,Annica %A von Koch,Lena %+ Care Sciences and Society, Department of Neurobiology, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden, 46 23778554, malin.tistad@ki.se %K compassion %K experiential knowledge %K fatigue %K self-compassion %K stroke %K social media %K meaning %K interview %K normalization %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Stroke and other acquired brain injuries (ABIs) can present challenging experiences for individuals, both in recovery of functions affected by visible or invisible impairments and in learning to live with the new situation. Research has shown that sharing experiences face-to-face in peer groups can be beneficial during recovery. However, there is limited knowledge about the lived experiences of people with ABI who participate in online peer-to-peer groups. Objective: The aim of our study was to explore the lived experiences of participating in online peer-to-peer groups for people with ABI, where participants themselves set the agenda. Methods: Members of 2 Facebook groups (FBGs) for people with ABI were invited to participate in this study, and 20 individuals were included (14 women and 6 men; age range 24-74 years). One FBG focused on stroke and the other on fatigue caused by ABI. One group was private, and the other group was public. Data were collected through semistructured interviews, in which participants were encouraged to describe their experiences of engaging in FBGs in detail. The interviews were conducted over telephone or Zoom and digitally recorded. The audio recordings were then transcribed verbatim, resulting in 224 pages of text, and analyzed using the empirical phenomenological psychological method. Results: The analysis presented a common meaning structure with 1 main characteristic that is, “validating self,” common for all 20 participants, and 3 subcharacteristics, that is, “learning—having one’s own experiences confirmed,” “adjusting self—building competence and self-compassion,” and “supporting others—becoming a valued lived-experience expert/authority.” Together, the subcharacteristics reflected a process of validating self from newcomer to lived-experience expert or authority. In this process, members of FBGs moved from being newcomers with pronounced needs for support and to learn and to have their experiences confirmed by others with similar experiences. Thus, participants were building competence and developing self-compassion. Gradually, they assumed the role of advisors, mentors, or coaches, acknowledging their experiences and competence as valuable to others, thereby validating themselves as compassionate lived-experience experts or authorities in supporting others. Conclusions: Participation in online peer-to-peer groups can offer unique opportunities for individuals with ABI to validate self through processes that involve learning, developing self-compassion and compassion for others, and offering support to others with similar experiences. Given that rehabilitation after an ABI is often of limited duration and that positive experiences can be achieved over time through involvement in digital peer-to-peer support, health care professionals should assist patients by providing information and directing them to digital networks for people with ABI. However, when recommending the use of online peer-to-peer support, impairments and insufficient digital competence that may complicate or prevent the use of social media should be assessed and support provided when relevant. %M 40131323 %R 10.2196/67658 %U https://www.jmir.org/2025/1/e67658 %U https://doi.org/10.2196/67658 %U http://www.ncbi.nlm.nih.gov/pubmed/40131323 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63153 %T Reliability of Average Daily Steps Measured Through a Consumer Smartwatch in Parkinson Disease Phenotypes, Stages, and Severities: Cross-Sectional Study %A Bianchini,Edoardo %A Rinaldi,Domiziana %A De Carolis,Lanfranco %A Galli,Silvia %A Alborghetti,Marika %A Hansen,Clint %A Suppa,Antonio %A Salvetti,Marco %A Pontieri,Francesco Ernesto %A Vuillerme,Nicolas %K gait %K Parkinson disease %K phenotype %K wearable sensors %K smartwatch %K step count %K reliability %K activity monitor %K digital health technology %K digital outcome measures %K wearable %K mHealth %K motor %K quality of life %K fall %K posture %K mobile health %D 2025 %7 18.3.2025 %9 %J JMIR Form Res %G English %X Background: Average daily steps (avDS) could be a valuable indicator of real-world ambulation in people with Parkinson disease (PD), and previous studies have reported the validity and reliability of this measure. Nonetheless, no study has considered disease phenotype, stage, and severity when assessing the reliability of consumer wrist-worn devices to estimate daily step count in unsupervised, free-living conditions in PD. Objective: This study aims to assess and compare the reliability of a consumer wrist-worn smartwatch (Garmin Vivosmart 4) in counting avDS in people with PD in unsupervised, free-living conditions among disease phenotypes, stages, and severity groups. Methods: A total of 104 people with PD were monitored through Garmin Vivosmart 4 for 5 consecutive days. Total daily steps were recorded and avDS were calculated. Participants were dichotomized into tremor dominant (TD; n=39) or postural instability and gait disorder (PIGD; n=65), presence (n=57) or absence (n=47) of tremor, and mild (n=65) or moderate (n=39) disease severity. Based on the modified Hoehn and Yahr scale (mHY), participants were further dichotomized into earlier (mHY 1‐2; n=68) or intermediate (mHY 2.5‐3; n=36) disease stages. Intraclass correlation coefficient (ICC; 3,k), standard error of measurement (SEM), and minimal detectable change (MDC) were used to evaluate the reliability of avDS for each subgroup. The threshold for acceptability was set at an ICC ≥0.8 with a lower bound of 95% CI ≥0.75. The 2-tailed Student t tests for independent groups and analysis of 83.4% CI overlap were used to compare ICC between each group pair. Results: Reliability of avDS measured through Garmin Vivosmart 4 for 5 consecutive days in unsupervised, free-living conditions was acceptable in the overall population with an ICC of 0.89 (95% CI 0.85‐0.92), SEM below 10%, and an MDC of 1580 steps per day (27% of criterion). In all investigated subgroups, the reliability of avDS was also acceptable (ICC range 0.84‐0.94). However, ICCs were significantly lower in participants with tremor (P=.03), with mild severity (P=.04), and earlier stage (P=.003). Moreover, SEM was below 10% in participants with PIGD phenotype, without tremor, moderate disease severity, and intermediate disease stage, with an MDC ranging from 1148 to 1687 steps per day (18%‐25% of criterion). Conversely, in participants with TD phenotype, tremor, mild disease severity, and earlier disease stage, SEM was >10% of the criterion and MDC values ranged from 1401 to 2263 steps per day (30%‐33% of the criterion). Conclusions: In mild-to-moderate PD, avDS measured through a consumer smartwatch in unsupervised, free-living conditions for 5 consecutive days are reliable irrespective of disease phenotype, stage, and severity. However, in individuals with TD phenotype, tremor, mild disease severity, and earlier disease stages, reliability could be lower. These findings could facilitate a broader and informed implementation of avDS as an index of ambulatory activity in PD. %R 10.2196/63153 %U https://formative.jmir.org/2025/1/e63153 %U https://doi.org/10.2196/63153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56720 %T YouTube User Traffic to Paired Epilepsy Education Videos in English and Spanish: Comparative Study %A Varela,Luna Kimahri %A Horton,Stephanie %A Abdelmoity,Ahmed %A Le Pichon,Jean-Baptiste %A Hoffman,Mark A %K epilepsy %K patient education %K informatics %K social media %K biomedical research %K social determinants of health %K accessibility %K engagement %K comparative analysis %K clinical videos %K English %K Spanish %K neurological disorder %K YouTube %K bilingual %K audience engagement %K clinical knowledge %D 2025 %7 13.3.2025 %9 %J JMIR Form Res %G English %X Background: Effectively managing epilepsy in children necessitates the active engagement of parents, a factor that is reliant on their understanding of this neurological disorder. Widely available, high-quality, patient-focused, bilingual videos describing topics important for managing epilepsy are limited. YouTube Analytics is a helpful resource for gaining insights into how users of differing backgrounds consume video content. Objective: This study analyzes traffic to paired educational videos of English and Spanish versions of the same content. By examining the use patterns and preferences of individuals seeking information in different languages, we gained valuable insights into how language influences the use of clinical content. Methods: Physician experts created epilepsy management videos for the REACT (Reaching Out for Epilepsy in Adolescents and Children Through Telemedicine) YouTube channel about 17 subjects, with an English and Spanish version of each. The Children’s Mercy Kansas City neurology clinic incorporated these into the department’s educational process. YouTube Analytics enabled analysis of traffic patterns and video characteristics between September 2, 2021, and August 31, 2023. Results: The Spanish group had higher engagement and click-through rates. The English versions of all videos had 141,605 total impressions, while impressions for the Spanish versions totaled 156,027. The Spanish videos had 11,339 total views, while the English videos had 3366. The views per month were higher for the Spanish videos (mean 472, SD 292) compared to the English set (mean 140, SD 91; P<.001). The two groups also differed in search behavior and external traffic sources, with WhatsApp driving more traffic to the Spanish videos than the English versions (94 views compared to 1). The frequency of search terms used varied by language. For example, “tonic clonic” was the most frequent term (n=372) resulting in views for English videos, while “tipos de convulsiones” (types of convulsions) was the most common expression (n=798) resulting in views for Spanish videos. We noted increased monthly views for all videos after adding tags on YouTube. Before tagging, the mean number of views per month for the English-language group was 61 (SD 28), which increased to 220 (SD 53) post tagging. A similar trend can be observed in the Spanish-language group as well. Before tagging, the mean number of monthly views was 201 (SD 71), which increased to 743 (SD 144) after tagging. Conclusions: This study showed high traffic for Spanish video content related to epilepsy in a set of paired English/Spanish videos. This highlights the importance of bilingual health content and optimizing video content based on viewer preferences and search behavior. Understanding audience engagement patterns through YouTube Analytics can further enhance the dissemination of clinical video content to users seeking content in their primary language, and tagging videos can have a substantial impact on views. %R 10.2196/56720 %U https://formative.jmir.org/2025/1/e56720 %U https://doi.org/10.2196/56720 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60437 %T Integrating Ambient In-Home Sensor Data and Electronic Health Record Data for the Prediction of Outcomes in Amyotrophic Lateral Sclerosis: Protocol for an Exploratory Feasibility Study %A Janes,William E %A Marchal,Noah %A Song,Xing %A Popescu,Mihail %A Mosa,Abu Saleh Mohammad %A Earwood,Juliana H %A Jones,Vovanti %A Skubic,Marjorie %+ Department of Occupational Therapy, College of Health Science, University of Missouri, 802 Clark Hall, Columbia, MO, 65211, United States, 1 5738824183, janesw@health.missouri.edu %K amyotrophic lateral sclerosis %K machine learning %K precision health %K ALS %K health monitoring %K electronic health record %K EHR %K federated approach %K in-home sensor data %D 2025 %7 12.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Amyotrophic lateral sclerosis (ALS) leads to rapid physiological and functional decline before causing untimely death. Current best-practice approaches to interdisciplinary care are unable to provide adequate monitoring of patients’ health. Passive in-home sensor systems enable 24×7 health monitoring. Combining sensor data with outcomes extracted from the electronic health record (EHR) through a supervised machine learning algorithm may enable health care providers to predict and ultimately slow decline among people living with ALS. Objective: This study aims to describe a federated approach to assimilating sensor and EHR data in a machine learning algorithm to predict decline among people living with ALS. Methods: Sensor systems have been continuously deployed in the homes of 4 participants for up to 330 days. Sensors include bed, gait, and motion sensors. Sensor data are subjected to a multidimensional streaming clustering algorithm to detect changes in health status. Specific health outcomes are identified in the EHR and extracted via the REDCap (Research Electronic Data Capture; Vanderbilt University) Fast Healthcare Interoperability Resource directly into a secure database. Results: As of this writing (fall 2024), machine learning algorithms are currently in development to predict those health outcomes from sensor-detected changes in health status. This methodology paper presents preliminary results from one participant as a proof of concept. The participant experienced several notable changes in activity, fluctuations in heart rate and respiration rate, and reductions in gait speed. Data collection will continue through 2025 with a growing sample. Conclusions: The system described in this paper enables tracking the health status of people living with ALS at unprecedented levels of granularity. Combined with tightly integrated EHR data, we anticipate building predictive models that can identify opportunities for health care services before adverse events occur. We anticipate that this system will improve and extend the lives of people living with ALS. International Registered Report Identifier (IRRID): DERR1-10.2196/60437 %M 40073394 %R 10.2196/60437 %U https://www.researchprotocols.org/2025/1/e60437 %U https://doi.org/10.2196/60437 %U http://www.ncbi.nlm.nih.gov/pubmed/40073394 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67188 %T Monitoring Sleep Quality Through Low α-Band Activity in the Prefrontal Cortex Using a Portable Electroencephalogram Device: Longitudinal Study %A Han,Chuanliang %A Zhang,Zhizhen %A Lin,Yuchen %A Huang,Shaojia %A Mao,Jidong %A Xiang,Weiwen %A Wang,Fang %A Liang,Yuping %A Chen,Wufang %A Zhao,Xixi %+ National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100088, China, 86 15501193896, zhaoxixi@ccmu.edu.cn %K EEG %K electroencephalogram %K alpha oscillation %K prefrontal cortex %K sleep %K portable device %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The pursuit of sleep quality has become an important aspect of people’s global quest for overall health. However, the objective neurobiological features corresponding to subjective perceptions of sleep quality remain poorly understood. Although previous studies have investigated the relationship between electroencephalogram (EEG) and sleep, the lack of longitudinal follow-up studies raises doubts about the reproducibility of their findings. Objective: Currently, there is a gap in research regarding the stable associations between EEG data and sleep quality assessed through multiple data collection sessions, which could help identify potential neurobiological targets related to sleep quality. Methods: In this study, we used a portable EEG device to collect resting-state prefrontal cortex EEG data over a 3-month follow-up period from 42 participants (27 in the first month, 25 in the second month, and 40 in the third month). Each month, participants’ sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) to estimate their recent sleep quality. Results: We found that there is a significant and consistent positive correlation between low α band activity in the prefrontal cortex and PSQI scores (r=0.45, P<.001). More importantly, this correlation remained consistent across all 3-month follow-up recordings (P<.05), regardless of whether we considered the same cohort or expanded the sample size. Furthermore, we discovered that the periodic component of the low α band primarily contributed to this significant association with PSQI. Conclusions: These findings represent the first identification of a stable and reliable neurobiological target related to sleep quality through multiple follow-up sessions. Our results provide a solid foundation for future applications of portable EEG devices in monitoring sleep quality and screening for sleep disorders in a broad population. %M 40063935 %R 10.2196/67188 %U https://www.jmir.org/2025/1/e67188 %U https://doi.org/10.2196/67188 %U http://www.ncbi.nlm.nih.gov/pubmed/40063935 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64465 %T Tablet- and Group-Based Multicomponent Cognitive Stimulation for Older Adults With Mild Cognitive Impairment: Single-Group Pilot Study and Protocol for Randomized Controlled Trial %A Jornkokgoud,Khanitin %A Makmee,Pattrawadee %A Wongupparaj,Peera %A Grecucci,Alessandro %+ Department of Psychology, Faculty of Humanities and Social Sciences, Burapha University, 169 Long-Haad Bang Saen Road, Saen-Sook Sub-district, Mueang District, Chon Buri, 20131, Thailand, 66 38 102622, peera.wo@go.buu.ac.th %K computerized cognitive stimulation %K multisensory integration %K cognitive decline %K aging %K electroencephalography %K randomized controlled trial %K RCT %K protocol %K cognitive stimulation %K mild cognitive impairment %K cognitive %K cognition %K cognitive simulation therapy %K CST %K MCI %K tablet %K effectiveness %K pilot study %K neuropsychological tests %K behavioral %K emotional %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive stimulation therapy is a group-based psychological treatment for people with dementia as well as those with mild cognitive impairment (MCI) and is shown to improve both cognition and quality of life. Previous studies have indicated the potential to benefit from the use of technological devices in group interventions. Objective: The pilot study aimed to assess the effectiveness of a tablet- and group-based multicomponent cognitive stimulation therapy (MCST) for enhancing cognitive functions among older adults with MCI. The following study aims to report the protocol for a trial evaluating whether the MCST program is affecting individuals with MCI. Methods: In the first study, 30 individuals with MCI participated in 10 sessions of the tablet- and group-based MCST group. A subsequent protocol study will compare tablet-based MCST, tablet-based cognitive stimulation therapy, and control groups among 93 individuals with MCI. All participants will be recruited from older adults living in semiurban communities. Intervention groups will be facilitated by trained therapists, nurses, or psychologists. The study will be assessed by a pre- and posttest evaluation, including computer-based neuropsychological tests and electroencephalography assessment. The effects of several indicators, such as cognitive functions, behavioral, and emotional, will be analyzed as being indexed by their neurophysiological data. Results: The pilot study showed significant cognitive improvement (P<.001), reduced depression (P=.002), and decreased state anxiety (P=.001) post intervention. Quality of life remained unchanged (P=.18). The randomized controlled trial study was funded in March 2023. Enrolling began in August 2023 and was completed in December 2023. The data analysis was started, and the results are expected to be published by mid- to late-2025. Conclusions: The study is the first tablet-group–based MCST for older adults with MCI in middle-income countries. It will provide deeper insight into participants’ neuropsychological data, thus identifying specific processes underlying physiologically measured positive outcomes. Furthermore, the project will deliver solid and integrative results to mental health professionals in terms of knowledge and guidance for implementing the tablet- and group-based MCST in people with MCI. Trial Registration: Thai Clinical Trials Registry TCTR20230829004; https://tinyurl.com/3wuaue3e International Registered Report Identifier (IRRID): DERR1-10.2196/64465 %M 39983114 %R 10.2196/64465 %U https://www.researchprotocols.org/2025/1/e64465 %U https://doi.org/10.2196/64465 %U http://www.ncbi.nlm.nih.gov/pubmed/39983114 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66838 %T Neural Mechanism of Cognitive Reserve in Acupuncture Stimulation: Protocol for a Randomized, Placebo-Controlled Functional Near-Infrared Spectroscopy Trial %A Shin,Hyeonsang %A Seong,Woohyun %A Woo,Yeonju %A Kim,Joo-Hee %A Park,Kwang-Rak %A Lee,Dong Hyuk %+ Department of Anatomy, College of Korean Medicine, Sangji University, 83 Sangjidae-gil, Wonju-si, Gangwon-do, 26339, Republic of Korea, 82 01071017317, leedh1103@gmail.com %K cognitive reserve %K acupuncture %K dementia %K mild cognitive impairment %K neuroimaging %K fNIRS %K brain connectivity %K neural mechanism %K RCT %K randomized controlled trial %D 2025 %7 19.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is a clinical syndrome characterized by a progressive decline in various cognitive domains. Since there is still no treatment for dementia, early diagnosis and prevention are the best approaches. In this context, the cognitive reserve (CR) concept has received considerable attention in dementia research with regard to prognosis. It originates from discrepancies between the degree of brain pathology and clinical manifestations. Acupuncture, as a complementary intervention, has long been widely applied in neurological diseases in East Asia. At the macroscale level, how acupuncture stimulation affects neural activity concerning CR in normal aging and dementia is largely unknown. Objective: The aim of this study is to investigate the acute neural mechanisms of acupuncture stimulation concerning CR in the normal aging group and the group with cognitive impairment using neuroimaging methods. Methods: This study is a randomized, placebo-controlled trial. Participants without (n=30) and with cognitive impairment (n=30) will be randomly assigned to the verum or sham acupuncture groups. The verum acupuncture group will receive acupuncture stimulation at acupoints related to cognitive function and gain deqi sensation. The sham acupuncture group will receive superficial needling at nonacupoints not related to cognitive function. Each group will undergo cognitive function tests, functional near-infrared spectroscopy imaging before and after acupuncture stimulation, and an assessment of CR. The primary outcomes will be differences in resting brain activities according to disease status, differences in resting brain connectivity before and after acupuncture stimulation between the 2 groups, and changes in brain activity in relation to the CR index. The secondary outcomes will be brain connectivity or network metrics associated with CR and differences in neural activity between the cognitive task and resting states. Results: The recruitment began in August 2023; to date, there have been 50 participants, divided into 20 in the group with cognitive impairment and 30 in the unimpaired group. The recruitment process will continue until February 2025. Conclusions: CR refers to the individual susceptibility to age-related brain changes and pathologies in cognitive impairment, and it is a factor affecting the trajectories of the disease. Although acupuncture is a widely used intervention for various neurological diseases, including dementia, its mechanism associated with CR at the macroscale has not been clearly identified. This study could contribute to identifying the neural mechanisms of acupuncture stimulation associated with CR using neuroimaging methods and provide a basis for future longitudinal research. Trial Registration: Clinical Research Information Service of the Republic of Korea KCT0008719; https://tinyurl.com/ydv5537n International Registered Report Identifier (IRRID): DERR1-10.2196/66838 %M 39970435 %R 10.2196/66838 %U https://www.researchprotocols.org/2025/1/e66838 %U https://doi.org/10.2196/66838 %U http://www.ncbi.nlm.nih.gov/pubmed/39970435 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58612 %T Detecting Freezing of Gait in Parkinson Disease Using Multiple Wearable Sensors Sets During Various Walking Tasks Relative to Medication Conditions (DetectFoG): Protocol for a Prospective Cohort Study %A Cordillet,Sébastien %A Drapier,Sophie %A Leh,Frédérique %A Dumont,Audeline %A Bidet,Florian %A Bonan,Isabelle %A Jamal,Karim %+ Physical and Rehabilitation Medicine Department, Clinical Investigation Center INSERM 1414, University Hospital of Rennes, 2 Rue Henri Le Guilloux, Rennes, 35000, France, 33 0674113482, karim.jamal@univ-rennes.fr %K Parkinson %K detection %K freezing of gait %K sensor %K wearable %K freezing %K walk %K neurodegenerative %K movement %D 2025 %7 6.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Freezing of gait (FoG) is one of the most disabling symptoms of Parkinson disease (PD). Detecting and monitoring episodes of FoG are important in the medical follow-up of patients to assess disease progression and functional impact and to adjust treatment accordingly. Although several questionnaires exist, they lack objectivity. Using wearable sensors such as inertial measurement units (IMUs) to detect FoG episodes offers greater objectivity and accuracy. There is no consensus on the number and location of IMU, type of algorithm, and method of triggering and scoring the FoG episodes. Objective: The objective of this study is to investigate the use of multiple wearable sensors sets to detect FoG in patients with PD during various walking tasks under different medication conditions. Methods: This single-center, prospective cohort study (DetectFoG) will include 18 patients with PD. Patients will be fitted with 7 IMUs and will walk a freezing-provoking path under different tasks—“single task,” “dual motor task,” or “dual cognitive task”—and medical conditions corresponding to levodopa medication (“on” or “off”). Passages will be videotaped, and 2 movement disorder specialists will identify FoG episodes in the videos. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the most effective combination of wearable sensors for detecting FoG episodes will be studied. Results: The study is currently in the data collection phase, having commenced recruitment in February 2024. Once all data have been gathered, the data analysis will commence. As of August 2024, 3 patients have been recruited. It is anticipated that the results will be published by the end of 2025. Conclusions: Detecting FoG episodes in various medical and clinical settings would provide a more comprehensive understanding of this phenomenon. Furthermore, it would enable reliable and objective monitoring of the progression of this symptom based on treatments and the natural course of the disease. This could serve as an objective tool for monitoring patients and assessing the severity and frequency of FoG. Trial Registration: Clinicaltrials.gov NCT05822258; https://www.clinicaltrials.gov/study/NCT05822258 International Registered Report Identifier (IRRID): DERR1-10.2196/58612 %M 39913915 %R 10.2196/58612 %U https://www.researchprotocols.org/2025/1/e58612 %U https://doi.org/10.2196/58612 %U http://www.ncbi.nlm.nih.gov/pubmed/39913915 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62647 %T Detection of Alzheimer Disease in Neuroimages Using Vision Transformers: Systematic Review and Meta-Analysis %A Mubonanyikuzo,Vivens %A Yan,Hongjie %A Komolafe,Temitope Emmanuel %A Zhou,Liang %A Wu,Tao %A Wang,Nizhuan %+ , Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, Kowloon, 999077, China (Hong Kong), 852 27667681, wangnizhuan1120@gmail.com %K diagnostic accuracy %K vision transformer %K Alzheimer disease %K detection %K neuroimaging, meta-analysis %K neuroimaging %K deep learning %K medical database %K diagnostic %K clinical implementation %K machine learning %K magnetic resonance imaging %K neural networks %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Alzheimer disease (AD) is a progressive condition characterized by cognitive decline and memory loss. Vision transformers (ViTs) are emerging as promising deep learning models in medical imaging, with potential applications in the detection and diagnosis of AD. Objective: This review systematically examines recent studies on the application of ViTs in detecting AD, evaluating the diagnostic accuracy and impact of network architecture on model performance. Methods: We conducted a systematic search across major medical databases, including China National Knowledge Infrastructure, CENTRAL (Cochrane Central Register of Controlled Trials), ScienceDirect, PubMed, Web of Science, and Scopus, covering publications from January 1, 2020, to March 1, 2024. A manual search was also performed to include relevant gray literature. The included papers used ViT models for AD detection versus healthy controls based on neuroimaging data, and the included studies used magnetic resonance imaging and positron emission tomography. Pooled diagnostic accuracy estimates, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratios, were derived using random-effects models. Subgroup analyses comparing the diagnostic performance of different ViT network architectures were performed. Results: The meta-analysis, encompassing 11 studies with 95% CIs and P values, demonstrated pooled diagnostic accuracy: sensitivity 0.925 (95% CI 0.892-0.959; P<.01), specificity 0.957 (95% CI 0.932-0.981; P<.01), positive likelihood ratio 21.84 (95% CI 12.26-38.91; P<.01), and negative likelihood ratio 0.08 (95% CI 0.05-0.14; P<.01). The area under the curve was notably high at 0.924. The findings highlight the potential of ViTs as effective tools for early and accurate AD diagnosis, offering insights for future neuroimaging-based diagnostic approaches. Conclusions: This systematic review provides valuable evidence for the utility of ViT models in distinguishing patients with AD from healthy controls, thereby contributing to advancements in neuroimaging-based diagnostic methodologies. Trial Registration: PROSPERO CRD42024584347; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=584347 %M 39908541 %R 10.2196/62647 %U https://www.jmir.org/2025/1/e62647 %U https://doi.org/10.2196/62647 %U http://www.ncbi.nlm.nih.gov/pubmed/39908541 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57723 %T Transformers for Neuroimage Segmentation: Scoping Review %A Iratni,Maya %A Abdullah,Amira %A Aldhaheri,Mariam %A Elharrouss,Omar %A Abd-alrazaq,Alaa %A Rustamov,Zahiriddin %A Zaki,Nazar %A Damseh,Rafat %+ Department of Computer Science and Software Engineering, United Arab Emirates University, Sheik Khalifa Bin Zayed St - 'Asharij - Shiebat Al Oud - Abu Dhabi, Al Ain, 15551, United Arab Emirates, 971 37135586, rdamseh@uaeu.ac.ae %K 3D segmentation %K brain tumor segmentation %K deep learning %K neuroimaging %K transformer %D 2025 %7 29.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Neuroimaging segmentation is increasingly important for diagnosing and planning treatments for neurological diseases. Manual segmentation is time-consuming, apart from being prone to human error and variability. Transformers are a promising deep learning approach for automated medical image segmentation. Objective: This scoping review will synthesize current literature and assess the use of various transformer models for neuroimaging segmentation. Methods: A systematic search in major databases, including Scopus, IEEE Xplore, PubMed, and ACM Digital Library, was carried out for studies applying transformers to neuroimaging segmentation problems from 2019 through 2023. The inclusion criteria allow only for peer-reviewed journal papers and conference papers focused on transformer-based segmentation of human brain imaging data. Excluded are the studies dealing with nonneuroimaging data or raw brain signals and electroencephalogram data. Data extraction was performed to identify key study details, including image modalities, datasets, neurological conditions, transformer models, and evaluation metrics. Results were synthesized using a narrative approach. Results: Of the 1246 publications identified, 67 (5.38%) met the inclusion criteria. Half of all included studies were published in 2022, and more than two-thirds used transformers for segmenting brain tumors. The most common imaging modality was magnetic resonance imaging (n=59, 88.06%), while the most frequently used dataset was brain tumor segmentation dataset (n=39, 58.21%). 3D transformer models (n=42, 62.69%) were more prevalent than their 2D counterparts. The most developed were those of hybrid convolutional neural network-transformer architectures (n=57, 85.07%), where the vision transformer is the most frequently used type of transformer (n=37, 55.22%). The most frequent evaluation metric was the Dice score (n=63, 94.03%). Studies generally reported increased segmentation accuracy and the ability to model both local and global features in brain images. Conclusions: This review represents the recent increase in the adoption of transformers for neuroimaging segmentation, particularly for brain tumor detection. Currently, hybrid convolutional neural network-transformer architectures achieve state-of-the-art performances on benchmark datasets over standalone models. Nevertheless, their applicability remains highly limited by high computational costs and potential overfitting on small datasets. The heavy reliance of the field on the brain tumor segmentation dataset hints at the use of a more diverse set of datasets to validate the performances of models on a variety of neurological diseases. Further research is needed to define the optimal transformer architectures and training methods for clinical applications. Continuing development may make transformers the state-of-the-art for fast, accurate, and reliable brain magnetic resonance imaging segmentation, which could lead to improved clinical tools for diagnosing and evaluating neurological disorders. %M 39879621 %R 10.2196/57723 %U https://www.jmir.org/2025/1/e57723 %U https://doi.org/10.2196/57723 %U http://www.ncbi.nlm.nih.gov/pubmed/39879621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59663 %T Long-Term Impact of Using Mobile Phones and Playing Computer Games on the Brain Structure and the Risk of Neurodegenerative Diseases: Large Population-Based Study %A Xiao,Yi %A Zhang,Sirui %A Ma,Yuanzheng %A Wang,Shichan %A Li,Chunyu %A Liang,Yan %A Shang,Huifang %+ Department of Neurology, West China Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, China, 86 18980602127, hfshang2002@126.com %K electronic device %K parkinsonism %K dementia %K aging %K brain MRI %K magnetic resonance imaging %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: The aim of this study was to investigate the impact of the daily use of mobile phones/computers on the brain structure and the risk of neurodegenerative diseases. Methods: We used data from the UK Biobank, a longitudinal population-based cohort study, to analyze the impact of mobile phone use duration, weekly usage time, and playing computer games on the future brain structure and the future risk of various neurodegenerative diseases, including all-cause dementia (ACD), Alzheimer disease (AD), vascular dementia (VD), all-cause parkinsonism (ACP), and Parkinson disease (PD). All the characteristics of using mobile phones and playing computer games were collected through face-to-face interviews at baseline, and outcomes were extracted from the algorithmic combinations of self-reported medical conditions, hospital admissions, and death registries. In addition, a group of participants underwent magnetic resonance imaging (MRI) at follow-up. Cox regression and linear regression were performed. Results: The study included over 270,000 participants for risk analysis, with a mean baseline age of approximately 55.85 (SD 8.07) years. The average follow-up duration was approximately 13.9 (SD 1.99) years. Lengthy mobile phone use was associated with a reduced risk of ACD (2-4 years: hazard ratio [HR] 0.815, 95% CI 0.729-0.912, P<.001; 5-8 years: HR 0.749, 95% CI 0.677-0.829, P<.001; >8 years: HR 0.830, 95% CI 0.751-0.918, P<.001), AD (5-8 years: HR 0.787, 95% CI 0.672-0.922, P=.003), and VD (2-4 years: HR 0.616, 95% CI 0.477-0.794, P<.001; 5-8 years: HR 0.729, 95% CI 0.589-0.902, P=.004; >8 years: HR 0.750, 95% CI 0.605-0.930, P=.009) compared to rarely using mobile phones. Additionally, lengthy mobile phone use was linked to a decreased risk of ACP (5-8 years: HR 0.747, 95% CI 0.637-0.875, P<.001; >8 years: HR 0.774, 95% CI 0.663-0.904, P=.001) and PD (5-8 years: HR 0.760, 95% CI 0.644-0.897, P=.001; >8 years: HR 0.777, 95% CI 0.660-0.913, P=.002) in participants older than 60 years. However, higher weekly usage time did not confer additional risk reduction compared to lower weekly usage of mobile phones. The neuroimaging analysis involved 35,643 participants, with an average duration of approximately 9.0 years between baseline and neuroimaging scans. Lengthy mobile phone use was related to a thicker cortex in different areas of the brain. Conclusions: Lengthy mobile phone use is associated with a reduced risk of neurodegenerative diseases and improved brain structure compared to minimal usage. Our research provides valuable background knowledge for future studies on the impact of modern electronic devices on brain health. %M 39874583 %R 10.2196/59663 %U https://www.jmir.org/2025/1/e59663 %U https://doi.org/10.2196/59663 %U http://www.ncbi.nlm.nih.gov/pubmed/39874583 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63949 %T Influence of Partnership Relationships on Long-Term Neurological Rehabilitation in Germany: Protocol for a Qualitative Retrospective Study %A von Bosse,Alexa %A König,Peter %A Jansen,Eva %+ , Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Virchowweg 22, Berlin, 10117, Germany, 49 15142558462, alexa.von-bosse@charite.de %K neurological rehabilitation %K neurological injury %K therapeutic alliance %K relationship building %K caregivers %K family %K partnership %K health professionals %K neurological %K therapeutic %K Germany %K retrospective study %K narrative interview %K biopsychosocial %K family-centered %D 2025 %7 13.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Acquired neurological diseases entail significant changes and influence the relationship between a patient and their significant other. In the context of long-term rehabilitation, those affected collaborate with health care professionals who are expected to have a positive impact on the lives of the affected individuals. Objective: This study aims to examine the changes in the relationship between the patient and their loved ones due to acquired neurological disorders and the influence of health care professionals on this relationship. Methods: Through sociogenetic type building, we will identify different types of patient-caregiver dyads and their effects on health care professionals and vice versa. The results will then be integrated into a model based on the theory of symbolic interactionism and Baxter’s Relational Dialectics Theory. Results: This study is not funded and was approved by the ethics committee of the German Society for Nursing Science, and it complies with the Declaration of Helsinki. The data collection started in June 2024 based on narrative couple interviews and is running. We assume that patients and their relatives will demonstrate heterogeneity as individuals, as well as in their interactions within the dyad, regarding certain orientations such as coping with illness, motivation for therapy, and coping strategies. Conclusions: Our findings address a biopsychosocial perspective that enhances treatment approaches in neurological long-term care. Understanding the influence of professionals on dyadic couple relationships can improve rehabilitation effectiveness by tailoring therapeutic approaches to various patient types, relatives, and dyadic relationship constellations. This fosters patient- and family-centered therapy in line with holistic care. International Registered Report Identifier (IRRID): DERR1-10.2196/63949 %M 39804683 %R 10.2196/63949 %U https://www.researchprotocols.org/2025/1/e63949 %U https://doi.org/10.2196/63949 %U http://www.ncbi.nlm.nih.gov/pubmed/39804683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63004 %T Clinical Decision Support Using Speech Signal Analysis: Systematic Scoping Review of Neurological Disorders %A De Silva,Upeka %A Madanian,Samaneh %A Olsen,Sharon %A Templeton,John Michael %A Poellabauer,Christian %A Schneider,Sandra L %A Narayanan,Ajit %A Rubaiat,Rahmina %+ Department of Computer Science and Software Engineering, Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland 1010, Auckland, 1010, New Zealand, 64 09 9219999 ext 6539, sam.madanian@aut.ac.nz %K digital health %K health informatics %K digital biomarker %K speech analytics %K artificial intelligence %K machine learning %D 2025 %7 13.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital biomarkers are increasingly used in clinical decision support for various health conditions. Speech features as digital biomarkers can offer insights into underlying physiological processes due to the complexity of speech production. This process involves respiration, phonation, articulation, and resonance, all of which rely on specific motor systems for the preparation and execution of speech. Deficits in any of these systems can cause changes in speech signal patterns. Increasing efforts are being made to develop speech-based clinical decision support systems. Objective: This systematic scoping review investigated the technological revolution and recent digital clinical speech signal analysis trends to understand the key concepts and research processes from clinical and technical perspectives. Methods: A systematic scoping review was undertaken in 6 databases guided by a set of research questions. Articles that focused on speech signal analysis for clinical decision-making were identified, and the included studies were analyzed quantitatively. A narrower scope of studies investigating neurological diseases were analyzed using qualitative content analysis. Results: A total of 389 articles met the initial eligibility criteria, of which 72 (18.5%) that focused on neurological diseases were included in the qualitative analysis. In the included studies, Parkinson disease, Alzheimer disease, and cognitive disorders were the most frequently investigated conditions. The literature explored the potential of speech feature analysis in diagnosis, differentiating between, assessing the severity and monitoring the treatment of neurological conditions. The common speech tasks used were sustained phonations, diadochokinetic tasks, reading tasks, activity-based tasks, picture descriptions, and prompted speech tasks. From these tasks, conventional speech features (such as fundamental frequency, jitter, and shimmer), advanced digital signal processing–based speech features (such as wavelet transformation–based features), and spectrograms in the form of audio images were analyzed. Traditional machine learning and deep learning approaches were used to build predictive models, whereas statistical analysis assessed variable relationships and reliability of speech features. Model evaluations primarily focused on analytical validations. A significant research gap was identified: the need for a structured research process to guide studies toward potential technological intervention in clinical settings. To address this, a research framework was proposed that adapts a design science research methodology to guide research studies systematically. Conclusions: The findings highlight how data science techniques can enhance speech signal analysis to support clinical decision-making. By combining knowledge from clinical practice, speech science, and data science within a structured research framework, future research may achieve greater clinical relevance. %M 39804693 %R 10.2196/63004 %U https://www.jmir.org/2025/1/e63004 %U https://doi.org/10.2196/63004 %U http://www.ncbi.nlm.nih.gov/pubmed/39804693 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e54525 %T Standardized Outcomes for Randomized Controlled Trials Targeting Early Interventions in Patients With Moderate-to-Severe Traumatic Brain Injury: Protocol for the Development of a Core Outcome Set %A Cinotti,Raphael %A Derouin,Yvan %A Chenet,Amandine %A Oujamaa,Lydia %A Glize,Bertrand %A Launey,Yoann %A Dahyot-Fizelier,Claire %A Cartron,Emmanuelle %A Renvoise,Melodie %A Sautenet,Benedicte %A Sebille,Veronique %+ Department of Anaesthesia and Critical Care, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, Nantes, F-44000, France, 33 2 40 08 47 31, raphael.cinotti@chu-nantes.fr %K core outcome set %K outcomes research %K patient-centered outcomes %K traumatic brain injury %K patient outcome %K head trauma %K patient-centered %D 2025 %7 9.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: : With more than 60 million new cases around the world each year, traumatic brain injury (TBI) causes substantial mortality and morbidity. Managing TBI is a major human, social, and economic concern. In the last 20 years, there has been an increase in clinical trials in neurocritical care, leading mostly to negative results. The evaluation of neurological outcomes, predominantly as primary outcomes, using clinical scales (Glasgow Outcome Scale) has limitations that could explain these results. Moreover, patient-centered outcomes are seldom reported despite their recognized clinical relevance. Objective: : The aim of this project is to establish a core outcome set (COS) for patients with moderate-to-severe TBI in randomized control trials in neurocritical care research. Methods: This study will follow five distinct steps: (1) systematic review to identify outcomes that have been reported in trials; (2) semistructured interviews with patients and their families to identify their priorities after TBI and explore potential patient-centered outcomes; (3) health care stakeholder focus groups with clinicians, researchers, and policy makers to describe potential outcomes; (4) an eDelphi survey with stakeholder groups to make a list of previously identified core outcomes; and (5) a consensus workshop to establish a COS for moderate-to-severe TBI clinical trials. Results: : The systematic review was published in August 2024. Regarding Step 2, 30 semistructured interviews of patients and relatives were performed from July 2021 to December 2023, and analyses were completed in October 2024. Step 3 is currently under development, and Step 4 is planned for the end of 2025. Step 5 is expected to occur during fall/winter 2026. Conclusions: Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations. Conclusions: Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations. International Registered Report Identifier (IRRID): DERR1-10.2196/54525 %M 39787594 %R 10.2196/54525 %U https://www.researchprotocols.org/2025/1/e54525 %U https://doi.org/10.2196/54525 %U http://www.ncbi.nlm.nih.gov/pubmed/39787594 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e53957 %T Trends in Prescription of Stimulants and Narcoleptic Drugs in Switzerland: Longitudinal Health Insurance Claims Analysis for the Years 2014-2021 %A Scharf,Tamara %A Huber,Carola A %A Näpflin,Markus %A Zhang,Zhongxing %A Khatami,Ramin %K prescription trends %K claims data %K cross-sectional data %K narcolepsy %K prescribers %K prescribing practices %K medical care %K stimulants %K stimulant medication %D 2025 %7 7.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Stimulants are potent treatments for central hypersomnolence disorders or attention-deficit/hyperactivity disorders/attention deficit disorders but concerns have been raised about their potential negative consequences and their increasing prescription rates. Objective: We aimed to describe stimulant prescription trends in Switzerland from 2014 to 2021. Second, we aimed to analyze the characteristics of individuals who received stimulant prescriptions in 2021 and investigate the link between stimulant prescriptions and hospitalization rates in 2021, using hospitalization as a potential indicator of adverse health outcomes. Methods: Longitudinal and cross-sectional data from a large Swiss health care insurance were analyzed from all insureds older than 6 years. The results were extrapolated to the Swiss general population. We identified prescriptions for methylphenidate, lisdexamfetamine, modafinil, and sodium oxybate and calculated prevalences of each drug prescription over the period from 2014 to 2021. For 2021 we provide detailed information on the prescribers and evaluate the association of stimulant prescription and the number and duration of hospitalization using logistic regression models. Results: We observed increasing prescription rates of all stimulants in all age groups from 2014 to 2021 (0.55% to 0.81%, 43,848 to 66,113 insureds with a prescription). In 2021, 37.1% (28,057 prescriptions) of the medications were prescribed by psychiatrists, followed by 36.1% (n=27,323) prescribed by general practitioners and 1% (n=748) by neurologists. Only sodium oxybate, which is highly specific for narcolepsy treatment, was most frequently prescribed by neurologists (27.8%, 37 prescriptions). Comorbid psychiatric disorders were common in patients receiving stimulants. Patients hospitalized in a psychiatric institution were 5.3 times (odds ratio 5.3, 95% CI 4.63‐6.08, P<.001) more likely to have a stimulant prescription than those without hospitalization. There were no significant associations between stimulant prescription and the total length of inpatient stay (odds ratio 1, 95% CI 1‐1, P=.13). Conclusions: The prescription of stimulant medication in Switzerland increased slightly but continuously over years, but at lower rates compared to the estimated prevalence of central hypersomnolence disorders and attention-deficit/hyperactivity disorders/attention deficit disorders. Most stimulants are prescribed by psychiatrists, closely followed by general practitioners. The increased odds for hospitalization to psychiatric institutions for stimulant receivers reflects the severity of disease and the higher psychiatric comorbidities in these patients. %R 10.2196/53957 %U https://publichealth.jmir.org/2025/1/e53957 %U https://doi.org/10.2196/53957 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55032 %T Collecting Feedback From Neurologists and Patients to Guide Development of a Parkinson Disease App (DigiPark): Qualitative, Noninterventional Study %A Duracinsky,Martin %A Brown Hajdukova,Eva %A Péretz,Fabienne %A Sauzin,Julie %A Gouider-Khouja,Neziha %A Atlani,Caroline %A Dalili,Djamchid %K DigiPark %K Parkinson disease %K patient-centered app %K smartphones %K usability testing %K mHealth %K mobile health %D 2024 %7 31.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Parkinson disease (PD) is a worldwide, fast-growing, progressive neurodegenerative condition. Its multifaceted clinical presentation includes a wide range of motor and nonmotor symptoms. Smartphones present a potential solution to better monitor and subsequently alleviate PD symptoms. Objective: The aim of this study is to explore neurologists’ and patients’ needs and preferences regarding the design and functionality of a new smartphone app for PD, DigiPark. Methods: This qualitative, noninterventional study gathered data through two primary methods: (1) by conducting interviews with 9 neurologists and (2) through a usability test including 5 patients with PD. Results: The neurologists affirmed the necessity for a patient-centered app, highlighting the complexities of PD management. They advocated for personalized app functionalities to improve patients’ quality of life and emphasized the need for enhanced patient-provider communication. Feedback from the usability test indicated a preference for a clear, simple user interface, as well as elucidation of the app’s benefits. Concerns about the app’s time demands and the complexity of certain features like medication management were expressed. Furthermore, patients with PD consistently showed interest in features that could track and monitor their progress over time. This highlights the need to include clear benefits within the app to maintain user engagement and commitment. Conclusions: Neurologists’ and patients’ feedback on the design and functionality of the app complement each other. Collaborative efforts in shaping the app should better address genuine PD management needs. Future clinical trial inclusion can further validate the efficacy of DigiPark. %R 10.2196/55032 %U https://humanfactors.jmir.org/2024/1/e55032 %U https://doi.org/10.2196/55032 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e60017 %T Visualizing Patient Pathways and Identifying Data Repositories in a UK Neurosciences Center: Exploratory Study %A Knight,Jo %A Chandrabalan,Vishnu Vardhan %A Emsley,Hedley C A %K health data %K business process monitoring notation %K neurology %K process monitoring %K patient pathway %K clinical pathway %K patient care %K EHR %K electronic health record %K dataset %K questionnaire %K patient data %K NHS %K National Health Service %D 2024 %7 24.12.2024 %9 %J JMIR Med Inform %G English %X Background: Health and clinical activity data are a vital resource for research, improving patient care and service efficiency. Health care data are inherently complex, and their acquisition, storage, retrieval, and subsequent analysis require a thorough understanding of the clinical pathways underpinning such data. Better use of health care data could lead to improvements in patient care and service delivery. However, this depends on the identification of relevant datasets. Objective: We aimed to demonstrate the application of business process modeling notation (BPMN) to represent clinical pathways at a UK neurosciences center and map the clinical activity to corresponding data flows into electronic health records and other nonstandard data repositories. Methods: We used BPMN to map and visualize a patient journey and the subsequent movement and storage of patient data. After identifying several datasets that were being held outside of the standard applications, we collected information about these datasets using a questionnaire. Results: We identified 13 standard applications where neurology clinical activity was captured as part of the patient’s electronic health record including applications and databases for managing referrals, outpatient activity, laboratory data, imaging data, and clinic letters. We also identified 22 distinct datasets not within standard applications that were created and managed within the neurosciences department, either by individuals or teams. These were being used to deliver direct patient care and included datasets for tracking patient blood results, recording home visits, and tracking triage status. Conclusions: Mapping patient data flows and repositories allowed us to identify areas wherein the current electronic health record does not fulfill the needs of day-to-day patient care. Data that are being stored outside of standard applications represent a potential duplication in the effort and risks being overlooked. Future work should identify unmet data needs to inform correct data capture and centralization within appropriate data architectures. %R 10.2196/60017 %U https://medinform.jmir.org/2024/1/e60017 %U https://doi.org/10.2196/60017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54676 %T Machine Learning and Deep Learning for Diagnosis of Lumbar Spinal Stenosis: Systematic Review and Meta-Analysis %A Wang,Tianyi %A Chen,Ruiyuan %A Fan,Ning %A Zang,Lei %A Yuan,Shuo %A Du,Peng %A Wu,Qichao %A Wang,Aobo %A Li,Jian %A Kong,Xiaochuan %A Zhu,Wenyi %+ Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China, 86 51718268, zanglei@ccmu.edu.cn %K lumbar spinal stenosis %K LSS %K machine learning %K ML %K deep learning %K artificial intelligence %K AI %K diagnosis %K spine stenosis %K lumbar %K predictive model %K early detection %K diagnostic %K older adult %K %D 2024 %7 23.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Lumbar spinal stenosis (LSS) is a major cause of pain and disability in older individuals worldwide. Although increasing studies of traditional machine learning (TML) and deep learning (DL) were conducted in the field of diagnosing LSS and gained prominent results, the performance of these models has not been analyzed systematically. Objective: This systematic review and meta-analysis aimed to pool the results and evaluate the heterogeneity of the current studies in using TML or DL models to diagnose LSS, thereby providing more comprehensive information for further clinical application. Methods: This review was performed under the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using articles extracted from PubMed, Embase databases, and Cochrane Library databases. Studies that evaluated DL or TML algorithms assessment value on diagnosing LSS were included, while those with duplicated or unavailable data were excluded. Quality Assessment of Diagnostic Accuracy Studies 2 was used to estimate the risk of bias in each study. The MIDAS module and the METAPROP module of Stata (StataCorp) were used for data synthesis and statistical analyses. Results: A total of 12 studies with 15,044 patients reported the assessment value of TML or DL models for diagnosing LSS. The risk of bias assessment yielded 4 studies with high risk of bias, 3 with unclear risk of bias, and 5 with completely low risk of bias. The pooled sensitivity and specificity were 0.84 (95% CI: 0.82-0.86; I2=99.06%) and 0.87 (95% CI 0.84-0.90; I2=98.7%), respectively. The diagnostic odds ratio was 36 (95% CI 26-49), the positive likelihood ratio (LR+) was 6.6 (95% CI 5.1-8.4), and the negative likelihood ratio (LR–) was 0.18 (95% CI 0.16-0.21). The summary receiver operating characteristic curves, the area under the curve of TML or DL models for diagnosing LSS of 0.92 (95% CI 0.89-0.94), indicating a high diagnostic value. Conclusions: This systematic review and meta-analysis emphasize that despite the generally satisfactory diagnostic performance of artificial intelligence systems in the experimental stage for the diagnosis of LSS, none of them is reliable and practical enough to apply in real clinical practice. Further efforts, including optimization of model balance, widely accepted objective reference standards, multimodal strategy, large dataset for training and testing, external validation, and sufficient and scientific report, should be made to bridge the distance between current TML or DL models and real-life clinical applications in future studies. Trial Registration: PROSPERO CRD42024566535; https://tinyurl.com/msx59x8k %M 39715552 %R 10.2196/54676 %U https://www.jmir.org/2024/1/e54676 %U https://doi.org/10.2196/54676 %U http://www.ncbi.nlm.nih.gov/pubmed/39715552 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e58828 %T Making Video Games More Inclusive for People Living With Motor Neuron Disease: Scoping Review %A O'Mara,Ben %A Harrison,Matthew %A Harley,Kirsten %A Dwyer,Natasha %+ Department of Media & Communication, Faculty of Health, Arts & Design, Swinburne University, Hawthorn Campus, John Street, Hawthorn, Melbourne, 3122, Australia, 61 3 9214 4984, bomara@swin.edu.au %K motor neuron disease %K video games %K inclusion %K information technology %K well-being %K disability %K mobile phone %D 2024 %7 23.12.2024 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Evidence suggests that individuals with motor neuron disease (MND), a terminal illness, find enjoyment and social connection through video games. However, MND-related barriers can make gaming challenging, exacerbating feelings of boredom, stress, isolation, and loss of control over daily life. Objective: We scoped the evidence to describe relevant research and practice regarding what may help reduce difficulties for people with MND when playing video games. Methods: A scoping review was conducted using the Arksey and O’Malley framework, recent scoping review guidance, and engaging with people with lived experience of MND. Peer-reviewed studies were sourced from PubMed and the Swinburne University of Technology Library. Gray literature was identified from government, not-for-profit, commercial, and community websites. Data were extracted and summarized from the collected literature. Results: The evidence base, consisting of quantitative and qualitative research, lived experience stories, information resources, reviews, and guidelines, included 85 documents. Only 8 (9%) directly addressed video games and people with MND; however, these studies were limited in depth and quality. The primary technologies examined included customized information and communications technology for communication and control of computing systems (including desktop, laptop, smartphone, tablet, and console systems) and video game software and hardware (including hand controllers and accessibility features, such as difficulty level, speed, and remappable buttons and controls). Common factors in the evidence base highlight barriers and enablers to enjoying video games for people with MND. These include technological, physical, social, and economic challenges. Addressing these requires greater involvement of people with MND in game and technology research and development. Changes to information and communications technology, game software and hardware, policies, and guidelines are needed to better meet their needs. Conclusions: There is a significant gap in understanding the lived experience of people with MND with video games and what makes playing them easier, including appropriate customization of technology and the social experience of games. This gap perpetuates exclusion from gaming communities and recreation, potentially worsening social isolation. Existing evidence suggesting viable options for future research and practice. Video game and information and communications technology research and development must prioritize qualitative and quantitative research with people with MND at an appropriate scale, with a focus on lived experience, use of improved participant engagement techniques, and user-focused design for more inclusive games. Practical work needs to increase awareness of what can help make games more inclusive, including incorporation of accessibility early in the game production process, early incorporation of accessibility in game production, and affordable options for customized interfaces and other devices to play games. %M 39714921 %R 10.2196/58828 %U https://rehab.jmir.org/2024/1/e58828 %U https://doi.org/10.2196/58828 %U http://www.ncbi.nlm.nih.gov/pubmed/39714921 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59053 %T Use of Serious Games in Interventions of Executive Functions in Neurodiverse Children: Systematic Review %A Rodríguez Timaná,Luis Carlos %A Castillo García,Javier Ferney %A Bastos Filho,Teodiano %A Ocampo González,Alvaro Alexander %A Hincapié Monsalve,Nazly Rocio %A Valencia Jimenez,Nicolas Jacobo %+ Faculty of Engineering, Universidad Santiago de Cali, Calle 5 # 62-00 - Pampalinda, Santiago de Cali, 763022, Colombia, 57 3234664283, luis.rodriguez11@usc.edu.co %K executive functions %K neurodiversity %K serious games %K cognitive training %K therapeutic interventions %D 2024 %7 18.12.2024 %9 Review %J JMIR Serious Games %G English %X Background: Serious games (SG) have emerged as promising tools for cognitive training and therapeutic interventions, especially for enhancing executive functions. These games have demonstrated the potential to support individuals with diverse health conditions, including neurodevelopmental and cognitive disorders, through engaging and interactive experiences. However, a comprehensive understanding of the effectiveness of SG in enhancing executive functions is needed. Objective: This systematic review aims to assess the impact of serious games on executive functions (EF), focusing on attention, working memory, cognitive flexibility, and inhibitory control. In addition, it explores the integration of SG into educational and therapeutic settings for individuals with cognitive and neurodevelopmental conditions. Only open access articles published from 2019 to the search date were included to capture the most recent advancements in the field. Methods: A comprehensive search was conducted on June 20, 2024, across Scopus, Web of Science, and PubMed databases. Due to limited direct results linking SG and neurodiversity, separate searches were performed to analyze the relationship between SG and EF, as well as SG and neurodiverse populations. Two independent reviewers assessed the quality and risk of bias of the included studies using the Risk of Bias 2 tool for randomized studies and the Risk of Bias in Non-Randomized Studies of Interventions tool for nonrandomized studies. Results: The review identified 16 studies that met the inclusion criteria. Of these, 15 addressed the use of SG for improving EF in neurodiverse populations, such as children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and down syndrome. These studies demonstrated significant improvements in various EF domains, including attention, working memory, and cognitive flexibility. However, there was notable heterogeneity in sample sizes, participant ages, and game types. Three studies specifically focused on individuals with down syndrome, showing promising results in improving cognitive functions. Conclusions: SG hold considerable potential as therapeutic tools for enhancing EF across neurodiverse populations. They have shown positive effects in improving cognitive skills and promoting inclusion in both educational and therapeutic settings. However, further research is required to optimize game design, assess long-term outcomes, and address the variability in study quality. The exclusive inclusion of open access studies may have limited the scope of the review, and future research should incorporate a broader range of studies to provide a more comprehensive understanding of SG’s impact on neurodiversity. Trial Registration: PROSPERO CRD42024563231; https://tinyurl.com/ycxdymyb %M 39693133 %R 10.2196/59053 %U https://games.jmir.org/2024/1/e59053 %U https://doi.org/10.2196/59053 %U http://www.ncbi.nlm.nih.gov/pubmed/39693133 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58206 %T Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial %A Bernanke,Alyssa %A Hasley,Rebecca %A Sabetfakhri,Niki %A de Wit,Harriet %A Smith,Bridget M %A Wang,Lei %A Brenner,Lisa A %A Hanlon,Colleen %A Philip,Noah S %A Ajilore,Olusola %A Herrold,Amy %A Aaronson,Alexandra %+ Edward Hines Department of Veteran Affairs, Mental Health Service Line, 5001 S 5th Ave, Hines, IL, 60141, United States, 1 708 202 8387, alexandra.aaronson@va.gov %K mild traumatic brain injury %K transcranial magnetic stimulation %K intermittent theta burst stimulation %K suicidality %K suicidal ideation %K impulsivity %K neuromodulation %K social and occupational functioning %D 2024 %7 13.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide remains a leading cause of death among veterans in the United States, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation (SI) and suicide attempts (SAs). mTBI worsens impulsivity and contributes to poor social and occupational functioning, which further increases the risk of SI and SAs. Repetitive transcranial magnetic stimulation is a neuromodulatory treatment approach that induces neuroplasticity, potentially repairing neurodamage. Intermittent theta burst stimulation (iTBS) is a second-generation form of transcranial magnetic stimulation that is safe, shorter in duration, displays a minimal side effect profile and is a promising treatment approach for impulsivity in mTBI. Our novel proposed treatment protocol uses frontal pole iTBS to target the ventromedial prefrontal cortex, which may reduce impulsivity by strengthening functional connectivity between the limbic system and frontal cortex, allowing for improved top-down control of impulsive reactions, including SI and SAs. Objective: The objectives of this study are to (1) develop an iTBS intervention for veterans with mTBI, impulsivity, and SI; (2) assess the feasibility and tolerability of the intervention; and (3) gather preliminary clinical outcome data on SI, impulsivity, and functions that will guide future studies. Methods: This is a pilot, double-blinded, randomized controlled trial. In developing this protocol, we referenced the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. We will enroll 56 participants (28 active iTBS and 28 sham iTBS). The iTBS intervention will be performed daily, 5 days a week, for 2 weeks. We will collect 10 validated, psychometric, quantitative outcome measures before, during, and after the intervention. Measures included will assess functioning, impulsivity, suicidality, posttraumatic stress disorder, and depressive symptoms. We will collect qualitative data through semistructured interviews to elicit feedback on the participants’ experiences and symptoms. We will perform quantitative and qualitative analyses to (1) assess the feasibility, tolerability, and acceptability of the treatment; (2) gather advanced neuroimaging data to assess neural changes elicited by treatment; and (3) assess improvements in outcome measures of impulsivity and suicidality in veterans with mTBI. Results: This study protocol was approved by the Edward Hines, Jr. VA Hospital Institutional Review Board (Hines IRB number 14-003). This novel treatment is a 5-year research project (April 1, 2023, to March 31, 2028) funded by the Veterans Administration Rehabilitation Research and Development service (CDA2 award IK2 RX002938). Study results will be disseminated at or before the project’s end date in March 2028. Conclusions: We will provide preliminary evidence of the safety, feasibility, and acceptability of a novel frontal pole iTBS treatment for mTBI, impulsivity, SI and SAs, and functional deficits. Trial Registration: ClinicalTrials.gov NCT05647044; https://clinicaltrials.gov/study/NCT05647044 International Registered Report Identifier (IRRID): PRR1-10.2196/58206 %M 39671573 %R 10.2196/58206 %U https://www.researchprotocols.org/2024/1/e58206 %U https://doi.org/10.2196/58206 %U http://www.ncbi.nlm.nih.gov/pubmed/39671573 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 5 %N %P e44426 %T Impact of Weekly Community-Based Dance Training Over 8 Months on Depression and Blood Oxygen Level–Dependent Signals in the Subcallosal Cingulate Gyrus for People With Parkinson Disease: Observational Study %A Bearss,Karolina A %A Barnstaple,Rebecca E %A Bar,Rachel J %A DeSouza,Joseph F X %K depression %K cingulate %K GDS %K Geriatric Depression Scale %K neuroimaging %K dancing %K Parkinson disease %K neurodegenerative %K MRI %K imaging %K neurology %K magnetic resonance imaging %D 2024 %7 13.12.2024 %9 %J JMIRx Med %G English %X Background: Dance has emerged as a complementary treatment that may promote adaptive neural plasticity while improving symptoms of Parkinson disease (PD), such as balance, gait, posture, and walking. Understanding brain changes that arise from participation in dance interventions is important as these neural plastic changes play an important role in protecting and healing the brain. Although dance has been shown to improve PD motor and nonmotor symptoms, the neural mechanisms underlying these changes, specifically depression and mood, remain elusive. Further, many side effects of PD drug treatments can be exacerbated or even induced by dopaminergic drugs, particularly depression and anxiety, making these nonmotor symptoms more noticeable throughout the progression of the disease. Objective: In this study, we focused on the impact of dance interventions on PD nonmotor symptoms by conducting an 8-month observational study, tracking the relationship between depression scores and functional neuroimaging measures for people with PD. Methods: A total of 34 dancers—23 (68%) people with PD and 11 (32%) healthy controls—completed the Geriatric Depression Scale (GDS) before and after attending weekly community-based dance classes, referred to as Dance for PD classes. Specifically, we examined changes within the functional magnetic resonance imaging signal from the subcallosal cingulate gyrus (SCG), an important node within the depression network and a controversial target for deep brain stimulation in the treatment of major depressive disorder. Results: Depression scores on the GDS decreased in each preintervention to postintervention comparison (all P<.025). In addition, GDS scores also improved over the 8-month dance period (all P<.01). Blood oxygen level–dependent signals from frontal cortex brain region implicated for emotional regulation within the SCG decreased at each testing time point (all P<.05). Also, a significant decrease in depression scores (GDS) was correlated with reduced blood oxygen level–dependent signals from the SCG (P=.02). Conclusions: This study contributes to an improved understanding of the neural mechanisms that are involved in depression, as well as the beneficial contribution that longitudinal dance interventions have in reducing nonmotor symptoms associated with PD, particularly in depression symptoms. %R 10.2196/44426 %U https://xmed.jmir.org/2024/1/e44426 %U https://doi.org/10.2196/44426 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55986 %T Accuracy of Machine Learning in Detecting Pediatric Epileptic Seizures: Systematic Review and Meta-Analysis %A Zou,Zhuan %A Chen,Bin %A Xiao,Dongqiong %A Tang,Fajuan %A Li,Xihong %+ Department of Emergency, West China Second University Hospital, Sichuan University, No 20, Section 3, Renmin South Road, Wuhou District, Chengdu, 610000, China, 86 13551089846, lixihonghxey@163.com %K epileptic seizures %K machine learning %K deep learning %K electroencephalogram %K EEG %K children %K pediatrics %K epilepsy %K detection %D 2024 %7 11.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Real-time monitoring of pediatric epileptic seizures poses a significant challenge in clinical practice. In recent years, machine learning (ML) has attracted substantial attention from researchers for diagnosing and treating neurological diseases, leading to its application for detecting pediatric epileptic seizures. However, systematic evidence substantiating its feasibility remains limited. Objective: This systematic review aimed to consolidate the existing evidence regarding the effectiveness of ML in monitoring pediatric epileptic seizures with an effort to provide an evidence-based foundation for the development and enhancement of intelligent tools in the future. Methods: We conducted a systematic search of the PubMed, Cochrane, Embase, and Web of Science databases for original studies focused on the detection of pediatric epileptic seizures using ML, with a cutoff date of August 27, 2023. The risk of bias in eligible studies was assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies–2). Meta-analyses were performed to evaluate the C-index and the diagnostic 4-grid table, using a bivariate mixed-effects model for the latter. We also examined publication bias for the C-index by using funnel plots and the Egger test. Results: This systematic review included 28 original studies, with 15 studies on ML and 13 on deep learning (DL). All these models were based on electroencephalography data of children. The pooled C-index, sensitivity, specificity, and accuracy of ML in the training set were 0.76 (95% CI 0.69-0.82), 0.77 (95% CI 0.73-0.80), 0.74 (95% CI 0.70-0.77), and 0.75 (95% CI 0.72-0.77), respectively. In the validation set, the pooled C-index, sensitivity, specificity, and accuracy of ML were 0.73 (95% CI 0.67-0.79), 0.88 (95% CI 0.83-0.91), 0.83 (95% CI 0.71-0.90), and 0.78 (95% CI 0.73-0.82), respectively. Meanwhile, the pooled C-index of DL in the validation set was 0.91 (95% CI 0.88-0.94), with sensitivity, specificity, and accuracy being 0.89 (95% CI 0.85-0.91), 0.91 (95% CI 0.88-0.93), and 0.89 (95% CI 0.86-0.92), respectively. Conclusions: Our systematic review demonstrates promising accuracy of artificial intelligence methods in epilepsy detection. DL appears to offer higher detection accuracy than ML. These findings support the development of DL-based early-warning tools in future research. Trial Registration: PROSPERO CRD42023467260; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023467260 %M 39661965 %R 10.2196/55986 %U https://www.jmir.org/2024/1/e55986 %U https://doi.org/10.2196/55986 %U http://www.ncbi.nlm.nih.gov/pubmed/39661965 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e57661 %T Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study %A Barnes,Keely %A Sveistrup,Heidi %A Bayley,Mark %A Egan,Mary %A Bilodeau,Martin %A Rathbone,Michel %A Taljaard,Monica %A Karimijashni,Motahareh %A Marshall,Shawn %K brain injury %K virtual %K assessment %K remote %K evaluation %K concussion %K adult %K clinician review %K in-person %K comparison %K sensitivity %K reliability %K acceptability survey %K feasibility study %K psychometric properties %K vestibular/ocular motor screening %K VOMS %K workplace %K clinician %K hospital %K rehabilitation center %K brain %K neurology %K neuroscience %K neurotechnology %K technology %K digital intervention %K digital health %K psychometrics %K physical assessment %K clinical assessment %K workplace safety %K mobile phone %D 2024 %7 27.11.2024 %9 %J JMIR Neurotech %G English %X Background: Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective: The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods: People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results: The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: κ=0.38‐0.49) to excellent (VOMS change in symptoms: κ=1.0). Conclusions: The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision. International Registered Report Identifier (IRRID): RR2-10.2196/57663 %R 10.2196/57661 %U https://neuro.jmir.org/2024/1/e57661 %U https://doi.org/10.2196/57661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59749 %T Respiratory Strength Training Versus Respiratory Relaxation Training in the Rehabilitation of Physical Impairment, Function, and Return to Participation After Stroke: Protocol for a Randomized Controlled Trial %A Rose,Dorian K %A Brunetti,Gina %A Cavka,Kathryn %A Hoisington,J Brooke %A Snyder,Hannah %A Xue,Wei %A Smith,Barbara K %+ Department of Physical Therapy, University of Florida, College of PHHP; HSC; PO. Box 100154, Gainesville, FL, 32610-0154, United States, 1 352 273 8307, dkrose@phhp.ufl.edu %K stroke %K rehabilitation %K exercise %K clinical trial %K respiration %K wellness %K community based %D 2024 %7 27.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Persistent disability in chronic stroke survivors is often attributed to arm or leg weakness; however, respiratory muscle weakness also impedes poststroke rehabilitation, reduces quality of life, and increases the risk of health complications. Respiratory complications are common after stroke and place patients at risk for both prolonged functional disability and mortality. In addition, stroke survivors face ongoing cardiovascular disease that places them at risk for recurrent stroke. Objective: The study aims to compare the effects of 2 respiratory training programs, paired with individualized flexibility, strengthening, and cardiovascular exercise programs, on physiologic, activity, and societal participation outcomes in chronic stroke survivors. Methods: This study will be a randomized controlled trial. Participants are 80 community-dwelling adults with chronic stroke. In conjunction with a 24-session (3 times/week for 8 weeks), American Heart Association–informed, whole-body exercise program, participants will be randomized to receive either respiratory strength training or respiratory relaxation training. Study intervention will be directed by a physical therapist and take place in a community fitness center. Outcome assessments will occur in a clinical research center. The primary outcome measure is maximal respiratory pressure. Secondary outcome measures include airway clearance, walking endurance, spatial-temporal gait characteristics, community walking, functional strength and fatigue, depression, and societal participation measures. Longer-term societal participation is a complex domain that may be influenced by other factors beyond physical function. Participants’ health status will be monitored for 1 year following the intervention for falls, respiratory illness, and hospitalizations. Additional subanalyses will evaluate the effect of smoke exposure on short- and long-term outcomes. Outcome assessors are blinded to group assignments. Respiratory relaxation training is an active comparator, but no pure control group is included. Results: This study was funded in March 2020 with enrollment commencing in November 2020. Completion of enrollment is projected for May 2025 with a study projected end date of April 2026. Published results are anticipated in Fall 2026. Conclusions: Results from this study will improve our understanding of the additive benefits of respiratory exercises on short- and long-term physiologic, functional, and societal gains for these individuals. These data will be instructive to meet a current unmet rehabilitative need to promote patient-centered care and contribute to decreasing morbidity and mortality in chronic stroke survivors. Trial Registration: ClinicalTrials.gov: NCT05819333; https://clinicaltrials.gov/study/NCT05819333 International Registered Report Identifier (IRRID): DERR1-10.2196/59749 %M 39602207 %R 10.2196/59749 %U https://www.researchprotocols.org/2024/1/e59749 %U https://doi.org/10.2196/59749 %U http://www.ncbi.nlm.nih.gov/pubmed/39602207 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e59630 %T An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention %A Morrow,Emily L %A Nelson,Lyndsay A %A Duff,Melissa C %A Mayberry,Lindsay S %K chronic traumatic brain injury %K rehabilitation %K memory %K ecological momentary intervention %K text messaging %K mobile health %K mobile application %K digital health %K digital intervention %D 2024 %7 26.11.2024 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Memory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals’ behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. Objective: This study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message–based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. Methods: We developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI’s usability and acceptability. Results: Participants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. Conclusions: Testing MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users’ preferences and plan to test the efficacy of this tool in a future clinical trial. %R 10.2196/59630 %U https://rehab.jmir.org/2024/1/e59630 %U https://doi.org/10.2196/59630 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47754 %T Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study %A Fahr,Annina %A Kläy,Andrina %A Coka,Larissa S %A van Hedel,Hubertus J A %+ Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, Affoltern am Albis, 8910, Switzerland, 41 44 762 52 91, hubertus.vanhedel@kispi.uzh.ch %K neurorehabilitation %K single-case design %K interactive computer play %K cerebral palsy %K surface electromyography %K motor control %K mirror movements %K involuntary movements %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements. Objective: This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response–related factors in children with impaired SVMC undergoing inpatient neurorehabilitation. Methods: We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children’s Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment. Results: Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P<.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study. Conclusions: The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention. Trial Registration: German Clinical Trials Register DRKS00025184; https://tinyurl.com/msnkek9b %M 39556826 %R 10.2196/47754 %U https://formative.jmir.org/2024/1/e47754 %U https://doi.org/10.2196/47754 %U http://www.ncbi.nlm.nih.gov/pubmed/39556826 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59329 %T Collaborative Care to Improve Quality of Life for Anxiety and Depression in Posttraumatic Epilepsy (CoCarePTE): Protocol for a Randomized Hybrid Effectiveness-Implementation Trial %A Munger Clary,Heidi M %A Snively,Beverly M %A Cagle,Christian %A Kennerly,Richard %A Kimball,James N %A Alexander,Halley B %A Brenes,Gretchen A %A Moore,Justin B %A Hurley,Robin A %+ Department of Neurology, Wake Forest University School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC, 27157, United States, 1 3367167110, hmungerc@wakehealth.edu %K integrated care %K mental health %K seizures %K psychiatric comorbidity %K neurology clinic %K epilepsy %D 2024 %7 13.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety and depression in people with epilepsy are common and associated with poor outcomes; yet, they often go untreated due to poor mental health specialist access. Collaborative care is an integrated care model with a strong evidence base in primary care and medical settings, but it has not been evaluated in neurology clinics. Evaluating implementation outcomes when translating evidence-based interventions to new clinical settings to inform future scaling and incorporation into real-world practice is important. Objective: The Collaborative Care for Posttraumatic Epilepsy (CoCarePTE) trial aims to evaluate the effectiveness (improvement in emotional quality of life) and implementation of a collaborative care intervention for people with anxiety or depressive symptoms and posttraumatic epilepsy. Methods: CoCarePTE is a 2-site, randomized, single-blind, hybrid type 1 effectiveness-implementation trial that will randomize 60 adults to receive either neurology-based collaborative care or usual care. Adults receiving neurological care at participating centers with anxiety or depressive symptoms and a history of at least mild traumatic brain injury before epilepsy onset will be enrolled. The collaborative care intervention is a 24-week stepped-care model with video or telephone calls every 2 weeks by a care manager for measurement-based anxiety and depression care, seizure care monitoring, and brief therapy intervention delivery. This is supplemented by antidepressant prescribing recommendations by psychiatrists for neurologists via case conferences and care manager–facilitated team communication. In step 2 of the intervention, individuals with <50% symptom reduction by 10 weeks will receive an added 8-session remote cognitive behavioral therapy program. The study is powered to detect a moderate improvement in emotional quality of life. As a hybrid type 1 trial, effectiveness is the primary focus, with the primary outcome being a change in emotional quality of life at 6 months in the intervention group compared to control. Secondary effectiveness outcomes are 6-month changes in depression, anxiety, and overall quality of life. Implementation outcomes, including fidelity, acceptability, feasibility, and appropriateness, are evaluated before implementation and at 3 months. The primary effectiveness analysis will compare changes in emotional quality of life scores from baseline to 6 months between the intervention and control arms using multiple linear regression modeling, adjusting for study site and using an intent-to-treat approach. Results: Enrollment commenced in 2023, with modifications in the inclusion and exclusion made after the first 6 enrollees due to slow recruitment. Enrollment is expected to continue at least into early 2025. Conclusions: The CoCarePTE trial is novel in its use of a hybrid effectiveness-implementation design to evaluate an evidence-based mental health intervention in epilepsy, and by incorporating seizure care into a collaborative care model. If a significant improvement in emotional quality of life is found in the intervention group compared to usual care, this would support next step scaling or clinical implementation. Trial Registration: ClinicalTrials.gov NCT05353452; https://www.clinicaltrials.gov/study/NCT05353452 International Registered Report Identifier (IRRID): DERR1-10.2196/59329 %M 39535875 %R 10.2196/59329 %U https://www.researchprotocols.org/2024/1/e59329 %U https://doi.org/10.2196/59329 %U http://www.ncbi.nlm.nih.gov/pubmed/39535875 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51095 %T Assessing the Role of the Generative Pretrained Transformer (GPT) in Alzheimer’s Disease Management: Comparative Study of Neurologist- and Artificial Intelligence–Generated Responses %A Zeng,Jiaqi %A Zou,Xiaoyi %A Li,Shirong %A Tang,Yao %A Teng,Sisi %A Li,Huanhuan %A Wang,Changyu %A Wu,Yuxuan %A Zhang,Luyao %A Zhong,Yunheng %A Liu,Jialin %A Liu,Siru %+ Department of Medical Informatics, West China Medical School, No 37 Guoxue Road, Chengdu, 610041, China, 86 28 85422306, Dljl8@163.com %K Alzheimer's disease %K artificial intelligence %K AI %K large language model %K LLM %K Generative Pretrained Transformer %K GPT %K ChatGPT %K patient information %D 2024 %7 31.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder posing challenges to patients, caregivers, and society. Accessible and accurate information is crucial for effective AD management. Objective: This study aimed to evaluate the accuracy, comprehensibility, clarity, and usefulness of the Generative Pretrained Transformer’s (GPT) answers concerning the management and caregiving of patients with AD. Methods: In total, 14 questions related to the prevention, treatment, and care of AD were identified and posed to GPT-3.5 and GPT-4 in Chinese and English, respectively, and 4 respondent neurologists were asked to answer them. We generated 8 sets of responses (total 112) and randomly coded them in answer sheets. Next, 5 evaluator neurologists and 5 family members of patients were asked to rate the 112 responses using separate 5-point Likert scales. We evaluated the quality of the responses using a set of 8 questions rated on a 5-point Likert scale. To gauge comprehensibility and participant satisfaction, we included 3 questions dedicated to each aspect within the same set of 8 questions. Results: As of April 10, 2023, the 5 evaluator neurologists and 5 family members of patients with AD rated the 112 responses: GPT-3.5: n=28, 25%, responses; GPT-4: n=28, 25%, responses; respondent neurologists: 56 (50%) responses. The top 5 (4.5%) responses rated by evaluator neurologists had 4 (80%) GPT (GPT-3.5+GPT-4) responses and 1 (20%) respondent neurologist’s response. For the top 5 (4.5%) responses rated by patients’ family members, all but the third response were GPT responses. Based on the evaluation by neurologists, the neurologist-generated responses achieved a mean score of 3.9 (SD 0.7), while the GPT-generated responses scored significantly higher (mean 4.4, SD 0.6; P<.001). Language and model analyses revealed no significant differences in response quality between the GPT-3.5 and GPT-4 models (GPT-3.5: mean 4.3, SD 0.7; GPT-4: mean 4.4, SD 0.5; P=.51). However, English responses outperformed Chinese responses in terms of comprehensibility (Chinese responses: mean 4.1, SD 0.7; English responses: mean 4.6, SD 0.5; P=.005) and participant satisfaction (Chinese responses: mean 4.2, SD 0.8; English responses: mean 4.5, SD 0.5; P=.04). According to the evaluator neurologists’ review, Chinese responses had a mean score of 4.4 (SD 0.6), whereas English responses had a mean score of 4.5 (SD 0.5; P=.002). As for the family members of patients with AD, no significant differences were observed between GPT and neurologists, GPT-3.5 and GPT-4, or Chinese and English responses. Conclusions: GPT can provide patient education materials on AD for patients, their families and caregivers, nurses, and neurologists. This capability can contribute to the effective health care management of patients with AD, leading to enhanced patient outcomes. %M 39481104 %R 10.2196/51095 %U https://www.jmir.org/2024/1/e51095 %U https://doi.org/10.2196/51095 %U http://www.ncbi.nlm.nih.gov/pubmed/39481104 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53491 %T Self-Reported Patient and Provider Satisfaction With Neurology Telemedicine Visits After Rapid Telemedicine Implementation in an Urban Academic Center: Cross-Sectional Survey %A Robertson,Noah %A Syed,Maryam J %A Song,Bowen %A Kaur,Arshdeep %A Patel,Janaki G %A Marawar,Rohit %A Basha,Maysaa %A Zutshi,Deepti %+ Department of Neurology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, United States, 1 (313) 577 1245, dzutshi@med.wayne.edu %K telemedicine %K telehealth %K neurology %K eHealth %K teleneurology %K patient experience %K patient satisfaction %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many clinics and health systems implemented telemedicine appointment services out of necessity due to the COVID-19 pandemic. Objective: Our objective was to evaluate patient and general provider satisfaction with neurology telemedicine implementation at an urban academic medical center. Methods: Patients who had completed 1 or more teleneurology visits from April 1 to December 31, 2020, were asked to complete a survey regarding their demographic information and satisfaction with teleneurology visits. Providers of all specialties within the same hospital system were given a different survey to gather their experiences of providing telemedicine care. Results: Of the estimated 1500 patients who had completed a teleneurology visit within the given timeframe, 117 (7.8%) consented to complete the survey. Of these 117 respondents, most appointments were regarding epilepsy (n=59, 50.4%), followed by multiple sclerosis (n=33, 28.2%) and neuroimmunology (n=7, 6%). Overall, 74.4% (n=87) of patients rated their experience as 8 out of 10 or higher, with 10 being the highest satisfaction. Furthermore, 75.2% (n=88) of patients reported missing an appointment in the previous year due to transportation issues and thought telemedicine was more convenient instead. A significant relationship between racial or ethnic group and comfort sharing private information was found (P<.001), with 52% (26/50) of Black patients reporting that an office visit is better, compared to 25% (14/52) of non-Black patients. The provider survey gathered 40 responses, with 75% (n=30) of providers agreeing that virtual visits are a valuable tool for patient care and 80% (n=32) reporting few to no technical issues. The majority of provider respondents were physicians on faculty or staff (n=21, 52%), followed by residents or fellows (n=15, 38%) and nurse practitioners or physician assistants (n=4, 10%). Of the specialties represented, 15 (38%) of the providers were in neurology. Conclusions: Our study found adequate satisfaction among patients and providers regarding telemedicine implementation and its utility for patient care in a diverse urban population. Additionally, while access to technology and technology literacy are barriers to telemedical care, a substantial majority of patients who responded to the survey had access to devices (101/117, 86.3%) and were able to connect with few to no technological difficulties (84/117, 71.8%). One area identified by patients in need of improvement was comfortability in communicating via telemedicine with their providers. Furthermore, while providers agreed that telemedicine is a useful tool for patient care, it limits their ability to perform physical exams. More research and quality studies are needed to further appreciate and support the expansion of telemedical care into underserved and rural populations, especially in the area of subspecialty neurological care. %M 39476368 %R 10.2196/53491 %U https://formative.jmir.org/2024/1/e53491 %U https://doi.org/10.2196/53491 %U http://www.ncbi.nlm.nih.gov/pubmed/39476368 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59247 %T Discriminant Power of Smartphone-Derived Keystroke Dynamics for Mild Cognitive Impairment Compared to a Neuropsychological Screening Test: Cross-Sectional Study %A Park,Jin-Hyuck %+ Department of Occupational Therapy, College of Medical Science, Soonchunhyang University, Room 1401, Medical Science, 22, Soonchunhayng-ro, Shinchang-myeon, Asan, 31538, Republic of Korea, 82 41 530 4773, roophy@naver.com %K digital biomarker %K motor function %K digital device %K neuropsychological screening %K screening tools %K cognitive assessment %K mild cognitive impairment %K keystroke dynamics %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Conventional neuropsychological screening tools for mild cognitive impairment (MCI) face challenges in terms of accuracy and practicality. Digital health solutions, such as unobtrusively capturing smartphone interaction data, offer a promising alternative. However, the potential of digital biomarkers as a surrogate for MCI screening remains unclear, with few comparisons between smartphone interactions and existing screening tools. Objective: This study aimed to investigate the effectiveness of smartphone-derived keystroke dynamics, captured via the Neurokeys keyboard app, in distinguishing patients with MCI from healthy controls (HCs). This study also compared the discriminant performance of these digital biomarkers against the Korean version of the Montreal Cognitive Assessment (MoCA-K), which is widely used for MCI detection in clinical settings. Methods: A total of 64 HCs and 47 patients with MCI were recruited. Over a 1-month period, participants generated 3530 typing sessions, with 2740 (77.6%) analyzed for this study. Keystroke metrics, including hold time and flight time, were extracted. Receiver operating characteristics analysis was used to assess the sensitivity and specificity of keystroke dynamics in discriminating between HCs and patients with MCI. This study also explored the correlation between keystroke dynamics and MoCA-K scores. Results: Patients with MCI had significantly higher keystroke latency than HCs (P<.001). In particular, latency between key presses resulted in the highest sensitivity (97.9%) and specificity (96.9%). In addition, keystroke dynamics were significantly correlated with the MoCA-K (hold time: r=–.468; P<.001; flight time: r=–.497; P<.001), further supporting the validity of these digital biomarkers. Conclusions: These findings highlight the potential of smartphone-derived keystroke dynamics as an effective and ecologically valid tool for screening MCI. With higher sensitivity and specificity than the MoCA-K, particularly in measuring flight time, keystroke dynamics can serve as a noninvasive, scalable, and continuous method for early cognitive impairment detection. This novel approach could revolutionize MCI screening, offering a practical alternative to traditional tools in everyday settings. Trial Registration: Thai Clinical Trials Registry TCTR20220415002; https://www.thaiclinicaltrials.org/show/TCTR20220415002 %M 39475819 %R 10.2196/59247 %U https://www.jmir.org/2024/1/e59247 %U https://doi.org/10.2196/59247 %U http://www.ncbi.nlm.nih.gov/pubmed/39475819 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59018 %T Impact of Dance or Music and Meditation on the Progression of Parkinson Disease With Mild or Moderate Severity: Protocol for a Pilot Randomized Controlled Trial %A Mehrotra,Bhagyashree %A Rai,Neha %A MR,Rajani %A Budhakar,Aparna %A Aggarwal,Ritika %A Agarbattiwala,Raj Vinodkumar %A Thomas,Mona %A Patole,Sampada %A Doshi,Paresh %+ Stereotactic and Functional Neurosurgery Department, Jaslok Hospital and Research Centre, 15, G Deshmukh Marg, Pedder Road, IT Colony, Tardeo, Mumbai, 400026, India, 91 9820063854, pdoshi@neurologicalsurgery.in %K music therapy %K dance therapy %K neurodegenerative disorders %K meditation %K quality of life %K music %K pilot study %K Parkinson disease %K well-being %D 2024 %7 29.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor dysfunctions and nonmotor symptoms. Current treatments do not alter disease progression, highlighting the need for alternative therapies. Music, dance, and mindfulness meditation have shown the potential to improve symptoms and quality of life in patients with PD. Objective: This study aims to evaluate the effectiveness of dance or music and meditation on PD progression, cognitive functions, mood, behavior, and caregiver burden. Methods: This study is a single-blinded, longitudinal, parallel, randomized controlled trial. The participants consist of 30 patients with mild to moderate PD residing in Mumbai, India, who can physically participate in the activities. The exclusion criteria include advanced PD, severe balance issues, age >80 years, and other movement disorders. Participants in the intervention group will engage in dance or music sessions and guided meditation thrice weekly for 6 months. The control group will continue their usual activities and medication. The primary outcome is the progression of PD symptoms, measured using the Unified Parkinson’s Disease Rating Scale I-III, and quality of life, measured using the Parkinson’s Disease Questionnaire-39. The secondary outcomes include cognitive functions (Mini-Mental State Examination), mood (Beck Depression Inventory and Parkinson Anxiety Scale), mobility (timed up and go and Berg Balance Test), behavioral disorders (Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale), and caregiver burden (Zarit Burden Interview and Parkinson’s Disease Questionnaire-Carer). Results: Data collection was completed in February 2024, with 28 participants finishing the study (intervention group: n=15, 54% and control group: n=13, 46%). Data analysis is underway, with results expected to be published in December 2024. Conclusions: This study aims to provide significant insights into the effectiveness of dance or music and meditation in improving the quality of life and slowing the progression of PD. The findings are anticipated to support using these nonpharmaceutical therapies as complementary approaches to managing PD. Trial Registration: CTRI/2023/03/051064; https://tinyurl.com/2xdus53j International Registered Report Identifier (IRRID): DERR1-10.2196/59018 %M 39471378 %R 10.2196/59018 %U https://www.researchprotocols.org/2024/1/e59018 %U https://doi.org/10.2196/59018 %U http://www.ncbi.nlm.nih.gov/pubmed/39471378 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57503 %T Comparison of the Burdens and Attitudes Between Standard and Web-Based Remote Programming for Deep Brain Stimulation in Parkinson Disease: Survey Study %A Wan,Xiaonan %A Lin,Zhengyu %A Duan,Chengcheng %A Zeng,Zhitong %A Zhang,Chencheng %A Li,Dianyou %K remote programming %K Parkinson disease %K deep brain stimulation %K telemedicine %K economic evaluation %D 2024 %7 23.10.2024 %9 %J JMIR Aging %G English %X Background: Remote programming enables physicians to adjust implantable pulse generators over the internet for patients with Parkinson disease who have undergone deep brain stimulation (DBS) surgery. Despite these technological advances, the demand for and attitudes toward remote programming compared with standard programming among patients with Parkinson disease are still not well understood. Objective: This study aims to investigate the preferences and perceptions associated with these 2 programming methods among patients with Parkinson disease through a web-based survey. Methods: A web-based survey was administered to 463 patients with Parkinson disease who have undergone DBS surgery. The survey aimed to assess the burdens associated with postoperative programming and to compare patients’ attitudes toward the 2 different programming methods. Results: A total of 225 patients completed the survey, all of whom had undergone standard programming, while 132 patients had also experienced remote programming. Among those who received standard programming, 191 (85%) patients required the support of more than 1 caregiver, 129 (58%) patients experienced over 2 days of lost work time, 98 (42%) patients incurred expenses ranging from US $42 to US $146, and 14 (6%) patients spent over US $421. Of the 132 patients who had used remote programming, 81 (62%) patients indicated a preference for remote programming in the future. However, challenges with remote programming persisted, including difficulties in obtaining official prescriptions, a lack of medical insurance coverage, and limited medical resources. Conclusions: Postoperative programming of DBS imposes significant burdens on patients and their caregivers during standard programming sessions—burdens that could be mitigated through remote programming. While patient satisfaction with remote programming is high, it is imperative for clinicians to develop personalized programming strategies tailored to the needs of different patients. %R 10.2196/57503 %U https://aging.jmir.org/2024/1/e57503 %U https://doi.org/10.2196/57503 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e57940 %T Integrated Approach Using Intuitionistic Fuzzy Multicriteria Decision-Making to Support Classifier Selection for Technology Adoption in Patients with Parkinson Disease: Algorithm Development and Validation %A Ortiz-Barrios,Miguel %A Cleland,Ian %A Donnelly,Mark %A Gul,Muhammet %A Yucesan,Melih %A Jiménez-Delgado,Genett Isabel %A Nugent,Chris %A Madrid-Sierra,Stephany %K Parkinson disease %K technology adoption %K intuitionistic fuzzy analytic hierarchy process %K intuitionistic fuzzy decision-making trial and evaluation laboratory %K combined compromise solution %D 2024 %7 22.10.2024 %9 %J JMIR Rehabil Assist Technol %G English %X Background: Parkinson disease (PD) is reported to be among the most prevalent neurodegenerative diseases globally, presenting ongoing challenges and increasing burden on health care systems. In an effort to support patients with PD, their carers, and the wider health care sector to manage this incurable condition, the focus has begun to shift away from traditional treatments. One of the most contemporary treatments includes prescribing assistive technologies (ATs), which are viewed as a way to promote independent living and deliver remote care. However, the uptake of these ATs is varied, with some users not ready or willing to accept all forms of AT and others only willing to adopt low-technology solutions. Consequently, to manage both the demands on resources and the efficiency with which ATs are deployed, new approaches are needed to automatically assess or predict a user’s likelihood to accept and adopt a particular AT before it is prescribed. Classification algorithms can be used to automatically consider the range of factors impacting AT adoption likelihood, thereby potentially supporting more effective AT allocation. From a computational perspective, different classification algorithms and selection criteria offer various opportunities and challenges to address this need. Objective: This paper presents a novel hybrid multicriteria decision-making approach to support classifier selection in technology adoption processes involving patients with PD. Methods: First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) was implemented to calculate the relative priorities of criteria and subcriteria considering experts’ knowledge and uncertainty. Second, the intuitionistic fuzzy decision-making trial and evaluation laboratory (IF-DEMATEL) was applied to evaluate the cause-effect relationships among criteria/subcriteria. Finally, the combined compromise solution (CoCoSo) was used to rank the candidate classifiers based on their capability to model the technology adoption. Results: We conducted a study involving a mobile smartphone solution to validate the proposed methodology. Structure (F5) was identified as the factor with the highest relative priority (overall weight=0.214), while adaptability (F4) (D-R=1.234) was found to be the most influencing aspect when selecting classifiers for technology adoption in patients with PD. In this case, the most appropriate algorithm for supporting technology adoption in patients with PD was the A3 - J48 decision tree (M3=2.5592). The results obtained by comparing the CoCoSo method in the proposed approach with 2 alternative methods (simple additive weighting and technique for order of preference by similarity to ideal solution) support the accuracy and applicability of the proposed methodology. It was observed that the final scores of the algorithms in each method were highly correlated (Pearson correlation coefficient >0.8). Conclusions: The IF-AHP-IF-DEMATEL-CoCoSo approach helped to identify classification algorithms that do not just discriminate between good and bad adopters of assistive technologies within the Parkinson population but also consider technology-specific features like design, quality, and compatibility that make these classifiers easily implementable by clinicians in the health care system. %R 10.2196/57940 %U https://rehab.jmir.org/2024/1/e57940 %U https://doi.org/10.2196/57940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58419 %T Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial %A Pogrebnoy,Dina %A Ashton,Lee %A Beh,Brian A %A Burke,Meredith %A Cullen,Richard %A Czerenkowski,Jude %A Davey,Julie %A Dennett,Amy M %A English,Kevin %A Godecke,Erin %A Harper,Nicole %A Lynch,Elizabeth %A MacDonald-Wicks,Lesley %A Patterson,Amanda %A Ramage,Emily %A Schelfhaut,Ben %A Simpson,Dawn B %A Zacharia,Karly %A English,Coralie %+ Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia, 61 0403432415, dina.pogrebnoy@uon.edu.au %K stroke %K secondary prevention %K co-design %K how-to guide, website development %K accessibility %K navigation %K self-management %D 2024 %7 22.10.2024 %9 Tutorial %J J Med Internet Res %G English %X People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the “design thinking” framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND – Let’s get moving (physical activity intervention) and i-REBOUND – Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND – Let’s get moving and i-REBOUND – Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke. %M 39437389 %R 10.2196/58419 %U https://www.jmir.org/2024/1/e58419 %U https://doi.org/10.2196/58419 %U http://www.ncbi.nlm.nih.gov/pubmed/39437389 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43954 %T Data Visualization Preferences in Remote Measurement Technology for Individuals Living With Depression, Epilepsy, and Multiple Sclerosis: Qualitative Study %A Simblett,Sara %A Dawe-Lane,Erin %A Gilpin,Gina %A Morris,Daniel %A White,Katie %A Erturk,Sinan %A Devonshire,Julie %A Lees,Simon %A Zormpas,Spyridon %A Polhemus,Ashley %A Temesi,Gergely %A Cummins,Nicholas %A Hotopf,Matthew %A Wykes,Til %A , %+ Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 02078480762, sara.simblett@kcl.ac.uk %K mHealth %K qualitative %K technology %K depression %K epilepsy %K multiple sclerosis %K wearables %K devices %K smartphone apps %K application %K feedback %K users %K data %K data visualization %K mobile phone %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Remote measurement technology (RMT) involves the use of wearable devices and smartphone apps to measure health outcomes in everyday life. RMT with feedback in the form of data visual representations can facilitate self-management of chronic health conditions, promote health care engagement, and present opportunities for intervention. Studies to date focus broadly on multiple dimensions of service users’ design preferences and RMT user experiences (eg, health variables of perceived importance and perceived quality of medical advice provided) as opposed to data visualization preferences. Objective: This study aims to explore data visualization preferences and priorities in RMT, with individuals living with depression, those with epilepsy, and those with multiple sclerosis (MS). Methods: A triangulated qualitative study comparing and thematically synthesizing focus group discussions with user reviews of existing self-management apps and a systematic review of RMT data visualization preferences. A total of 45 people participated in 6 focus groups across the 3 health conditions (depression, n=17; epilepsy, n=11; and MS, n=17). Results: Thematic analysis validated a major theme around design preferences and recommendations and identified a further four minor themes: (1) data reporting, (2) impact of visualization, (3) moderators of visualization preferences, and (4) system-related factors and features. Conclusions: When used effectively, data visualizations are valuable, engaging components of RMT. Easy to use and intuitive data visualization design was lauded by individuals with neurological and psychiatric conditions. Apps design needs to consider the unique requirements of service users. Overall, this study offers RMT developers a comprehensive outline of the data visualization preferences of individuals living with depression, epilepsy, and MS. %M 39423366 %R 10.2196/43954 %U https://www.jmir.org/2024/1/e43954 %U https://doi.org/10.2196/43954 %U http://www.ncbi.nlm.nih.gov/pubmed/39423366 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e57727 %T Semiology Extraction and Machine Learning–Based Classification of Electronic Health Records for Patients With Epilepsy: Retrospective Analysis %A Xia,Yilin %A He,Mengqiao %A Basang,Sijia %A Sha,Leihao %A Huang,Zijie %A Jin,Ling %A Duan,Yifei %A Tang,Yusha %A Li,Hua %A Lai,Wanlin %A Chen,Lei %K epilepsy %K natural language processing %K machine learning %K electronic health record %K unstructured text %K semiology %K health records %K retrospective analysis %K diagnosis %K treatment %K decision support tools %K symptom %K ontology %K China %K Chinese %K seizure %D 2024 %7 17.10.2024 %9 %J JMIR Med Inform %G English %X Background: Obtaining and describing semiology efficiently and classifying seizure types correctly are crucial for the diagnosis and treatment of epilepsy. Nevertheless, there exists an inadequacy in related informatics resources and decision support tools. Objective: We developed a symptom entity extraction tool and an epilepsy semiology ontology (ESO) and used machine learning to achieve an automated binary classification of epilepsy in this study. Methods: Using present history data of electronic health records from the Southwest Epilepsy Center in China, we constructed an ESO and a symptom-entity extraction tool to extract seizure duration, seizure symptoms, and seizure frequency from the unstructured text by combining manual annotation with natural language processing techniques. In addition, we achieved automatic classification of patients in the study cohort with high accuracy based on the extracted seizure feature data using multiple machine learning methods. Results: Data included present history from 10,925 cases between 2010 and 2020. Six annotators labeled a total of 2500 texts to obtain 5844 words of semiology and construct an ESO with 702 terms. Based on the ontology, the extraction tool achieved an accuracy rate of 85% in symptom extraction. Furthermore, we trained a stacking ensemble learning model combining XGBoost and random forest with an F1-score of 75.03%. The random forest model had the highest area under the curve (0.985). Conclusions: This work demonstrated the feasibility of natural language processing–assisted structural extraction of epilepsy medical record texts and downstream tasks, providing open ontology resources for subsequent related work. %R 10.2196/57727 %U https://medinform.jmir.org/2024/1/e57727 %U https://doi.org/10.2196/57727 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57325 %T Fact or Fiction—Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study %A DeMatteo,Carol %A Randall,Sarah %A Jakubowski,Josephine %A Stazyk,Kathy %A Obeid,Joyce %A Noseworthy,Michael %A Mazurek,Michael %A Timmons,Brian W %A Connolly,John %A Giglia,Lucia %A Hall,Geoffrey %A Lin,Chia-Yu %A Perrotta,Samantha %K pediatric concussion %K guidelines %K adherence %K return to school %K return to sport %K actigraphy %D 2024 %7 9.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1‐17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population. Objective: This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury. Methods: Children and youth (N=139) aged 5‐18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution. Results: For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3). Conclusions: Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols. %R 10.2196/57325 %U https://pediatrics.jmir.org/2024/1/e57325 %U https://doi.org/10.2196/57325 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57685 %T Development and Evaluation of the Telehealth in Motor Neuron Disease System: The TIME Study Protocol %A Knox,Liam %A Coates,Elizabeth %A Griffiths,Alys %A Ali,Yasmin %A Hobson,Esther %A McDermott,Christopher %+ School of Neuroscience, University of Sheffield, Sheffield Institute For Translational Neuroscience, 385a Glossop Road, Sheffield, S10 2HQ, United Kingdom, 44 07387587319, l.knox@sheffield.ac.uk %K motor neuron disease %K amyotrophic lateral sclerosis %K telehealth %K digital health %K process evaluation %K implementation %K co-production %K digital technology %K mhealth %K eHealth %K virtual medicine %D 2024 %7 8.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: For more responsive care provision for motor neuron disease and caregivers, a digital system called Telehealth in MND-Care (TiM-C) was created. TiM-C sends regular symptom questionnaires to users; their responses are sent to health care professionals (HCPs). To enable people with motor neuron disease to participate in research studies more easily, a parallel platform was developed from TiM-C, called Telehealth in MND-Research (TiM-R). TiM-R can advertise studies, collect data, and make them available to MND researchers. Objective: This study has 4 work packages (WPs) to facilitate service approval, codevelop the TiM systems, and evaluate the service. Each WP aims to understand (1) what helps and hinders the approval of the TiM-C system as a National Health Service; (2) what aspects of MND care and research are currently unmet and can be addressed through the TiM-C and TiM-R systems; (3) how TiM-C influences MND care, from the perspective of people with motor neuron disease, their caregivers, and HCPs; and (4) the costs and benefits associated with TiM-C. Methods: WP1 will use semistructured interviews with 10-15 people involved in the approval of TiM-C to understand the barriers and facilitators to governance processes. WP2 will use individual and group interviews with 25-35 users (people with motor neuron disease, caregivers, HCPs, MND researchers, and industry) of TiM-C and TiM-R to understand the current unmet needs of these user groups and how TiM services can be developed to meet these needs. WP3 will use a process evaluation involving 5 elements; local context, engagement, user experiences, service impact, and mechanisms of action. A range of methods, including audits, analysis of routine data, questionnaires, interviews, and observations will be used with people with motor neuron disease, caregivers, and HCPs, both those using the system and those who declined the service when invited. WP4 will use data collected through the process evaluation and known costs to conduct a cost-consequence and budget impact analysis to explore the cost-benefit of the TiM-C service. Most data collected will be qualitative, with thematic and framework analysis used to develop themes from transcripts and observations. Descriptive statistics or t tests and chi-square tests will be used to describe and analyze quantitative data. Results: This study has received ethical approval and has begun recruitment in 1 site. Further, 13 specialist MND centers will adopt TiM-C and the TIME study, beginning in July 2024. The study will conclude in November 2026 and a final report will be produced 3 months after the completion date. Conclusions: This study will facilitate the implementation and development of TiM-C and TiM-R and fully evaluate the TiM-C service, enabling informed decision-making among health care providers regarding continued involvement and contribute to the wider literature relating to how technology-enabled care services can affect clinical care. International Registered Report Identifier (IRRID): DERR1-10.2196/57685 %M 39378421 %R 10.2196/57685 %U https://www.researchprotocols.org/2024/1/e57685 %U https://doi.org/10.2196/57685 %U http://www.ncbi.nlm.nih.gov/pubmed/39378421 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56424 %T Effects of Combined Visual-Motor Response Training on Cognitive Function and Brain Plasticity Mechanisms in Various Populations: Protocol for a Single-Center, Open-Label, Controlled Clinical Trial %A Yu,Wenlong %A Gao,Jiamin %A Zhu,Ping %+ Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China, 86 13817959206, 13817959206@126.com %K visual-motor %K response ability training %K cognitive function %K brain plasticity mechanism %K study protocol %D 2024 %7 7.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive impairment is one of the major diseases facing the aging population. The progressive decline of cognitive function can lead to declining health or even the loss of life, work, and social ability. Exercise and behavioral stimulation can increase neurotransmitters in the brain and improve overall health and cognitive function. Reactivity training can mobilize neuromuscular function and induce changes in brain plasticity, which may effectively improve cognitive dysfunction and delay the occurrence and development of Alzheimer disease; however, the evidence supporting its effectiveness is still limited. Objective: This study aims to explore the effectiveness and reliability of visual-motor reaction training in improving cognitive function, thereby promoting the application of novel nonpharmacological therapies. Methods: This study is a single-center, open-label, controlled clinical trial. A total of 78 participants will be recruited for the study, including an equal number of athletes, ordinary healthy college students, and ordinary older adults in the community. Participants will receive 2 weeks of visual-motor response training. The primary outcome of this study is to assess differences in functional magnetic resonance imaging (fMRI) at 2 weeks. The secondary outcomes were the following: acousto-optic response time, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Mini Mental State Examination (MMSE), Activity of Daily Living (ADL) Scale, Subjective Cognitive Decline Questionnaire–9 (SCD-Q9), a 10-word memory test, and safety. Results: The study was approved by the Shanghai Clinical Research Ethics Committee on January 2, 2024 (SECCR/2023-162-01). As of September 11, 2024, we have completed the recruitment of all 3 groups of volunteers. We expect to complete data collection and analysis by February 2025. Conclusions: The purpose of this study is to compare improvements in brain perceptual motor functions and cognitive levels across different populations through response ability training and to explore the efficacy and safety of exercise-based nonpharmacological therapies in improving cognitive function. Other potential benefits include understanding the functional differences and perceptual characteristics of the brain’s perceptual-motor system between athletes and the general population and exploring the adaptability of the brain in acquiring skills during competitive sports training. This could provide an evidence base for early sports talent development and broader youth development. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079602; https://tinyurl.com/23fbbndw International Registered Report Identifier (IRRID): DERR1-10.2196/56424 %M 39167080 %R 10.2196/56424 %U https://www.researchprotocols.org/2024/1/e56424 %U https://doi.org/10.2196/56424 %U http://www.ncbi.nlm.nih.gov/pubmed/39167080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56922 %T Machine Learning–Based Prediction of Neurodegenerative Disease in Patients With Type 2 Diabetes by Derivation and Validation in 2 Independent Korean Cohorts: Model Development and Validation Study %A Sang,Hyunji %A Lee,Hojae %A Park,Jaeyu %A Kim,Sunyoung %A Woo,Ho Geol %A Koyanagi,Ai %A Smith,Lee %A Lee,Sihoon %A Hwang,You-Cheol %A Park,Tae Sun %A Lim,Hyunjung %A Yon,Dong Keon %A Rhee,Sang Youl %+ Department of Endocrinology and Metabolism, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 2 958 8200, bard95@hanmail.net %K machine learning %K neurodegenerative disease %K diabetes mellitus %K prediction %K AdaBoost %D 2024 %7 3.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Several machine learning (ML) prediction models for neurodegenerative diseases (NDs) in type 2 diabetes mellitus (T2DM) have recently been developed. However, the predictive power of these models is limited by the lack of multiple risk factors. Objective: This study aimed to assess the validity and use of an ML model for predicting the 3-year incidence of ND in patients with T2DM. Methods: We used data from 2 independent cohorts—the discovery cohort (1 hospital; n=22,311) and the validation cohort (2 hospitals; n=2915)—to predict ND. The outcome of interest was the presence or absence of ND at 3 years. We selected different ML-based models with hyperparameter tuning in the discovery cohort and conducted an area under the receiver operating characteristic curve (AUROC) analysis in the validation cohort. Results: The study dataset included 22,311 (discovery) and 2915 (validation) patients with T2DM recruited between 2008 and 2022. ND was observed in 133 (0.6%) and 15 patients (0.5%) in the discovery and validation cohorts, respectively. The AdaBoost model had a mean AUROC of 0.82 (95% CI 0.79-0.85) in the discovery dataset. When this result was applied to the validation dataset, the AdaBoost model exhibited the best performance among the models, with an AUROC of 0.83 (accuracy of 78.6%, sensitivity of 78.6%, specificity of 78.6%, and balanced accuracy of 78.6%). The most influential factors in the AdaBoost model were age and cardiovascular disease. Conclusions: This study shows the use and feasibility of ML for assessing the incidence of ND in patients with T2DM and suggests its potential for use in screening patients. Further international studies are required to validate these findings. %M 39361401 %R 10.2196/56922 %U https://www.jmir.org/2024/1/e56922 %U https://doi.org/10.2196/56922 %U http://www.ncbi.nlm.nih.gov/pubmed/39361401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58763 %T Racial and Ethnic Differences in Traumatic Brain Injury Outcomes From 2009 to 2023: Protocol for a Systematic Review %A Pappadis,Monique R %A Talley,Kelli G %A Garcia,Patricia %A Aguirre,Caitlin R %A Onwudebe,Chinedu K %A Smith,Michelle %A Lequerica,Anthony H %+ Sealy Center on Aging, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0177, United States, 1 409 747 1632, mrpappad@utmb.edu %K traumatic brain injury %K TBI %K health disparities %K racial and ethnic differences %K injury outcomes %K outcomes assessment %K social determinants of health %K neurorehabilitation %K evidence-based interventions %D 2024 %7 3.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2009, Gary and colleagues reviewed prior research examining racial and ethnic differences in outcomes after traumatic brain injury (TBI). Over the past 15 years, advances in research and changes in the demographic composition of the United States warrant a comprehensive understanding of racial and ethnic disparities after TBI. Objective: A systematic review will be conducted to examine racial and ethnic differences in TBI outcomes from 2009 to 2023. Methods: Preliminary searches and study screening processes will identify relevant English-language articles published from January 2009 to December 2023 using the CINAHL, Gale OneFile, PsycINFO (Ovid), and PubMed electronic databases. Relevant articles will include quantitative or mixed method approaches, involve individuals with TBI or their caregivers, and compare 2 or more groups by race or ethnicity on post-TBI outcomes. Quality will be assessed using the Newcastle-Ottawa Scale. This systematic review protocol was developed following PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Results will be summarized, and a subgroup analysis may be conducted based on demographics (eg, age, gender, or sex). Results: We have already identified abstracts using the search strategy for all 4 of the included electronic databases. We recently updated the search and will begin abstract screening of the additional abstracts identified from the last search completed in January 2024. This systematic review is anticipated to be completed by fall 2024, and its findings will be disseminated to the scientific community, persons with TBI, caregivers, and the lay audience. Conclusions: This systematic review will advance our understanding regarding outcome disparities among minoritized individuals with TBI, examine progress over the past 15 years in minimizing barriers encountered by these racial and ethnic groups, and provide professionals with a roadmap illustrating existing gaps in rehabilitation care, making way for further development and implementation of evidence-based interventions to improve health equity in TBI outcomes. Trial Registration: PROSPERO CRD42023394529; https://tinyurl.com/53mtcz9b International Registered Report Identifier (IRRID): PRR1-10.2196/58763 %M 39361416 %R 10.2196/58763 %U https://www.researchprotocols.org/2024/1/e58763 %U https://doi.org/10.2196/58763 %U http://www.ncbi.nlm.nih.gov/pubmed/39361416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51383 %T Optimizing ChatGPT’s Interpretation and Reporting of Delirium Assessment Outcomes: Exploratory Study %A Choi,Yong K %A Lin,Shih-Yin %A Fick,Donna Marie %A Shulman,Richard W %A Lee,Sangil %A Shrestha,Priyanka %A Santoso,Kate %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6051B Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 624 6442, yong.choi@pitt.edu %K generative artificial intelligence %K generative AI %K large language models %K ChatGPT %K delirium detection %K Sour Seven Questionnaire %K prompt engineering %K clinical vignettes %K medical education %K caregiver education %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Generative artificial intelligence (AI) and large language models, such as OpenAI’s ChatGPT, have shown promising potential in supporting medical education and clinical decision-making, given their vast knowledge base and natural language processing capabilities. As a general purpose AI system, ChatGPT can complete a wide range of tasks, including differential diagnosis without additional training. However, the specific application of ChatGPT in learning and applying a series of specialized, context-specific tasks mimicking the workflow of a human assessor, such as administering a standardized assessment questionnaire, followed by inputting assessment results in a standardized form, and interpretating assessment results strictly following credible, published scoring criteria, have not been thoroughly studied. Objective: This exploratory study aims to evaluate and optimize ChatGPT’s capabilities in administering and interpreting the Sour Seven Questionnaire, an informant-based delirium assessment tool. Specifically, the objectives were to train ChatGPT-3.5 and ChatGPT-4 to understand and correctly apply the Sour Seven Questionnaire to clinical vignettes using prompt engineering, assess the performance of these AI models in identifying and scoring delirium symptoms against scores from human experts, and refine and enhance the models’ interpretation and reporting accuracy through iterative prompt optimization. Methods: We used prompt engineering to train ChatGPT-3.5 and ChatGPT-4 models on the Sour Seven Questionnaire, a tool for assessing delirium through caregiver input. Prompt engineering is a methodology used to enhance the AI’s processing of inputs by meticulously structuring the prompts to improve accuracy and consistency in outputs. In this study, prompt engineering involved creating specific, structured commands that guided the AI models in understanding and applying the assessment tool’s criteria accurately to clinical vignettes. This approach also included designing prompts to explicitly instruct the AI on how to format its responses, ensuring they were consistent with clinical documentation standards. Results: Both ChatGPT models demonstrated promising proficiency in applying the Sour Seven Questionnaire to the vignettes, despite initial inconsistencies and errors. Performance notably improved through iterative prompt engineering, enhancing the models’ capacity to detect delirium symptoms and assign scores. Prompt optimizations included adjusting the scoring methodology to accept only definitive “Yes” or “No” responses, revising the evaluation prompt to mandate responses in a tabular format, and guiding the models to adhere to the 2 recommended actions specified in the Sour Seven Questionnaire. Conclusions: Our findings provide preliminary evidence supporting the potential utility of AI models such as ChatGPT in administering standardized clinical assessment tools. The results highlight the significance of context-specific training and prompt engineering in harnessing the full potential of these AI models for health care applications. Despite the encouraging results, broader generalizability and further validation in real-world settings warrant additional research. %M 39353189 %R 10.2196/51383 %U https://formative.jmir.org/2024/1/e51383 %U https://doi.org/10.2196/51383 %U http://www.ncbi.nlm.nih.gov/pubmed/39353189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52323 %T Game-Based Assessment of Peripheral Neuropathy Combining Sensor-Equipped Insoles, Video Games, and AI: Proof-of-Concept Study %A Ming,Antao %A Clemens,Vera %A Lorek,Elisabeth %A Wall,Janina %A Alhajjar,Ahmad %A Galazky,Imke %A Baum,Anne-Katrin %A Li,Yang %A Li,Meng %A Stober,Sebastian %A Mertens,Nils David %A Mertens,Peter Rene %+ University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto von Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany, 49 391 6713236, peter.mertens@med.ovgu.de %K diabetes mellitus %K metabolic syndrome %K peripheral neuropathy %K sensor-equipped insoles %K video games %K machine learning %K feature extraction %D 2024 %7 1.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Detecting peripheral neuropathy (PNP) is crucial in preventing complications such as foot ulceration. Clinical examinations for PNP are infrequently provided to patients at high risk due to restrictions on facilities, care providers, or time. A gamified health assessment approach combining wearable sensors holds the potential to address these challenges and provide individuals with instantaneous feedback on their health status. Objective: We aimed to develop and evaluate an application that assesses PNP through video games controlled by pressure sensor–equipped insoles. Methods: In the proof-of-concept exploratory cohort study, a complete game-based framework that allowed the study participant to play 4 video games solely by modulating plantar pressure values was established in an outpatient clinic setting. Foot plantar pressures were measured by the sensor-equipped insole and transferred via Bluetooth to an Android tablet for game control in real time. Game results and sensor data were delivered to the study server for visualization and analysis. Each session lasted about 15 minutes. In total, 299 patients with diabetes mellitus and 30 with metabolic syndrome were tested using the game application. Patients’ game performance was initially assessed by hypothesis-driven key capabilities that consisted of reaction time, sensation, skillfulness, balance, endurance, and muscle strength. Subsequently, specific game features were extracted from gaming data sets and compared with nerve conduction study findings, neuropathy symptoms, or disability scores. Multiple machine learning algorithms were applied to 70% (n=122) of acquired data to train predictive models for PNP, while the remaining data were held out for final model evaluation. Results: Overall, clinically evident PNP was present in 247 of 329 (75.1%) participants, with 88 (26.7%) individuals showing asymmetric nerve deficits. In a subcohort (n=37) undergoing nerve conduction study as the gold standard, sensory and motor nerve conduction velocities and nerve amplitudes in lower extremities significantly correlated with 79 game features (|R|>0.4, highest R value +0.65; P<.001; adjusted R2=0.36). Within another subcohort (n=173) with normal cognition and matched covariates (age, sex, BMI, etc), hypothesis-driven key capabilities and specific game features were significantly correlated with the presence of PNP. Predictive models using selected game features achieved 76.1% (left) and 81.7% (right foot) accuracy for PNP detection. Multiclass models yielded an area under the receiver operating characteristic curve of 0.76 (left foot) and 0.72 (right foot) for assessing nerve damage patterns (small, large, or mixed nerve fiber damage). Conclusions: The game-based application presents a promising avenue for PNP screening and classification. Evaluation in expanded cohorts may iteratively optimize artificial intelligence model efficacy. The integration of engaging motivational elements and automated data interpretation will support acceptance as a telemedical application. %M 39353184 %R 10.2196/52323 %U https://www.jmir.org/2024/1/e52323 %U https://doi.org/10.2196/52323 %U http://www.ncbi.nlm.nih.gov/pubmed/39353184 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e51606 %T Development of MyREADY Transition BBD Mobile App, a Health Intervention Technology Platform, to Improve Care Transition for Youth With Brain-Based Disabilities: User-Centered Design Approach %A Marelli,Ariane %A Rozenblum,Ronen %A Bolster-Foucault,Clara %A Via-Dufresne Ley,Alicia %A Maynard,Noemie %A Amaria,Khush %A Galuppi,Barb %A Strohm,Sonya %A Nguyen,Linda %A Dawe-McCord,Claire %A Putterman,Connie %A Kovacs,Adrienne H %A Gorter,Jan Willem %+ McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, 1001 Decarie Boulevard, D055108, Montreal, QC, H4A3J1, Canada, 1 5149341934 ext 31978, ariane.marelli@mcgill.ca %K patient-centered care %K patient engagement %K mobile app %K health IT %K health care transition %K mobile phone %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Transition from pediatric to adult health care varies and is resource intensive. Patient-centered health information technology (HIT) interventions are increasingly being developed in partnership with patients. Objective: This study aims to develop an internet-based mobile app intervention for patients with brain-based disabilities to improve transition in care readiness. Methods: The app was designed for patients aged 15 to 17 years with brain-based disabilities having the ability to use a mobile app. A multidisciplinary team, an industry partner, and a patient and family advisory council was assembled. We hypothesized that existing tools could be migrated into the app to address education, empowerment, and navigation. We used cognitive learning theory to support chapters targeting transition in care skill sets. We used the agile iterative methodology to engage stakeholders. Results: We developed a novel MyREADY Transition HIT platform. An electronic mentor supported cognitive learning with messaging, quizzes, rewards, and videos. We used gaming to guide navigation through a fictitious health care city. Adapting existing tools was achieved by the patient and family advisory council requesting personalization. Our iterative design required time-consuming back-end technology management. Developing the platform took 24 months instead of our grant-approved 12 months, impacting the onset of the planned trial within the allotted budget. Conclusions: A novel patient-centered HIT platform to improve health care transition was successfully developed in partnership with patients and industry. Careful resource management was needed to achieve timely delivery of the end product, flagging the cautious planning required to deliver HIT tools in time for the much-needed trials informing their clinical application. Trial Registration: ClinicalTrials.gov NCT03852550; https://clinicaltrials.gov/study/NCT03852550 %M 39352737 %R 10.2196/51606 %U https://pediatrics.jmir.org/2024/1/e51606 %U https://doi.org/10.2196/51606 %U http://www.ncbi.nlm.nih.gov/pubmed/39352737 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58079 %T Italian Version of the mHealth App Usability Questionnaire (Ita-MAUQ): Translation and Validation Study in People With Multiple Sclerosis %A Podda,Jessica %A Grange,Erica %A Susini,Alessia %A Tacchino,Andrea %A Di Antonio,Federica %A Pedullà,Ludovico %A Brichetto,Giampaolo %A Ponzio,Michela %K mHealth %K multiple sclerosis %K cognitive assessment %K questionnaire validation %K usability %K mHealth app %K mHealth application %K validation study %K MAUQ %K app usability %K telemedicine %K disability %K usability questionnaire %K mobile health %D 2024 %7 30.9.2024 %9 %J JMIR Hum Factors %G English %X Background: Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires. Objective: This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS. Methods: The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender. Results: In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach α=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02). Conclusions: The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS. %R 10.2196/58079 %U https://humanfactors.jmir.org/2024/1/e58079 %U https://doi.org/10.2196/58079 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59876 %T Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis With Ambulatory Cognitive Tests: Protocol for the Longitudinal Observational CogDetect-MS Study %A Kratz,Anna Louise %A Ehde,Dawn M %A Alschuler,Kevin N %A Pickup,Kristen %A Ginell,Keara %A Fritz,Nora E %+ Department of Physical Medicine and Rehabilitation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Room G17-W, Ann Arbor, MI, 48109, United States, 1 734 647 5982, alkratz@med.umich.edu %K ambulatory assessment %K longitudinal data collection %K ecological momentary assessment %K cognitive function %K cognitive assessment %K multiple sclerosis %K physical activity %K neuropsychology %K physical function %K observational study %K wrist-worn accelerometry %K social function %K smartphone app %K mobile phone %D 2024 %7 26.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive dysfunction is a common problem in multiple sclerosis (MS). Progress toward understanding and treating cognitive dysfunction is thwarted by the limitations of traditional cognitive tests, which demonstrate poor sensitivity and ecological validity. Ambulatory methods of assessing cognitive function in the lived environment may improve the detection of subtle changes in cognitive function and the identification of predictors of cognitive changes and downstream effects of cognitive change on other functional domains. Objective: This paper describes the study design and protocol for the Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis (CogDetect-MS) study, a 2-year longitudinal observational study designed to examine short- and long-term changes in cognition, predictors of cognitive change, and effects of cognitive change on social and physical function in MS. Methods: Participants—ambulatory adults with medically documented MS—are assessed over the course of 2 years on an annual basis (3 assessments: T1, T2, and T3). A comprehensive survey battery, in-laboratory cognitive and physical performance tests, and 14 days of ambulatory data collection are completed at each annual assessment. The 14-day ambulatory data collection includes continuous wrist-worn accelerometry (to measure daytime activity and sleep); ecological momentary assessments (real-time self-report) of somatic symptoms, mood, and contextual factors; and 2 brief, validated cognitive tests, administered by smartphone app 4 times per day. Our aim was to recruit 250 participants. To ensure standard test protocol administration, all examiners passed a rigorous examiner certification process. Planned analyses include (1) nonparametric 2-tailed t tests to compare in-person to ambulatory cognitive test scores; (2) mixed effects models to examine cognitive changes over time; (3) mixed effects multilevel models to evaluate whether ambulatory measures of physical activity, sleep, fatigue, pain, mood, and stress predict changes in objective or subjective measures of cognitive functioning; and (4) mixed effects multilevel models to examine whether ambulatory measures of cognitive functioning predict social and physical functioning over short (within-day) and long (over years) time frames. Results: The study was funded in August 2021 and approved by the University of Michigan Medical Institutional Review Board on January 27, 2022. A total of 274 adults with MS (first participant enrolled on May 12, 2022) have been recruited and provided T1 data. Follow-up data collection will continue through March 2026. Conclusions: Results from the CogDetect-MS study will shed new light on the temporal dynamics of cognitive function, somatic and mood symptoms, sleep, physical activity, and physical and social function. These insights have the potential to improve our understanding of changes in cognitive function in MS and enable us to generate new interventions to maintain or improve cognitive function in those with MS. Trial Registration: ClinicalTrials.gov NCT05252195; https://clinicaltrials.gov/study/NCT05252195 International Registered Report Identifier (IRRID): DERR1-10.2196/59876 %M 39325510 %R 10.2196/59876 %U https://www.researchprotocols.org/2024/1/e59876 %U https://doi.org/10.2196/59876 %U http://www.ncbi.nlm.nih.gov/pubmed/39325510 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58845 %T Self-Management Systems for Patients and Clinicians in Parkinson Care: Protocol for an Integrated Scoping Review, Product Search, and Evaluation %A Boege,Selina %A Milne-Ives,Madison %A Meinert,Edward %A Carroll,Camille %+ Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, United Kingdom, 44 0191 208 6000, e.meinert14@imperial.ac.uk %K Parkinson’s disease %K digital health %K self-management %K health care systems %K self-care %K Parkinson %K mobile health %K mHeath %K evaluation %K acceptability %K usability %K decision-making support %K database %K qualitative %K quantitative %K mixed method %K perception %D 2024 %7 24.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) poses emotional and financial challenges to patients, families, caregivers, and health care systems. Self-management systems show promise in empowering people with PD and enabling more control over their treatment. The collaborative nature of PD care requires communication between patients and health care professionals. While past reviews explored self-management systems in PD diagnosis and symptom management with a focus on patient portals, there is limited research addressing the interconnectivity of systems catering to the needs of both patients and clinicians. A system’s acceptability and usability for clinicians are pivotal for enabling comprehensive data collection and supporting clinical decision-making, which can enhance patient care and treatment outcomes. Objective: This review study aims to assess PD self-management systems that include a clinician portal and to determine which features enhance acceptability and usability for clinicians. The primary aim is to assess evidence of clinicians’ acceptability and usability of self-management systems with a focus on the integration of systems into clinical workflows, data collection points, monitoring, clinical decision-making support, and extended education and training. Methods: The review will entail 3 separate stages: a literature review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a product search, and an evaluation of the level of evidence for the identified products. For the first stage, 5 databases will be searched: PubMed, CINAHL, Scopus, ACM digital library, and IEEE Xplore. Studies eligible for inclusion will be qualitative, quantitative, and mixed methods studies examining patients’ and clinician’s perceptions of the acceptability and usability of digital health interventions, synthesized by a narrative qualitative analysis. A web search in the iOS Apple App Store and Android Google Play Store will identify currently available tools; the level of evidence for these will then be assessed using the Oxford Centre for Evidence-Based Medicine guidelines. Results: Literature search and screening began soon after submission of the protocol, and the review is expected to be completed by end of September 2024. Conclusions: This review will examine currently available self-management systems in PD care, focusing on their acceptability and usability. This is significant because there is limited research addressing the integration of clinicians into these systems. The findings from this study may provide critical knowledge and insight to help inform future research and will contribute to the design of self-management systems that promote collaborative efforts in PD care. International Registered Report Identifier (IRRID): PRR1-10.2196/58845 %M 39316796 %R 10.2196/58845 %U https://www.researchprotocols.org/2024/1/e58845 %U https://doi.org/10.2196/58845 %U http://www.ncbi.nlm.nih.gov/pubmed/39316796 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64446 %T Prescribing Trends and Associated Outcomes of Antiepileptic Drugs and Other Psychotropic Medications in US Nursing Homes: Proposal for a Mixed Methods Investigation %A Winter,Jonathan D %A Kerns,J William %A Brandt,Nicole %A Wastila,Linda %A Qato,Danya %A Sabo,Roy T %A Petterson,Stephen %A Chung,YoonKyung %A Reves,Sarah %A Winter,Christopher %A Winter,Katherine M %A Elonge,Eposi %A Ewasiuk,Craig %A Fu,Yu-Hua %A Funk,Adam %A Krist,Alex %A Etz,Rebecca %+ Department of Family Medicine and Population Health, School of Medicine, Viginia Commonwealth University, 1001 East Leight St, Richmond, VA, 23219, United States, 1 5406313700, jwinter@valleyhealthlink.com %K Alzheimer disease %K dementia %K antiepileptic drug %K antiseizure medication %K antipsychotic %K National Partnership %K nursing home %K mood stabilizer %K COVID-19 %D 2024 %7 19.9.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Pilot data suggest that off-label, unmonitored antiepileptic drug prescribing for behavioral and psychological symptoms of dementia is increasing, replacing other psychotropic medications targeted by purposeful reduction efforts. This trend accelerated during the COVID-19 pandemic. Although adverse outcomes related to this trend remain unknown, preliminary results hint that harms may be increasing and concentrated in vulnerable populations. Objective: Using a mixed methods approach including both a retrospective secondary data analysis and a national clinician survey, this study aims to describe appropriate and potentially inappropriate antiepileptic and other psychoactive drug prescribing in US nursing homes (NHs), characteristics and patient-oriented outcomes associated with this prescribing, and how these phenomena may be changing under the combined stressors of the COVID-19 pandemic and the pressure of reduction initiatives. Methods: To accomplish the objective, resident-level, mixed-effects regression models and interrupted time-series analyses will draw on cohort elements linked at an individual level from the Centers for Medicare and Medicaid Services’ (CMS) Minimum Data Set, Medicare Part D, Medicare Provider Analysis and Review, and Outpatient and Public Use Files. Quarterly cohorts of NH residents (2009-2021) will incorporate individual-level data, including demographics; health status; disease variables; psychotropic medication claims; comprehensive NH health outcomes; hospital and emergency department adverse events; and NH details, including staffing resources and COVID-19 statistics. To help explain and validate findings, we will conduct a national qualitative survey of NH prescribers regarding their knowledge and beliefs surrounding changing approaches to dementia care and associated outcomes. Results: Funding was obtained in September 2022. Institutional review board exemption approval was obtained in January 2023. The CMS Data Use Agreement was submitted in May 2023 and signed in March 2024. Data access was obtained in June 2024. Cohort creation is anticipated by January 2025, with crosswalks finalized by July 2025. The first survey was fielded in October 2023 and published in July 2024. The second survey was fielded in March 2024. The results are in review as of July 2024. Iterative survey cycles will continue biannually until December 2026. Multidisciplinary dissemination of survey analysis results began in July 2023, and dissemination of secondary data findings is anticipated to begin January 2025. These processes are ongoing, with investigation to wrap up by June 2027. Conclusions: This study will detail appropriate and inappropriate antiepileptic drug use and related outcomes in NHs and describe disparities in long-stay subpopulations treated or not treated with psychotropics. It will delineate the impact of the pandemic in combination with national policies on dementia management and outcomes. We believe this mixed methods approach, including processes that link multiple CMS data sets at an individual level and survey-relevant stakeholders, can be replicated and applied to evaluate a variety of patient-oriented questions in diverse clinical populations. International Registered Report Identifier (IRRID): DERR1-10.2196/64446 %M 39298758 %R 10.2196/64446 %U https://www.researchprotocols.org/2024/1/e64446 %U https://doi.org/10.2196/64446 %U http://www.ncbi.nlm.nih.gov/pubmed/39298758 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60129 %T A Digital Intervention for Capturing the Real-Time Health Data Needed for Epilepsy Seizure Forecasting: Protocol for a Formative Co-Design and Usability Study (The ATMOSPHERE Study) %A Quilter,Emily E V %A Downes,Samuel %A Deighan,Mairi Therese %A Stuart,Liz %A Charles,Rosie %A Tittensor,Phil %A Junges,Leandro %A Kissack,Peter %A Qureshi,Yasser %A Kamaraj,Aravind Kumar %A Brigden,Amberly %+ School of Engineering Mathematics and Technology, University of Bristol, 1 Cathedral Square, Bristol, BS1 5DD, United Kingdom, 44 01174282343, amberly.brigden@bristol.ac.uk %K epilepsy %K seizure forecasting %K data science %K artificial intelligence %K machine learning %K wearable technology %K mobile phone %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epilepsy is a chronic neurological disorder affecting individuals globally, marked by recurrent and apparently unpredictable seizures that pose significant challenges, including increased mortality, injuries, and diminished quality of life. Despite advancements in treatments, a significant proportion of people with epilepsy continue to experience uncontrolled seizures. The apparent unpredictability of these events has been identified as a major concern for people with epilepsy, highlighting the need for innovative seizure forecasting technologies. Objective: The ATMOSPHERE study aimed to develop and evaluate a digital intervention, using wearable technology and data science, that provides real-time, individualized seizure forecasting for individuals living with epilepsy. This paper reports the protocol for one of the workstreams focusing on the design and testing of a prototype to capture real-time input data needed for predictive modeling. The first aim was to collaboratively design the prototype (work completed). The second aim is to conduct an “in-the-wild” study to assess usability and refine the prototype (planned research). Methods: This study uses a person-based approach to design and test the usability of a prototype for real-time seizure precipitant data capture. Phase 1 (work completed) involved co-design with individuals living with epilepsy and health care professionals. Sessions explored users’ requirements for the prototype, followed by iterative design of low-fidelity, static prototypes. Phase 2 (planned research) will be an “in-the-wild” usability study involving the deployment of a mid-fidelity, functional prototype for 4 weeks, with the collection of mixed methods usability data to assess the prototype’s real-world application, feasibility, acceptability, and engagement. This phase involves primary participants (adults diagnosed with epilepsy) and, optionally, their nominated significant other. The usability study will run in 3 rounds of deployment and data collection, aiming to recruit 5 participants per round, with prototype refinement between rounds. Results: The phase-1 co-design study engaged 22 individuals, resulting in the development of a mid-fidelity, functional prototype based on identified requirements, including the tracking of evidence-based and personalized seizure precipitants. The upcoming phase-2 usability study is expected to provide insights into the prototype’s real-world usability, identify areas for improvement, and refine the technology for future development. The estimated completion date of phase 2 is the last quarter of 2024. Conclusions: The ATMOSPHERE study aims to make a significant step forward in epilepsy management, focusing on the development of a user-centered, noninvasive wearable device for seizure forecasting. Through a collaborative design process and comprehensive usability testing, this research aims to address the critical need for predictive seizure forecasting technologies, offering a promising approach to improving the lives of individuals with epilepsy. By leveraging predictive analytics and personalized machine learning models, this technology seeks to offer a novel approach to managing epilepsy, potentially improving clinical outcomes, including quality of life, through increased predictability and seizure management. International Registered Report Identifier (IRRID): DERR1-10.2196/60129 %M 39298757 %R 10.2196/60129 %U https://www.researchprotocols.org/2024/1/e60129 %U https://doi.org/10.2196/60129 %U http://www.ncbi.nlm.nih.gov/pubmed/39298757 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57033 %T User Experience of a Large-Scale Smartphone-Based Observational Study in Multiple Sclerosis: Global, Open-Access, Digital-Only Study %A Galati,Adriano %A Kriara,Lito %A Lindemann,Michael %A Lehner,Rea %A Jones,JB %+ F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070, Switzerland, 41 61 682 25 79, adriano.galati@roche.com %K smartphone %K multiple sclerosis %K user experience %K retention %K digital health %K digital health technology %K mobile phone %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Floodlight Open app is a digital health technology tool (DHTT) that comprises remote, smartphone sensor–based tests (daily activities) for assessing symptoms of multiple sclerosis (MS). User acquisition, engagement, and retention remain a barrier to successfully deploying such tools. Objective: This study aims to quantitatively and qualitatively investigate key user experience (UX) factors associated with the Floodlight Open app. Methods: Floodlight Open is a global, open-access, digital-only study designed to understand the drivers and barriers in deploying a DHTT in a naturalistic setting without supervision and onboarding by a clinician. Daily activities included tests assessing cognition (Information Processing Speed and Information Processing Speed Digit–Digit), hand-motor function (Pinching Test and Draw a Shape Test), and postural stability and gait (Static Balance Test, U-Turn Test, and Two-Minute Walk Test [2MWT]). All daily activities except the 2MWT were taken in a fixed sequence. Qualitative UX was studied through semistructured interviews in a substudy of US participants with MS. The quantitative UX analysis investigated the impact of new UX design features on user engagement and retention in US participants for 3 separate test series: all daily activities included in the fixed sequence (DA), all daily activities included in the fixed sequence except the Static Balance Test and U-Turn Test (DAx), and the 2MWT. Results: The qualitative UX substudy (N=22) revealed the need for 2 new UX design features: a more seamless user journey during the activation process that eliminates the requirement of switching back and forth between the app and the email that the participants received upon registration, and configurable reminders and push notifications to help plan and remind the participants to complete their daily activities. Both UX design features were assessed in the quantitative UX analysis. Introducing the more seamless user journey (original user journey: n=608; more seamless user journey: n=481) improved the conversion rate of participants who enrolled in the study and proceeded to successfully activate the app from 53.9% (328/608) to 74.6% (359/481). Introducing reminders and push notifications (with reminders and notifications: n=350; without reminders and notifications: n=172) improved continuous usage time (proportion of participants with ≥3 consecutive days of usage: DA and DAx: ~30% vs ~12%; 2MWT: ~30% vs ~20%); test completion rates (maximum number of test series completed: DA: 279 vs 64; DAx: 283 vs 126; 2MWT: 302 vs 76); and user retention rates (at day 30: DA: 53/172, 30.8% vs 34/350, 9.7%; DAx: 53/172, 30.8% vs 60/350, 17.1%; 2MWT: 39/172, 22.6% vs 22/350, 6.2%). Inactivity times remained comparable. Conclusions: The remote assessment of MS with DHTTs is a relatively nascent but growing field of research. The continued assessment and improvement of UX design features can play a crucial role in the successful long-term adoption of new DHTTs. %M 39259964 %R 10.2196/57033 %U https://humanfactors.jmir.org/2024/1/e57033 %U https://doi.org/10.2196/57033 %U http://www.ncbi.nlm.nih.gov/pubmed/39259964 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55996 %T Electroacupuncture and Transcutaneous Electrical Acupoint Stimulation for Perioperative Neurocognitive Disorder in Older Patients Undergoing Cardiac Surgery: Protocol for Systematic Review and Meta-Analysis %A Peng,Yanbin %A Wei,Xuqiang %A Sun,Linxi %A Wang,Ke %A Zhou,Jia %+ Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China, 86 21 20256344, pdzhoujia@163.com %K perioperative neurocognitive disorder %K cardiac surgery %K elderly patients %K systematic review %K meta-analysis %D 2024 %7 29.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Perioperative neurocognitive disorder (PND) is a critical concern for older patients undergoing cardiac surgery, impacting cognitive function and quality of life. Electroacupuncture and transcutaneous electrical acupoint stimulation (TEAS) hold promise for mitigating PND. This protocol outlines a systematic review and meta-analysis to thoroughly assess the efficacy of electroacupuncture and TEAS in older patients undergoing cardiac surgery with PND, providing up-to-date evidence for PND prevention and treatment. Objective: This study aimed to thoroughly assess the efficacy of electroacupuncture and TEAS in older patients undergoing cardiac surgery with PND, providing up-to-date evidence for PND prevention and treatment. Methods: A comprehensive and systematic approach will be used to identify eligible studies from a diverse range of electronic databases, including 9 major sources such as PubMed (NLM) and Cochrane (Wiley), as well as 2 clinical trial registration websites. These studies will focus on investigating the effects of electroacupuncture and TEAS on PND in older patients undergoing cardiac surgery. The study selection will adhere to the criteria outlined in the patient, intervention, comparison, outcome, and studies (PICOS) format. Data extraction will be carried out by 2 independent researchers (YP and LS), using established tools to evaluate the risk of bias. The primary outcome will be PND incidence, with secondary outcomes including Mini Mental State Examination scores, neuron-specific enolase, S100β, interleukin-1β, interleukin-6, tumor necrosis factor-α, time to first flatus, first defecation, bowel sound recovery, and hospitalization duration to be selectively reported. Adverse events linked to acupuncture, such as bleeding, needle site pain, and local reactions, rather than serious adverse events, will also be considered. Meta-analysis will be performed using appropriate statistical methods to assess the overall effect of electroacupuncture and TEAS on PND prevention, treatment, or other relevant outcomes. The Cochrane Collaboration Risk of Bias tool will be used for assessment, and data synthesis will be executed using the RevMan 5.4 software (Cochrane). Results: We plan to summarize the eligible studies through the use of a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The findings will be showcased in the form of a summary table of evidence. Figures and forest plots will be used to illustrate the outcomes of the meta-analysis. Conclusions: The impacts of electroacupuncture and TEAS interventions on PND in older patients undergoing cardiac surgery have not yet been established. This protocol addresses a critical gap by thoroughly assessing electroacupuncture and TEAS for PND in older patients undergoing cardiac surgery, enhancing understanding of nonpharmacological interventions, and guiding future research and clinical practices in this field. Its strength lies in rigorous methodology, including comprehensive search strategies, independent review processes, and thorough assessments of the risk of bias. Trial Registration: PROSPERO CRD42023411927; https://tinyurl.com/39xdz6jb International Registered Report Identifier (IRRID): PRR1-10.2196/55996 %M 39208417 %R 10.2196/55996 %U https://www.researchprotocols.org/2024/1/e55996 %U https://doi.org/10.2196/55996 %U http://www.ncbi.nlm.nih.gov/pubmed/39208417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50128 %T Live Streaming of the Professor’s Ward Rounds in Undergraduate Neurology Education: Usability Study %A Sekiguchi,Kenji %A Kawano,Seiji %A Chihara,Norio %A Satomi-Kobayashi,Seimi %A Maeda,Eiichi %A Matsumoto,Riki %+ Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, 6500017, Japan, 81 783825885, sekiguch@med.kobe-u.ac.jp %K live streaming %K ward round %K web conferencing software %K neurological examination %K undergraduate education %K medical student %K medical education %K rounds %K remote education %K video-conferencing %K residents %K live-stream %K neurology %K neuroscience %K web conferencing %K distance education %K technology enhanced learning %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited from contacting patients altogether during the COVID-19 pandemic. One possible solution is to use commercial videoconferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet. Objective: The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients’ personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning. Methods: We created an on-premises videoconferencing system using an open-source app. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person rounds and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live stream. In total, 112 of 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour in-person and remote rounds. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds. Results: The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The postexperience survey (82/112, 73% response rate) showed that the mean score of participants’ satisfaction was 3.94 (SD 0.83; excellent 5 and poor 1). No participant scoring 1 was noted. The proportion of students who observed 6 representative abnormal neurological findings (Babinski sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 22% (18/82, range 13-24) compared to in-person rounds alone. When self-rating the learning value, 43% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 32% (26/82) preferred remote rounds. Conclusions: Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning before entering a clinical clerkship. %M 39172503 %R 10.2196/50128 %U https://formative.jmir.org/2024/1/e50128 %U https://doi.org/10.2196/50128 %U http://www.ncbi.nlm.nih.gov/pubmed/39172503 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e48148 %T Assessing the Role of the Autonomic Nervous System as a Driver of Sleep Quality in Patients With Multiple Sclerosis: Observation Study %A Moebus,Max %A Hilty,Marc %A Oldrati,Pietro %A Barrios,Liliana %A , %A Holz,Christian %+ Department of Computer Science, Eidgenössische Technische Hochschule Zürich (ETH Zurich), Stampfenbachstrasse 48, Zurich, 8092, Switzerland, 41 44 632 84 39, christian.holz@inf.ethz.ch %K sleep quality %K multiple sclerosis %K autonomic nervous system %K wearable sensors %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Neurotech %G English %X Background: Low sleep quality is a common symptom of multiple sclerosis (MS) and substantially decreases patients’ quality of life. The autonomic nervous system (ANS) is crucial to healthy sleep, and the transition from wake to sleep produces the largest shift in autonomic activity we experience every day. For patients with MS, the ANS is often impaired. The relationship between the ANS and perceived sleep quality in patients with MS remains elusive. Objective: In this study, we aim to quantify the impact of the ANS and MS on perceived sleep quality. Methods: We monitored 77 participants over 2 weeks using an arm-worn wearable sensor and a custom smartphone app. Besides recording daily perceived sleep quality, we continuously recorded participants’ heart rate (HR) and HR variability on a per-second basis, as well as stress, activity, and the weather (20,700 hours of sensor data). Results: During sleep, we found that reduced HR variability and increased motion led to lower perceived sleep quality in patients with MS (n=53) as well as the age- and gender-matched control group (n=24). An activated stress response (high sympathetic activity and low parasympathetic activity) while asleep resulted in lower perceived sleep quality. For patients with MS, an activated stress response while asleep reduced perceived sleep quality more heavily than in the control group. Similarly, the effect of increased stress levels throughout the day is particularly severe for patients with MS. For patients with MS, we found that stress correlated negatively with minimal observed HR while asleep and might even affect their daily routine. We found that patients with MS with more severe impairments generally recorded lower perceived sleep quality than patients with MS with less severe disease progression. Conclusions: For patients with MS, stress throughout the day and an activated stress response while asleep play a crucial role in determining sleep quality, whereas this is less important for healthy individuals. Besides ensuring an adequate sleep duration, patients with MS might thus work to reduce stressors, which seem to have a particularly negative effect on sleep quality. Generally, however, sleep quality decreases with MS disease progression. %R 10.2196/48148 %U https://neuro.jmir.org/2024/1/e48148 %U https://doi.org/10.2196/48148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58802 %T Degenerative Cervical Myelopathy Awareness in Primary Care: UK National Cross-Sectional Survey of General Practitioners %A Rufus-Toye,Remi M %A Rafati Fard,Amir %A Mowforth,Oliver D %A McCarron,Luke V %A Chan,Kayen %A Hirayama,Yuri %A Smith,Emma K %A Veremu,Munashe %A Davies,Benjamin M %A Brannigan,Jamie F M %+ Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom, 44 7825545404, Jamie.brannigan@medsci.ox.ac.uk %K cervical spine %K degeneration %K general practice %K myelopathy %K neurology %K neurosurgery %K medical education %K cervical myelopathy %K primary care %K misdiagnosis %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a progressive neurological condition, characterized by spinal cord injury secondary to degenerative changes in the spine. Misdiagnosis in primary care forms part of a complex picture leading to an average diagnostic delay of 2 years. This leads to potentially preventable and permanent disability. A lack of awareness secondary to deficits in postgraduate education may contribute to these delays. Objective: This study aims to assess the awareness of DCM in the setting of general practice. Methods: General practitioners completed a quantitative web-based cross-sectional questionnaire. The 17-item questionnaire captured data regarding demographics, subjective awareness, and objective knowledge. The questionnaire was disseminated via professional networks, including via practice managers and senior practice partners. Incentivization was provided via a bespoke DCM fact sheet for those that completed the survey. Results: A total of 54 general practitioners representing all 4 UK nations responded to the survey. General practitioners most commonly self-assessed that they had “limited awareness” of DCM (n=24, 51%). General practitioners felt most commonly “moderately able” to recognize a case of DCM (n=21, 46%). In total, 13% (n=6) of respondents reported that they would not be at all able to recognize a patient with DCM. Respondents most commonly reported that they were “moderately confident” in their ability to triage a patient with DCM (n=19, 41%). A quarter of respondents reported no prior introduction to DCM throughout their medical training (n=13, 25%). The mean score for knowledge-based questions was 42.6% (SD 3.96%) with the lowest performance observed in patient demographic and clinical recognition items. Conclusions: General practitioners lack confidence in the recognition and management of DCM. These findings are consistent with the diagnostic delays previously described in the literature at the primary care level. Further work to develop and implement educational interventions to general practitioner practices is a crucial step to improving patient outcomes in DCM. %M 39158957 %R 10.2196/58802 %U https://formative.jmir.org/2024/1/e58802 %U https://doi.org/10.2196/58802 %U http://www.ncbi.nlm.nih.gov/pubmed/39158957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56388 %T Effects of Auditory and Visual White Noise on Oculomotor Inhibition in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Crossover Study %A Jostrup,Erica %A Nyström,Marcus %A Tallberg,Pia %A Söderlund,Göran %A Gustafsson,Peik %A Claesdotter-Knutsson,Emma %+ Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Baravägen 1, Lund, 221 85, Sweden, 46 46178800, erica.jostrup@med.lu.se %K white noise %K attention-deficit/hyperactivity disorder %K eye tracking %K cognitive performance %K auditory %K visual %K oculomotor %K child %K children %K protocol %K crossover study %K impairment %K impairments %K psychiatric disorders %K cross modal %K sensory stimulation %K eye movement %K noise %D 2024 %7 15.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In attention-deficit/hyperactivity disorder (ADHD), poor inhibitory control is one of the main characteristics, with oculomotor inhibition impairments being considered a potential biomarker of the disorder. While auditory white noise has demonstrated the ability to enhance working memory in this group, visual white noise is still unexplored and so are the effects of both types of white noise stimulation on oculomotor inhibition. Objective: This crossover study aims to explore the impact of auditory and visual white noise on oculomotor inhibition in children with ADHD and typically developing (TD) children. The study will investigate the impact of different noise levels (25% and 50% visual, 78 dB auditory), and performance will be evaluated both with and without noise stimulation. We hypothesize that exposure to white noise will improve performance in children with ADHD and impair the performance for TD children. Methods: Memory-guided saccades and prolonged fixations, known for their sensitivity in detecting oculomotor disinhibition in ADHD, will be used to assess performance. Children diagnosed with ADHD, withdrawing from medication for 24 hours, and TD children without psychiatric disorders were recruited for the study. Results: Data collection was initiated in October 2023 and ended in February 2024. A total of 97 participants were enrolled, and the first results are expected between September and November 2024. Conclusions: This study will examine whether cross-modal sensory stimulation can enhance executive function, specifically eye movement control, in children with ADHD. In addition, the study will explore potential differences between auditory and visual noise effects in both groups. Our goal is to identify implications for understanding how noise can be used to improve cognitive performance. Trial Registration: ClinicalTrials.gov NCT06057441; https://clinicaltrials.gov/study/NCT06057441 International Registered Report Identifier (IRRID): DERR1-10.2196/56388 %M 39146010 %R 10.2196/56388 %U https://www.researchprotocols.org/2024/1/e56388 %U https://doi.org/10.2196/56388 %U http://www.ncbi.nlm.nih.gov/pubmed/39146010 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57692 %T Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury %A Perrin,Paul B %A Haun,Jolie N %A Klyce,Daniel W %A Melillo,Christine %A Nakase-Richardson,Risa %A Seel,Ronald T %A Martindale-Adams,Jennifer %A Nichols,Linda O %A Perera,Robert A %A Xia,Bridget %A Hahm,Bridget %A Zuber,Jeffrey %+ School of Data Science, University of Virginia, 102 Cresap Road, #101, Charlottesville, VA, 22903, United States, 1 (434) 982 2600, perrin@virginia.edu %K traumatic brain injury %K telehealth %K caregiver %K methodology %K veterans %K service members %D 2024 %7 15.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The responsibility of care for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI) often defaults to informal family caregivers. Caregiving demands considerable knowledge, skill, and support to facilitate the health and well-being of V/SMs and themselves. Persistent and common TBI caregiver issues include strain, depression, and anxiety. While evidence-based, brief interventions have been developed and implemented for family caregivers in Veteran neurodegenerative populations, few interventions have been developed, adapted, or tested to support the unique needs of caregivers of V/SMs with TBI. Objective: This study will adapt and test an evidence-based, personalized, 6-session telehealth caregiver intervention, “Resources for Enhancing All Caregivers’ Health” (REACH), to meet the unique needs of caregivers of V/SMs with TBI. If successful, a community-based participatory research team will develop an implementation plan to roll out REACH TBI across the national Veterans Affairs Polytrauma System of Care. Methods: This mixed methods, crossover waitlist control clinical trial will use a Type 1 Hybrid Effectiveness-Implementation approach to adapt and then test the effects of REACH TBI on key TBI caregiver outcomes. Results: This study was funded by the Department of Defense in September 2023. Participant enrollment and data collection will begin in 2024. Conclusions: If effective, REACH TBI will be the first evidence-based intervention for caregivers of V/SMs with TBI that can be scaled to implement across the Veterans Affairs Polytrauma System of Care and fill a notable gap in clinical services. International Registered Report Identifier (IRRID): PRR1-10.2196/57692 %M 39145996 %R 10.2196/57692 %U https://www.researchprotocols.org/2024/1/e57692 %U https://doi.org/10.2196/57692 %U http://www.ncbi.nlm.nih.gov/pubmed/39145996 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56452 %T Examining the Relationships Between Indoor Environmental Quality Parameters Pertaining to Light, Noise, Temperature, and Humidity and the Behavioral and Psychological Symptoms of People Living With Dementia: Scoping Review %A Au-Yeung,Wan-Tai M %A Miller,Lyndsey %A Wu,Chao-Yi %A Beattie,Zachary %A Nunnerley,Michael %A Hanna,Remonda %A Gothard,Sarah %A Wild,Katherine %A Kaye,Jeffrey %+ Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode: UHN13, Portland, OR, 97239, United States, 1 5034946695, auyeungm@ohsu.edu %K dementia %K behavioral and psychological symptoms of dementia %K neuropsychiatric symptoms %K physical environment %K light %K noise %K temperature %K humidity %D 2024 %7 9.8.2024 %9 Review %J Interact J Med Res %G English %X Background: A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers’ burden, and lower health care cost. Objective: In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions. Methods: Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD. Results: A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89%), while there were fewer studies (from 5/38, 13% to 11/38, 29%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated. Conclusions: The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system. %M 39121471 %R 10.2196/56452 %U https://www.i-jmr.org/2024/1/e56452 %U https://doi.org/10.2196/56452 %U http://www.ncbi.nlm.nih.gov/pubmed/39121471 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51872 %T Effects of a Digital Care Pathway for Multiple Sclerosis: Observational Study %A Vesinurm,Märt %A Maunula,Anna %A Olli,Päivi %A Lillrank,Paul %A Ijäs,Petra %A Torkki,Paulus %A Mäkitie,Laura %A Laakso,Sini M %+ Institute of Healthcare Engineering and Management, Department of Industrial Engineering and Management, Aalto University School of Science, Maarintie 8, Espoo, 02150, Finland, 358 503228815, mart.vesinurm@aalto.fi %K digital care pathway %K multiple sclerosis %K patient satisfaction %K outcome %K patient reported outcome measures %K resource usage %K telemedicine %K digital care %K outpatient clinic %K quality of life %K quality of care %K communication %K caregiver %K chronic condition %K strategy %K long-term %K patient engagement %K digital health service %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease. Objective: This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in health care use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction. Methods: We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number of users, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studied in a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63) or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services were considered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period). Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, and their physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months. Results: During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1% (178/225) logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29% (1182/1635) of logins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences between the groups were found for physical doctors’ appointments, remote doctors’ contacts, physical nurse appointments, remote nurse contacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visit increase in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change was observed in the physical functional health between the 0 and 12-month marks, but psychological functional health was improved between 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPS index of 63 (excellent) at the 12-month mark. Conclusions: The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations, and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicate that DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPs in different health care settings and patient subgroups. %M 39110966 %R 10.2196/51872 %U https://humanfactors.jmir.org/2024/1/e51872 %U https://doi.org/10.2196/51872 %U http://www.ncbi.nlm.nih.gov/pubmed/39110966 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55577 %T Benchmarking Large Language Models for Cervical Spondylosis %A Zhang,Boyan %A Du,Yueqi %A Duan,Wanru %A Chen,Zan %+ Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100000, China, 86 13911712120, chenzan66@163.com %K cervical spondylosis %K large language model %K LLM %K patient %K ChatGPT %D 2024 %7 5.8.2024 %9 Research Letter %J JMIR Form Res %G English %X Cervical spondylosis is the most common degenerative spinal disorder in modern societies. Patients require a great deal of medical knowledge, and large language models (LLMs) offer patients a novel and convenient tool for accessing medical advice. In this study, we collected the most frequently asked questions by patients with cervical spondylosis in clinical work and internet consultations. The accuracy of the answers provided by LLMs was evaluated and graded by 3 experienced spinal surgeons. Comparative analysis of responses showed that all LLMs could provide satisfactory results, and that among them, GPT-4 had the highest accuracy rate. Variation across each section in all LLMs revealed their ability boundaries and the development direction of artificial intelligence. %M 39102674 %R 10.2196/55577 %U https://formative.jmir.org/2024/1/e55577 %U https://doi.org/10.2196/55577 %U http://www.ncbi.nlm.nih.gov/pubmed/39102674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54599 %T The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial %A Johnson,Joshua K. %A Longhurst,Jason K %A Gevertzman,Michael %A Jefferson,Corey %A Linder,Susan M %A Bethoux,Francois %A Stilphen,Mary %+ Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code M83-13, Cleveland, OH, 44915, United States, 1 2169030621, johnsoj8@ccf.org %K rehabilitation %K physical therapy %K PT %K physiotherapy %K telehealth %K Parkinson disease %K tele-rehabilitation %K telerehabilitation %K TR %K exercise %K physical activity %K exercise therapy %K tele-health %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K Parkinson’s disease %K Parkinson %K Parkinsons %K Parkinsonism %K PD %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non–study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as “good” or “very good” across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 %M 39083792 %R 10.2196/54599 %U https://formative.jmir.org/2024/1/e54599 %U https://doi.org/10.2196/54599 %U http://www.ncbi.nlm.nih.gov/pubmed/39083792 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55408 %T Assessing the Impact of the Mindfulness-Based Body Scan Technique on Sleep Quality in Multiple Sclerosis Using Objective and Subjective Assessment Tools: Single-Case Study %A Iliakis,Ioannis %A Anagnostouli,Maria %A Chrousos,George %+ Medical School, University of Athens, National and Kapodistrian University of Athens, Omiriou 22, Athens, 16122, Greece, 30 6948531978, kiko_sympa@hotmail.com %K multiple sclerosis %K MS %K sleep problems %K electronic portable device %K EPD %K mindfulness-based body scan technique %K sleep quality %K neurodegenerative disease %K quality of life %K anxiety %K pain %K nocturia %K assessment tools %K single-case study %K effectiveness %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system, often leading to poor sleep quality and diminished quality of life (QoL) for affected patients. Sleep disturbances in MS do not always correlate linearly with other symptoms such as anxiety, depression, fatigue, or pain. Various approaches, including stress reduction techniques such as mindfulness-based interventions, have been proposed to manage MS-related sleep issues. Objective: The aim of this study was to evaluate the effects of the mindfulness-based body scan technique on sleep quality and QoL in patients with MS using both subjective (questionnaires) and objective (electronic portable device) measures. Methods: A single-case study was performed involving a 31-year-old woman diagnosed with relapsing-remitting MS. The patient practiced the mindfulness-based body scan technique daily before bedtime and outcomes were compared to measures evaluated at baseline. Results: The mindfulness-based body scan intervention demonstrated positive effects on both sleep quality and overall QoL. Biometric data revealed a notable dissociation between daily stress levels and sleep quality during the intervention period. Although self-report instruments indicated significant improvement, potential biases were noted. Conclusions: While this study is limited to a single patient, the promising outcomes suggest the need for further investigation on a larger scale. These findings underscore the potential benefits of the mindfulness-based body scan technique in managing sleep disturbances and enhancing QoL among patients with MS. %M 39052996 %R 10.2196/55408 %U https://formative.jmir.org/2024/1/e55408 %U https://doi.org/10.2196/55408 %U http://www.ncbi.nlm.nih.gov/pubmed/39052996 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48212 %T Radiological Progression of Degenerative Cervical Myelopathy in a Clinically Stable Patient: Case Report %A Umeria,Rishi %A Mowforth,Oliver %A Veremu,Munashe %A Davies,Benjamin %A Kotter,Mark %+ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom, 44 1223 336946, mrk25@cam.ac.uk %K degenerative cervical myelopathy %K neurosurgery %K radiology %K magnetic resonance imaging %D 2024 %7 27.6.2024 %9 Case Report %J Interact J Med Res %G English %X Degenerative cervical myelopathy (DCM) is a common neurological condition, with disease progression that is both variable and difficult to predict. Here, we present a case of DCM in a gentleman in his late 60s with significant radiological disease progression without consequent change in clinical symptoms. The case serves as a reminder of an enduring medical aphorism that clinical history and examination should be prioritized above more complex data, such as imaging investigations. In addition, the case also highlights that guidelines should be contextualized within individual clinical circumstances. %M 38935951 %R 10.2196/48212 %U https://www.i-jmr.org/2024/1/e48212 %U https://doi.org/10.2196/48212 %U http://www.ncbi.nlm.nih.gov/pubmed/38935951 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58501 %T Improving the Acceptability and Implementation of Information and Communication Technology–Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders %A Ahmed,Mona %A Marín,Mayca %A Gangas,Pilar %A Bentlage,Ellen %A Louro,Claudia %A Brach,Michael %+ Institute of Sport and Exercise Sciences, University of Münster, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 8334812, mona.ahmad@uni-muenster.de %K acceptability %K implementation %K neurodegenerative diseases %K Parkinson disease %K dementia %K chronic diseases %K health care technologies %K older people %K stakeholders %K information and communication technology %K ICT %K user-centered design %K co-design %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups. Objective: Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union–funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs. Methods: The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied. Results: This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users’ needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future. International Registered Report Identifier (IRRID): RR2-10.2196/22463 %M 38935424 %R 10.2196/58501 %U https://formative.jmir.org/2024/1/e58501 %U https://doi.org/10.2196/58501 %U http://www.ncbi.nlm.nih.gov/pubmed/38935424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57519 %T The Feasibility and Acceptability of Sharing Video Recordings of Amyotrophic Lateral Sclerosis Clinical Encounters With Patients and Their Caregivers: Pilot Randomized Clinical Trial %A Bratches,Reed W R %A Cohen,Jeffrey %A Carpenter-Song,Elizabeth %A Mistler,Lisa %A Barr,Paul J %+ School of Nursing, University of Alabama at Birmingham, 1720 University Boulevard, Birmingham, AL, 35222, United States, 1 2059316655, rbratches@gmail.com %K feasibility %K acceptability %K amyotrophic lateral sclerosis %K digital intervention %K ALS %K video recording %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multidisciplinary clinics (MDCs) provide benefits to patients with amyotrophic lateral sclerosis (ALS) and their caregivers, but MDC visits are information-heavy and can last 4 hours, with patients and caregivers meeting with multiple specialists within each MDC visit. There are questions about the effectiveness of current methods of sharing information from MDCs with patients. Video recordings are a promising new method of sharing information that may allow patients and caregivers to revisit the MDC and remind them of clinical recommendations and conversations. Objective: The objective of this trial is to determine the feasibility and acceptability of sharing information through video recordings of ALS MDC visits with patients and caregivers. Methods: This study was a randomized, controlled pilot trial with 3 months of follow-up from April 2021 to March 2022 in a rural multidisciplinary neurology clinic. We recruited patients with ALS, their caregivers, and their clinicians. Patients and their caregivers were randomized to either receive their normal after-visit summary (treatment as usual) or to receive their normal after-visit summary and a video recording of their MDC visit (video). Each specialist visit had its own recording and was accessible by patients and caregivers using a secure web-based platform called HealthPAL over a 3-month follow-up period. Primary study outcomes were feasibility and acceptability of the video intervention measured by recruitment rate (target: 70%), percentage of participants watching videos (target: 75%), and the Feasibility of Intervention Measure and Acceptability of Intervention Measure (targets: 3/5). We hypothesized that video recording would be feasible and acceptable to patients and their caregivers. Results: Of the 30 patients approached, 24 were recruited, while all caregivers (n=21) and clinicians (n=34) approached were recruited. A total of 144 specialist visits were recorded, approximately 12 specialist visits at a median of one MDC visit per patient. Of the recorded patients, 75% (9/12) viewed videos. High median intervention feasibility (4, SD 0.99) and acceptability (4, SD 1.22) of intervention measures were reported by patients and caregivers in the intervention arm. High median intervention feasibility (5, SD 0.21) and acceptability (4.88, SD 0.4) were reported by clinicians. Of the 24 patients, 50% (n=12) did not complete a 3-month follow-up, primarily due to death (n=10). Conclusions: Video recording is highly feasible and acceptable for patients, caregivers, and clinicians at a rural ALS clinic. Our level of attrition is a useful benchmark for future studies in MDC populations. Despite high rates of patient death, 1-week assessments highlight the value of recordings for both patients and caregivers. Trial Registration: ClinicalTrials.gov NCT04719403; https://clinicaltrials.gov/study/NCT04719403 %M 38924779 %R 10.2196/57519 %U https://formative.jmir.org/2024/1/e57519 %U https://doi.org/10.2196/57519 %U http://www.ncbi.nlm.nih.gov/pubmed/38924779 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e54496 %T Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review %A Fernandes,Sofia %A von Gunten,Armin %A Verloo,Henk %+ School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Chemin de l’Agasse 5, Sion, 1950, Switzerland, 41 00415860861, sofia.fernandes@hevs.ch %K artificial intelligence %K behavioral and psychological symptoms of dementia %K neuropsychiatric symptoms %K early detection %K management %K narrative literature review %D 2024 %7 28.5.2024 %9 Review %J JMIR Nursing %G English %X Background: The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence–based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. Objective: The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. Methods: A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. Results: A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. Conclusions: Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions. %M 38805252 %R 10.2196/54496 %U https://nursing.jmir.org/2024/1/e54496 %U https://doi.org/10.2196/54496 %U http://www.ncbi.nlm.nih.gov/pubmed/38805252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51977 %T Web Application to Enable Online Social Interactions in a Parkinson Disease Risk Cohort: Feasibility Study and Social Network Analysis %A Li,Xiancheng %A Gill,Aneet %A Panzarasa,Pietro %A Bestwick,Jonathan %A Schrag,Anette %A Noyce,Alastair %A De Simoni,Anna %+ Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, United Kingdom, 44 2078822520, a.desimoni@qmul.ac.uk %K pilot studies %K network analysis %K Parkinson disease %K risk factors %K risk %K risk cohort %K social interaction %K development %K neurodegenerative disease %K neurodegenerative %K United Kingdom %K feasibility %K design %K pilot %K engagement %K users %K online forum %K online network %K online %K regression analysis %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is evidence that social interaction has an inverse association with the development of neurodegenerative diseases. PREDICT-Parkinson Disease (PREDICT-PD) is an online UK cohort study that stratifies participants for risk of future Parkinson disease (PD). Objective: This study aims to explore the methodological approach and feasibility of assessing the digital social characteristics of people at risk of developing PD and their social capital within the PREDICT-PD platform, making hypotheses about the relationship between web-based social engagement and potential predictive risk indicators of PD. Methods: A web-based application was built to enable social interaction through the PREDICT-PD portal. Feedback from existing members of the cohort was sought and informed the design of the pilot. Dedicated staff used weekly engagement activities, consisting of PD-related research, facts, and queries, to stimulate discussion. Data were collected by the hosting platform. We examined the pattern of connections generated over time through the cumulative number of posts and replies and ego networks using social network analysis. We used network metrics to describe the bonding, bridging, and linking of social capital among participants on the platform. Relevant demographic data and Parkinson risk scores (expressed as an odd 1:x) were analyzed using descriptive statistics. Regression analysis was conducted to estimate the relationship between risk scores (after log transformation) and network measures. Results: Overall, 219 participants took part in a 4-month pilot forum embedded in the study website. In it, 200 people (n=80, 40% male and n=113, 57% female) connected in a large group, where most pairs of users could reach one another either directly or indirectly through other users. A total of 59% (20/34) of discussions were spontaneously started by participants. Participation was asynchronous, with some individuals acting as “brokers” between groups of discussions. As more participants joined the forum and connected to one another through online posts, distinct groups of connected users started to emerge. This pilot showed that a forum application within the cohort web platform was feasible and acceptable and fostered digital social interaction. Matching participants’ web-based social engagement with previously collected data at individual level in the PREDICT-PD study was feasible, showing potential for future analyses correlating online network characteristics with the risk of PD over time, as well as testing digital social engagement as an intervention to modify the risk of developing neurodegenerative diseases. Conclusions: The results from the pilot suggest that an online forum can serve as an intervention to enhance social connectedness and investigate whether patterns of online engagement can impact the risk of developing PD through long-term follow-up. This highlights the potential of leveraging online platforms to study the role of social capital in moderating PD risk and underscores the feasibility of such approaches in future research or interventions. %M 38788211 %R 10.2196/51977 %U https://formative.jmir.org/2024/1/e51977 %U https://doi.org/10.2196/51977 %U http://www.ncbi.nlm.nih.gov/pubmed/38788211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56889 %T Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study %A Yanez Touzet,Alvaro %A Houhou,Tatiana %A Rahic,Zerina %A Kolias,Angelos %A Yordanov,Stefan %A Anderson,David B %A Laufer,Ilya %A Li,Maggie %A Grahovac,Gordan %A Kotter,Mark RN %A Davies,Benjamin M %A , %+ Department of Clinical Neurosciences, University of Cambridge, Level 3, A Block, Box 165, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 01223746454, bd375@cam.ac.uk %K reproducibility of results %K patient outcome assessment %K smartphone %K neurology %K psychometrics %K spinal cord compression %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective: The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. Methods: A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ≥0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ≤1 point and MCID ≤2 points. Results: In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ≤2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ≥0.7) in both MCID ≤1 and MCID ≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. Conclusions: The criteria from COSMIN provide “very good” quality evidence of the reliability of the MoveMed tests in an adult population living with DCM. %M 38787602 %R 10.2196/56889 %U https://formative.jmir.org/2024/1/e56889 %U https://doi.org/10.2196/56889 %U http://www.ncbi.nlm.nih.gov/pubmed/38787602 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e51822 %T Direct Clinical Applications of Natural Language Processing in Common Neurological Disorders: Scoping Review %A Lefkovitz,Ilana %A Walsh,Samantha %A Blank,Leah J %A Jetté,Nathalie %A Kummer,Benjamin R %+ Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1137, New York, NY, 10029, United States, 1 212 241 5050, benjamin.kummer@mountsinai.org %K natural language processing %K NLP %K unstructured %K text %K machine learning %K deep learning %K neurology %K headache disorders %K migraine %K Parkinson disease %K cerebrovascular disease %K stroke %K transient ischemic attack %K epilepsy %K multiple sclerosis %K cardiovascular %K artificial intelligence %K Parkinson %K neurological %K neurological disorder %K scoping review %K diagnosis %K treatment %K prediction %D 2024 %7 22.5.2024 %9 Review %J JMIR Neurotech %G English %X Background: Natural language processing (NLP), a branch of artificial intelligence that analyzes unstructured language, is being increasingly used in health care. However, the extent to which NLP has been formally studied in neurological disorders remains unclear. Objective: We sought to characterize studies that applied NLP to the diagnosis, prediction, or treatment of common neurological disorders. Methods: This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) standards. The search was conducted using MEDLINE and Embase on May 11, 2022. Studies of NLP use in migraine, Parkinson disease, Alzheimer disease, stroke and transient ischemic attack, epilepsy, or multiple sclerosis were included. We excluded conference abstracts, review papers, as well as studies involving heterogeneous clinical populations or indirect clinical uses of NLP. Study characteristics were extracted and analyzed using descriptive statistics. We did not aggregate measurements of performance in our review due to the high variability in study outcomes, which is the main limitation of the study. Results: In total, 916 studies were identified, of which 41 (4.5%) met all eligibility criteria and were included in the final review. Of the 41 included studies, the most frequently represented disorders were stroke and transient ischemic attack (n=20, 49%), followed by epilepsy (n=10, 24%), Alzheimer disease (n=6, 15%), and multiple sclerosis (n=5, 12%). We found no studies of NLP use in migraine or Parkinson disease that met our eligibility criteria. The main objective of NLP was diagnosis (n=20, 49%), followed by disease phenotyping (n=17, 41%), prognostication (n=9, 22%), and treatment (n=4, 10%). In total, 18 (44%) studies used only machine learning approaches, 6 (15%) used only rule-based methods, and 17 (41%) used both. Conclusions: We found that NLP was most commonly applied for diagnosis, implying a potential role for NLP in augmenting diagnostic accuracy in settings with limited access to neurological expertise. We also found several gaps in neurological NLP research, with few to no studies addressing certain disorders, which may suggest additional areas of inquiry. Trial Registration: Prospective Register of Systematic Reviews (PROSPERO) CRD42021228703; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228703 %R 10.2196/51822 %U https://neuro.jmir.org/2024/1/e51822 %U https://doi.org/10.2196/51822 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52922 %T Motor Effects of Intervention With Transcranial Direct Current Stimulation for Physiotherapy Treatment in Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial %A Cangussu,Anna Izabel %A Lucarini,Beatriz %A Melo,Igor de Freitas %A Diniz,Paula Araújo %A Mancini,Marisa %A Viana,Bernardo de Mattos %A Romano-Silva,Marco Aurélio %A Miranda,Débora Marques de %+ Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 3134099670, anna_izabel@yahoo.com.br %K cerebral palsy %K tDCS %K motor %K development %K randomized clinical trial %K RCT %K clinical trial %K randomized %K transcranial direct current stimulation %K stimulation %K children %K child %K brain stimulation %K physical therapy %K quality of life %K researchers %K researcher %K neurological injuries %K injury %K injuries %K gait %K patient %K patients %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children diagnosed with cerebral palsy (CP) often experience various limitations, particularly in gross motor function and activities of daily living. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been used to improve movement, gross motor function, and activities of daily living. Objective: This study aims to evaluate the potential additional effects of physiotherapy combined with tDCS in children with CP in comparison with physiotherapy only. Methods: This is a 2-arm randomized controlled trial that will compare the effects of tDCS as an adjunctive treatment during rehabilitation sessions to rehabilitation without tDCS. Children with CP classified by the Gross Motor Function Classification System as levels I and II will be randomly assigned to either the sham + rehabilitation group or the tDCS + rehabilitation group. The primary outcome will be the motor skills assessed using the Gross Motor Function Measure domain E scores, and the secondary outcome will be the measurement scores of the children’s quality of life. The intervention will consist of a 10-day stimulation protocol with tDCS spread over 2 weeks, with stimulation or sham tDCS administered for 20 minutes at a frequency of 1 Hz, in combination with physiotherapy. Physical therapy exercises will be conducted in a circuit based on each child’s baseline Gross Motor Function Measure results. The participants’ changes will be evaluated and compared in both groups. Intervenient features will be tested. Results: Data collection is ongoing and is expected to be completed by January 2025. A homogeneous sample and clear outcomes may be a highlight of this protocol, which may allow us to understand the potential use of tDCS and for whom it should or should not be used. Conclusions: A study with good evidence and clear outcomes in children with CP might open an avenue for the potential best use of neurostimulation. Trial Registration: Brazilian Registry of Clinical Trials RBR-104h4s4y; https://tinyurl.com/47r3x2e4 International Registered Report Identifier (IRRID): PRR1-10.2196/52922 %M 38687586 %R 10.2196/52922 %U https://www.researchprotocols.org/2024/1/e52922 %U https://doi.org/10.2196/52922 %U http://www.ncbi.nlm.nih.gov/pubmed/38687586 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e51508 %T Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study %A Webster,Amy %A Poyade,Matthieu %A Coulter,Elaine %A Forrest,Lisa %A Paul,Lorna %+ School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 141 273 1345, Amy.Webster@gcu.ac.uk %K virtual reality %K multiple sclerosis %K upper limb rehabilitation %K coproduction %K activities of daily living %K exercise games %K upper limb impairment %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. Objective: This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. Methods: Separate focus groups were conducted with people with MS, recruited through the MS Society UK’s research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. Results: People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. Conclusions: VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS. %M 38669680 %R 10.2196/51508 %U https://games.jmir.org/2024/1/e51508 %U https://doi.org/10.2196/51508 %U http://www.ncbi.nlm.nih.gov/pubmed/38669680 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e53421 %T A Multidisciplinary Assessment of ChatGPT’s Knowledge of Amyloidosis: Observational Study %A King,Ryan C %A Samaan,Jamil S %A Yeo,Yee Hui %A Peng,Yuxin %A Kunkel,David C %A Habib,Ali A %A Ghashghaei,Roxana %+ Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868, United States, 1 714 456 7890, kingrc@hs.uci.edu %K amyloidosis %K ChatGPT %K large language models %K cardiology %K gastroenterology %K neurology %K artificial intelligence %K multidisciplinary care %K assessment %K patient education %K large language model %K accuracy %K reliability %K accessibility %K educational resources %K dissemination %K gastroenterologist %K cardiologist %K medical society %K institution %K institutions %K Facebook %K neurologist %K reproducibility %K amyloidosis-related %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Amyloidosis, a rare multisystem condition, often requires complex, multidisciplinary care. Its low prevalence underscores the importance of efforts to ensure the availability of high-quality patient education materials for better outcomes. ChatGPT (OpenAI) is a large language model powered by artificial intelligence that offers a potential avenue for disseminating accurate, reliable, and accessible educational resources for both patients and providers. Its user-friendly interface, engaging conversational responses, and the capability for users to ask follow-up questions make it a promising future tool in delivering accurate and tailored information to patients. Objective: We performed a multidisciplinary assessment of the accuracy, reproducibility, and readability of ChatGPT in answering questions related to amyloidosis. Methods: In total, 98 amyloidosis questions related to cardiology, gastroenterology, and neurology were curated from medical societies, institutions, and amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and ChatGPT-4. Cardiology- and gastroenterology-related responses were independently graded by a board-certified cardiologist and gastroenterologist, respectively, who specialize in amyloidosis. These 2 reviewers (RG and DCK) also graded general questions for which disagreements were resolved with discussion. Neurology-related responses were graded by a board-certified neurologist (AAH) who specializes in amyloidosis. Reviewers used the following grading scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Questions were stratified by categories for further analysis. Reproducibility was assessed by inputting each question twice into each model. The readability of ChatGPT-4 responses was also evaluated using the Textstat library in Python (Python Software Foundation) and the Textstat readability package in R software (R Foundation for Statistical Computing). Results: ChatGPT-4 (n=98) provided 93 (95%) responses with accurate information, and 82 (84%) were comprehensive. ChatGPT-3.5 (n=83) provided 74 (89%) responses with accurate information, and 66 (79%) were comprehensive. When examined by question category, ChatGTP-4 and ChatGPT-3.5 provided 53 (95%) and 48 (86%) comprehensive responses, respectively, to “general questions” (n=56). When examined by subject, ChatGPT-4 and ChatGPT-3.5 performed best in response to cardiology questions (n=12) with both models producing 10 (83%) comprehensive responses. For gastroenterology (n=15), ChatGPT-4 received comprehensive grades for 9 (60%) responses, and ChatGPT-3.5 provided 8 (53%) responses. Overall, 96 of 98 (98%) responses for ChatGPT-4 and 73 of 83 (88%) for ChatGPT-3.5 were reproducible. The readability of ChatGPT-4’s responses ranged from 10th to beyond graduate US grade levels with an average of 15.5 (SD 1.9). Conclusions: Large language models are a promising tool for accurate and reliable health information for patients living with amyloidosis. However, ChatGPT’s responses exceeded the American Medical Association’s recommended fifth- to sixth-grade reading level. Future studies focusing on improving response accuracy and readability are warranted. Prior to widespread implementation, the technology’s limitations and ethical implications must be further explored to ensure patient safety and equitable implementation. %M 38640472 %R 10.2196/53421 %U https://cardio.jmir.org/2024/1/e53421 %U https://doi.org/10.2196/53421 %U http://www.ncbi.nlm.nih.gov/pubmed/38640472 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e48146 %T Finite Element Analysis for Degenerative Cervical Myelopathy: Scoping Review of the Current Findings and Design Approaches, Including Recommendations on the Choice of Material Properties %A Davies,Benjamin %A Schaefer,Samuel %A Rafati Fard,Amir %A Newcombe,Virginia %A Sutcliffe,Michael %+ Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom, 44 07766692608, bd375@cam.ac.uk %K scoping review %K fine element analysis %K cervical spine %K spinal cord %K degenerative cervical myelopathy %D 2024 %7 28.3.2024 %9 Review %J JMIR Biomed Eng %G English %X Background: Degenerative cervical myelopathy (DCM) is a slow-motion spinal cord injury caused via chronic mechanical loading by spinal degenerative changes. A range of different degenerative changes can occur. Finite element analysis (FEA) can predict the distribution of mechanical stress and strain on the spinal cord to help understand the implications of any mechanical loading. One of the critical assumptions for FEA is the behavior of each anatomical element under loading (ie, its material properties). Objective: This scoping review aims to undertake a structured process to select the most appropriate material properties for use in DCM FEA. In doing so, it also provides an overview of existing modeling approaches in spinal cord disease and clinical insights into DCM. Methods: We conducted a scoping review using qualitative synthesis. Observational studies that discussed the use of FEA models involving the spinal cord in either health or disease (including DCM) were eligible for inclusion in the review. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The MEDLINE and Embase databases were searched to September 1, 2021. This was supplemented with citation searching to retrieve the literature used to define material properties. Duplicate title and abstract screening and data extraction were performed. The quality of evidence was appraised using the quality assessment tool we developed, adapted from the Newcastle-Ottawa Scale, and shortlisted with respect to DCM material properties, with a final recommendation provided. A qualitative synthesis of the literature is presented according to the Synthesis Without Meta-Analysis reporting guidelines. Results: A total of 60 papers were included: 41 (68%) “FEA articles” and 19 (32%) “source articles.” Most FEA articles (33/41, 80%) modeled the gray matter and white matter separately, with models typically based on tabulated data or, less frequently, a hyperelastic Ogden variant or linear elastic function. Of the 19 source articles, 14 (74%) were identified as describing the material properties of the spinal cord, of which 3 (21%) were considered most relevant to DCM. Of the 41 FEA articles, 15 (37%) focused on DCM, of which 9 (60%) focused on ossification of the posterior longitudinal ligament. Our aggregated results of DCM FEA indicate that spinal cord loading is influenced by the pattern of degenerative changes, with decompression alone (eg, laminectomy) sufficient to address this as opposed to decompression combined with other procedures (eg, laminectomy and fusion). Conclusions: FEA is a promising technique for exploring the pathobiology of DCM and informing clinical care. This review describes a structured approach to help future investigators deploy FEA for DCM. However, there are limitations to these recommendations and wider uncertainties. It is likely that these will need to be overcome to support the clinical translation of FEA to DCM. %M 38875683 %R 10.2196/48146 %U https://biomedeng.jmir.org/2024/1/e48146 %U https://doi.org/10.2196/48146 %U http://www.ncbi.nlm.nih.gov/pubmed/38875683 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e48265 %T Performance Differences of a Touch-Based Serial Reaction Time Task in Healthy Older Participants and Older Participants With Cognitive Impairment on a Tablet: Experimental Study %A Mychajliw,Christian %A Holz,Heiko %A Minuth,Nathalie %A Dawidowsky,Kristina %A Eschweiler,Gerhard Wilhelm %A Metzger,Florian Gerhard %A Wortha,Franz %+ Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076, Germany, 49 07071 ext 2985358, christian.mychajliw@med.uni-tuebingen.de %K serial reaction time task %K SRTT %K implicit learning %K mobile digital assessments %K cognitive impairment %K neurodegeneration %K tablet-based testing %K mild cognitive impairment %K MCI %K dementia %K Alzheimer %K neuropsychology %K aging %K older individuals %D 2024 %7 21.3.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital neuropsychological tools for diagnosing neurodegenerative diseases in the older population are becoming more relevant and widely adopted because of their diagnostic capabilities. In this context, explicit memory is mainly examined. The assessment of implicit memory occurs to a lesser extent. A common measure for this assessment is the serial reaction time task (SRTT). Objective: This study aims to develop and empirically test a digital tablet–based SRTT in older participants with cognitive impairment (CoI) and healthy control (HC) participants. On the basis of the parameters of response accuracy, reaction time, and learning curve, we measure implicit learning and compare the HC and CoI groups. Methods: A total of 45 individuals (n=27, 60% HCs and n=18, 40% participants with CoI—diagnosed by an interdisciplinary team) completed a tablet-based SRTT. They were presented with 4 blocks of stimuli in sequence and a fifth block that consisted of stimuli appearing in random order. Statistical and machine learning modeling approaches were used to investigate how healthy individuals and individuals with CoI differed in their task performance and implicit learning. Results: Linear mixed-effects models showed that individuals with CoI had significantly higher error rates (b=−3.64, SE 0.86; z=−4.25; P<.001); higher reaction times (F1,41=22.32; P<.001); and lower implicit learning, measured via the response increase between sequence blocks and the random block (β=−0.34; SE 0.12; t=−2.81; P=.007). Furthermore, machine learning models based on these findings were able to reliably and accurately predict whether an individual was in the HC or CoI group, with an average prediction accuracy of 77.13% (95% CI 74.67%-81.33%). Conclusions: Our results showed that the HC and CoI groups differed substantially in their performance in the SRTT. This highlights the promising potential of implicit learning paradigms in the detection of CoI. The short testing paradigm based on these results is easy to use in clinical practice. %M 38512340 %R 10.2196/48265 %U https://aging.jmir.org/2024/1/e48265 %U https://doi.org/10.2196/48265 %U http://www.ncbi.nlm.nih.gov/pubmed/38512340 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e47196 %T Nutritional Interventions for the Prevention of Cognitive Decline in Patients With Mild Cognitive Impairment and Alzheimer Disease: Protocol for a Network Meta-Analysis of Randomized Controlled Trials %A He,Qian %A Wu,Kevin Chun Hei %A Bennett,Adam N %A Zhang,Jia Yue %A Chan,Kei Hang Katie %+ Department of Electrical Engineering, City University of Hong Kong, 1A-313 To Yuen Building, Hong Kong, 999077, China, 86 34426661, kkhchan@cityu.edu.hk %K network meta-analysis %K cognitive impairment %K Alzheimer disease %K Alzheimer %K neurodegenerative disorders %K geriatric care %K nutritional interventions %K older patient %K geriatric %K cognitive decline %K aging %K older people %K nutrition %K cognitive %K aging %K intervention %K Alzheimer disease %K dementia %K acute confusional senile dementia %K Elder Nutritional Physiological Phenomena %K Nutrition Physiology %K nutrition %K meta-analysis %K meta-analyses %K systematic review %K systematic reviews %D 2024 %7 28.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mild cognitive impairment (MCI) is the stage between cognitive decline due to physiological aging and the severity of decline seen in neurodegenerative disorders like Alzheimer disease (AD), which is among the most prevalent neurodegenerative disorders characterized by cognitive impairment. People with MCI are at increased risk of developing AD. Although MCI and AD are incurable, nutritional interventions can potentially delay or prevent their onset. Consequently, effective interventions used to decelerate or alleviate the progress of cognitive impairment in older people are a significant focus in geriatric care. Given the synergistic effects of nutrition on health, assessing the effectiveness of nutritional supplements or dietary composition in preventing MCI or AD is essential for developing interventional strategies. Objective: Our study aims to assess the effectiveness of various nutritional interventions, including special dietary types, dietary patterns, specific foods, nutritional intake, and nutritional supplements, in preventing cognitive decline among patients diagnosed with MCI or AD. To achieve this, we will use a comprehensive approach, including network meta-analysis, pairwise meta-analysis, and systematic review of randomized controlled trials (RCTs). Methods: The review will follow the Population, Intervention, Comparison, Outcome (PICO) model and the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Two investigators will independently search PubMed electronically. Data extraction will follow the inclusion criteria, and data will be assessed for risk of bias using a revised tool. Additionally, evidence quality will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. The outcomes of interest are assessing the cognitive outcomes in patients with MCI or AD. A systematic literature search will be conducted, identifying randomized controlled trials that investigate the impact of these nutritional interventions on cognitive function decline in individuals with MCI and AD. Network meta-analyses (random-effects model) and pairwise meta-analyses will then estimate the relative effectiveness of different nutritional interventions. Results: We included 51 studies, published between 1999 and 2023 (27 studies for AD and 24 studies for MCI) and involving 8420 participants. We completed data extraction for all 51 studies by December 2023. Currently, we are actively engaged in data analysis and manuscript preparation. We plan to finalize the manuscript and publish the comprehensive results by the end of 2024. Conclusions: Our study holds significant clinical relevance given the rising prevalence of AD and the potential influence of nutritional interventions on cognitive function in individuals with MCI and AD. By investigating this relationship, our research aims to inform evidence-based decision-making in the development of prevention strategies for MCI and AD. The outcomes are expected to contribute to the establishment of reliable recommendations for MCI or AD management, providing substantial support in the field. Trial Registration: PROSPERO CRD42022331173; http://tinyurl.com/3snjp7a4 International Registered Report Identifier (IRRID): PRR1-10.2196/47196 %M 38416536 %R 10.2196/47196 %U https://www.researchprotocols.org/2024/1/e47196 %U https://doi.org/10.2196/47196 %U http://www.ncbi.nlm.nih.gov/pubmed/38416536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53372 %T Web-Based Health Information Seeking by People Living With Multiple Sclerosis: Qualitative Investigation of the Multiple Sclerosis Online Course %A Bevens,William %A Davenport,Rebekah %A Neate,Sandra %A Yu,Maggie %A Jelinek,Pia %A Jelinek,George Alexander %A Reece,Jeanette %+ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 335 Bouverie Street, Carlton, 3053, Australia, 61 3 8344 2173, wbevens@hs.uci.edu %K information-seeking behavior %K self-management %K lifestyle %K digital health %D 2024 %7 9.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies have afforded people living with multiple sclerosis (MS) access to telehealth consultations, diagnostic tools, and monitoring. Although health care professionals remain the most trusted source of information, the internet has emerged as a valuable resource for providing MS-related information, particularly during the COVID-19 pandemic. Notably, people living with MS are increasingly seeking educational content for a range of topics related to the self-management of MS; however, web-based information seeking remains largely underevaluated. To address this gap and ensure that web-based health-related information is accessible and engaging, this study used qualitative methods to analyze the reflections from participants of web-based educational programs for people living with MS. Objective: This study aimed to explore the motivations, behaviors, and expectations of web-based health information seeking for people living with MS. Methods: We conducted semistructured interviews for 38 people living with MS 1 month after they completed the novel MS Online Course, which provided information on modifiable lifestyle-related risk factors for people living with MS. Of the 38 participants, 22 (58%) completed the intervention course and 16 (42%) completed the standard care course. Inductive thematic analysis was used within a qualitative paradigm, and 2 authors coded each interview separately and arrived at themes with consensus. Results: We identified 2 themes: motivation to learn and MS information on the web. The diagnosis of MS was described as a pivotal moment for precipitating web-based information seeking. People living with MS sought lifestyle-related information to facilitate self-management and increase control of their MS. Although social media sites and MS websites were considered useful for providing both support and information, discretion was needed to critically appraise information. Recognizable institutions were frequently accessed because of their trustworthiness. Conclusions: This study provided novel insights into the motivations of people living with MS for seeking web-based health information. Furthermore, their preferences for the content and format of the web-based information accessed and their experiences and reactions to this information were explored. These findings may guide educators, researchers, and clinicians involved in MS care to optimize the engagement and processing of web-based health information seeking by people living with MS. %M 38335016 %R 10.2196/53372 %U https://www.jmir.org/2024/1/e53372 %U https://doi.org/10.2196/53372 %U http://www.ncbi.nlm.nih.gov/pubmed/38335016 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45429 %T Impact of the COVID-19 Pandemic on the Personal Networks and Neurological Outcomes of People With Multiple Sclerosis: Cross-Sectional and Longitudinal Case-Control Study %A Riley,Claire %A Venkatesh,Shruthi %A Dhand,Amar %A Doshi,Nandini %A Kavak,Katelyn %A Levit,Elle %A Perrone,Christopher %A Weinstock-Guttman,Bianca %A Longbrake,Erin %A De Jager,Philip %A Xia,Zongqi %+ University of Pittsburgh, 3501 Fifth Ave, BST3-10.044, Pittsburgh, PA, 15260, United States, 1 412 383 5377, zxia1@post.harvard.edu %K neurology %K neurodegenerative disease %K multiple sclerosis %K personal networks %K COVID-19 %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the social fabric. Objective: We evaluated the associations between personal social networks and neurological function in people with multiple sclerosis (pwMS) and controls in the prepandemic and pandemic periods. Methods: During the early pandemic (March-December 2020), 8 cohorts of pwMS and controls completed a questionnaire quantifying the structure and composition of their personal social networks, including the health behaviors of network members. Participants from 3 of the 8 cohorts had additionally completed the questionnaire before the pandemic (2017-2019). We assessed neurological function using 3 interrelated patient-reported outcomes: Patient Determined Disease Steps (PDDS), Multiple Sclerosis Rating Scale-Revised (MSRS-R), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function. We identified the network features associated with neurological function using paired 2-tailed t tests and covariate-adjusted regressions. Results: In the cross-sectional analysis of the pandemic data from 1130 pwMS and 1250 controls during the pandemic, having a higher percentage of network members with a perceived negative health influence was associated with worse disability in pwMS (MSRS-R: β=2.181, 95% CI 1.082-3.279; P<.001) and poor physical function in controls (PROMIS Physical Function: β=–5.707, 95% CI –7.405 to –4.010; P<.001). In the longitudinal analysis of 230 pwMS and 136 controls, the networks of all participants contracted, given an increase in constraint (pwMS-prepandemic: mean 52.24, SD 15.81; pwMS-pandemic: mean 56.77, SD 18.91; P=.006. Controls-prepandemic: mean 48.07, SD 13.36; controls-pandemic: mean 53.99, SD 16.31; P=.001) and a decrease in network size (pwMS-prepandemic: mean 8.02, SD 5.70; pwMS-pandemic: mean 6.63, SD 4.16; P=.003. Controls-prepandemic: mean 8.18, SD 4.05; controls-pandemic: mean 6.44, SD 3.92; P<.001), effective size (pwMS-prepandemic: mean 3.30, SD 1.59; pwMS-pandemic: mean 2.90, SD 1.50; P=.007. Controls-prepandemic: mean 3.85, SD 1.56; controls-pandemic: mean 3.40, SD 1.55; P=.01), and maximum degree (pwMS-prepandemic: mean 4.78, SD 1.86; pwMS-pandemic: mean 4.32, SD 1.92; P=.01. Controls-prepandemic: mean 5.38, SD 1.94; controls-pandemic: mean 4.55, SD 2.06; P<.001). These network changes were not associated with worsening function. The percentage of kin in the networks of pwMS increased (mean 46.06%, SD 29.34% to mean 54.36%, SD 30.16%; P=.003) during the pandemic, a change that was not seen in controls. Conclusions: Our findings suggest that high perceived negative health influence in the network was associated with worse function in all participants during the pandemic. The networks of all participants became tighter knit, and the percentage of kin in the networks of pwMS increased during the pandemic. Despite these perturbations in social connections, network changes from the prepandemic to the pandemic period were not associated with worsening function in all participants, suggesting possible resilience. %M 38319703 %R 10.2196/45429 %U https://publichealth.jmir.org/2024/1/e45429 %U https://doi.org/10.2196/45429 %U http://www.ncbi.nlm.nih.gov/pubmed/38319703 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51245 %T Addressing Cyberscams and Acquired Brain Injury (“I Desperately Need to Know What to Do”): Qualitative Exploration of Clinicians’ and Service Providers’ Perspectives %A Chew,Kimberly Ann %A Ponsford,Jennie %A Gould,Kate Rachel %+ Monash-Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia, 61 03 9426 8923, kimberly.chew@monash.edu %K cyberscam %K cyberscams %K fraud %K cybercrime %K cybersafety %K brain injury %K disability %K neurorehabilitation %K interventions %K treatment %K qualitative %D 2024 %7 29.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: People with acquired brain injury (ABI) may be more susceptible to scams owing to postinjury cognitive and psychosocial consequences. Cyberscams result in financial loss and debilitating psychological impacts such as shame and mistrust, interference with neurorehabilitation, and reduced independence. Despite these significant consequences, there are no psychological treatments to support cyberscam survivors. There is limited evidence regarding how the current workforce is addressing post-ABI cyberscams. Objective: This study aims to understand the perspectives and needs of clinicians and service providers in addressing post-ABI cyberscams. Methods: Overall, 20 multidisciplinary clinicians and service providers were recruited through purposive sampling across Australia. Semistructured interviews explored post-ABI scam experiences and vulnerabilities, treatments and their efficacy, and recommendations for future cybersafety recovery interventions. Reflexive thematic analysis was used. Results: In total, 8 themes encompassing a biopsychosocial understanding of scam vulnerabilities and impacts were identified: “genuine lack of awareness: cognitive-executive difficulties”; “not coping with the loss of it all”; “needing trust and connection”; “strong reactions of trusted others”; “nothing structured to do”; “financial stress and independence”; “cyberability”; and “scammer persuasion.” Each theme informed clinical recommendations including the need to provide psychological and cognitive support, enhance financial and cybersafety skills, promote meaningful social engagement, and foster collaboration between families and clinical support teams. Conclusions: The multifaceted range of scam vulnerabilities and impacts highlighted the need for individualized, comprehensive, and targeted treatments using a biopsychosocial approach to enable cyberscam recovery among people with ABI. These findings will guide the development of a co-designed intervention. %M 38285489 %R 10.2196/51245 %U https://www.jmir.org/2024/1/e51245 %U https://doi.org/10.2196/51245 %U http://www.ncbi.nlm.nih.gov/pubmed/38285489 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50300 %T Novel Strategy to Assess the Neurotoxicity of Organic Solvents Such as Glycol Ethers: Protocol for Combining In Vitro and In Silico Methods With Human-Controlled Exposure Experiments %A Hopf,Nancy B %A Suter-Dick,Laura %A Huwyler,Jörg %A Borgatta,Myriam %A Hegg,Lucie %A Pamies,David %A Paschoud,Hélène %A Puligilla,Ramya Deepthi %A Reale,Elena %A Werner,Sophie %A Zurich,Marie-Gabrielle %+ Department of Biomedical Sciences, University of Lausanne, Bugnon 7, Lausanne, 1005, Switzerland, 41 21 692 5542, mzurich@unil.ch %K organic solvent exposure %K workers %K general population %K neurotoxicity %K blood-brain barrier %K liver toxicity %K human cell cultures %D 2024 %7 18.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chemicals are not required to be tested systematically for their neurotoxic potency, although they may contribute to the development of several neurological diseases. The absence of systematic testing may be partially explained by the current Organisation for Economic Co-operation and Development (OECD) Test Guidelines, which rely on animal experiments that are expensive, laborious, and ethically debatable. Therefore, it is important to understand the risks to exposed workers and the general population exposed to domestic products. In this study, we propose a strategy to test the neurotoxicity of solvents using the commonly used glycol ethers as a case study. Objective: This study aims to provide a strategy that can be used by regulatory agencies and industries to rank solvents according to their neurotoxicity and demonstrate the use of toxicokinetic modeling to predict air concentrations of solvents that are below the no observed adverse effect concentrations (NOAECs) for human neurotoxicity determined in in vitro assays. Methods: The proposed strategy focuses on a complex 3D in vitro brain model (BrainSpheres) derived from human-induced pluripotent stem cells (hiPSCs). This model is accompanied by in vivo, in vitro, and in silico models for the blood-brain barrier (BBB) and in vitro models for liver metabolism. The data are integrated into a toxicokinetic model. Internal concentrations predicted using this toxicokinetic model are compared with the results from in vivo human-controlled exposure experiments for model validation. The toxicokinetic model is then used in reverse dosimetry to predict air concentrations, leading to brain concentrations lower than the NOAECs determined in the hiPSC-derived 3D brain model. These predictions will contribute to the protection of exposed workers and the general population with domestic exposures. Results: The Swiss Centre for Applied Human Toxicology funded the project, commencing in January 2021. The Human Ethics Committee approval was obtained on November 16, 2022. Zebrafish experiments and in vitro methods started in February 2021, whereas recruitment of human volunteers started in 2022 after the COVID-19 pandemic–related restrictions were lifted. We anticipate that we will be able to provide a neurotoxicity testing strategy by 2026 and predicted air concentrations for 6 commonly used propylene glycol ethers based on toxicokinetic models incorporating liver metabolism, BBB leakage parameters, and brain toxicity. Conclusions: This study will be of great interest to regulatory agencies and chemical industries needing and seeking novel solutions to develop human chemical risk assessments. It will contribute to protecting human health from the deleterious effects of environmental chemicals. International Registered Report Identifier (IRRID): DERR1-10.2196/50300 %M 38236630 %R 10.2196/50300 %U https://www.researchprotocols.org/2024/1/e50300 %U https://doi.org/10.2196/50300 %U http://www.ncbi.nlm.nih.gov/pubmed/38236630 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48175 %T Information and Communication Technology for Managing Social Isolation and Loneliness Among People Living With Parkinson Disease: Qualitative Study of Barriers and Facilitators %A Thangavel,Gomathi %A Memedi,Mevludin %A Hedström,Karin %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 70281, Sweden, 46 19302471, gomathi.thangavel@oru.se %K social isolation %K loneliness %K Parkinson disease %K ICT %K information and communication technology %D 2024 %7 17.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Parkinson disease (PD) is a complex, noncurable, and progressive neurological disease affecting different areas of the human nervous system. PD is associated with both motor and nonmotor symptoms, which negatively affect patients’ quality of life and may cause changes in socialization such as intentional social withdrawal. This may further lead to social isolation and loneliness. The use of information and communication technology (ICT) plays an important role in managing social isolation and loneliness. Currently, there is a lack of research focusing on designing and developing ICT solutions that specifically address social isolation and loneliness among people living with PD. Objective: This study addresses this gap by investigating barriers and social needs in the context of social isolation, loneliness, and technology use among people living with PD. The insights gained can inform the development of effective ICT solutions, which can address social isolation and loneliness and improve the quality of life for people living with PD. Methods: A qualitative study with 2 phases of data collection were conducted. During the first phase, 9 health care professionals and 16 people living with PD were interviewed to understand how PD affects social life and technology use. During the second phase, 2 focus groups were conducted with 4 people living with PD in each group to gather insights into their needs and identify ways to manage social isolation and loneliness. Thematic analysis was used to analyze both data sets and identify key themes. Results: The results showed that the barriers experienced by people living with PD due to PD such as “fatigue,” “psychological conditions,” “social stigma,” and “medication side effects” affect their social life. People living with PD also experience difficulties using a keyboard and mouse, remembering passwords, and navigating complex applications due to their PD-related physical and cognitive limitations. To manage their social isolation and loneliness, people living with PD suggested having a simple and easy-to-use solution, allowing them to participate in a digital community based on their interests, communicate with others, and receive recommendations for social events. Conclusions: The new ICT solutions focusing on social isolation and loneliness among people living with PD should consider the barriers restricting user’s social activities and technology use. Given the wide range of needs and barriers experienced by people living with PD, it is more suitable to adopt user-centered design approaches that emphasize the active participation of end users in the design process. Importantly, any ICT solution designed for people living with PD should not encourage internet addiction, which will further contribute to the person’s withdrawal from society. %M 38231548 %R 10.2196/48175 %U https://www.jmir.org/2024/1/e48175 %U https://doi.org/10.2196/48175 %U http://www.ncbi.nlm.nih.gov/pubmed/38231548 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46957 %T The Effect of Web-Based Telerehabilitation Programs on Children and Adolescents With Brain Injury: Systematic Review and Meta-Analysis %A Wang,Zeyu %A He,Kang %A Sui,Xin %A Yi,Jiang %A Yang,Zhaoyun %A Wang,Kai %A Gao,Yan %A Bian,Linfang %A Jiang,Junjie %A Zhao,Lijing %+ The Second Hospital of Jilin University, Jilin University, 218 Ziqiang Street, Nanguan District, Jilin Province, Changchun City, 130041, China, 86 18166882294, jjj520512@163.com %K acquired brain injury %K web-based %K telerehabilitation %K motor function %K physical activity level %K lower limb strength %K children %K adolescents %K meta-analysis %D 2023 %7 25.12.2023 %9 Review %J J Med Internet Res %G English %X Background: Acquired brain injury (ABI) in children and adolescents can lead to motor and executive impairments that often require long-term treatment. The implementation of web-based telerehabilitation therapy at home is a method to improve the functional status of patients. Therefore, we performed a systematic review of the effects of web-based telerehabilitation programs on functional outcomes in children and adolescents with brain injury and supplemented the findings with a meta-analysis. Objective: This study evaluated the therapeutic effect of web-based telerehabilitation training on children and adolescents with brain injury to determine whether web-based telerehabilitation therapy improved motor function, executive function, physical activity level, lower limb strength, hand and upper limb function, visual processing skills, and occupational functional performance in children and adolescents with brain injury. Methods: PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials on web-based telerehabilitation programs in children and adolescents with brain injury until December 2022, and the risk of bias was evaluated using the Cochrane Collaboration Tool. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software. Results: Overall, 17 studies involving 848 patients were included. Web-based telerehabilitation therapy improved the motor function (standardized mean difference [SMD] 0.29, 95% CI 0.01-0.57; P=.04), physical activity level (SMD 0.42, 95% CI 0.11-0.73; P=.007), lower limb strength (SMD 0.52, 95% CI 0.13-0.90; P=.009), and visual processing skills (SMD 0.26, 95% CI 0.02-0.50; P=.04) of children and adolescents with brain injury. It also improved executive function in letter-number sequencing (SMD 1.26, 95% CI 0.26-2.26; P=.01), attention (SMD 0.38, 95% CI 0.09-0.66; P=.009), and symbol search (SMD 1.18, 95% CI 0.43-1.93, P=.002). Conclusions: Web-based telerehabilitation therapy improved motor function, physical activity level, lower limb strength, letter-number sequencing, attention, and symbol search, which improved the quality of life in children and adolescents with brain injury. Web-based telerehabilitation programs provide great convenience for children and adolescents with ABI who need long-term treatment and allow them to exercise at home for rehabilitation training. The widespread implementation of remote interventions also provides children and adolescents in remote areas with better access to rehabilitation services. This review provides evidence for the effectiveness of web-based telerehabilitation therapy, but there was heterogeneity in some of the results because of different disease types and intervention programs. Future studies can expand the sample size according to disease type and increase follow-up time according to different exercise prescriptions to further refine the long-term effects of this intervention on various functions of children and adolescents with ABI. Trial Registration: PROSPERO CRD42023421917; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421917 %M 38145485 %R 10.2196/46957 %U https://www.jmir.org/2023/1/e46957 %U https://doi.org/10.2196/46957 %U http://www.ncbi.nlm.nih.gov/pubmed/38145485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51336 %T Comparison of Polysomnography, Single-Channel Electroencephalogram, Fitbit, and Sleep Logs in Patients With Psychiatric Disorders: Cross-Sectional Study %A Kawai,Keita %A Iwamoto,Kunihiro %A Miyata,Seiko %A Okada,Ippei %A Fujishiro,Hiroshige %A Noda,Akiko %A Nakagome,Kazuyuki %A Ozaki,Norio %A Ikeda,Masashi %+ Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan, 81 52 744 2282, iwamoto@med.nagoya-u.ac.jp %K consumer sleep-tracking device %K polysomnography %K portable sleep EEG monitor %K electroencephalography %K EEG %K psychiatric disorders %K sleep logs %K sleep state misperception %K polysomnography %K sleep study %K wearable %K psychiatric disorder %K sleep %K disturbances %K quality of sleep %K Fitbit %K mHealth %K wearables %K psychiatry %K electroencephalogram %D 2023 %7 13.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disturbances are core symptoms of psychiatric disorders. Although various sleep measures have been developed to assess sleep patterns and quality of sleep, the concordance of these measures in patients with psychiatric disorders remains relatively elusive. Objective: This study aims to examine the degree of agreement among 3 sleep recording methods and the consistency between subjective and objective sleep measures, with a specific focus on recently developed devices in a population of individuals with psychiatric disorders. Methods: We analyzed 62 participants for this cross-sectional study, all having data for polysomnography (PSG), Zmachine, Fitbit, and sleep logs. Participants completed questionnaires on their symptoms and estimated sleep duration the morning after the overnight sleep assessment. The interclass correlation coefficients (ICCs) were calculated to evaluate the consistency between sleep parameters obtained from each instrument. Additionally, Bland-Altman plots were used to visually show differences and limits of agreement for sleep parameters measured by PSG, Zmachine, Fitbit, and sleep logs. Results: The findings indicated a moderate agreement between PSG and Zmachine data for total sleep time (ICC=0.46; P<.001), wake after sleep onset (ICC=0.39; P=.002), and sleep efficiency (ICC=0.40; P=.006). In contrast, Fitbit demonstrated notable disagreement with PSG (total sleep time: ICC=0.08; wake after sleep onset: ICC=0.18; sleep efficiency: ICC=0.10) and exhibited particularly large discrepancies from the sleep logs (total sleep time: ICC=–0.01; wake after sleep onset: ICC=0.05; sleep efficiency: ICC=–0.02). Furthermore, subjective and objective concordance among PSG, Zmachine, and sleep logs appeared to be influenced by the severity of the depressive symptoms and obstructive sleep apnea, while these associations were not observed between the Fitbit and other sleep instruments. Conclusions: Our study results suggest that Fitbit accuracy is reduced in the presence of comorbid clinical symptoms. Although user-friendly, Fitbit has limitations that should be considered when assessing sleep in patients with psychiatric disorders. %M 38090797 %R 10.2196/51336 %U https://www.jmir.org/2023/1/e51336 %U https://doi.org/10.2196/51336 %U http://www.ncbi.nlm.nih.gov/pubmed/38090797 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e46959 %T Rehabilitation Supported by Immersive Virtual Reality for Adults With Communication Disorders: Semistructured Interviews and Usability Survey Study %A Vaezipour,Atiyeh %A Aldridge,Danielle %A Koenig,Sebastian %A Burns,Clare %A Baghaei,Nilufar %A Theodoros,Deborah %A Russell,Trevor %+ RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Surgical, Treatment and Rehabilitation Service, 296 Herston Road, Brisbane, 4029, Australia, 61 733655560, atiyeh.vaezipour@gmail.com %K communication disorders %K speech and language therapy %K rehabilitation %K virtual reality %K human-computer interaction %K technology acceptance %K acceptance %K communication %K therapy %K usefulness %K usability %K survey %K barrier %K mobile phone %D 2023 %7 31.10.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Individuals who have acquired communication disorders often struggle to transfer the skills they learn during therapy sessions to real-life situations. Immersive virtual reality (VR) technology has the potential to create realistic communication environments that can be used both in clinical settings and for practice at home by individuals with communication disorders. Objective: This research aims to enhance our understanding of the acceptance, usefulness, and usability of a VR application (SIM:Kitchen), designed for communication rehabilitation. Additionally, this research aims to identify the perceived barriers and benefits of using VR technology from the perspective of individuals with acquired communication disorders. Methods: Semistructured interviews and usability surveys were conducted with 10 individuals with acquired neurogenic communication disorders aged 46-81 (mean 58, SD 9.57) years after trialing an immersive VR application. The audio-recorded interviews were transcribed and analyzed to identify themes. Results: The quantitative data regarding the usability of the system associated with participants’ immersion experience in the VR application were promising. Findings from semistructured interviews are discussed across five key thematic areas including (1) participant’s attitude toward VR, (2) perceived usefulness of the VR system, (3) perceived ease of use of the VR system, (4) their willingness to continue using VR, and (5) the factors they perceived as challenges or facilitators to adopting this VR technology. Conclusions: Overall, participants in this study found the VR experience to be enjoyable and were impressed by the realism of the VR application designed for communication rehabilitation. This study highlighted personally relevant, immersive VR interventions with different levels of task difficulty that could enhance technology uptake in the context of communication rehabilitation. However, it is essential that VR hand controller technology is refined to be more naturalistic in movement and able to accommodate user capabilities. %M 37906228 %R 10.2196/46959 %U https://rehab.jmir.org/2023/1/e46959 %U https://doi.org/10.2196/46959 %U http://www.ncbi.nlm.nih.gov/pubmed/37906228 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e40433 %T A Wearable Vibratory Device (The Emma Watch) to Address Action Tremor in Parkinson Disease: Pilot Feasibility Study %A Pacheco,Alissa %A van Schaik,Tempest A %A Paleyes,Nadzeya %A Blacutt,Miguel %A Vega,Julio %A Schreier,Abigail R %A Zhang,Haiyan %A Macpherson,Chelsea %A Desai,Radhika %A Jancke,Gavin %A Quinn,Lori %+ Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, United States, 1 2126783424, lq2165@tc.columbia.edu %K Parkinson’s disease %K action tremor %K Emma Watch %K vibration %K haptic feedback %K handwriting %K drawing %K spirals %K hand function %D 2023 %7 23.10.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Parkinson disease (PD) is a neurodegenerative disease that has a wide range of motor symptoms, such as tremor. Tremors are involuntary movements that occur in rhythmic oscillations and are typically categorized into rest tremor or action tremor. Action tremor occurs during voluntary movements and is a debilitating symptom of PD. As noninvasive interventions are limited, there is an ever-increasing need for an effective intervention for individuals experiencing action tremors. The Microsoft Emma Watch, a wristband with 5 vibrating motors, is a noninvasive, nonpharmaceutical intervention for tremor attenuation. Objective: This pilot study investigated the use of the Emma Watch device to attenuate action tremor in people with PD. Methods: The sample included 9 people with PD who were assessed on handwriting and hand function tasks performed on a digitized tablet. Tasks included drawing horizontal or vertical lines, tracing a star, spiral, writing “elelelel” in cursive, and printing a standardized sentence. Each task was completed 3 times with the Emma Watch programmed at different vibration intensities, which were counterbalanced: high intensity, low intensity (sham), and no vibration. Digital analysis from the tablet captured kinematic, dynamic, and spatial attributes of drawing and writing samples to calculate mathematical indices that quantify upper limb motor function. APDM Opal sensors (APDM Wearable Technologies) placed on both wrists were used to calculate metrics of acceleration and jerk. A questionnaire was provided to each participant after using the Emma Watch to gain a better understanding of their perspectives of using the device. In addition, drawings were compared to determine whether there were any visual differences between intensities. Results: In total, 9 people with PD were tested: 4 males and 5 females with a mean age of 67 (SD 9.4) years. There were no differences between conditions in the outcomes of interest measured with the tablet (duration, mean velocity, number of peaks, pause time, and number of pauses). Visual differences were observed within a small subset of participants, some of whom reported perceived improvement. The majority of participants (8/9) reported the Emma Watch was comfortable, and no problems with the device were reported. Conclusions: There were visually depicted and subjectively reported improvements in handwriting for a small subset of individuals. This pilot study was limited by a small sample size, and this should be taken into consideration with the interpretation of the quantitative results. Combining vibratory devices, such as the Emma Watch, with task specific training, or personalizing the frequency to one’s individual tremor may be important steps to consider when evaluating the effect of vibratory devices on hand function or writing ability in future studies. While the Emma Watch may help attenuate action tremor, its efficacy in improving fine motor or handwriting skills as a stand-alone tool remains to be demonstrated. %M 38875672 %R 10.2196/40433 %U https://biomedeng.jmir.org/2023/1/e40433 %U https://doi.org/10.2196/40433 %U http://www.ncbi.nlm.nih.gov/pubmed/38875672 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 2 %N %P e45828 %T Connect Brain, a Mobile App for Studying Depth Perception in Angiography Visualization: Gamification Study %A Titov,Andrey %A Drouin,Simon %A Kersten-Oertel,Marta %+ Gina Cody School of Computer Science and Engineering, Concordia University, 1455 Boul. de Maisonneuve Ouest, Montreal, QC, H3G 1M8, Canada, 1 514 848 2424, andrey.titov.1@ens.etsmtl.ca %K medical image visualization %K volume visualization %K depth cues %K angiography %K gamification %K mobile games %K mobile phone %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Neurotech %G English %X Background: One of the bottlenecks of visualization research is the lack of volunteers for studies that evaluate new methods and paradigms. The increased availability of web-based marketplaces, combined with the possibility of implementing volume rendering, a computationally expensive method, on mobile devices, has opened the door for using gamification in the context of medical image visualization studies. Objective: We aimed to describe a gamified study that we conducted with the goal of comparing several cerebrovascular visualization techniques and to evaluate whether gamification is a valid paradigm for conducting user studies in the domain of medical imaging. Methods: The study was implemented in the form of a mobile game, Connect Brain, which was developed and distributed on both Android (Google LLC) and iOS (Apple Inc) platforms. Connect Brain features 2 minigames: one asks the player to make decisions about the depth of different vessels, and the other asks the player to determine whether 2 vessels are connected. Results: The gamification paradigm, which allowed us to collect many data samples (5267 and 1810 for the depth comparison and vessel connectivity tasks, respectively) from many participants (N=111), yielded similar results regarding the effectiveness of visualization techniques to those of smaller in-laboratory studies. Conclusions: The results of our study suggest that the gamification paradigm not only is a viable alternative to traditional in-laboratory user studies but could also present some advantages. %R 10.2196/45828 %U https://neuro.jmir.org/2023/1/e45828 %U https://doi.org/10.2196/45828 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47319 %T Addressing the Chronic Pain–Early Cognitive Decline Comorbidity Among Older Adults: Protocol for the Active Brains Remote Efficacy Trial %A Vranceanu,Ana-Maria %A Choukas,Nathaniel R %A Rochon,Elizabeth A %A Duarte,Brooke %A Pietrzykowski,Malvina O %A McDermott,Katherine %A Hooker,Julia E %A Kulich,Ronald %A Quiroz,Yakeel T %A Parker,Robert A %A Macklin,Eric A %A Ritchie,Christine %A , %A Mace,Ryan A %+ Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States, 1 (617) 432 1000, avranceanu@mgh.harvard.edu %K chronic pain %K cognitive decline %K physical activity %K mind-body therapies %K aged %K telemedicine %K randomized clinical trial %K mobile phone %D 2023 %7 28.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain and early cognitive decline, which are costly to treat and highly prevalent among older adults, commonly co-occur, exacerbate one another over time, and can accelerate the development and progression of Alzheimer disease and related dementias. We developed the first mind-body activity program (Active Brains [AB]) tailored to the needs of older adults with chronic pain and early cognitive decline. Results from our previous study strongly supported the feasibility of conducting AB remotely and provided evidence for improvements in outcomes. Objective: We are conducting a single-blinded, National Institutes of Health stage-2, randomized clinical trial to establish the efficacy of AB versus a time-matched and dose-matched education control (Health Enhancement Program [HEP]) in improving self-reported and objective outcomes of physical, cognitive, and emotional functions in 260 participants. The methodology described in this paper was informed by the lessons learned from the first year of the trial. Methods: Participants are identified and recruited through multidisciplinary clinician–referred individuals (eg, pain psychologists and geriatricians), the Rally Research platform, social media, and community partnerships. Interested participants complete eligibility screening and electronic informed consent. Baseline assessments include self-report, performance-based measures (eg, 6-min walk test) and objective measures (eg, Repeatable Battery for the Assessment of Neuropsychological Status). Participants are mailed a wrist-worn ActiGraph device (ActiGraph LLC) to passively monitor objective function (eg, steps) during the week between the baseline assessment and the beginning of the programs, which they continue to wear throughout the programs. After baseline assessments, participants are randomized to either AB or HEP and complete 8 weekly, remote, group sessions with a Massachusetts General Hospital psychologist. The AB group receives a Fitbit (Fitbit Inc) to help reinforce increased activity. Assessments are repeated after the intervention and at the 6-month follow-up. Coprimary outcomes include multimodal physical function (self-report, performance based, and objective). Secondary outcomes are cognitive function (self-report and objective), emotional function, and pain. Results: We began recruitment in July 2022 and recruited 37 participants across 4 cohorts. Of them, all (n=37, 100%) have completed the baseline assessment, 26 (70%) have completed the posttest assessment, and 9 (24%) are actively enrolled in the intervention (total dropout: n=2, 5%). In the three cohorts (26/37, 70%) that have completed the AB or HEP, 26 (100%) participants completed all 8 group sessions (including minimal makeups), and watch adherence (1937/2072, 93.48%, average across ActiGraph and Fitbit devices) has been excellent. The fourth cohort is ongoing (9/37, 24%), and we plan to complete enrollment by March 2026. Conclusions: We aim to establish the efficacy of the AB program over a time-matched and dose-matched control in a live video-based trial and test the mechanisms through theoretically driven mediators and moderators. Findings will inform the development of a future multisite effectiveness-implementation trial. Trial Registration: ClinicalTrials.gov NCT05373745; https://classic.clinicaltrials.gov/ct2/show/NCT05373745 International Registered Report Identifier (IRRID): DERR1-10.2196/47319 %M 37768713 %R 10.2196/47319 %U https://www.researchprotocols.org/2023/1/e47319 %U https://doi.org/10.2196/47319 %U http://www.ncbi.nlm.nih.gov/pubmed/37768713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47486 %T Toward Personalized Medicine Approaches for Parkinson Disease Using Digital Technologies %A Khanna,Amit %A Jones,Graham %+ GDD Connected Health and Innovation Group, Novartis Pharmaceuticals, 1 Health Plaza, East Hanover, NJ, 07936, United States, 1 8572757045, graham.jones@novartis.com %K digital health %K monitoring %K personalized medicine %K Parkinson disease %K wearables %K neurodegenerative disorder %K cognitive impairment %K economic burden %K digital technology %K symptom management %K disease control %K debilitating disease %K intervention %D 2023 %7 27.9.2023 %9 Viewpoint %J JMIR Form Res %G English %X Parkinson disease (PD) is a complex neurodegenerative disorder that afflicts over 10 million people worldwide, resulting in debilitating motor and cognitive impairment. In the United States alone (with approximately 1 million cases), the economic burden for treating and caring for persons with PD exceeds US $50 billion and myriad therapeutic approaches are under development, including both symptomatic- and disease-modifying agents. The challenges presented in addressing PD are compounded by observations that numerous, statistically distinct patient phenotypes present with a wide variety of motor and nonmotor symptomatic profiles, varying responses to current standard-of-care symptom-alleviating medications (L-DOPA and dopaminergic agonists), and different disease trajectories. The existence of these differing phenotypes highlights the opportunities in personalized approaches to symptom management and disease control. The prodromal period of PD can span across several decades, allowing the potential to leverage the unique array of composite symptoms presented to trigger early interventions. This may be especially beneficial as disease progression in PD (alongside Alzheimer disease and Huntington disease) may be influenced by biological processes such as oxidative stress, offering the potential for individual lifestyle factors to be tailored to delay disease onset. In this viewpoint, we offer potential scenarios where emerging diagnostic and monitoring strategies might be tailored to the individual patient under the tenets of P4 medicine (predict, prevent, personalize, and participate). These approaches may be especially relevant as the causative factors and biochemical pathways responsible for the observed neurodegeneration in patients with PD remain areas of fluid debate. The numerous observational patient cohorts established globally offer an excellent opportunity to test and refine approaches to detect, characterize, control, modify the course, and ultimately stop progression of this debilitating disease. Such approaches may also help development of parallel interventive strategies in other diseases such as Alzheimer disease and Huntington disease, which share common traits and etiologies with PD. In this overview, we highlight near-term opportunities to apply P4 medicine principles for patients with PD and introduce the concept of composite orthogonal patient monitoring. %M 37756050 %R 10.2196/47486 %U https://formative.jmir.org/2023/1/e47486 %U https://doi.org/10.2196/47486 %U http://www.ncbi.nlm.nih.gov/pubmed/37756050 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e48222 %T Rapidly Deteriorating Degenerative Cervical Myelopathy Following Ventricular Shunt Revision for Hydrocephalus: Case Report %A Rujeedawa,Tanzil %A Mowforth,Oliver %A Kotter,Mark %A Davies,Benjamin %+ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, The Old Schools, Trinity Ln, Cambridge, CB2 1TN, United Kingdom, 1 44 01223 337733, benjamin.davies4@nhs.net %K cervical myelopathy %K ossification of posterior longitudinal ligament %K spondylosis %K disk herniation %K stenosis %K spine %K spinal %K neck %K disk %K myelopathy %K case %K cervical %K woman %K women %K ligament %K gait %D 2023 %7 28.8.2023 %9 Case Report %J Interact J Med Res %G English %X A female patient in her early 40s presented with a several-month history of gait unsteadiness and dragging her left leg. She had a background of congenital hydrocephalus, treated with a ventriculoatrial shunt. On examination, she had increased tone and brisk reflexes in the lower limbs and a positive Hoffmann sign. A computed tomography (CT) scan and shunt series x-rays identified hydrocephalus secondary to a disconnected shunt. Magnetic resonance imaging (MRI) of her cervical spine was also performed as part of the workup for her presenting symptoms and demonstrated features compatible with degenerative cervical myelopathy (DCM). The patient subsequently underwent a shunt revision. Following the operation, her walking and hand function deteriorated over a period of several weeks. She consequently underwent an anterior cervical decompression and fusion for DCM, which partially improved her symptoms.The sequence of events suggests that the shunt surgery may have precipitated a worsening of the DCM. Possible explanations include spinal cord injury related to neck extension or hypoperfusion during intubation and general anesthesia or the loss of cerebrospinal fluid cushioning following the reinstitution of effective cerebrospinal fluid shunting. Surgeons should be alert to this possibility and offer prompt surgical intervention for DCM if required. %M 37639306 %R 10.2196/48222 %U https://www.i-jmr.org/2023/1/e48222 %U https://doi.org/10.2196/48222 %U http://www.ncbi.nlm.nih.gov/pubmed/37639306 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45458 %T Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality %A Calabrò,Rocco Salvatore %A Bonanno,Mirjam %A Torregrossa,William %A Cacciante,Luisa %A Celesti,Antonio %A Rifici,Carmela %A Tonin,Paolo %A De Luca,Rosaria %A Quartarone,Angelo %+ Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino Pulejo, Cda Casazza, SS 113, Messina, 98123, Italy, 39 09060128391, mirjam.bonanno@irccsme.it %K telerehabilitation %K teleneuro-VRRS %K virtual reality rehabilitation system %K SABI %K severe acquired brain injury %K acquired brain injury %K virtual reality %K rehabilitation %K neurorehabilitation %K brain injury %K neurology %D 2023 %7 21.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). Objective: The main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. Methods: In total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. Results: The teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. Conclusions: Our results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers’ burden distress management, mitigating distress and promoting positive aspects of caring. Trial Registration: ClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT03709875 %M 37490017 %R 10.2196/45458 %U https://www.jmir.org/2023/1/e45458 %U https://doi.org/10.2196/45458 %U http://www.ncbi.nlm.nih.gov/pubmed/37490017 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46135 %T Adaptive P300-Based Brain-Computer Interface for Attention Training: Protocol for a Randomized Controlled Trial %A Noble,Sandra-Carina %A Woods,Eva %A Ward,Tomas %A Ringwood,John V %+ Department of Electronic Engineering, Maynooth University, BioScience & Electronic Engineering Building, Maynooth, W23 F2H6, Ireland, 353 17084760, sandracarina.noble.2017@mumail.ie %K ADHD %K attention %K BCI %K brain-computer interface %K cognitive deficit %K cognitive disease %K cognitive training %K dementia %K EEG %K electroencephalography %K ERP %K event-related potential %K neurodegeneration %K neurofeedback training %K P300 speller %K stroke %D 2023 %7 5.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The number of people with cognitive deficits and diseases, such as stroke, dementia, or attention-deficit/hyperactivity disorder, is rising due to an aging, or in the case of attention-deficit/hyperactivity disorder, a growing population. Neurofeedback training using brain-computer interfaces is emerging as a means of easy-to-use and noninvasive cognitive training and rehabilitation. A novel application of neurofeedback training using a P300-based brain-computer interface has previously shown potential to improve attention in healthy adults. Objective: This study aims to accelerate attention training using iterative learning control to optimize the task difficulty in an adaptive P300 speller task. Furthermore, we hope to replicate the results of a previous study using a P300 speller for attention training, as a benchmark comparison. In addition, the effectiveness of personalizing the task difficulty during training will be compared to a nonpersonalized task difficulty adaptation. Methods: In this single-blind, parallel, 3-arm randomized controlled trial, 45 healthy adults will be recruited and randomly assigned to the experimental group or 1 of 2 control groups. This study involves a single training session, where participants receive neurofeedback training through a P300 speller task. During this training, the task’s difficulty is progressively increased, which makes it more difficult for the participants to maintain their performance. This encourages the participants to improve their focus. Task difficulty is either adapted based on the participants’ performance (in the experimental group and control group 1) or chosen randomly (in control group 2). Changes in brain patterns before and after training will be analyzed to study the effectiveness of the different approaches. Participants will complete a random dot motion task before and after the training so that any transfer effects of the training to other cognitive tasks can be evaluated. Questionnaires will be used to estimate the participants’ fatigue and compare the perceived workload of the training between groups. Results: This study has been approved by the Maynooth University Ethics Committee (BSRESC-2022-2474456) and is registered on ClinicalTrials.gov (NCT05576649). Participant recruitment and data collection began in October 2022, and we expect to publish the results in 2023. Conclusions: This study aims to accelerate attention training using iterative learning control in an adaptive P300 speller task, making it a more attractive training option for individuals with cognitive deficits due to its ease of use and speed. The successful replication of the results from the previous study, which used a P300 speller for attention training, would provide further evidence to support the effectiveness of this training tool. Trial Registration: ClinicalTrials.gov NCT05576649; https://clinicaltrials.gov/ct2/show/NCT05576649 International Registered Report Identifier (IRRID): DERR1-10.2196/46135 %M 37405822 %R 10.2196/46135 %U https://www.researchprotocols.org/2023/1/e46135 %U https://doi.org/10.2196/46135 %U http://www.ncbi.nlm.nih.gov/pubmed/37405822 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e41906 %T The Variability of Lumbar Sequential Motion Patterns: Observational Study %A Caelers,Inge %A Boselie,Toon %A van Hemert,Wouter %A Rijkers,Kim %A De Bie,Rob %A van Santbrink,Henk %+ Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419 PC, Netherlands, 31 652593545, inge.caelers@mumc.nl %K lumbar spine %K cinematographic recordings %K sequence %K motion pattern %K flexion %K extension %K rotation %K physiological %K musculoskeletal %K motion %K spine %K upper lumbar %K observational study %K physiological motion %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Physiological motion of the lumbar spine is a topic of interest for musculoskeletal health care professionals since abnormal motion is believed to be related to lumbar complaints. Many researchers have described ranges of motion for the lumbar spine, but only few have mentioned specific motion patterns of each individual segment during flexion and extension, mostly comprising the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion is still lacking. For the lower cervical spine, a consistent pattern of segmental contributions in a flexion-extension movement in young healthy individuals was described, resulting in a definition of physiological motion of the cervical spine. Objective: This study aimed to define the lumbar spines’ physiological motion pattern by determining the sequence of segmental contribution in sagittal rotation of each vertebra during maximum flexion and extension in healthy male participants. Methods: Cinematographic recordings were performed twice in 11 healthy male participants, aged 18-25 years, without a history of spine problems, with a 2-week interval (time point T1 and T2). Image recognition software was used to identify specific patterns in the sequence of segmental contributions per individual by plotting segmental rotation of each individual segment against the cumulative rotation of segments L1 to S1. Intraindividual variability was determined by testing T1 against T2. Intraclass correlation coefficients were tested by reevaluation of 30 intervertebral sequences by a second researcher. Results: No consistent pattern was found when studying the graphs of the cinematographic recordings during flexion. A much more consistent pattern was found during extension, especially in the last phase. It consisted of a peak in rotation in L3L4, followed by a peak in L2L3, and finally, in L1L2. This pattern was present in 71% (15/21) of all recordings; 64% (7/11) of the participants had a consistent pattern at both time points. Sequence of segmental contribution was less consistent in the lumbar spine than the cervical spine, possibly caused by differences in facet orientation, intervertebral discs, overprojection of the pelvis, and muscle recruitment. Conclusions: In 64% (7/11) of the recordings, a consistent motion pattern was found in the upper lumbar spine during the last phase of extension in asymptomatic young male participants. Physiological motion of the lumbar spine is a broad concept, influenced by multiple factors, which cannot be captured in a firm definition yet. Trial Registration: ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID): RR2-10.2196/14741 %M 38875682 %R 10.2196/41906 %U https://biomedeng.jmir.org/2023/1/e41906 %U https://doi.org/10.2196/41906 %U http://www.ncbi.nlm.nih.gov/pubmed/38875682 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45533 %T Focus Group Study of Medical Stakeholders to Inform the Development of Resilient Together for Dementia: Protocol for a Postdiagnosis Live Video Dyadic Resiliency Intervention %A Bannon,Sarah %A Brewer,Julie %A Cornelius,Talea %A Jackson,Jonathan %A Parker,Robert A %A Dams-O'Connor,Kristen %A Dickerson,Bradford %A Ritchie,Christine %A Vranceanu,Ana-Maria %+ Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, 100 Bowdoin Square, Suite 100, Boston, MA, MA, United States, 1 7733696338, smbannon@mgh.harvard.edu %K dementia %K stakeholders %K focus group %K intervention %K video %K telehealth %D 2023 %7 29.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease and related dementias (ADRD) are increasingly common conditions that disrupt the lives of persons living with dementia and their spousal care partners. At the time of ADRD diagnoses, many couples experience challenges that produce emotional distress and relationship strain. At present, there are no interventions to address these challenges early after diagnoses to promote positive adjustment. Objective: The study protocol described here is part of the first phase of a larger program of research that aims to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention to be delivered over live video early after diagnosis, with the goal of preventing chronic emotional distress. This study will elicit and systematically summarize perspectives of ADRD medical stakeholders to inform the procedures (eg, recruitment and screening methods, eligibility, timing of intervention, and intervention delivery) of the first iteration of RT-ADRD prior to pilot-testing. Methods: We will recruit interdisciplinary medical stakeholders (eg, neurologists, social workers, neuropsychologists, care coordinators, and speech language pathologists) from academic medical center clinics in the departments treating persons living with dementia such as neurology, psychiatry, and geriatric medicine via flyers and word-of-mouth referrals from clinic directors and members of relevant organizations (eg, dementia care collaboratives and Alzheimer disease research centers). The participants will complete electronic screening and consent procedures. Consenting individuals will then participate in a 30- to 60-minute qualitative virtual focus group, held either via telephone or Zoom, using an interview guide designed to assess provider experiences with postdiagnosis clinical care and to gather feedback on the proposed RT-ADRD protocol. The participants will also have the opportunity to participate in an optional exit interview and web-based survey to gather additional feedback. Qualitative data will be analyzed using a hybrid inductive-deductive approach and the framework method for thematic synthesis. We will conduct approximately 6 focus groups with 4-6 individuals in each group (maximum N=30 individuals; until saturation is reached). Results: Data collection began in November 2022 and will continue through June 2023. We anticipate that the study will be completed by late 2023. Conclusions: The results from this study will inform the procedures of the first live video RT-ADRD dyadic resiliency intervention focused on the prevention of chronic emotional and relational distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from stakeholders on ways to best deliver our early prevention–focused intervention and gain detailed feedback on study procedures prior to further testing. International Registered Report Identifier (IRRID): DERR1-10.2196/45533 %M 37247224 %R 10.2196/45533 %U https://www.researchprotocols.org/2023/1/e45533 %U https://doi.org/10.2196/45533 %U http://www.ncbi.nlm.nih.gov/pubmed/37247224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45213 %T Clinical Efficacy of Deep Transcranial Magnetic Stimulation in Psychiatric and Cognitive Disorders: Protocol for a Systematic Review %A Di Passa,Anne-Marie %A Dabir,Melissa %A Fein,Allan %A Khoshroo,Saba %A McIntyre-Wood,Carly %A Marsden,Emma %A MacKillop,Emily %A De Jesus,Jane %A MacKillop,James %A Duarte,Dante %+ Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L9C 0E3, Canada, 1 905 522 1155 ext 36396, duartedante@mcmaster.ca %K cognitive disorders %K deep rTMS %K deep TMS %K deep transcranial magnetic stimulation %K dTMS %K H-coil %K prospective meta-analysis %K psychiatry %K systematic review protocol %D 2023 %7 26.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Transcranial magnetic stimulation (TMS) is a widely used noninvasive brain stimulation technique for psychiatric and cognitive disorders. In recent years, deep TMS (dTMS) has shown promise as an enhanced form of TMS able to stimulate deeper brain structures and target broader networks. Various magnetic Hesed-coil (H-coil) designs—a novel feature of dTMS—have been used to stimulate brain regions implicated in the pathophysiology of specific psychiatric and cognitive disorders, thereby producing therapeutic effects. Given the novelty of dTMS in psychiatry, little is known about the clinical efficacy of dTMS across psychiatric and cognitive disorders—that is, whether dTMS performs superiorly to sham or control. Objective: In this paper, we outline a protocol for a systematic review investigating the clinical efficacy of dTMS. The primary objective is to conduct a systematic review of the literature on dTMS for psychiatric and cognitive disorders and, if feasible, a meta-analysis to compare the efficacy of active dTMS versus sham/control for psychiatric disorders. Dementia and related cognitive disorders will also be examined. A secondary objective will be to examine subgroup differences (by age, sex, H-coil design, and dTMS parameters [ie, pulses per session, percentage of motor threshold, etc]) to evaluate whether dTMS differentially influences clinical outcomes based on these factors. Methods: A comprehensive search of the APA PsycINFO, Embase, MEDLINE, and PubMed databases will be conducted using keywords such as “H-coil” and “dTMS.” Two authors (AD and MD) will be responsible for screening relevant articles, assessing article eligibility (according to predetermined inclusion and exclusion criteria), and data extraction. All included articles will undergo a quality and risk of bias assessment. Data from included articles will be summarized qualitatively in a systematic review. If a sufficient number of equivalent studies are available, a meta-analysis will be performed to (1) determine the effect of active versus sham dTMS (or another control arm) across psychiatric and cognitive disorders, and (2) examine subgroup effects of clinical outcomes. Results: The preliminary search rendered a total of 1134 articles from the APA PsycINFO, Embase, and MEDLINE databases. After full-text screening, 21 eligible articles remained. One additional article was identified from the references section of an existing systematic review. In total, 22 eligible articles were included. Data extraction and quality of assessment procedures are ongoing. Conclusions: We will outline the evidence relating to the clinical efficacy of dTMS in various psychiatric and cognitive disorders. The results of the prospective systematic review will provide clinicians with valuable insight into the clinical (ie, participant age, sex, psychiatric or cognitive disorder, etc) and methodological factors (ie, H-coil design, dTMS parameters, etc) which may contribute to dTMS efficacy, and thereby may assist clinicians in their decision to prescribe dTMS for specific psychiatric and cognitive disorders. Trial Registration: PROSPERO CRD42022360066; https://tinyurl.com/5ev6byrn International Registered Report Identifier (IRRID): DERR1-10.2196/45213 %M 37234039 %R 10.2196/45213 %U https://www.researchprotocols.org/2023/1/e45213 %U https://doi.org/10.2196/45213 %U http://www.ncbi.nlm.nih.gov/pubmed/37234039 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38552 %T Clinical Assessment of Eye Movement Desensitization and Reprocessing in Memory Distress: Protocol for a Double-Blinded Randomized Controlled Trial %A Babaei,Nazanin %A Kerry,Camrie %A Goode,Kisha %A Dang,Kevin %A Mirzadeh,Parsa %A Pirbaglou,Meysam %A Kirk,Megan A %A Ritvo,Paul %+ School of Kinesiology and Health Science, York University, 4700 Keele St,, Toronto, ON, M3J1P3, Canada, 1 416 580 8021, pritvo@yorku.ca %K EMDR variants %K eye movement desensitization reprocessing %K flash technique-EMDR %K posttraumatic stress disorder %D 2023 %7 12.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Exposures to “traumatic” events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video. Objective: This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up. Methods: This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up. Results: If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts. Conclusions: This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory–related distress. Trial Registration: ClinicalTrials.gov NCT05262127; https://clinicaltrials.gov/ct2/show/NCT05262127 %M 37171869 %R 10.2196/38552 %U https://www.researchprotocols.org/2023/1/e38552 %U https://doi.org/10.2196/38552 %U http://www.ncbi.nlm.nih.gov/pubmed/37171869 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44776 %T Traumatic Brain Injury Intensive Evaluation and Treatment Program: Protocol for a Partnered Evaluation Initiative Mixed Methods Study %A Haun,Jolie N %A Nakase-Richardson,Risa %A Melillo,Christine %A Kean,Jacob %A Benzinger,Rachel C %A Schneider,Tali %A Pugh,Mary Jo V %+ James A. Haley Veterans' Hospital, Research Service, 8200 Grand Oak Circle, Tampa, FL, 33637, United States, 1 813 558 7622, rachel.benzinger@va.gov %K service member %K rehabilitation %K traumatic brain injury %K TBI %K posttraumatic stress disorder %K PTSD %K pain %K military %K brain injury %K trauma %K traumatic %K participatory %K recovery %K veteran %K implementation %K service delivery %K protocol %K treatment program %K implementation %K health care implementation %K Consolidated Framework for Implementation Research %K CFIR %K cognitive %K cognition %K brain %K script %K Bayesian %K network analysis %K directed acyclic graph %K effect size %K missing data %K inpatient %K modality %D 2023 %7 9.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The traumatic brain injury (TBI) Intensive Evaluation and Treatment Program (IETP) is an innovative modality for delivering evidence-based treatments in a residential, inpatient format to special operational forces service members and veterans with mild TBI. IETPs provide bundled evidence-based assessment, treatment, referral, and case management in concordance with the existing guidelines for mild TBI and commonly co-occurring comorbidities. To date, there has been no formal characterization or evaluation of the IETP to understand the determinants of implementation across the system of care. The goal of our partnered evaluation initiative (PEI) with an operational partner, the Physical Medicine and Rehabilitation National Program Office, is to facilitate the full implementation of the IETP across all 5 Veterans Health Administration TBI–Centers of Excellence (TBI-COE) and to inform minimum standards while supporting the unique characteristics of each site. Objective: This IETP partnered evaluation will describe each of the 5 TBI-COE IETP services and state of implementation to identify opportunities for adaptation and scale, characterize the relationship between patient characteristics and clinical services received, evaluate the outcomes for participants in the IETP, and inform ongoing implementation and knowledge translation efforts to support IETP expansion. In alignment with the goals of the protocol, ineffective treatment components will be targeted for deimplementation. Methods: A 3-year concurrent mixed methods evaluation using a participatory approach in collaboration with the operational partner and TBI-COE site leadership will be conducted. Qualitative observations, semistructured focus groups, and interviewing methods will be used to describe IETP, stakeholder experiences and needs, and suggestions for IETP implementation. Quantitative methods will include primary data collection from patients in the IETP at each site to characterize long-term outcomes and patient satisfaction with treatment and secondary data collection to quantitatively characterize patient-level and care system–level data. Finally, data sets will be triangulated to share data findings with partners to inform ongoing implementation efforts. Results: Data collection began in December 2021 and is currently ongoing. The results and deliverables will inform IETP characterization, evaluation, implementation, and knowledge translation. Conclusions: The results of this evaluation seek to provide an understanding of the determinants affecting the implementation of IETPs. Service member, staff, and stakeholder insights will inform the state of implementation at each site, and quantitative measures will provide options for standardized outcome measures. This evaluation is expected to inform national Physical Medicine and Rehabilitation Office policies and processes and knowledge translation efforts to improve and expand the IETP. Future work may include cost evaluations and rigorous research, such as randomized controlled trials. International Registered Report Identifier (IRRID): DERR1-10.2196/44776 %M 37159250 %R 10.2196/44776 %U https://www.researchprotocols.org/2023/1/e44776 %U https://doi.org/10.2196/44776 %U http://www.ncbi.nlm.nih.gov/pubmed/37159250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42723 %T Exploring Novel Innovation Strategies to Close a Technology Gap in Neurosurgery: HORAO Crowdsourcing Campaign %A Schucht,Philippe %A Mathis,Andrea Maria %A Murek,Michael %A Zubak,Irena %A Goldberg,Johannes %A Falk,Stephanie %A Raabe,Andreas %+ Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16, Bern, 3010, Switzerland, 41 31 632 95 64, andrea.mathis@insel.ch %K collective intelligence %K crowdsourcing %K fiber tracts %K ideation %K Mueller polarimetry %K neuroscience %K neurosurgery %K open innovation %K polarization %D 2023 %7 28.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Scientific research is typically performed by expert individuals or groups who investigate potential solutions in a sequential manner. Given the current worldwide exponential increase in technical innovations, potential solutions for any new problem might already exist, even though they were developed to solve a different problem. Therefore, in crowdsourcing ideation, a research question is explained to a much larger group of individuals beyond the specialist community to obtain a multitude of diverse, outside-the-box solutions. These are then assessed in parallel by a group of experts for their capacity to solve the new problem. The 2 key problems in brain tumor surgery are the difficulty of discerning the exact border between a tumor and the surrounding brain, and the difficulty of identifying the function of a specific area of the brain. Both problems could be solved by a method that visualizes the highly organized fiber tracts within the brain; the absence of fibers would reveal the tumor, whereas the spatial orientation of the tracts would reveal the area’s function. To raise awareness about our challenge of developing a means of intraoperative, real-time, noninvasive identification of fiber tracts and tumor borders to improve neurosurgical oncology, we turned to the crowd with a crowdsourcing ideation challenge. Objective: Our objective was to evaluate the feasibility of a crowdsourcing ideation campaign for finding novel solutions to challenges in neuroscience. The purpose of this paper is to introduce our chosen crowdsourcing method and discuss it in the context of the current literature. Methods: We ran a prize-based crowdsourcing ideation competition called HORAO on the commercial platform HeroX. Prize money previously collected through a crowdfunding campaign was offered as an incentive. Using a multistage approach, an expert jury first selected promising technical solutions based on broad, predefined criteria, coached the respective solvers in the second stage, and finally selected the winners in a conference setting. We performed a postchallenge web-based survey among the solvers crowd to find out about their backgrounds and demographics. Results: Our web-based campaign reached more than 20,000 people (views). We received 45 proposals from 32 individuals and 7 teams, working in 26 countries on 4 continents. The postchallenge survey revealed that most of the submissions came from single solvers or teams working in engineering or the natural sciences, with additional submissions from other nonmedical fields. We engaged in further exchanges with 3 out of the 5 finalists and finally initiated a successful scientific collaboration with the winner of the challenge. Conclusions: This open innovation competition is the first of its kind in medical technology research. A prize-based crowdsourcing ideation campaign is a promising strategy for raising awareness about a specific problem, finding innovative solutions, and establishing new scientific collaborations beyond strictly disciplinary domains. %M 37115612 %R 10.2196/42723 %U https://www.jmir.org/2023/1/e42723 %U https://doi.org/10.2196/42723 %U http://www.ncbi.nlm.nih.gov/pubmed/37115612 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41082 %T Turning When Using Smartphone in Persons With and Those Without Neurologic Conditions: Observational Study %A Bianchini,Edoardo %A Warmerdam,Elke %A Romijnders,Robbin %A Stürner,Klarissa Hanja %A Baron,Ralf %A Heinzel,Sebastian %A Pontieri,Francesco Ernesto %A Hansen,Clint %A Maetzler,Walter %+ Department of Neurology, Kiel University, Klinik für Neurologie UKSH, Campus Kiel, Arnold-Heller-Strasse 3, Haus D, Kiel, 24105, Germany, 49 431500 23981, w.maetzler@neurologie.uni-kiel.de %K turning %K turning coordination %K smartphone %K dual task %K dual task cost %K Parkinson disease %K Parkinson %K stroke %K multiple sclerosis %K low back pain %K neurology %K neurological %K movement %K biomechanics %K gait %K balance %K walk %K kinesiology %K fall %D 2023 %7 30.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. Objective: This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. Methods: Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. Results: In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. Conclusions: Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. Trial Registration: German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998 %M 36995756 %R 10.2196/41082 %U https://www.jmir.org/2023/1/e41082 %U https://doi.org/10.2196/41082 %U http://www.ncbi.nlm.nih.gov/pubmed/36995756 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43870 %T Detection of Motor Cerebral Activity After Median Nerve Stimulation During General Anesthesia (STIM-MOTANA): Protocol for a Prospective Interventional Study %A Rimbert,Sébastien %A Lelarge,Julien %A Guerci,Philippe %A Bidgoli,Seyed Javad %A Meistelman,Claude %A Cheron,Guy %A Cebolla Alvarez,Ana Maria %A Schmartz,Denis %+ CHU Brugmann, Université Libre de Bruxelles, Place A.Van Gehuchten 4, Bruxelles, 1020, Belgium, 32 499829407, sebastien.rimbert@inria.fr %K intraoperative awareness %K brain-computer interfaces %K median nerve stimulation %K electroencephalography %K general anesthesia %D 2023 %7 2.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accidental awareness during general anesthesia (AAGA) is defined as an unexpected awareness of the patient during general anesthesia. This phenomenon occurs in 1%-2% of high-risk practice patients and can cause physical suffering and psychological after-effects, called posttraumatic stress disorder. In fact, no monitoring techniques are satisfactory enough to effectively prevent AAGA; therefore, new alternatives are needed. Because the first reflex for a patient during an AAGA is to move, but cannot do so because of the neuromuscular blockers, we believe that it is possible to design a brain-computer interface (BCI) based on the detection of movement intention to warn the anesthetist. To do this, we propose to describe and detect the changes in terms of motor cortex oscillations during general anesthesia with propofol, while a median nerve stimulation is performed. We believe that our results could enable the design of a BCI based on median nerve stimulation, which could prevent AAGA. Objective: To our knowledge, no published studies have investigated the detection of electroencephalographic (EEG) patterns in relation to peripheral nerve stimulation over the sensorimotor cortex during general anesthesia. The main objective of this study is to describe the changes in terms of event-related desynchronization and event-related synchronization modulations, in the EEG signal over the motor cortex during general anesthesia with propofol while a median nerve stimulation is performed. Methods: STIM-MOTANA is an interventional and prospective study conducted with patients scheduled for surgery under general anesthesia, involving EEG measurements and median nerve stimulation at two different times: (1) when the patient is awake before surgery (2) and under general anesthesia. A total of 30 patients will receive surgery under complete intravenous anesthesia with a target-controlled infusion pump of propofol. Results: The changes in event-related desynchronization and event-related synchronization during median nerve stimulation according to the various propofol concentrations for 30 patients will be analyzed. In addition, we will apply 4 different offline machine learning algorithms to detect the median nerve stimulation at the cerebral level. Recruitment began in December 2022. Data collection is expected to conclude in June 2024. Conclusions: STIM-MOTANA will be the first protocol to investigate median nerve stimulation cerebral motor effect during general anesthesia for the detection of intraoperative awareness. Based on strong practical and theoretical scientific reasoning from our previous studies, our innovative median nerve stimulation–based BCI would provide a way to detect intraoperative awareness during general anesthesia. Trial Registration: Clinicaltrials.gov NCT05272202; https://clinicaltrials.gov/ct2/show/NCT05272202 International Registered Report Identifier (IRRID): PRR1-10.2196/43870 %M 36729587 %R 10.2196/43870 %U https://www.researchprotocols.org/2023/1/e43870 %U https://doi.org/10.2196/43870 %U http://www.ncbi.nlm.nih.gov/pubmed/36729587 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40856 %T Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND): Protocol for a Multimodal Feasibility Study %A Gutierrez,Robert %A McCrady,Allison %A Masterson,Chelsea %A Tolman,Sarah %A Boukhechba,Mehdi %A Barnes,Laura %A Blemker,Silvia %A Scharf,Rebecca %+ University of Virginia Children's Hospital, 1204 W. Main St., Charlottesville, VA, 22903, United States, 1 434 924 1647, rebeccascharf@virginia.edu %K mHealth %K ubiquitous computing %K neuromuscular disorders %K inertial measurement unit %K motor function %K specific torque %K cross-sectional area %K echogenicity %D 2022 %7 27.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neuromuscular diseases, such as spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD), may result in the loss of motor movements, respiratory failure, and early mortality in young children and in adulthood. With novel treatments now available, new evaluation methods are needed to assess progress that is not currently captured in existing motor scale tests. Objective: With our feasibility study, our interdisciplinary team of investigators aims to develop a novel, multimodal paradigm of measuring motor function in children with neuromuscular diseases that will revolutionize the way that clinical trial end points are measured, thereby accelerating the pipeline of new treatments for childhood neuromuscular diseases. Through the Upper Extremity Examination for Neuromuscular Diseases (U-EXTEND) study, we hypothesize that the novel objective measures of upper extremity muscle structure and function proposed herein will be able to capture small changes and differences in function that cannot be measured with current clinical metrics. Methods: U-EXTEND introduces a novel paradigm in which concrete, quantitative measures are used to assess motor function in patients with SMA and DMD. Aim 1 will focus on the use of ultrasound techniques to study muscle size, quality, and function, specifically isolating the biceps and pronator muscles of the upper extremities for follow-ups over time. To achieve this, clinical investigators will extract a set of measurements related to muscle structure, quality, and function by using ultrasound imaging and handheld dynamometry. Aim 2 will focus on leveraging wearable wireless sensor technology to capture motion data as participants perform activities of daily living. Measurement data will be examined and compared to those from a healthy cohort, and a motor function score will be calculated. Results: Data collection for both aims began in January 2021. As of July 2022, we have enrolled 44 participants (9 with SMA, 20 with DMD, and 15 healthy participants). We expect the initial results to be published in summer 2022. Conclusions: We hypothesize that by applying the described tools and techniques for measuring muscle structure and upper extremity function, we will have created a system for the precise quantification of changes in motor function among patients with neuromuscular diseases. Our study will allow us to track the minimal clinically important difference over time to assess progress in novel treatments. By comparing the muscle scores and functional scores over multiple visits, we will be able to detect small changes in both the ability of the participants to perform the functional tasks and their intrinsic muscle properties. International Registered Report Identifier (IRRID): DERR1-10.2196/40856 %M 36301603 %R 10.2196/40856 %U https://www.researchprotocols.org/2022/10/e40856 %U https://doi.org/10.2196/40856 %U http://www.ncbi.nlm.nih.gov/pubmed/36301603 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e38190 %T Investigating Recovery After Subarachnoid Hemorrhage With the Imaging, Cognition and Outcome of Neuropsychological Functioning After Subarachnoid Hemorrhage (ICONS) Study: Protocol for a Longitudinal, Prospective Cohort Study %A Khosdelazad,Sara %A Jorna,Lieke S %A Groen,Rob J M %A Rakers,Sandra E %A Timmerman,Marieke E %A Borra,Ronald J H %A van der Hoorn,Anouk %A Spikman,Jacoba M %A Buunk,Anne M %+ Neuropsychology Unit, Department of Neurology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, 9700 RB, Netherlands, 31 503614664, s.khosdelazad@umcg.nl %K subarachnoid haemorrhage %K cognition %K neuroimaging %K emotion and behavior %K neuropsychology %K longitudinal study %K protocol %K cohort study %K bleeding %K rupture %K aneurysm %K emotional %K behavioral %K brain damage %D 2022 %7 29.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: A subarachnoid hemorrhage is a hemorrhage in the subarachnoid space that is often caused by the rupture of an aneurysm. Patients who survive a subarachnoid hemorrhage have a high risk of complications and a negative long-term outcome. Objective: The aim of the Imaging, Cognition and Outcome of Neuropsychological functioning after Subarachnoid hemorrhage (ICONS) study is to investigate whether and to what extent deficits exist in multiple domains after subarachnoid hemorrhage, including cognition, emotion and behavior, and to investigate whether brain damage can be detected in patients with subarachnoid hemorrhage. We aim to determine which early measures of cognition, emotion and behavior, and brain damage in the subacute stage play a role in long-term recovery after subarachnoid hemorrhage. Recovery is defined as functioning at a societal participation level, with a focus on resuming and maintaining work, leisure activities, and social relationships over the long term. Methods: The ICONS study is an observational, prospective, single-center cohort study. The study includes patients with subarachnoid hemorrhage admitted to the Neurosurgery Unit of the University Medical Centre Groningen in the Netherlands. The inclusion criteria include diagnosis of an aneurysmal subarachnoid hemorrhage or an angiographically negative subarachnoid hemorrhage, sufficient ability in the Dutch language, and age older than 18 years. Patients will undergo neuropsychological assessment and magnetic resonance imaging 6 months after the subarachnoid hemorrhage. Furthermore, patients will be asked to fill in questionnaires on multiple psychosocial measures and undergo a structured interview at 6 months, 1 year, and 2 years after the subarachnoid hemorrhage. The primary outcome measure of the ICONS study is societal participation 1 year after the subarachnoid hemorrhage, measured with the Dutch version of the Impact on Participation and Autonomy questionnaire. Results: The study was launched in December 2019 and recruitment is expected to continue until June 2023. At the time of the acceptance of this paper, 76 patients and 69 healthy controls have been included. The first results are expected in early 2023. Conclusions: The ICONS study is the first to collect and combine data after subarachnoid hemorrhage in a variety of domains, including cognition, emotion and behavior, and brain damage. The results will contribute to a more comprehensive understanding of the consequences of both aneurysmal subarachnoid hemorrhage and angiographically negative subarachnoid hemorrhage, which may ultimately optimize timely treatment for this patient group by setting realistic and attainable goals to improve daily functioning. Trial Registration: Netherlands Trial Register NL7803; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7803 International Registered Report Identifier (IRRID): DERR1-10.2196/38190 %M 36173673 %R 10.2196/38190 %U https://www.researchprotocols.org/2022/9/e38190 %U https://doi.org/10.2196/38190 %U http://www.ncbi.nlm.nih.gov/pubmed/36173673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e36294 %T Association of Transcranial Direct Current Stimulation and Neurofeedback With Declarative Memory and Cerebral Arterial Flow in University Students: Protocol for a Double-blind Randomized Controlled Study %A Grecco,Leandro H %A Gonçalves,Giuliano R %A Perri,Bárbara Neiva %A Bispo,Breno Alexander %A Grandin,Isabella Favilla Jorge %A Gomes,Paula Valentina Nunes Dias %A Bocchi,André Alexandre %A Oliveira,Kennedy Martinez %A Maldonado,Diogo Correa %A Silva,Marcelo Cavenaghi Pereira da %+ Department of Morphology and Genetics, Universidade Federal de São Paulo, Rua Botucatu, 682, São Paulo, 04021-001, Brazil, 55 11 5576 4848, leandrohgrecco@gmail.com %K transcranial direct current stimulation %K neurofeedback stimulation %K TDCS %K memory %K Doppler ultrasonography %K arterial flow %K brain stimulation %K electrical stimulation %K transcranial %K neurofeedback %K brain %K neurology %K cerebral %K blood flow %K cerebrum %K declarative memory %K double-blind %K controlled trial %K RCT %K randomized controlled trial %K university %K college %K student %K postsecondary %K graduate %K undergraduate %D 2022 %7 26.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The performance of a task depends on ongoing brain activity, which can be influenced by attention, excitement, or motivation. Scientific studies have confirmed that mindfulness leads to better performance, health, and well-being. However, these cognitive efficiency modulating factors are nonspecific, can be difficult to control, and are not suitable to specifically facilitate neural processing. Objective: The aim of this study is to evaluate the effects of transcranial direct current stimulation associated with neurofeedback on declarative memory and cerebral blood flow in university students. Methods: In this study, we will use transcranial direct current stimulation, a low-cost physical resource that is easy to apply, has few adverse effects, and is associated with a neurofeedback resource. This, in turn, has been shown to be a training program capable of improving working memory function. Results: Participants will be recruited between July 2022 and December 2022. This study is expected to conclude in July 2023. Conclusions: This study will provide preliminary results on the benefits of using the direct current neurostimulation and neurofeedback tools on the participants being analyzed. Trial Registration: Brazilian Clinical Trials Registry RBR-7zs8b5; https://ensaiosclinicos.gov.br/rg/RBR-7zs8b5 International Registered Report Identifier (IRRID): PRR1-10.2196/36294 %M 36018619 %R 10.2196/36294 %U https://www.researchprotocols.org/2022/8/e36294 %U https://doi.org/10.2196/36294 %U http://www.ncbi.nlm.nih.gov/pubmed/36018619 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e38495 %T Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping %A Chikersal,Prerna %A Venkatesh,Shruthi %A Masown,Karman %A Walker,Elizabeth %A Quraishi,Danyal %A Dey,Anind %A Goel,Mayank %A Xia,Zongqi %+ Department of Neurology, University of Pittsburgh, 3501 Fifth Avenue,, BST3, Suite 7014, Pittsburgh, PA, 15260, United States, 1 412 383 5377, zxia1@pitt.edu %K mobile sensing %K sensor %K sensing %K mobile health %K mHealth %K algorithm %K multiple sclerosis %K disability %K mental health %K depression %K sleep %K fatigue %K tiredness %K predict %K machine learning %K feature selection %K neurological disorder %K COVID-19 %K isolation %K behavior change %K health outcome %K fitness %K movement %K physical activity %K exercise %K tracker %K digital phenotyping %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has broad negative impact on the physical and mental health of people with chronic neurological disorders such as multiple sclerosis (MS). Objective: We presented a machine learning approach leveraging passive sensor data from smartphones and fitness trackers of people with MS to predict their health outcomes in a natural experiment during a state-mandated stay-at-home period due to a global pandemic. Methods: First, we extracted features that capture behavior changes due to the stay-at-home order. Then, we adapted and applied an existing algorithm to these behavior-change features to predict the presence of depression, high global MS symptom burden, severe fatigue, and poor sleep quality during the stay-at-home period. Results: Using data collected between November 2019 and May 2020, the algorithm detected depression with an accuracy of 82.5% (65% improvement over baseline; F1-score: 0.84), high global MS symptom burden with an accuracy of 90% (39% improvement over baseline; F1-score: 0.93), severe fatigue with an accuracy of 75.5% (22% improvement over baseline; F1-score: 0.80), and poor sleep quality with an accuracy of 84% (28% improvement over baseline; F1-score: 0.84). Conclusions: Our approach could help clinicians better triage patients with MS and potentially other chronic neurological disorders for interventions and aid patient self-monitoring in their own environment, particularly during extraordinarily stressful circumstances such as pandemics, which would cause drastic behavior changes. %M 35849686 %R 10.2196/38495 %U https://mental.jmir.org/2022/8/e38495 %U https://doi.org/10.2196/38495 %U http://www.ncbi.nlm.nih.gov/pubmed/35849686 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 1 %N 1 %P e41122 %T JMIR Neurotechnology: Connecting Clinical Neuroscience and (Information) Technology %A Kubben,Pieter %+ Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 43 388 2222, pieter.kubben@maastrichtuniversity.nl %K neurotechnology %K neurological disorders %K treatment tools %K chronic neurological disease %K information technology %D 2022 %7 11.8.2022 %9 Editorial %J JMIR Neurotech %G English %X %R 10.2196/41122 %U https://neuro.jmir.org/2022/1/e41122 %U https://doi.org/10.2196/41122 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e40181 %T Self-management Interventions for People With Parkinson Disease: Scoping Review %A Milne-Ives,Madison %A Carroll,Camille %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DN, United Kingdom, 44 01752600600, edward.meinert@plymouth.ac.uk %K Parkinson disease %K self-management %K self-care %K home nursing %K self-efficacy %K quality of life %K signs and symptoms %K health behaviour %D 2022 %7 5.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Parkinson disease can impose substantial distress and costs on patients, their families and caregivers, and health care systems. To address these burdens for families and health care systems, there is a need to better support patient self-management. To achieve this, an overview of the current state of the literature on self-management is needed to identify what is being done, how well it is working, and what might be missing. Objective: The aim of this scoping review was to provide an overview of the current body of research on self-management interventions for people with Parkinson disease and identify any knowledge gaps. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study type frameworks were used to structure the methodology of the review. Due to time and resource constraints, 1 reviewer systematically searched 4 databases (PubMed, Ovid, Scopus, and Web of Science) for the evaluations of self-management interventions for Parkinson disease published in English. The references were screened using the EndNote X9 citation management software, titles and abstracts were manually reviewed, and studies were selected for inclusion based on the eligibility criteria. Data were extracted into a pre-established form and synthesized in a descriptive analysis. Results: There was variation among the studies on study design, sample size, intervention type, and outcomes measured. The randomized controlled trials had the strongest evidence of effectiveness: 5 out of 8 randomized controlled trials found a significant difference between groups favoring the intervention on their primary outcome, and the remaining 3 had significant effects on at least some of the secondary outcomes. The 2 interventions included in the review that targeted mental health outcomes both found significant changes over time, and the 3 algorithms evaluated performed well. The remaining studies examined patient perceptions, acceptability, and cost-effectiveness and found generally positive results. Conclusions: This scoping review identified a wide variety of interventions designed to support various aspects of self-management for people with Parkinson disease. The studies all generally reported positive results, and although the strength of the evidence varied, it suggests that self-management interventions are promising for improving the care and outcomes of people with Parkinson disease. However, the research tended to focus on the motor aspects of Parkinson disease, with few nonmotor or holistic interventions, and there was a lack of evaluation of cost-effectiveness. This research will be important to providing self-management interventions that meet the varied and diverse needs of people with Parkinson disease and determining which interventions are worth promoting for widespread adoption. %M 35930315 %R 10.2196/40181 %U https://www.jmir.org/2022/8/e40181 %U https://doi.org/10.2196/40181 %U http://www.ncbi.nlm.nih.gov/pubmed/35930315 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e34821 %T Development of an Assistive Technology for Cognition to Support Meal Preparation in Severe Traumatic Brain Injury: User-Centered Design Study %A Pinard,Stéphanie %A Bottari,Carolina %A Laliberté,Catherine %A Pigot,Hélène %A Olivares,Marisnel %A Couture,Mélanie %A Aboujaoudé,Aline %A Giroux,Sylvain %A Bier,Nathalie %+ École de réadaptation, Université de Montréal, CP 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada, 1 5143436564, nathalie.bier@umontreal.ca %K user-centered design %K needs assessment %K assistive technology %K brain injury %K activities of daily living %K cognitive rehabilitation %K meal preparation %K mobile phone %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population. Objective: This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users’ profiles and establishing the clinical requirements of the ATC. Methods: In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework. Results: The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task. Conclusions: This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability. %M 35925663 %R 10.2196/34821 %U https://humanfactors.jmir.org/2022/3/e34821 %U https://doi.org/10.2196/34821 %U http://www.ncbi.nlm.nih.gov/pubmed/35925663 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 1 %N 1 %P e36960 %T The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study %A Chidambaram,Swathi %A Palumbo,Maria Chiara %A Stifano,Vito %A McKenna,John %A Redaelli,Alberto %A Olivi,Alessandro %A Apuzzo,Michael %A Pannullo,Susan %+ Department of Neurosurgery, Weill Cornell Medical College, 1305 York Ave 9th Floor, New York, NY, 10021, United States, 1 2127462438, scp2002@med.cornell.edu %K mixed reality %K augmented reality %K extended reality %K HoloLens %K interdisciplinary teams %K virtual reality %K brain tumour %K tumor %K radiosurgery %K surgery %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Neurotech %G English %X Background: Extended reality (XR) is a term that captures a variety of techniques, such as augmented reality (AR) and mixed reality (MR), which allow users to interact with virtual models in real time. This technology has an emerging role in several applications within neurosurgery. XR can be useful in enhancing how radiosurgical cases are planned. Multidisciplinary team (MDT) review is an essential part of the radiosurgery case planning process; during case discussions, patient images are reviewed, usually in 2D or 3D modifications. The current commercially available platforms for this review need improvement. Objective: We describe a novel visualization application, titled “NeuroVis” by our development team, which uses an XR Microsoft HoloLens headset to provide an interactive 3D visualization of a patient’s neuroanatomy in stereotactic surgery (SRS) case planning discussions. Methods: We present examples of 6 common radiosurgery indications to demonstrate the utility of NeuroVis to solve common visualization hurdles in MDTs. Results: The utility of NeuroVis is demonstrated through 6 common brain tumor SRS cases as a proof-of-concept illustration of the utility of NeuroVis to enhance radiosurgery case discussion by improving visualization of the standard neuroimaging used in radiosurgery treatment planning by MDTs. Conclusions: The NeuroVis application provides several interactive features that produce an enhanced ability to place participating members of an interdisciplinary treatment team on the same visualization plane. This technology, by facilitating team discussions and case review, has the potential to improve the efficiency, efficacy, and safety of radiosurgery treatment planning and, as a result, to optimize patient care. %R 10.2196/36960 %U https://neuro.jmir.org/2022/1/e36960 %U https://doi.org/10.2196/36960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32922 %T Web-Based Independent Versus Laboratory-Based Stop-Signal Task Performance: Within-Subjects Counterbalanced Comparison Study %A Poulton,Antoinette %A Chen,Li Peng Evelyn %A Dali,Gezelle %A Fox,Michael %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 3 8344 6377, antoinette.poulton@unimelb.edu.au %K Stop-Signal Task %K response inhibition %K inhibitory control %K online assessment %K web-based assessment %K cognition %D 2022 %7 30.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Considered a facet of behavioral impulsivity, response inhibition facilitates adaptive and goal-directed behavior. It is often assessed using the Stop-Signal Task (SST), which is presented on stand-alone computers under controlled laboratory conditions. Sample size may consequently be a function of cost or time and sample diversity constrained to those willing or able to attend the laboratory. Statistical power and generalizability of results might, in turn, be impacted. Such limitations may potentially be overcome via the implementation of web-based testing. Objective: The aim of this study was to investigate if there were differences between variables derived from a web-based SST when it was undertaken independently—that is, outside the laboratory, on any computer, and in the absence of researchers—versus when it was performed under laboratory conditions. Methods: We programmed a web-based SST in HTML and JavaScript and employed a counterbalanced design. A total of 166 individuals (mean age 19.72, SD 1.85, range 18-36 years; 146/166, 88% female) were recruited. Of them, 79 undertook the independent task prior to visiting the laboratory and 78 completed the independent task following their laboratory visit. The average time between SST testing was 3.72 (SD 2.86) days. Dependent samples and Bayesian paired samples t tests were used to examine differences between laboratory-based and independent SST variables. Correlational analyses were conducted on stop-signal reaction times (SSRT). Results: After exclusions, 123 participants (mean age 19.73, SD 1.97 years) completed the SST both in the laboratory and independently. While participants were less accurate on go trials and exhibited reduced inhibitory control when undertaking the independent—compared to the laboratory-based—SST, there was a positive association between the SSRT of each condition (r=.48; P<.001; 95% CI 0.33-0.61). Conclusions: Findings suggest a web-based SST, which participants undertake on any computer, at any location, and in the absence of the researcher, is a suitable measure of response inhibition. %M 35635745 %R 10.2196/32922 %U https://www.jmir.org/2022/5/e32922 %U https://doi.org/10.2196/32922 %U http://www.ncbi.nlm.nih.gov/pubmed/35635745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29509 %T Key Drivers and Facilitators of the Choice to Use mHealth Technology in People With Neurological Conditions: Observational Study %A Simblett,Sara %A Pennington,Mark %A Quaife,Matthew %A Theochari,Evangelia %A Burke,Patrick %A Brichetto,Giampaolo %A Devonshire,Julie %A Lees,Simon %A Little,Ann %A Pullen,Angie %A Stoneman,Amanda %A Thorpe,Sarah %A Weyer,Janice %A Polhemus,Ashley %A Novak,Jan %A Dawe-Lane,Erin %A Morris,Daniel %A Mutepua,Magano %A Odoi,Clarissa %A Wilson,Emma %A Wykes,Til %+ Psychology Department, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207 848 0762, sara.simblett@kcl.ac.uk %K mobile technology %K neurological conditions %K multiple sclerosis %K epilepsy %K discrete choice experiment %K digital health %K mHealth %K wearable technology %K wearable biosensors %K health economics %K health data %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is increasing interest in the potential uses of mobile health (mHealth) technologies, such as wearable biosensors, as supplements for the care of people with neurological conditions. However, adherence is low, especially over long periods. If people are to benefit from these resources, we need a better long-term understanding of what influences patient engagement. Previous research suggests that engagement is moderated by several barriers and facilitators, but their relative importance is unknown. Objective: To determine preferences and the relative importance of user-generated factors influencing engagement with mHealth technologies for 2 common neurological conditions with a relapsing-remitting course: multiple sclerosis (MS) and epilepsy. Methods: In a discrete choice experiment, people with a diagnosis of MS (n=141) or epilepsy (n=175) were asked to select their preferred technology from a series of 8 vignettes with 4 characteristics: privacy, clinical support, established benefit, and device accuracy; each of these characteristics was greater or lower in each vignette. These characteristics had previously been emphasized by people with MS and or epilepsy as influencing engagement with technology. Mixed multinomial logistic regression models were used to establish which characteristics were most likely to affect engagement. Subgroup analyses explored the effects of demographic factors (such as age, gender, and education), acceptance of and familiarity with mobile technology, neurological diagnosis (MS or epilepsy), and symptoms that could influence motivation (such as depression). Results: Analysis of the responses to the discrete choice experiment validated previous qualitative findings that a higher level of privacy, greater clinical support, increased perceived benefit, and better device accuracy are important to people with a neurological condition. Accuracy was perceived as the most important factor, followed by privacy. Clinical support was the least valued of the attributes. People were prepared to trade a modest amount of accuracy to achieve an improvement in privacy, but less likely to make this compromise for other factors. The type of neurological condition (epilepsy or MS) did not influence these preferences, nor did the age, gender, or mental health status of the participants. Those who were less accepting of technology were the most concerned about privacy and those with a lower level of education were prepared to trade accuracy for more clinical support. Conclusions: For people with neurological conditions such as epilepsy and MS, accuracy (ie, the ability to detect symptoms) is of the greatest interest. However, there are individual differences, and people who are less accepting of technology may need far greater reassurance about data privacy. People with lower levels of education value greater clinician involvement. These patient preferences should be considered when designing mHealth technologies. %M 35604761 %R 10.2196/29509 %U https://formative.jmir.org/2022/5/e29509 %U https://doi.org/10.2196/29509 %U http://www.ncbi.nlm.nih.gov/pubmed/35604761 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33967 %T Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform %A Brown,Ethan G %A Schleimer,Erica %A Bledsoe,Ian O %A Rowles,William %A Miller,Nicolette A %A Sanders,Stephan J %A Rankin,Katherine P %A Ostrem,Jill L %A Tanner,Caroline M %A Bove,Riley %+ University of California San Francisco Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States, 1 415 353 2311, riley.bove@ucsf.edu %K human-centered design %K personal health record %K visualization in eHealth %K Parkinson disease %K digital health %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: People with Parkinson disease (PD) have a variety of complex medical problems that require detailed review at each clinical encounter for appropriate management. Care of other complex conditions has benefited from digital health solutions that efficiently integrate disparate clinical information. Although various digital approaches have been developed for research and care in PD, no digital solution to personalize and improve communication in a clinical encounter is readily available. Objective: We intend to improve the efficacy and efficiency of clinical encounters with people with PD through the development of a platform (PD-BRIDGE) with personalized clinical information from the electronic health record (EHR) and patient-reported outcome (PRO) data. Methods: Using human-centered design (HCD) processes, we engaged clinician and patient stakeholders in developing PD-BRIDGE through three phases: an inspiration phase involving focus groups and discussions with people having PD, an ideation phase generating preliminary mock-ups for feedback, and an implementation phase testing the platform. To qualitatively evaluate the platform, movement disorders neurologists and people with PD were sent questionnaires asking about the technical validity, usability, and clinical relevance of PD-BRIDGE after their encounter. Results: The HCD process led to a platform with 4 modules. Among these, 3 modules that pulled data from the EHR include a longitudinal module showing motor ratings over time, a display module showing the most recently collected clinical rating scales, and another display module showing relevant laboratory values and diagnoses; the fourth module displays motor symptom fluctuation based on an at-home diary. In the implementation phase, PD-BRIDGE was used in 17 clinical encounters for patients cared for by 1 of 11 movement disorders neurologists. Most patients felt that PD-BRIDGE facilitated communication with their clinician (n=14, 83%) and helped them understand their disease trajectory (n=11, 65%) and their clinician’s recommendations (n=11, 65%). Neurologists felt that PD-BRIDGE improved their ability to understand the patients’ disease course (n=13, 75% of encounters), supported clinical care recommendations (n=15, 87%), and helped them communicate with their patients (n=14, 81%). In terms of improvements, neurologists noted that data in PD-BRIDGE were not exhaustive in 62% (n=11) of the encounters. Conclusions: Integrating clinically relevant information from EHR and PRO data into a visually efficient platform (PD-BRIDGE) can facilitate clinical encounters with people with PD. Developing new modules with more disparate information could improve these complex encounters even further. %M 35522472 %R 10.2196/33967 %U https://humanfactors.jmir.org/2022/2/e33967 %U https://doi.org/10.2196/33967 %U http://www.ncbi.nlm.nih.gov/pubmed/35522472 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37255 %T Effectiveness of Hydrotherapy on Neuropathic Pain and Pain Catastrophization in Patients With Spinal Cord Injury: Protocol for a Pilot Trial Study %A Campo,Andrés Reyes %A Pacichana-Quinayáz,Sara Gabriela %A Bonilla-Escobar,Francisco Javier %A Leiva-Pemberthy,Luz Miriam %A Tovar-Sánchez,Maria Ana %A Hernández-Orobio,Olga Marina %A Arango-Hoyos,Gloria-Patricia %A Mujanovic,Adnan %+ Departamento de Medicina Física y Rehabilitación, Grupo de Investigación en Rehabilitación de la Universidad del Valle, Universidad del Valle, Hospital Universitario del Valle, Cl 5#36-08, Cali, 760001, Colombia, 57 2 6206000, fjbonillaescobar@gmail.com %K spinal cord injury %K neuropathic pain %K quality of life %K catastrophization %K hydrotherapy %K neurology %K spinal cord %K nonpharmacological %D 2022 %7 29.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neuropathic pain (NP) is one of the most frequent spinal cord injury (SCI) complications. Pain, quality of life, and functionality are associated and can lead to pain catastrophization. Pharmacological management of patients with NP secondary to SCI is widely known and there is increasing evidence in the area. Nevertheless, nonpharmacological management is not fully elucidated since its efficacy is inconclusive. Objective: We hypothesize that (1) hydrotherapy is effective in reducing NP secondary to SCI. Additionally, our secondary hypotheses are that (2) hydrotherapy decreases the catastrophization of NP, and that (3) hydrotherapy improves life quality and minimizes the degree of disability, when compared to physical therapy. Methods: A sample of approximately 20 participants will be randomly assigned to either the intervention (hydrotherapy) or control group (standard physical therapy). Both interventions will be administered twice a week over a 9-week period (18 sessions in total). Primary outcomes are changes in neuropathic pain perception and pain catastrophization. Secondary outcomes are changes in disability and quality of life scores. They will be assessed at baseline and follow-up at 4 weeks after discharge. Validated Spanish language scales that will be used are the following: Numerical Pain Rating Scale, Pain Catastrophization, Health-related Quality of life, and the World Health Organization’s Disability Assessment Schedule 2.0. Generalized mixed linear models will be used for comparing baseline and postintervention means of each group and their differences, together with 95% CIs and P values. A P value of less than .05 will be considered significant. Results: Recruitment began in April 2019, and we recruited the last participants by December 2019, with 10 individuals assigned to hydrotherapy and 8 to physical therapy (control). Results from this study will be disseminated via scientific publication, in ClinicalTrials.gov, and in national and international conferences in the latter half of 2022. Conclusions: This trial will explore the effects of hydrotherapy on neuropathic pain, together with functionality and quality of life, in patients with SCI. Furthermore, this study aims to evaluate these therapeutic modalities, including perception variables, and mental processes, which may affect the clinical condition and rehabilitation outcomes in these patients. Hydrotherapy is likely to be a safe, efficient, and cost-effective alternative to the current standard of care for NP secondary to SCI, with comparable results between the two. Trial Registration: ClinicalTrials.gov NCT04164810; https://clinicaltrials.gov/ct2/show/NCT04164810 International Registered Report Identifier (IRRID): DERR1-10.2196/37255 %M 35486436 %R 10.2196/37255 %U https://www.researchprotocols.org/2022/4/e37255 %U https://doi.org/10.2196/37255 %U http://www.ncbi.nlm.nih.gov/pubmed/35486436 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e25249 %T Data Visualization for Chronic Neurological and Mental Health Condition Self-management: Systematic Review of User Perspectives %A Polhemus,Ashley %A Novak,Jan %A Majid,Shazmin %A Simblett,Sara %A Morris,Daniel %A Bruce,Stuart %A Burke,Patrick %A Dockendorf,Marissa F %A Temesi,Gergely %A Wykes,Til %+ Merck Research Labs, Information Technology, Merck, Sharpe, & Dohme, The Circle 66, Zurich, 8058, Switzerland, 41 764922388, ashley.polhemus@uzh.ch %K digital health %K remote measurement technology %K neurology %K mental health %K data visualization %K user-centered design %D 2022 %7 28.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Remote measurement technologies (RMT) such as mobile health devices and apps are increasingly used by those living with chronic neurological and mental health conditions. RMT enables real-world data collection and regular feedback, providing users with insights about their own conditions. Data visualizations are an integral part of RMT, although little is known about visualization design preferences from the perspectives of those living with chronic conditions. Objective: The aim of this review was to explore the experiences and preferences of individuals with chronic neurological and mental health conditions on data visualizations derived from RMT to manage health. Methods: In this systematic review, we searched peer-reviewed literature and conference proceedings (PubMed, IEEE Xplore, EMBASE, Web of Science, Association for Computing Machinery Computer-Human Interface proceedings, and the Cochrane Library) for original papers published between January 2007 and September 2021 that reported perspectives on data visualization of people living with chronic neurological and mental health conditions. Two reviewers independently screened each abstract and full-text article, with disagreements resolved through discussion. Studies were critically appraised, and extracted data underwent thematic synthesis. Results: We identified 35 eligible publications from 31 studies representing 12 conditions. Coded data coalesced into 3 themes: desire for data visualization, impact of visualizations on condition management, and visualization design considerations. Data visualizations were viewed as an integral part of users’ experiences with RMT, impacting satisfaction and engagement. However, user preferences were diverse and often conflicting both between and within conditions. Conclusions: When used effectively, data visualizations are valuable, engaging components of RMT. They can provide structure and insight, allowing individuals to manage their own health more effectively. However, visualizations are not “one-size-fits-all,” and it is important to engage with potential users during visualization design to understand when, how, and with whom the visualizations will be used to manage health. %M 35482368 %R 10.2196/25249 %U https://mental.jmir.org/2022/4/e25249 %U https://doi.org/10.2196/25249 %U http://www.ncbi.nlm.nih.gov/pubmed/35482368 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37282 %T The Effect of Transcranial Alternating Current Stimulation With Cognitive Training on Executive Brain Function in Individuals With Dementia: Protocol for a Crossover Randomized Controlled Trial %A Jacobson,Natasha %A Lithgow,Brian %A Jafari Jozani,Mohammad %A Moussavi,Zahra %+ Department of Electrical and Computer Engineering, University of Manitoba, SP-423 Engineering Building, Fort Gary Campus, 97 Dafoe Rd, Winnipeg, MB, R3T 5V6, Canada, 1 204 474 7023, Zahra.Moussavi@Umanitoba.ca %K transcranial alternating current stimulation %K Alzheimer disease %K cognitive impairment %K double blind %K treatment %K placebo-controlled %K randomized %K crossover %K dementia %K cognitive %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although memory and cognitive declines are associated with normal brain aging, they may also be precursors to dementia. Objective: We aim to offer a novel approach to prevent or slow the progress of neurodegenerative dementia, or plausibly, improve the cognitive functions of individuals with dementia. Methods: We will recruit and enroll 75 participants (older than 50 years old with either mild cognitive impairment or probable early or moderate dementia) for this double-blind randomized controlled study to estimate the efficacy of active transcranial alternating current stimulation with cognitive treatment (in comparison with sham transcranial alternating current stimulation). This will be a crossover study; a cycle consists of sham or active treatment for a period of 4 weeks (5 days per week, in two 30-minute sessions with a half-hour break in between), and participants are randomized into 2 groups, with stratification by age, sex, and cognitive level (measured with the Montreal Cognitive Assessment). Outcomes will be assessed before and after each treatment cycle. The primary outcomes are changes in Wechsler Memory Scale Older Adult Battery and Alzheimer Disease Assessment Scale scores. Secondary outcomes are changes in performance on tests of frontal lobe functioning (verbal fluency), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), mood changes (Montgomery-Åsberg Depression Rating Scale), and short-term recall (visual 1-back task). Exploratory outcome measures will also be assessed: static and dynamic vestibular response using electrovestibulography, neuronal changes using functional near-infrared spectroscopy, and change in spatial orientation using virtual reality navigation. Results: As of February 10, 2022, the study is ongoing: 7 patients have been screened, and all were deemed eligible for and enrolled in the study; 4 participants have completed baseline assessments. Conclusions: We anticipate that transcranial alternating current stimulation will be a well-tolerated treatment, with no serious side effects and with considerable short- and long-term cognitive improvements. Trial Registration: Clinicaltrials.gov NCT05203523; https://clinicaltrials.gov/show/NCT05203523 International Registered Report Identifier (IRRID): DERR1-10.2196/37282 %M 35475789 %R 10.2196/37282 %U https://www.researchprotocols.org/2022/4/e37282 %U https://doi.org/10.2196/37282 %U http://www.ncbi.nlm.nih.gov/pubmed/35475789 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e34513 %T Associations Between the Digital Clock Drawing Test and Brain Volume: Large Community-Based Prospective Cohort (Framingham Heart Study) %A Yuan,Jing %A Au,Rhoda %A Karjadi,Cody %A Ang,Ting Fang %A Devine,Sherral %A Auerbach,Sanford %A DeCarli,Charles %A Libon,David J %A Mez,Jesse %A Lin,Honghuang %+ Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, S7-749, Worcester, MA, 01655, United States, 1 774 455 4881, Honghuang.Lin3@umassmed.edu %K Clock Drawing Test %K digital %K neuropsychological test %K cognitive %K technology %K Boston Process Approach %K neurology %K Framingham Heart Study %K dementia %K Alzheimer %D 2022 %7 15.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital Clock Drawing Test (dCDT) has been recently used as a more objective tool to assess cognition. However, the association between digitally obtained clock drawing features and structural neuroimaging measures has not been assessed in large population-based studies. Objective: We aimed to investigate the association between dCDT features and brain volume. Methods: This study included participants from the Framingham Heart Study who had both a dCDT and magnetic resonance imaging (MRI) scan, and were free of dementia or stroke. Linear regression models were used to assess the association between 18 dCDT composite scores (derived from 105 dCDT raw features) and brain MRI measures, including total cerebral brain volume (TCBV), cerebral white matter volume, cerebral gray matter volume, hippocampal volume, and white matter hyperintensity (WMH) volume. Classification models were also built from clinical risk factors, dCDT composite scores, and MRI measures to distinguish people with mild cognitive impairment (MCI) from those whose cognition was intact. Results: A total of 1656 participants were included in this study (mean age 61 years, SD 13 years; 50.9% women), with 23 participants diagnosed with MCI. All dCDT composite scores were associated with TCBV after adjusting for multiple testing (P value <.05/18). Eleven dCDT composite scores were associated with cerebral white matter volume, but only 1 dCDT composite score was associated with cerebral gray matter volume. None of the dCDT composite scores was associated with hippocampal volume or WMH volume. The classification model for differentiating MCI and normal cognition participants, which incorporated age, sex, education, MRI measures, and dCDT composite scores, showed an area under the curve of 0.897. Conclusions: dCDT composite scores were significantly associated with multiple brain MRI measures in a large community-based cohort. The dCDT has the potential to be used as a cognitive assessment tool in the clinical diagnosis of MCI. %M 35436225 %R 10.2196/34513 %U https://www.jmir.org/2022/4/e34513 %U https://doi.org/10.2196/34513 %U http://www.ncbi.nlm.nih.gov/pubmed/35436225 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31019 %T Left Ventricular Outflow Tract Obstruction in Patients Treated With Milrinone for Cerebral Vasospasm: Case Report and Literature Review %A Baulier,Charles %A Lessert,Marc %A Chauvet,Jean-Louis %A Garel,Pauline %A Bergis,Alexandre %A Burdeau,Julie %A Clavier,Thomas %+ Anesthesia and Intensive Care Department, Rouen University Hospital, 1 rue de Germont, Rouen, 76000, France, 33 668527500, charles.baulier@gmail.com %K ventricular outflow obstruction %K subarachnoid hemorrhage %K vasospasm %K intracranial %K milrinone %K hemorrhage %K neurosurgery %K neurology %K surgery %K pharmaceutical %D 2022 %7 11.4.2022 %9 Case Report %J JMIRx Med %G English %X Subarachnoid hemorrhage is associated with high morbidity and mortality, and cerebral arterial vasospasm is one of its main complications that determines neurological prognosis. The use of intravenous milrinone is becoming more common in the treatment of vasospasm. This molecule has positive inotropic and vasodilating properties by inhibiting phosphodiesterase-3. Its most described side effects are cardiac arrhythmias and arterial hypotension. In this paper, we raise a new issue concerning milrinone and discuss an undescribed side effect of this treatment, left ventricular outflow tract obstruction (LVOTO). Dynamic LVOTO is a clinical situation favored by hypovolemia, decreased left ventricular afterload, and excessive inotropism that can lead to severe hemodynamic failure and pulmonary edema. To our knowledge, this is the first study describing milrinone-induced LVOTO. This could compromise cerebral perfusion and therefore the neurological prognosis of patients. While it is known that catecholamines may induce LVOTO, milrinone-induced LVOTO appears to be a new pathophysiological entity of which neurosurgical intensivists should be aware. %M 37463041 %R 10.2196/31019 %U https://med.jmirx.org/2022/2/e31019 %U https://doi.org/10.2196/31019 %U http://www.ncbi.nlm.nih.gov/pubmed/37463041 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34822 %T Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development %A Shore,Josh %A Nalder,Emily %A Hutchison,Michael %A Reed,Nick %A Hunt,Anne %+ Department of Occupational Science and Occupational Therapy, University of Toronto, Rehabilitation Sciences Building, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada, 1 (416) 946 8568, anne.hunt@utoronto.ca %K concussion %K pediatrics %K active rehabilitation %K telehealth %K exercise %K mobile phone %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective: This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods: The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results: Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions: The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach. %M 35377326 %R 10.2196/34822 %U https://pediatrics.jmir.org/2022/2/e34822 %U https://doi.org/10.2196/34822 %U http://www.ncbi.nlm.nih.gov/pubmed/35377326 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e26825 %T Proposal for Post Hoc Quality Control in Instrumented Motion Analysis Using Markerless Motion Capture: Development and Usability Study %A Röhling,Hanna Marie %A Althoff,Patrik %A Arsenova,Radina %A Drebinger,Daniel %A Gigengack,Norman %A Chorschew,Anna %A Kroneberg,Daniel %A Rönnefarth,Maria %A Ellermeyer,Tobias %A Rosenkranz,Sina Cathérine %A Heesen,Christoph %A Behnia,Behnoush %A Hirano,Shigeki %A Kuwabara,Satoshi %A Paul,Friedemann %A Brandt,Alexander Ulrich %A Schmitz-Hübsch,Tanja %+ Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, Berlin, 13125, Germany, 49 30 450539718, hanna-marie.roehling@charite.de %K instrumented motion analysis %K markerless motion capture %K visual perceptive computing %K quality control %K quality reporting %K gait analysis %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Instrumented assessment of motor symptoms has emerged as a promising extension to the clinical assessment of several movement disorders. The use of mobile and inexpensive technologies such as some markerless motion capture technologies is especially promising for large-scale application but has not transitioned into clinical routine to date. A crucial step on this path is to implement standardized, clinically applicable tools that identify and control for quality concerns. Objective: The main goal of this study comprises the development of a systematic quality control (QC) procedure for data collected with markerless motion capture technology and its experimental implementation to identify specific quality concerns and thereby rate the usability of recordings. Methods: We developed a post hoc QC pipeline that was evaluated using a large set of short motor task recordings of healthy controls (2010 recordings from 162 subjects) and people with multiple sclerosis (2682 recordings from 187 subjects). For each of these recordings, 2 raters independently applied the pipeline. They provided overall usability decisions and identified technical and performance-related quality concerns, which yielded respective proportions of their occurrence as a main result. Results: The approach developed here has proven user-friendly and applicable on a large scale. Raters’ decisions on recording usability were concordant in 71.5%-92.3% of cases, depending on the motor task. Furthermore, 39.6%-85.1% of recordings were concordantly rated as being of satisfactory quality whereas in 5.0%-26.3%, both raters agreed to discard the recording. Conclusions: We present a QC pipeline that seems feasible and useful for instant quality screening in the clinical setting. Results confirm the need of QC despite using standard test setups, testing protocols, and operator training for the employed system and by extension, for other task-based motor assessment technologies. Results of the QC process can be used to clean existing data sets, optimize quality assurance measures, as well as foster the development of automated QC approaches and therefore improve the overall reliability of kinematic data sets. %M 35363150 %R 10.2196/26825 %U https://humanfactors.jmir.org/2022/2/e26825 %U https://doi.org/10.2196/26825 %U http://www.ncbi.nlm.nih.gov/pubmed/35363150 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e35134 %T User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials %A Lee,Jennifer M %A Woon,Rex %A Ramsum,Mandy %A Halperin,Daniel S %A Jain,Roshini %+ Boston Scientific Neuromodulation, 25155 Rye Canyon Loop, Valencia, CA, 91355, United States, 1 66169494350, Roshini.Jain@bsci.com %K spinal cord stimulation %K SCS %K chronic pain %K digital health %K smartphone app %K mobile health %K mHealth %K smart device %K digital application %K application %K app %K spine %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR eHum Factors %G English %X Background: Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether to proceed with long-term, permanent implantation of an SCS device for the treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the SCS-based neurostimulative modalities and parameters that may provide substantial analgesia in a patient-specific manner. Objective: In this report, we aimed to describe a preliminary, real-world assessment of a new, real time tracking, smart, device-based digital app used by patients with chronic pain undergoing trial screening for SCS therapy. Methods: This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who used the new “mySCS” mobile app during an SCS screening trial. The app design is health insurance portability and accountability act (HIPAA)-compliant and compatible with most commercially available smartphones (eg, Apple, iPhone, and Android). The app enables tracking of user-inputted health-related responses (ie, pain relief, activity level, and sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A deidentified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. Results: When provided the opportunity, the percentage of users who engaged with the tracking app for ≥50% of the time during their trial was found to be 64.43% (n=8589). Among the 13,331 patients who used the app, 58.24% (n=7764) entered a trial goal. Most patients underwent SCS screening with a trial duration of at least 7 days (n=7739, 58.05%). Of those patients who undertook a 7-day SCS trial, 62.30% (n=3456) engaged the app for 4 days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 77.84% (n=10,377) of patients who reached day 3 of the screening phase assessment and by 83.04% (n=11,070) of those who reached trial completion. A trial success rate of 91% was determined for those who used the app (versus 85% success rate for nonusers). Conclusions: Data from this initial, real-world examination of a mobile, digital-health–based tracking app (“mySCS”), as used during the SCS screening phase, demonstrate that substantial patient engagement can be achieved while also providing for the acquisition of more real time patient-outcome measures that may help facilitate improved SCS trial success. %M 35167484 %R 10.2196/35134 %U https://humanfactors.jmir.org/2022/1/e35134 %U https://doi.org/10.2196/35134 %U http://www.ncbi.nlm.nih.gov/pubmed/35167484 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29513 %T Occurrence Patterns of Traumatic Brain Injury Within the Emergency Department and Internal Screening Process Efficacy During the COVID-19 Pandemic: Retrospective Analysis %A Paralkar,Tapasvini Anmol %A Lay,Phoebe %A Stubbs,Sawyer %A Ahmed,Syed Hadi %A Ghani,Minha %A Osier,Nico %+ School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, United States, 1 (512) 471 7913, nicoosier@utexas.edu %K COVID-19 %K coronavirus %K pandemic %K clinical recruitment %K traumatic brain injury %K children %K participant-focused %K recruitment %K enrollment %K digital screening %K brain %K EHR %K electronic health record %K database %D 2022 %7 23.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Traumatic brain injury (TBI) is one of the leading causes of death in pediatric patients. Continued recruitment of pediatric TBI participants into a biobank amidst the COVID-19 pandemic not only necessitates adaptive changes to traditional recruitment methods but also requires an evaluation of emergency department (ED) utilization by TBI-presenting patients. Objective: The primary objective of this exploratory retrospective study was to evaluate pediatric TBI-related ED utilization during the pandemic. The secondary objective was to appraise the efficacy of the research team’s internal screening processes. Methods: Potential participants (ie, individuals who met all inclusion criteria and would be approached by a consenter) were screened from an ED’s electronic health record system. Data regarding their visit were recorded in a Health Insurance Portability and Accountability Act–compliant manner, which were cleaned through Google Sheets. Cleaned data were then coded as either a screening variable or a hospital utilization variable to examine the effects of the pandemic on internal operations and hospital utilization patterns. The variables were compared between select months during the pandemic in 2020 to analogous months in 2019 in the R programming language via the two-sample Student t test and the Mann-Whitney-Wilcoxon rank-sum test. Results: The sample (N=2321) consisted of 1245 entries from 2019 and 1076 entries from 2020. A significantly greater proportion of potential participants (P<.001) were identified in 2020 (222/633, 35.1%) than in 2019 (195/908, 21.4%). A significantly greater proportion of potential participants (P<.001) had a visit reason indicative of a TBI in 2020 (181/222, 81.5%) than in 2019 (103/195, 52.8%). A significantly greater proportion of these injuries (P=.02) occurred inside (39/181, 21.5%) in 2020 than in 2019 (11/103, 10.7%). No significant difference was found across the mechanism of injury categories reported for potential participants between 2019 and 2020. Potential participants were significantly older (P=.006) in 2019 (mean 8.93 years) than in 2020 (mean 7.31 years). Screeners spent significantly longer (P=.03) to identify potential participants in March 2020 (55 minutes) than in March 2019 (32 minutes), but spent significantly less time (P=.01) to do so in July 2020 (22 minutes) than in July 2019 (42 minutes). Screening coverage was significantly lower (P<.001) in March 2020 (241.8 hours) than in March 2019 (346.5 hours). Screening coverage was significantly greater (P<.001) in April 2020 (611.5 hours) and July 2020 (513.5 hours) than in April 2019 (470.5 hours) and July 2019 (404.3 hours), respectively. Conclusions: There was a significant increase in the rate of incoming TBI cases to the ED during the COVID-19 pandemic, warranting continued enrollment with added safety measures. Additionally, refinement of internal processes improved the accuracy of data collection. As demonstrated in this study, researchers can leverage ongoing data collection to facilitate process improvements and evaluate the impact of unexpected global events on their research. %M 35225820 %R 10.2196/29513 %U https://www.i-jmr.org/2022/1/e29513 %U https://doi.org/10.2196/29513 %U http://www.ncbi.nlm.nih.gov/pubmed/35225820 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30366 %T Determining the Optimal Virtual Reality Exergame Approach for Balance Therapy in Persons With Neurological Disorders Using a Rasch Analysis: Longitudinal Observational Study %A Wiskerke,Evelyne %A Kool,Jan %A Hilfiker,Roger %A Sattelmayer,Karl Martin %A Verheyden,Geert %+ Rehazentrum Valens, Kliniken Valens, Taminaplatz 1, Valens, 7317, Switzerland, 41 813031403, evelien.wiskerke@kuleuven.be %K digital therapeutics %K virtual reality %K exergaming %K balance %K stroke %K multiple sclerosis %K neurorehabilitation %K Rasch analysis %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) exergames have gained popularity in the rehabilitation of persons with neurological disorders as an add-on therapy to increase intensity of training. Intensity is strongly dependent on the motivation of the patient. Motivation can be increased by delivering variation within training and challenging exercises. However, patients are often underchallenged, as exergame difficulty often does not match the patient’s ability. A Rasch analysis can establish hierarchy of exergame items in order to assist the delivery of patient-centered therapy. Objective: The aim of this study was to apply the Rasch model to create a hierarchical order of existing VR balance exergames and to relate these exergames to the abilities of persons with neurological disorders, in order to deliver challenge and variation. Methods: A total of 30 persons with stroke and 51 persons with multiple sclerosis (MS) were included in the study. All participants performed a training program, lasting 3 weeks for persons with MS and 4 weeks for persons with stroke, in which they performed VR balance exergames with a movement recognition–based system (MindMotion GO; MindMaze SA). VR exercise scores, Berg Balance Scale scores, and clinical descriptive data were collected. Berg Balance Scale and device scores were analyzed with the Rasch model using a repeated-measures approach to examine whether the distribution of exercise scores fitted the Rasch model. Secondly, a person-item map was created to show the hierarchy of exercise difficulty and person ability. Results: Participants completed a selection of 56 balance exercises (ie, items), which consisted of a combination of various balance tasks and levels (ie, exercises). Using repeated measures, this resulted in a count of 785 observations. Analysis showed strong evidence for unidimensionality of the data. A total of 47 exercises (ie, items) had a sufficiently good fit to the Rasch model. Six items showed underfit, with outfit mean square values above 1.5. One item showed underfit but was kept in the analysis. Three items had negative point-biserial correlations. The final model consisted of 47 exercises, which were provided for persons with low to moderate balance ability. Conclusions: The VR exercises sufficiently fitted the Rasch model and resulted in a hierarchical order of VR balance exercises for persons with stroke and MS with low to moderate balance ability. In combination with the Berg Balance Scale, the results can guide clinical decision-making in the selection of patient-focused VR balance exercises. Trial Registration: ClinicalTrials.gov NCT03993275; https://clinicaltrials.gov/ct2/show/NCT03993275 %M 35315785 %R 10.2196/30366 %U https://games.jmir.org/2022/1/e30366 %U https://doi.org/10.2196/30366 %U http://www.ncbi.nlm.nih.gov/pubmed/35315785 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e31308 %T Treatment of Persistent Postconcussion Syndrome With Repetitive Transcranial Magnetic Stimulation Using Functional Near-Infrared Spectroscopy as a Biomarker of Response: Protocol for a Randomized Controlled Clinical Trial %A du Plessis,Sané %A Oni,Ibukunoluwa K %A Lapointe,Andrew P %A Campbell,Christina %A Dunn,Jeff F %A Debert,Chantel T %+ Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N4N1, Canada, 1 9448643, sane.duplessis@ucalgary.ca %K concussion %K mild traumatic brain injury %K persistent postconcussion syndrome %K repetitive transcranial magnetic stimulation %K functional near-infrared spectroscopy %K traumatic brain injury %K TBI %K brain injury %K brain %K symptom burden %K mental health %K quality of life %K neuroscience %K neurology %D 2022 %7 22.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately one-third of all concussions lead to persistent postconcussion syndrome (PPCS). Repetitive transcranial magnetic stimulation (rTMS) is a form of noninvasive brain stimulation that has been extensively used to treat refractory major depressive disorder and has a strong potential to be used as a treatment for patients with PPCS. Functional near-infrared spectroscopy (fNIRS) has already been used as a tool to assess patients with PPCS and may provide insight into the pathophysiology of rTMS treatment in patients with PPCS. Objective: The primary objective of this research is to determine whether rTMS treatment improves symptom burden in patients with PPCS compared to sham treatment using the Rivermead postconcussion symptom questionnaire. The secondary objective is to explore the neuropathophysiological changes that occur following rTMS in participants with PPCS using fNIRS. Exploratory objectives include determining whether rTMS treatment in participants with PPCS will also improve quality of life, anxiety, depressive symptoms, cognition, posttraumatic stress, and function secondary to headaches. Methods: A total of 44 adults (18-65 years old) with PPCS (>3 months to 5 years) will participate in a double-blind, sham-controlled, concealed allocation, randomized clinical trial. The participants will engage in either a 4-week rTMS treatment protocol or sham rTMS protocol (20 treatments). The left dorsolateral prefrontal cortex will be located through Montreal Neurologic Institute coordinates. The intensity of the rTMS treatment over the left dorsolateral prefrontal cortex will be 120% of resting motor threshold, with a frequency of 10 Hz, 10 trains of 60 pulses per train (total of 600 pulses), and intertrain interval of 45 seconds. Prior to starting the rTMS treatment, participant and injury characteristics, questionnaires (symptom burden, quality of life, depression, anxiety, cognition, and headache), and fNIRS assessment will be collected. Repeat questionnaires and fNIRS will occur immediately after rTMS treatment and at 1 month and 3 months post rTMS. Outcome parameters will be analyzed by a 2-way (treatment × time) mixed analysis of variance. Results: As of May 6, 2021, 5 participants have been recruited for the study, and 3 have completed the rTMS protocol. The estimated completion date of the trial is May 2022. Conclusions: This trial will expand our knowledge of how rTMS can be used as a treatment option of PPCS and will explore the neuropathophysiological response of rTMS through fNIRS analysis. Trial Registration: ClinicalTrials.gov NCT04568369; https://clinicaltrials.gov/ct2/show/NCT04568369 International Registered Report Identifier (IRRID): DERR1-10.2196/31308 %M 35315783 %R 10.2196/31308 %U https://www.researchprotocols.org/2022/3/e31308 %U https://doi.org/10.2196/31308 %U http://www.ncbi.nlm.nih.gov/pubmed/35315783 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31164 %T The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study %A Gulde,Philipp %A Rieckmann,Peter %+ Center for Clinical Neuroplasticity, Medical Park Loipl, Medical Park Societas Europaea, Thanngasse 15, Bischofswiesen, 83483, Germany, 49 865289522, p.gulde@medicalpark.de %K multiple sclerosis %K actigraphy %K cluster analysis %K fatigue %K physical activity %K neurology %K neurorehabilitation %K rehabilitation %K digital health %K health technology %K digital tools %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Persons with multiple sclerosis frequently report increased levels of fatigue and fatigability. However, behavioral surrogates that are strongly associated with self-reports are lacking, which limits research and treatment. Objective: The aim of this study was to derive distinct behavioral syndromes that are reflected by self-reports concerning fatigue and fatigability. Methods: We collected actigraphic data of 30 persons with multiple sclerosis over a period of 1 week during an inpatient stay at a neurorehabilitation facility. Further, participants completed the German fatigue severity scale. A principal component analysis of actigraphic parameters was performed to extract the latent component levels of behaviors that reflect fatigue (quantity of activity) and fatigability (fragmentation of activity). The resulting components were used in a cluster analysis. Results: Analyses suggested 3 clusters, one with high activity (d=0.65-1.57) and low clinical disability levels (d=0.91-1.39), one with high levels of sedentary behavior (d=1.06-1.58), and one with strong activity fragmentation (d=1.39-1.94). The cluster with high levels of sedentary behavior further revealed strong differences from the other clusters concerning participants’ reported levels of fatigue (d=0.99-1.28). Conclusions: Cluster analysis data proved to be feasible to meaningfully differentiate between different behavioral syndromes. Self-reports reflected the different behavioral syndromes strongly. Testing of additional domains (eg, volition or processing speed) and assessments during everyday life seem warranted to better understand the origins of reported fatigue symptomatology. %M 35297774 %R 10.2196/31164 %U https://rehab.jmir.org/2022/1/e31164 %U https://doi.org/10.2196/31164 %U http://www.ncbi.nlm.nih.gov/pubmed/35297774 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e32352 %T Impact of Biological and Lifestyle Factors on Cognitive Aging and Work Ability in the Dortmund Vital Study: Protocol of an Interdisciplinary, Cross-sectional, and Longitudinal Study %A Gajewski,Patrick D %A Getzmann,Stephan %A Bröde,Peter %A Burke,Michael %A Cadenas,Cristina %A Capellino,Silvia %A Claus,Maren %A Genç,Erhan %A Golka,Klaus %A Hengstler,Jan G %A Kleinsorge,Thomas %A Marchan,Rosemarie %A Nitsche,Michael A %A Reinders,Jörg %A van Thriel,Christoph %A Watzl,Carsten %A Wascher,Edmund %+ Leibniz Research Centre for Working Environment and Human Factors (IfADo) at the Technical University of Dortmund, Ardeystr. 67, Dortmund, 44139, Germany, 49 231 1084 383, gajewski@ifado.de %K cognitive aging %K genetic polymorphisms %K immunology %K metabolism %K latent infections %K stress %K occupational health %K cardiovascular system %K neuropsychology %K magnetic resonance imaging %K electroencephalography %K lifespan %K lifestyle %K longitudinal study %K biomarkers %K longevity %K aging. %D 2022 %7 14.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous research revealed several biological and environmental factors modulating cognitive functioning over a human’s lifespan. However, the relationships and interactions between biological factors (eg, genetic polymorphisms, immunological parameters, metabolic products, or infectious diseases) and environmental factors (eg, lifestyle, physical activity, nutrition, and work type or stress at work) as well as their impact on cognitive functions across the lifespan are still poorly understood with respect to their complexity. Objective: The goal of the Dortmund Vital Study is to validate previous hypotheses as well as generate and validate new hypotheses about the relationships among aging, working conditions, genetic makeup, stress, metabolic functions, the cardiovascular system, the immune system, and mental performance over the human lifespan with a focus on healthy working adults. The Dortmund Vital Study is a multidisciplinary study involving the Departments of Ergonomics, Immunology, Psychology and Neurosciences, and Toxicology at the Leibniz Research Centre for Working Environment and Human Factors at the Technical University of Dortmund (IfADo) in Germany, as well as several national and international partners. Methods: The Dortmund Vital Study is designed as a combined cross-sectional and longitudinal study. Approximately 600 healthy subjects aged between 20 and 70 years will participate. A wide range of demographic, psychological, behavioral, sensory, cardiovascular, immunological, and biochemical data, a comprehensive electroencephalography (EEG)-based cognitive test battery as well as structural and functional magnetic resonance imaging (MRI) have been included in the study. Results: The study was approved by the Ethics Committee of IfADo in October 2015. The baseline testing was conducted between 2016 and 2021 and will be repeated every 5 years (3 follow-up measures until 2035). As of March 2020 (until the outbreak of the COVID-19 pandemic), 593 participants have been enrolled. Some results from the cross-sectional part of the study were already published, further results will be published soon. Longitudinal data will be analyzed and published by 2025. Conclusions: We anticipate that the study will shed light on sources of interindividual differences in the alterations of cognitive functioning with increasing age and reveal biological and lifestyle markers contributing to work ability, longevity, and healthy aging on the one hand, and to risk factors for cognitive decline, mild cognitive impairment, or even dementia on the other hand. Trial Registration: ClinicalTrials.gov NCT05155397; https://clinicaltrials.gov/ct2/show/NCT05155397 International Registered Report Identifier (IRRID): DERR1-10.2196/32352 %M 35285810 %R 10.2196/32352 %U https://www.researchprotocols.org/2022/3/e32352 %U https://doi.org/10.2196/32352 %U http://www.ncbi.nlm.nih.gov/pubmed/35285810 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e34592 %T The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis %A Abd-alrazaq,Alaa %A Alajlani,Mohannad %A Alhuwail,Dari %A Toro,Carla T %A Giannicchi,Anna %A Ahmed,Arfan %A Makhlouf,Ahmed %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K serious games %K cognitive training %K exergames %K mild cognitive impairment %K Alzheimer disease %K dementia %K global cognition %K systematic review %K meta-analysis %D 2022 %7 10.3.2022 %9 Review %J JMIR Serious Games %G English %X Background: Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. Objective: This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results: Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups. Conclusions: Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects. %M 35266877 %R 10.2196/34592 %U https://games.jmir.org/2022/1/e34592 %U https://doi.org/10.2196/34592 %U http://www.ncbi.nlm.nih.gov/pubmed/35266877 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e31106 %T A Digital Screening System for Alzheimer Disease Based on a Neuropsychological Test and a Convolutional Neural Network: System Development and Validation %A Cheah,Wen-Ting %A Hwang,Jwu-Jia %A Hong,Sheng-Yi %A Fu,Li-Chen %A Chang,Yu-Ling %A Chen,Ta-Fu %A Chen,I-An %A Chou,Chun-Chen %+ Department of Computer Science and Information Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd, Taipei, 10617, Taiwan, 886 935545846, lichen@ntu.edu.tw %K Alzheimer disease %K mild cognitive impairment %K screening system %K convolutional neural network %K Rey-Osterrieth Complex Figure %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Alzheimer disease (AD) and other types of dementia are now considered one of the world’s most pressing health problems for aging people worldwide. It was the seventh-leading cause of death, globally, in 2019. With a growing number of patients with dementia and increasing costs for treatment and care, early detection of the disease at the stage of mild cognitive impairment (MCI) will prevent the rapid progression of dementia. In addition to reducing the physical and psychological stress of patients’ caregivers in the long term, it will also improve the everyday quality of life of patients. Objective: The aim of this study was to design a digital screening system to discriminate between patients with MCI and AD and healthy controls (HCs), based on the Rey-Osterrieth Complex Figure (ROCF) neuropsychological test. Methods: The study took place at National Taiwan University between 2018 and 2019. In order to develop the system, pretraining was performed using, and features were extracted from, an open sketch data set using a data-driven deep learning approach through a convolutional neural network. Later, the learned features were transferred to our collected data set to further train the classifier. The first data set was collected using pen and paper for the traditional method. The second data set used a tablet and smart pen for data collection. The system’s performance was then evaluated using the data sets. Results: The performance of the designed system when using the data set that was collected using the traditional pen and paper method resulted in a mean area under the receiver operating characteristic curve (AUROC) of 0.913 (SD 0.004) when distinguishing between patients with MCI and HCs. On the other hand, when discriminating between patients with AD and HCs, the mean AUROC was 0.950 (SD 0.003) when using the data set that was collected using the digitalized method. Conclusions: The automatic ROCF test scoring system that we designed showed satisfying results for differentiating between patients with AD and MCI and HCs. Comparatively, our proposed network architecture provided better performance than our previous work, which did not include data augmentation and dropout techniques. In addition, it also performed better than other existing network architectures, such as AlexNet and Sketch-a-Net, with transfer learning techniques. The proposed system can be incorporated with other tests to assist clinicians in the early diagnosis of AD and to reduce the physical and mental burden on patients’ family and friends. %M 35262497 %R 10.2196/31106 %U https://medinform.jmir.org/2022/3/e31106 %U https://doi.org/10.2196/31106 %U http://www.ncbi.nlm.nih.gov/pubmed/35262497 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e33157 %T Remote Assessments of Hand Function in Neurological Disorders: Systematic Review %A Gopal,Arpita %A Hsu,Wan-Yu %A Allen,Diane D %A Bove,Riley %+ Weill Institute of Neurosciences, University of California San Francisco, 1651 4th Street, Room 622A, San Francisco, CA, 94143, United States, 1 415 353 8903, arpita.gopal@ucsf.edu %K neurological disease %K hand function %K remote assessment %K assessment %K telemedicine %K rehabilitation %K telerehabilitation %K review %K neurological %K hand %K function %K diagnosis %K intervention %K dysfunction %K feasibility %K mobile phone %D 2022 %7 9.3.2022 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be regularly assessed to monitor loss of fine motor skills in people with central nervous system disorders; however, there are challenges to in-clinic assessments. Remotely assessing hand function could facilitate monitoring and supporting of early diagnosis and intervention when warranted. Objective: Remote assessments can facilitate the tracking of limitations, aiding in early diagnosis and intervention. This study aims to systematically review existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction. Methods: PubMed and MEDLINE, CINAHL, Web of Science, and Embase were searched for studies that reported remote assessment of hand function (ie, outside of traditional in-person clinical settings) in adults with chronic central nervous system disorders. We excluded studies that included participants with orthopedic upper limb dysfunction or used tools for intervention and treatment. We extracted data on the evaluated hand function domains, validity and reliability, feasibility, and stage of development. Results: In total, 74 studies met the inclusion criteria for Parkinson disease (n=57, 77% studies), stroke (n=9, 12%), multiple sclerosis (n=6, 8%), spinal cord injury (n=1, 1%), and amyotrophic lateral sclerosis (n=1, 1%). Three assessment modalities were identified: external device (eg, wrist-worn accelerometer), smartphone or tablet, and telerehabilitation. The feasibility and overall participant acceptability were high. The most common hand function domains assessed included finger tapping speed (fine motor control and rigidity), hand tremor (pharmacological and rehabilitation efficacy), and finger dexterity (manipulation of small objects required for daily tasks) and handwriting (coordination). Although validity and reliability data were heterogeneous across studies, statistically significant correlations with traditional in-clinic metrics were most commonly reported for telerehabilitation and smartphone or tablet apps. The most readily implementable assessments were smartphone or tablet-based. Conclusions: The findings show that remote assessment of hand function is feasible in neurological disorders. Although varied, the assessments allow clinicians to objectively record performance in multiple hand function domains, improving the reliability of traditional in-clinic assessments. Remote assessments, particularly via telerehabilitation and smartphone- or tablet-based apps that align with in-clinic metrics, facilitate clinic to home transitions, have few barriers to implementation, and prompt remote identification and treatment of hand function impairments. %M 35262502 %R 10.2196/33157 %U https://rehab.jmir.org/2022/1/e33157 %U https://doi.org/10.2196/33157 %U http://www.ncbi.nlm.nih.gov/pubmed/35262502 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30882 %T Benefits of Virtual Reality Balance Training for Patients With Parkinson Disease: Systematic Review, Meta-analysis, and Meta-Regression of a Randomized Controlled Trial %A Wu,Jinlong %A Zhang,Hui %A Chen,Ziyan %A Fu,Ruijia %A Yang,Hao %A Zeng,Hongfa %A Ren,Zhanbing %+ Department of Physical Education, Shenzhen University, No 3588 Nanhai Road, Shenzhen, 518060, China, 86 13318881919, rzb@szu.edu.cn %K virtual reality %K Parkinson disease %K balance %K systematic review %K meta-analysis %K meta-regression %K serious games %K VR %K rehabilitation %K VR training %D 2022 %7 1.3.2022 %9 Review %J JMIR Serious Games %G English %X Background: Virtual reality (VR) balance training is increasingly being pursued in biomedical research, specifically with respect to investigating balance ability with VR. However, existing systematic reviews have found inconsistent conclusions about the efficacy of VR in improving balance in Parkinson disease (PD) patients. Objective: The goal of the research was to evaluate the impact of VR balance training on the balance ability of patients with PD. Methods: All major databases, including Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang, were searched to identify all relevant studies published in English or Chinese since September 15, 2010. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation. Results: A total of 16 randomized controlled trials were analyzed (n=583 patients with PD), with the methodological quality evaluation score ranging from 5 to 8 points. A random effects model was selected to combine effect sizes. Meta-analysis showed that the balance ability of PD was significantly improved after VR training compared with the control group (standardized mean difference [SMD] 2.127, 95% CI 1.202 to 3.052, P<.001, I2=95.1, df=15). It is worth noting that the intervention platform may be the main reason for heterogeneity. Meta regression analysis showed that no training program could predict the impact of VR training (P=.57 to .94) on PD balance ability. Subgroup result showed that a single training time of 0 to 20 minutes (SMD 6.446), 4 to 6 times per week (SMD 4.067), training for 3 to 5 weeks (SMD 62.478), training course reached more than 30 times (SMD 4.405), and 201 to 300 minutes per week (SMD 4.059) maybe have more benefit. Conclusions: A systematic review and meta-analysis confirmed that VR balance training is a highly effective means to improve balance performance with large effects in PD. In addition, we preliminarily extracted dose-effect relationships for training volume, informing clinicians and practitioners to design effective VR balance training for balance ability. Further research is needed to reveal optimal dose-response relationships following VR balance training. %M 35230242 %R 10.2196/30882 %U https://games.jmir.org/2022/1/e30882 %U https://doi.org/10.2196/30882 %U http://www.ncbi.nlm.nih.gov/pubmed/35230242 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34688 %T Island Study Linking Aging and Neurodegenerative Disease (ISLAND) Targeting Dementia Risk Reduction: Protocol for a Prospective Web-Based Cohort Study %A Bartlett,Larissa %A Doherty,Kathleen %A Farrow,Maree %A Kim,Sarang %A Hill,Edward %A King,Anna %A Alty,Jane %A Eccleston,Claire %A Kitsos,Alex %A Bindoff,Aidan %A Vickers,James C %+ Wicking Dementia Research and Education Centre, University of Tasmania, Medical Sciences Precinct, 17 Liverpool Street, Hobart, 7000, Australia, 1800 982 600, larissa.bartlett@utas.edu.au %K public health %K online %K prospective research cohort %K dementia %K aging %K older adult %K neurodegenerative %K modifiable risk factors %K risk reduction %K prevention %K lifestyle and behaviors %K lifestyle %K behavior change %K intervention %K risk %K cognition %K blood-based dementia biomarkers %K research translation %D 2022 %7 1.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Up to 40% of incident dementia is considered attributable to behavioral and lifestyle factors. Given the current lack of medical treatments and the projected increase in dementia prevalence, a focus on prevention through risk reduction is needed. Objective: We aim to increase dementia risk knowledge and promote changes in dementia risk behaviors at individual and population levels. Methods: The Island Study Linking Aging and Neurodegenerative Disease (ISLAND) is a long-term prospective, web-based cohort study with nested interventions that will be conducted over a 10-year period. Target participants (n=10,000) reside in Tasmania and are aged 50 years or over. Survey data on knowledge, attitudes, and behaviors related to modifiable dementia risk factors will be collected annually. After each survey wave, participants will be provided with a personalized dementia risk profile containing guidelines for reducing risk across 9 behavioral and lifestyle domains and with opportunities to engage in educational and behavioral interventions targeting risk reduction. Survey data will be modeled longitudinally with intervention engagement indices, cognitive function indices, and blood-based biomarkers, to measure change in risk over time. Results: In the initial 12 months (October 2019 to October 2020), 6410 participants have provided baseline data. The study is ongoing. Conclusions: Recruitment targets are feasible and efforts are ongoing to achieve a representative sample. Findings will inform future public health dementia risk reduction initiatives by showing whether, when, and how dementia risk can be lowered through educational and behavioral interventions, delivered in an uncontrolled real-world context. International Registered Report Identifier (IRRID): DERR1-10.2196/34688 %M 35230251 %R 10.2196/34688 %U https://www.researchprotocols.org/2022/3/e34688 %U https://doi.org/10.2196/34688 %U http://www.ncbi.nlm.nih.gov/pubmed/35230251 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33812 %T Remote Electroencephalography Monitoring of Epilepsy in Adults: Protocol for a Scoping Review %A Milne-Ives,Madison %A Shankar,Rohit %A McLean,Brendan %A Duun-Henriksen,Jonas %A Blaabjerg,Lykke %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DT, United Kingdom, 44 1752600600, edward.meinert@plymouth.ac.uk %K epilepsy %K remote monitoring %K electroencephalography %K EEG %K seizures, home care services %K mental health %D 2022 %7 25.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Electroencephalography (EEG) monitoring is a key tool in diagnosing and determining treatment for people with epilepsy; however, obtaining sufficient high-quality data can be a time-consuming, costly, and inconvenient process for patients and health care providers. Remote EEG monitoring has the potential to improve patient experience, data quality, and accessibility for people with intellectual or developmental disabilities. Objective: The purpose of this scoping review is to provide an overview of the current research evidence and knowledge gaps regarding the use of remote EEG monitoring interventions for adults with epilepsy. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks will be used to structure the review. Searches will be conducted in 6 databases (PubMed, MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov) for articles published in English that evaluate at least one out-of-hospital EEG monitoring intervention or device for adults with epilepsy. A descriptive analysis will be conducted to summarize the results; key themes and gaps in the literature will be discussed. Results: Results will be included in the scoping review, which will be submitted for publication by April 2022. Conclusions: This scoping review will summarize the state of the field of remote EEG monitoring interventions for adults with epilepsy and provide an overview of the strengths, weaknesses, and gaps in the research. International Registered Report Identifier (IRRID): PRR1-10.2196/33812 %M 35212630 %R 10.2196/33812 %U https://www.researchprotocols.org/2022/2/e33812 %U https://doi.org/10.2196/33812 %U http://www.ncbi.nlm.nih.gov/pubmed/35212630 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e25238 %T International Technologies on Prevention and Treatment of Neurological and Psychiatric Diseases: Bibliometric Analysis of Patents %A Zheng,Fuhao %A Wang,Ling %A Zeng,Zhaonan %A Wu,Siying %+ Public Health School of Fujian Medical University, Number 1, Xueyuan Road, Fuzhou, 350108, China, 86 591 228 6202 ext 5, fmuwsy@163.com %K neurological diseases %K psychiatric diseases %K patent %K bibliometric analysis %K prevention %K treatment %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Neurological and psychiatric disorders are serious and expensive global public health problems. Therefore, exploring effective intervention technologies plays an important role in improving patients’ clinical symptoms and social functions, as well as reducing medical burden. Objective: The aim of this study is to analyze and summarize the key new technologies and innovative development trends witnessed globally for neurological illness and psychiatric disorders by mining the relevant patent data. Methods: A bibliometric analysis was conducted on patent applications, priority countries, main patentees, hot technologies, and other patent information on neurological and psychiatric disorders, revealing the current situation along with the trend of technology development in this field. Results: In recent years, inventions and innovations related to neurological and psychiatric diseases have become very active, with China being the largest patent priority country. Of the top patent holders, Visicu (headquartered in the United States) is the leader. The distribution of patent holders in China remains relatively scattered, with no monopoly organization at present. Global technologies on neurological illness and psychiatric disorders are mainly concentrated around A61B (diagnosis, surgery, and identification). Conclusions: This paper analyzed and summarized the key new technologies and global innovative development trends of neurological and psychiatric diseases by mining the relevant patent data, and provides practical references and research perspectives for the prevention and treatment of the aforesaid diseases. %M 35191849 %R 10.2196/25238 %U https://mental.jmir.org/2022/2/e25238 %U https://doi.org/10.2196/25238 %U http://www.ncbi.nlm.nih.gov/pubmed/35191849 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31020 %T Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report %A García-Muñoz,Cristina %A Cortés-Vega,María-Dolores %A Hernández-Rodríguez,Juan-Carlos %A Fernández-Seguín,Lourdes M %A Escobio-Prieto,Isabel %A Casuso-Holgado,María Jesús %+ Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/ Avicena S/N, Seville, 41009, Spain, 34 954486528, mdcortes@us.es %K immersive virtual reality %K vestibular rehabilitation %K multiple sclerosis %K exergames %D 2022 %7 16.2.2022 %9 Case Report %J JMIR Serious Games %G English %X Background: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16% in the physical health area at T2; 33.56% in the mental health area at T2). The patient rated the usability of the system as 90%, based on the System Usability Scale, and gave the system a grade of A. Conclusions: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation. %M 34766551 %R 10.2196/31020 %U https://games.jmir.org/2022/1/e31020 %U https://doi.org/10.2196/31020 %U http://www.ncbi.nlm.nih.gov/pubmed/34766551 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e24946 %T Evaluation of a Digitally Guided Self-Rehabilitation Device Coupled With Telerehabilitation Monitoring in Patients With Parkinson Disease (TELEP@RK): Open, Prospective Observational Study %A Blanc,Margaux %A Roy,Anne-Laure %A Fraudet,Bastien %A Piette,Patrice %A Le Toullec,Elodie %A Nicolas,Benoit %A Gallien,Philippe %A Leblong,Emilie %+ Hospital Center (CH) Saint Malo, 1 rue de la Marne, Saint Malo, 35403, France, 33 299212121, M.BLANC@ch-stmalo.fr %K Parkinson's disease %K telerehabilitation %K serious games %K UTAUT %K physiotherapist %K acceptability %K acceptance %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Parkinson disease is a neurodegenerative disease causing a progressive loss of autonomy. This requires long-term rehabilitation care. Currently, new technologies are being developed for use in daily life, and there is a progressive implementation of telerehabilitation. Objective: The aim of this study (the TELEP@RK study) is to evaluate the uses of a digital self-rehabilitation device in patients with Parkinson disease and their independent physiotherapists on the scale of a health territory. Methods: A total of 10 independent physiotherapists and 31 patients with Parkinson disease were followed for 1 year to evaluate the use of a telerehabilitation tool (digital tablet and inertial sensor) via questionnaires of the Unified Theory of Acceptance and Use of Technology (UTAUT). The questionnaires were submitted to participants at 0, 2, and 12 months from the start of follow-up. The averages of the scores of the different determinants and constructs of the UTAUT questionnaires were compared at the different follow-up times. Results: Among professionals, the averages of the various determinants were generally high at the beginning of the study with an average (out of 5) performance expectancy of 4.19, effort expectancy of 3.88, social influence of 3.95, facilitating conditions of 4, and intention to use of 3.97. These averages decreased over time. Conclusions: Acceptability, acceptance, and appropriation of the tool were very high among the physiotherapists as well as the patients, despite the tool’s lack of evolution during the study. In the current health care context, these results allow us to envision a new organization of the care pathway for patients with chronic diseases, with the increased use of new technologies associated with telecare. %M 35129449 %R 10.2196/24946 %U https://games.jmir.org/2022/1/e24946 %U https://doi.org/10.2196/24946 %U http://www.ncbi.nlm.nih.gov/pubmed/35129449 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31841 %T Intervention for a Digital, Cognitive, Multi-Domain Alzheimer Risk Velocity Study: Protocol for a Randomized Controlled Trial %A Gray,Michelle %A Madero,Erica N %A Gills,Joshua L %A Paulson,Sally %A Jones,Megan D %A Campitelli,Anthony %A Myers,Jennifer %A Bott,Nicholas T %A Glenn,Jordan M %+ Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, 1 University of Arkansas, Fayetteville, AR, 72701, United States, 1 4795756713, rgray@uark.edu %K health coaching %K Alzheimer risk %K digital health %K mobile phone %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, more than 6 million adults live with Alzheimer disease (AD) that affects 1 out of every 3 older adults. Although there is no cure for AD currently, lifestyle-based interventions aimed at slowing the rate of cognitive decline or delaying the onset of AD have shown promising results. However, most studies primarily focus on older adults (>55 years) and use in-person interventions. Objective: The aim of this study is to determine the effects of a 2-year digital lifestyle intervention on AD risk among at-risk middle-aged and older adults (45-75 years) compared with a health education control. Methods: The lifestyle intervention consists of a digitally delivered, personalized health coaching program that directly targets the modifiable risk factors for AD. The primary outcome measure is AD risk as determined by the Australian National University-Alzheimer Disease Risk Index; secondary outcome measures are functional fitness, blood biomarkers (inflammation, glucose, cholesterol, and triglycerides), and cognitive function (Repeatable Battery for the Assessment of Neuropsychological Status and Neurotrack Cognitive Battery). Screening commenced in January 2021 and was completed in June 2021. Results: Baseline characteristics indicate no difference between the intervention and control groups for AD risk (mean −1.68, SD 7.31; P=.90). Conclusions: The intervention in the Digital, Cognitive, Multi-domain Alzheimer Risk Velocity is uniquely designed to reduce the risk of AD through a web-based health coaching experience that addresses the modifiable lifestyle-based risk factors. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): DERR1-10.2196/31841 %M 35119374 %R 10.2196/31841 %U https://www.researchprotocols.org/2022/2/e31841 %U https://doi.org/10.2196/31841 %U http://www.ncbi.nlm.nih.gov/pubmed/35119374 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27641 %T A Novel Virtual Reality Assessment of Functional Cognition: Validation Study %A Porffy,Lilla Alexandra %A Mehta,Mitul A %A Patchitt,Joel %A Boussebaa,Celia %A Brett,Jack %A D’Oliveira,Teresa %A Mouchlianitis,Elias %A Shergill,Sukhi S %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 07738244217, lilla.a.porffy@kcl.ac.uk %K virtual reality %K virtual reality assessment %K cognition %K functional cognition %K functional capacity %K neuropsychological testing %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive deficits are present in several neuropsychiatric disorders, including Alzheimer disease, schizophrenia, and depression. Assessments used to measure cognition in these disorders are time-consuming, burdensome, and have low ecological validity. To address these limitations, we developed a novel virtual reality shopping task—VStore. Objective: This study aims to establish the construct validity of VStore in relation to the established computerized cognitive battery, Cogstate, and explore its sensitivity to age-related cognitive decline. Methods: A total of 142 healthy volunteers aged 20-79 years participated in the study. The main VStore outcomes included verbal recall of 12 grocery items, time to collect items, time to select items on a self-checkout machine, time to make the payment, time to order coffee, and total completion time. Construct validity was examined through a series of backward elimination regression models to establish which Cogstate tasks, measuring attention, processing speed, verbal and visual learning, working memory, executive function, and paired associate learning, in addition to age and technological familiarity, best predicted VStore performance. In addition, 2 ridge regression and 2 logistic regression models supplemented with receiver operating characteristic curves were built, with VStore outcomes in the first model and Cogstate outcomes in the second model entered as predictors of age and age cohorts, respectively. Results: Overall VStore performance, as indexed by the total time spent completing the task, was best explained by Cogstate tasks measuring attention, working memory, paired associate learning, and age and technological familiarity, accounting for 47% of the variance. In addition, with λ=5.16, the ridge regression model selected 5 parameters for VStore when predicting age (mean squared error 185.80, SE 19.34), and with λ=9.49 for Cogstate, the model selected all 8 tasks (mean squared error 226.80, SE 23.48). Finally, VStore was found to be highly sensitive (87%) and specific (91.7%) to age cohorts, with 94.6% of the area under the receiver operating characteristic curve. Conclusions: Our findings suggest that VStore is a promising assessment that engages standard cognitive domains and is sensitive to age-related cognitive decline. %M 35080501 %R 10.2196/27641 %U https://www.jmir.org/2022/1/e27641 %U https://doi.org/10.2196/27641 %U http://www.ncbi.nlm.nih.gov/pubmed/35080501 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e28701 %T Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study %A Gagnon-Roy,Mireille %A Pinard,Stéphanie %A Bottari,Carolina %A Le Morellec,Fanny %A Laliberté,Catherine %A Ben Lagha,Rym %A Yaddaden,Amel %A Pigot,Hélène %A Giroux,Sylvain %A Bier,Nathalie %+ School of Rehabilitation, Université de Montréal, 7077 Av du Parc, Montreal, QC, H3N 1X7, Canada, 1 514 343 6111 ext 44048, carolina.bottari@umontreal.ca %K usability testing and evaluation %K user experience %K qualitative methods %K assistive technologies %K rehabilitation %K patient safety %D 2022 %7 26.1.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. Objective: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. Methods: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. Results: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). Conclusions: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology. %M 35080496 %R 10.2196/28701 %U https://rehab.jmir.org/2022/1/e28701 %U https://doi.org/10.2196/28701 %U http://www.ncbi.nlm.nih.gov/pubmed/35080496 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e31925 %T Connectivity-Guided Theta Burst Transcranial Magnetic Stimulation Versus Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Moderate to Severe Depression: Magnetic Resonance Imaging Protocol and SARS-CoV-2–Induced Changes for a Randomized Double-blind Controlled Trial %A Pszczolkowski,Stefan %A Cottam,William J %A Briley,Paul M %A Iwabuchi,Sarina J %A Kaylor-Hughes,Catherine %A Shalabi,Abdulrhman %A Babourina-Brooks,Ben %A Berrington,Adam %A Barber,Shaun %A Suazo Di Paola,Ana %A Blamire,Andrew %A McAllister-Williams,R Hamish %A Parikh,Jehill %A Abdelghani,Mohamed %A Matthäus,Lars %A Hauffe,Ralf %A Liddle,Peter %A Auer,Dorothee P %A Morriss,Richard %+ Institute of Mental Health, School of Medicine, University of Nottingham, Room C20, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, United Kingdom, 44 0115 823 0427, richard.morriss@nottingham.ac.uk %K depression %K magnetic resonance imaging %K image-guidance %K personalized medicine %K transcranial magnetic stimulation %D 2022 %7 20.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression is a substantial health and economic burden. In approximately one-third of patients, depression is resistant to first-line treatment; therefore, it is essential to find alternative treatments. Transcranial magnetic stimulation (TMS) is a neuromodulatory treatment involving the application of magnetic pulses to the brain that is approved in the United Kingdom and the United States in treatment-resistant depression. This trial aims to compare the clinical effectiveness, cost-effectiveness, and mechanism of action of standard treatment repetitive TMS (rTMS) targeted at the F3 electroencephalogram site with a newer treatment—a type of TMS called theta burst stimulation (TBS) targeted based on measures of functional brain connectivity. This protocol outlines brain imaging acquisition and analysis for the Brain Imaging Guided Transcranial Magnetic Stimulation in Depression (BRIGhTMIND) study trial that is used to create personalized TMS targets and answer the proposed mechanistic hypotheses. Objective: The aims of the imaging arm of the BRIGhTMIND study are to identify functional and neurochemical brain signatures indexing the treatment mechanisms of rTMS and connectivity-guided intermittent theta burst TMS and to identify imaging-based markers predicting response to treatment. Methods: The study is a randomized double-blind controlled trial with 1:1 allocation to either 20 sessions of TBS or standard rTMS. Multimodal magnetic resonance imaging (MRI) is acquired for each participant at baseline (before TMS treatment) with T1-weighted and task-free functional MRI during rest used to estimate TMS targets. For participants enrolled in the mechanistic substudy, additional diffusion-weighted sequences are acquired at baseline and at posttreatment follow-up 16 weeks after treatment randomization. Core data sets of T1-weighted and task-free functional MRI during rest are acquired for all participants and are used to estimate TMS targets. Additional sequences of arterial spin labeling, magnetic resonance spectroscopy, and diffusion-weighted images are acquired depending on the recruitment site for mechanistic evaluation. Standard rTMS treatment is targeted at the F3 electrode site over the left dorsolateral prefrontal cortex, whereas TBS treatment is guided using the coordinate of peak effective connectivity from the right anterior insula to the left dorsolateral prefrontal cortex. Both treatment targets benefit from the level of MRI guidance, but only TBS is provided with precision targeting based on functional brain connectivity. Results: Recruitment began in January 2019 and is ongoing. Data collection is expected to continue until January 2023. Conclusions: This trial will determine the impact of precision MRI guidance on rTMS treatment and assess the neural mechanisms underlying this treatment in treatment-resistant depressed patients. Trial Registration: ISRCTN Registry ISRCTN19674644; https://www.isrctn.com/ISRCTN19674644 International Registered Report Identifier (IRRID): DERR1-10.2196/31925 %M 35049517 %R 10.2196/31925 %U https://www.researchprotocols.org/2022/1/e31925 %U https://doi.org/10.2196/31925 %U http://www.ncbi.nlm.nih.gov/pubmed/35049517 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31664 %T Factors Associated With the Experience of Cognitive Training Apps for the Prevention of Dementia: Cross-sectional Study Using an Extended Health Belief Model %A Lee,Jaegyeong %A Lim,Jung Min %+ Department of Pharmacology, Yonsei University College of Medicine, Avison Biomedical Research Center, Room 318, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 0925, dreamist88@gmail.com %K cognitive training apps %K dementia knowledge %K health belief model %K middle-aged %K logistic regression analysis %K dementia %K Alzheimer disease %K cognition %K mobile apps %K health apps %D 2022 %7 14.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence and economic burden of dementia are increasing dramatically. Using information communication technology to improve cognitive functions is proven to be effective and holds the potential to serve as a new and efficient method for the prevention of dementia. Objective: The aim of this study was to identify factors associated with the experience of mobile apps for cognitive training in middle-aged adults. We evaluated the relationships between the experience of cognitive training apps and structural variables using an extended health belief model. Methods: An online survey was conducted on South Korean participants aged 40 to 64 years (N=320). General characteristics and dementia knowledge were measured along with the health belief model constructs. Statistical analysis and logistic regression analysis were performed. Results: Higher dementia knowledge (odds ratio [OR] 1.164, P=.02), higher perceived benefit (OR 1.373, P<.001), female gender (OR 0.499, P=.04), and family history of dementia (OR 1.933, P=.04) were significantly associated with the experience of cognitive training apps for the prevention of dementia. Conclusions: This study may serve as a theoretical basis for the development of intervention strategies to increase the use of cognitive training apps for the prevention of dementia. %M 35029540 %R 10.2196/31664 %U https://www.jmir.org/2022/1/e31664 %U https://doi.org/10.2196/31664 %U http://www.ncbi.nlm.nih.gov/pubmed/35029540 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e35080 %T Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study %A Miao,Melissa %A Power,Emma %A Rietdijk,Rachael %A Debono,Deborah %A Brunner,Melissa %A Salomon,Alexander %A Mcculloch,Ben %A Wright,Meg Rebecca %A Welsh,Monica %A Tremblay,Bastian %A Rixon,Caleb %A Williams,Liz %A Morrow,Rosemary %A Evain,Jean-Christophe %A Togher,Leanne %+ University of Technology Sydney, 100 Broadway, Ultimo, Sydney, 2007, Australia, 61 295147348, melissa.miao@uts.edu.au %K priority setting %K public involvement %K implementation science %K internet interventions %K acquired brain injury %K delivery of health care %K caregivers %K speech-language pathology %K brain injury %K mobile phone %D 2022 %7 10.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective: This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. Methods: Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results: Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions: In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID): DERR1-10.2196/35080 %M 35006082 %R 10.2196/35080 %U https://www.researchprotocols.org/2022/1/e35080 %U https://doi.org/10.2196/35080 %U http://www.ncbi.nlm.nih.gov/pubmed/35006082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28368 %T A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study %A Leong,Victoria %A Raheel,Kausar %A Sim,Jia Yi %A Kacker,Kriti %A Karlaftis,Vasilis M %A Vassiliu,Chrysoula %A Kalaivanan,Kastoori %A Chen,S H Annabel %A Robbins,Trevor W %A Sahakian,Barbara J %A Kourtzi,Zoe %+ Psychology, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, 639818, Singapore, 65 6514 1052, victorialeong@ntu.edu.sg %K web-based testing %K neurocognitive assessment %K COVID-19 %K executive functions %K learning %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The global COVID-19 pandemic has triggered a fundamental reexamination of how human psychological research can be conducted safely and robustly in a new era of digital working and physical distancing. Online web-based testing has risen to the forefront as a promising solution for the rapid mass collection of cognitive data without requiring human contact. However, a long-standing debate exists over the data quality and validity of web-based studies. This study examines the opportunities and challenges afforded by the societal shift toward web-based testing and highlights an urgent need to establish a standard data quality assurance framework for online studies. Objective: This study aims to develop and validate a new supervised online testing methodology, remote guided testing (RGT). Methods: A total of 85 healthy young adults were tested on 10 cognitive tasks assessing executive functioning (flexibility, memory, and inhibition) and learning. Tasks were administered either face-to-face in the laboratory (n=41) or online using remote guided testing (n=44) and delivered using identical web-based platforms (Cambridge Neuropsychological Test Automated Battery, Inquisit, and i-ABC). Data quality was assessed using detailed trial-level measures (missed trials, outlying and excluded responses, and response times) and overall task performance measures. Results: The results indicated that, across all data quality and performance measures, RGT data was statistically-equivalent to in-person data collected in the lab (P>.40 for all comparisons). Moreover, RGT participants out-performed the lab group on measured verbal intelligence (P<.001), which could reflect test environment differences, including possible effects of mask-wearing on communication. Conclusions: These data suggest that the RGT methodology could help ameliorate concerns regarding online data quality—particularly for studies involving high-risk or rare cohorts—and offer an alternative for collecting high-quality human cognitive data without requiring in-person physical attendance. %M 34989691 %R 10.2196/28368 %U https://www.jmir.org/2022/1/e28368 %U https://doi.org/10.2196/28368 %U http://www.ncbi.nlm.nih.gov/pubmed/34989691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e27418 %T The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration %A Kenny,Lorna %A Moore,Kevin %A O' Riordan,Clíona %A Fox,Siobhan %A Barton,John %A Tedesco,Salvatore %A Sica,Marco %A Crowe,Colum %A Alamäki,Antti %A Condell,Joan %A Nordström,Anna %A Timmons,Suzanne %+ Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr's Hospital, Douglas Road, Cork, T12 XH60, Ireland, 353 851085070, lorna.kenny@ucc.ie %K Parkinson disease %K wearable devices %K technology %K mixed method %K focus group %K survey %K mobile phone %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease–related health barriers and the users’ confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management. %M 34989693 %R 10.2196/27418 %U https://formative.jmir.org/2022/1/e27418 %U https://doi.org/10.2196/27418 %U http://www.ncbi.nlm.nih.gov/pubmed/34989693 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e29249 %T Speech and Language Practitioners’ Experiences of Commercially Available Voice-Assisted Technology: Web-Based Survey Study %A Kulkarni,Pranav %A Duffy,Orla %A Synnott,Jonathan %A Kernohan,W George %A McNaney,Roisin %+ Action Lab, Department of Human Centred Computing, Monash University, 7 Innovation Walk, Clayton, 3168, Australia, 61 0444511615, pranav.kulkarni1@monash.edu %K speech and language therapy %K voice-assisted technology %K professional practice %K rehabilitation %K speech therapy %K health technology %K mobile phone %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Speech and language therapy involves the identification, assessment, and treatment of children and adults who have difficulties with communication, eating, drinking, and swallowing. Globally, pressing needs outstrip the availability of qualified practitioners who, of necessity, focus on individuals with advanced needs. The potential of voice-assisted technology (VAT) to assist people with speech impairments is an emerging area of research but empirical work exploring its professional adoption is limited. Objective: This study aims to explore the professional experiences of speech and language therapists (SaLTs) using VAT with their clients to identify the potential applications and barriers to VAT adoption and thereby inform future directions of research. Methods: A 23-question survey was distributed to the SaLTs from the United Kingdom using a web-based platform, eliciting both checkbox and free-text responses, to questions on perceptions and any use experiences of VAT. Data were analyzed descriptively with content analysis of free text, providing context to their specific experiences of using VAT in practice, including barriers and opportunities for future use. Results: A total of 230 UK-based professionals fully completed the survey; most were technologically competent and were aware of commercial VATs (such as Alexa and Google Assistant). However, only 49 (21.3%) SaLTs had used VAT with their clients and described 57 use cases. They reported using VAT with 10 different client groups, such as people with dysarthria and users of augmentative and alternative communication technologies. Of these, almost half (28/57, 49%) used the technology to assist their clients with day-to-day tasks, such as web browsing, setting up reminders, sending messages, and playing music. Many respondents (21/57, 37%) also reported using the technology to improve client speech, to facilitate speech practice at home, and to enhance articulation and volume. Most reported a positive impact of VAT use, stating improved independence (22/57, 39%), accessibility (6/57, 10%), and confidence (5/57, 8%). Some respondents reported increased client communication (5/57, 9%) and sociability (3/57, 5%). Reasons given for not using VAT in practice included lack of opportunity (131/181, 72.4%) and training (63/181, 34.8%). Most respondents (154/181, 85.1%) indicated that they would like to try VAT in the future, stating that it could have a positive impact on their clients’ speech, independence, and confidence. Conclusions: VAT is used by some UK-based SaLTs to enable communication tasks at home with their clients. However, its wider adoption may be limited by a lack of professional opportunity. Looking forward, additional benefits are promised, as the data show a level of engagement, empowerment, and the possibility of achieving therapeutic outcomes in communication impairment. The disparate responses suggest that this area is ripe for the development of evidence-based clinical practice, starting with a clear definition, outcome measurement, and professional standardization. %M 34989694 %R 10.2196/29249 %U https://rehab.jmir.org/2022/1/e29249 %U https://doi.org/10.2196/29249 %U http://www.ncbi.nlm.nih.gov/pubmed/34989694 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e30975 %T Military Injuries—Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study %A Bouldin,Erin D %A Delgado,Roxana %A Peacock,Kimberly %A Hale,Willie %A Roghani,Ali %A Trevino,Amira Y %A Viny,Mikayla %A Wetter,David W %A Pugh,Mary Jo %+ Department of Health and Exercise Science, Appalchian State University, 1179 State Farm Rd, Boone, NC, 28608, United States, 1 8282626892, bouldinel@appstate.edu %K epilepsy %K military personnel %K veterans %K caregiver %K traumatic brain injury %K quality of life %K health status %K longitudinal studies %K ecologic momentary assessment %K qualitative research %D 2022 %7 5.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Veterans with posttraumatic epilepsy (PTE), particularly those with comorbidities associated with epilepsy or traumatic brain injury (TBI), have poorer health status and higher symptom burden than their peers without PTE. One area that has been particularly poorly studied is that of the role of caregivers in the health of veterans with PTE and the impact caring for someone with PTE has on the caregivers themselves. Objective: In this study, we aim to address the following: describe and compare the health and quality of life of veterans and caregivers of veterans with and without PTE; evaluate the change in available supports and unmet needs for services among caregivers of post-9/11 veterans with PTE over a 2-year period and to compare support and unmet needs with those without PTE; and identify veteran and caregiver characteristics associated with the 2-year health trajectories of caregivers and veterans with PTE compared with veterans without PTE. Methods: We conducted a prospective cohort study of the health and quality of life among 4 groups of veterans and their caregivers: veterans with PTE, nontraumatic epilepsy, TBI only, and neither epilepsy nor TBI. We will recruit participants from previous related studies and collect information about both the veterans and their primary informal caregivers on health, quality of life, unmet needs for care, PTE and TBI symptoms and treatment, relationship, and caregiver experience. Data sources will include existing data supplemented with primary data, such as survey data collected at baseline, intermittent brief reporting using ecological momentary assessment, and qualitative interviews. We will make both cross-sectional and longitudinal comparisons, using veteran-caregiver dyads, along with qualitative findings to better understand risk and promotive factors for quality of life and health among veterans and caregivers, as well as the bidirectional impact of caregivers and care recipients on one another. Results: This study was approved by the institutional review boards of the University of Utah and Salt Lake City Veterans Affairs and is under review by the Human Research Protection Office of the United States Army Medical Research and Development Command. The Service Member, Veteran, and Caregiver Community Stakeholders Group has been formed and the study questionnaire will be finalized once the panel reviews it. We anticipate the start of recruitment and primary data collection by January 2022. Conclusions: New national initiatives aim to incorporate the caregiver into the veteran’s treatment plan; however, we know little about the impact of caregiving—both positive and negative—on the caregivers themselves and on the veterans for whom they provide care. We will identify specific needs in this understudied population, which will inform clinicians, patients, families, and policy makers about the specific impact and needs to equip caregivers in caring for veterans at home. International Registered Report Identifier (IRRID): PRR1-10.2196/30975 %M 34989689 %R 10.2196/30975 %U https://www.researchprotocols.org/2022/1/e30975 %U https://doi.org/10.2196/30975 %U http://www.ncbi.nlm.nih.gov/pubmed/34989689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25748 %T Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study %A Hsu,Wan-Yu %A Rowles,William %A Anguera,Joaquin A %A Anderson,Annika %A Younger,Jessica W %A Friedman,Samuel %A Gazzaley,Adam %A Bove,Riley %+ Department of Neurology, Weill Institute for Neurosciences, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, United States, 1 415 595 2795, Riley.Bove@ucsf.edu %K cognition %K digital health %K mHealth %K multiple sclerosis %K cognitive assessment %D 2021 %7 30.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective: To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods: In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results: Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions: These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration: ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618 %M 34967751 %R 10.2196/25748 %U https://www.jmir.org/2021/12/e25748 %U https://doi.org/10.2196/25748 %U http://www.ncbi.nlm.nih.gov/pubmed/34967751 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31890 %T Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial %A Elzinga,Willem O %A Prins,Samantha %A Borghans,Laura G J M %A Gal,Pim %A Vargas,Gabriel A %A Groeneveld,Geert J %A Doll,Robert J %+ Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333CL, Netherlands, 31 715246400, rjdoll@chdr.nl %K photoplethysmography %K smartwatch %K wearable %K at-home %K heart rate %K RCT %K wearable device %K digital health %K cardiovascular %K cardiology %K sensors %K heart rate sensor %K smart technology %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective: The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods: The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results: Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions: We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration: Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002 %M 34967757 %R 10.2196/31890 %U https://formative.jmir.org/2021/12/e31890 %U https://doi.org/10.2196/31890 %U http://www.ncbi.nlm.nih.gov/pubmed/34967757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31844 %T The Effects of Virtual Reality Treatment on Prefrontal Cortex Activity in Patients With Social Anxiety Disorder: Participatory and Interactive Virtual Reality Treatment Study %A Lee,Hojun %A Choi,JongKwan %A Jung,Dooyoung %A Hur,Ji-Won %A Cho,Chul-Hyun %+ Department of Psychiatry, College of Medicine, Chungnam National University, 82 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 044 995 4775, david0203@gmail.com %K anxiety %K social anxiety disorder %K virtual reality %K fNIRS %K brain activity %K prefrontal cortex %K effectiveness %D 2021 %7 17.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. Objective: The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). Methods: Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant’s self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant’s self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). Results: We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (t=–2.01, P=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: t=–2.93, P<.001; left: t=–2.25, P=.03) and the orbitofrontal cortex (OFC) (right: t=–2.10, P=.045; left: t=–2.21, P=.04) while watching video 2. Conclusions: Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. Trial Registration: Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp %M 34801979 %R 10.2196/31844 %U https://www.jmir.org/2021/12/e31844 %U https://doi.org/10.2196/31844 %U http://www.ncbi.nlm.nih.gov/pubmed/34801979 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30151 %T One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial %A Bekkelund,Svein Ivar %A Müller,Kai Ivar %+ Department of Clinical Medicine, The Arctic University of Norway, Hansine Hansens veg 18, Tromsø, 9037, Norway, 47 90185090, svein-ivar.bekkelund@uit.no %K chronic headache %K remission %K video consultation %K telemedicine %K eHealth %K digital consultation %K consultation %K treatment %K follow-up %K RCT %K randomized controlled trial %D 2021 %7 13.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective: The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods: Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results: From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions: One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration: ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177 %M 34898455 %R 10.2196/30151 %U https://www.jmir.org/2021/12/e30151 %U https://doi.org/10.2196/30151 %U http://www.ncbi.nlm.nih.gov/pubmed/34898455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e19230 %T Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study %A Thomas,Sarah %A Pulman,Andy %A Dogan,Huseyin %A Jiang,Nan %A Passmore,David %A Pretty,Keith %A Fairbanks,Beth %A Davies Smith,Angela %A Thomas,Peter W %+ Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, United Kingdom, 44 1202 961953, saraht@bournemouth.ac.uk %K multiple sclerosis %K fatigue %K self-management %K cognitive behavioral %K digital health %K mHealth %K eHealth %K development %K participatory design %K usability testing %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. Objective: The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users’ unique requirements throughout the design, build, prototyping, and testing stages. Methods: Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. Results: The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users’ needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. Conclusions: This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue. %M 34889744 %R 10.2196/19230 %U https://formative.jmir.org/2021/12/e19230 %U https://doi.org/10.2196/19230 %U http://www.ncbi.nlm.nih.gov/pubmed/34889744 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e27186 %T Identification and Description of Balance, Mobility, and Gait Assessments Conducted via Telerehabilitation for Individuals With Neurological Conditions: Protocol for a Scoping Review %A O'Neil,Jennifer %A Barnes,Keely %A Morgan Donnelly,Erin %A Sheehy,Lisa %A Sveistrup,Heidi %+ School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada, 1 613 562 5800, joneil@uottawa.ca %K telerehabilitation %K remote assessment %K outcome measures %K neurology %K rehabilitation %D 2021 %7 9.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 global pandemic pushed many rehabilitation practitioners to pivot their in-person practice to adopt telerehabilitation as their main method of delivery. In addition to documenting information on interventions used with clients, it is best practice for therapists to use reliable and validated outcome measures to inform their interventions. Objective: Through this scoping review, we aim to identify (1) which outcomes are being used remotely to assess balance, mobility, and gait in patients with neurological conditions, and (2) what psychometric data (validity, reliability, etc.) for remotely administered outcomes are available. Methods: Three main concepts will be included in our search: (1) neurological conditions; (2) administration by telerehabilitation; and (3) outcome measures for balance, mobility, and gait. Studies reporting remote assessment of neurological conditions published since 1990 will be included. The database search will be completed in MEDLINE (Ovid), CINAHL, PubMed, PsycINFO, EMBASE, and Cochrane. Gray literature including dissertations, conference papers, and protocol papers will also be sourced. Two reviewers will independently screen each title and abstract using pre-established inclusion and exclusion criteria. Manuscripts that appear to meet the criteria will be subject to further review, and full-text extraction using a pre-piloted extraction sheet if all criteria are met. The data will be categorized by assessment types describing impairments (such as balance, strength, and mobility) or activity limitations or participation restriction (such as functional mobility, ambulatory functions, and activities of daily living). Results: This scoping review will document outcome measures currently used in the remote assessment of neurological conditions. To date, 235 titles and abstracts were screened. We are in the process of finalizing the full text screening for the inclusion of articles. We expect the full screening to be completed in November 2021 and data analysis in January 2022. Our results are expected to be published in early 2022. Conclusions: The optimal use of telerehabilitation as a mode to deliver rehabilitation intervention should be coupled with the completion of validated outcome measures. Therefore, it is crucial to further our knowledge on remote outcome measures and therapeutic assessments. International Registered Report Identifier (IRRID): PRR1-10.2196/27186 %M 34889765 %R 10.2196/27186 %U https://www.researchprotocols.org/2021/12/e27186 %U https://doi.org/10.2196/27186 %U http://www.ncbi.nlm.nih.gov/pubmed/34889765 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e21681 %T Evaluating Course Completion, Appropriateness, and Burden in the Understanding Multiple Sclerosis Massive Open Online Course: Cohort Study %A Claflin,Suzi B %A Campbell,Julie A %A Doherty,Kathleen %A Farrow,Maree %A Bessing,Barnabas %A Taylor,Bruce V %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 0362267728, suzi.claflin@utas.edu.au %K multiple sclerosis %K massive open online course %K health promotion %K eHealth education %K mobile phone %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Massive open online course (MOOC) research is an emerging field; to date, most research in this area has focused on participant engagement. Objective: The aim of this study is to evaluate both participant engagement and measures of satisfaction, appropriateness, and burden for a MOOC entitled Understanding Multiple Sclerosis (MS) among a cohort of 3518 international course participants. Methods: We assessed the association of key outcomes with participant education level, MS status, caregiver status, sex, and age using summary statistics, and 2-tailed t tests, and chi-square tests. Results: Of the 3518 study participants, 928 (26.37%) were people living with MS. Among the 2590 participants not living with MS, 862 (33.28%) identified as formal or informal caregivers. Our key findings were as follows: the course completion rate among study participants was 67.17% (2363/3518); the course was well received, with 96.97% (1502/1549) of participants satisfied, with an appropriate pitch and low burden (a mean of 2.2 hours engagement per week); people living with MS were less likely than those not living with MS to complete the course; and people with a recent diagnosis of MS, caregivers, and participants without a university education were more likely to apply the material by course completion. Conclusions: The Understanding MS MOOC is fit for purpose; it presents information in a way that is readily understood by course participants and is applicable in their lives. %M 34878985 %R 10.2196/21681 %U https://www.jmir.org/2021/12/e21681 %U https://doi.org/10.2196/21681 %U http://www.ncbi.nlm.nih.gov/pubmed/34878985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28021 %T Recruitment of Patients With Amyotrophic Lateral Sclerosis for Clinical Trials and Epidemiological Studies: Descriptive Study of the National ALS Registry’s Research Notification Mechanism %A Mehta,Paul %A Raymond,Jaime %A Han,Moon Kwon %A Larson,Theodore %A Berry,James D %A Paganoni,Sabrina %A Mitsumoto,Hiroshi %A Bedlack,Richard Stanley %A Horton,D Kevin %+ Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, United States, 1 770 488 0556, pum4@cdc.gov %K amyotrophic lateral sclerosis %K Lou Gehrig disease %K motor neuron disease %K clinical trials %K patient recruitment %K National ALS Registry %K research notification mechanism %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers face challenges in patient recruitment, especially for rare, fatal diseases such as amyotrophic lateral sclerosis (ALS). These challenges include obtaining sufficient statistical power as well as meeting eligibility requirements such as age, sex, and study proximity. Similarly, persons with ALS (PALS) face difficulty finding and enrolling in research studies for which they are eligible. Objective: The aim of this study was to describe how the federal Agency for Toxic Substances and Disease Registry’s (ATSDR) National ALS Registry is linking PALS to scientists who are conducting research, clinical trials, and epidemiological studies. Methods: Through the Registry’s online research notification mechanism (RNM), PALS can elect to be notified about new research opportunities. This mechanism allows researchers to upload a standardized application outlining their study design and objectives, and proof of Institutional Review Board approval. If the application is approved, ATSDR queries the Registry for PALS meeting the study’s specific eligibility criteria, and then distributes the researcher’s study material and contact information to PALS via email. PALS then need to contact the researcher directly to take part in any research. Such an approach allows ATSDR to protect the confidentiality of Registry enrollees. Results: From 2013 to 2019, a total of 46 institutions around the United States and abroad have leveraged this tool and over 600,000 emails have been sent, resulting in over 2000 patients conservatively recruited for clinical trials and epidemiological studies. Patients between the ages of 60 and 69 had the highest level of participation, whereas those between the ages of 18 and 39 and aged over 80 had the lowest. More males participated (4170/7030, 59.32%) than females (2860/7030, 40.68%). Conclusions: The National ALS Registry’s RNM benefits PALS by connecting them to appropriate ALS research. Simultaneously, the system benefits researchers by expediting recruitment, increasing sample size, and efficiently identifying PALS meeting specific eligibility requirements. As more researchers learn about and use this mechanism, both PALS and researchers can hasten research and expand trial options for PALS. %M 34878988 %R 10.2196/28021 %U https://www.jmir.org/2021/12/e28021 %U https://doi.org/10.2196/28021 %U http://www.ncbi.nlm.nih.gov/pubmed/34878988 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e18972 %T Acceptance of Enhanced Robotic Assistance Systems in People With Amyotrophic Lateral Sclerosis–Associated Motor Impairment: Observational Online Study %A Maier,André %A Eicher,Cornelia %A Kiselev,Joern %A Klebbe,Robert %A Greuèl,Marius %A Kettemann,Dagmar %A Gaudlitz,Marcel %A Walter,Bertram %A Oleimeulen,Ursula %A Münch,Christoph %A Meyer,Thomas %A Spittel,Susanne %+ Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany, Augustenburger Platz 1, Berlin, 13353, Germany, 49 030 450560132, Andre.Maier@charite.de %K amyotrophic lateral sclerosis %K assistive robotics %K technology commitment %K robotic arm assistance %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by a progressive paresis of the extremities and the loss of manual functioning. Due to the severe functional impairment that the disease entails, ALS requires the provision of comprehensive nursing care and a complex set of assistive technology devices. To relieve caregivers and promote autonomy of people with ALS, robotic assistance systems are being developed. This trial aims to evaluate the acceptance of technology, in general, and of robotic arm assistance among people with ALS in order to lay the groundwork for the development of a semiautomatic robotic arm that can be controlled by humans via a multimodal user interface and that will allow users to handle objects and attend to their own bodies. Objective: The aim of this study was to perform a systematic analysis of technology commitment and acceptance of robotic assistance systems from the perspective of physically limited people living with ALS. Methods: The investigation was conducted as a study of a prospective cohort. Participants were only included if they had received a medical diagnosis of ALS. Data collection took place via an online questionnaire on the Ambulanzpartner Soziotechnologie internet platform. Technological commitment was measured using the Neyer short scale. Furthermore, a multidimensional questionnaire was specially developed to analyze participant acceptance of robotic arm assistance: the Acceptance Measure of Robotic Arm Assistance (AMRAA). This questionnaire was accompanied by a video introducing the robot arm. ALS severity was ascertained using the ALS Functional Rating Scale–Extended (ALSFRS-EX). Results: A total of 268 people with ALS participated in the survey. Two-thirds of the participants were male. The overall mean ALS severity score was 42.9 (SD 11.7) points out of 60 on the ALSFRS-EX, with the most relevant restrictions on arms and legs (<60% of normal functioning). Technological commitment ranked high, with the top third scoring 47.2 points out of 60. Younger participants and males showed significantly higher values. The AMRAA score was, again, significantly higher among younger participants. However, the gender difference within the overall cohort was not significant. The more limited the arm functioning of participants according to the ALSFRS-EX subscale, the higher the acceptance rate of robotic assistance. This relationship proved significant. Conclusions: People with ALS display high technological commitment and feel positive about using technological assistance systems. In our study, younger participants were more open to technology use, in general, and robotic assistance, in particular. Self-appraisal of technology acceptance, competence, and control conviction were generally higher among men. However, any presumed gender difference vanished when users were asked to rate the anticipated usefulness of the technology, in particular the robotic arm. The acceptance was also reflected in users’ increased willingness to use a robotic arm as the functionality of their own arms decreased. From the perspective of people with ALS, robotic assistance systems are critical to promoting individual autonomy. Another key consideration in the development of future assistive technologies should be the reduction of caregiver burden. Trial Registration: German Clinical Trials Register DRKS00012803; https://tinyurl.com/w9yzduhd %M 34874891 %R 10.2196/18972 %U https://rehab.jmir.org/2021/4/e18972 %U https://doi.org/10.2196/18972 %U http://www.ncbi.nlm.nih.gov/pubmed/34874891 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29554 %T A Markerless 2D Video, Facial Feature Recognition–Based, Artificial Intelligence Model to Assist With Screening for Parkinson Disease: Development and Usability Study %A Hou,Xinyao %A Zhang,Yu %A Wang,Yanping %A Wang,Xinyi %A Zhao,Jiahao %A Zhu,Xiaobo %A Su,Jianbo %+ Department of Automation, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai, 200240, China, 86 21 34204276, jbsu@sjtu.edu.cn %K Parkinson disease %K facial features %K artificial intelligence %K diagnosis %D 2021 %7 19.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Masked face is a characteristic clinical manifestation of Parkinson disease (PD), but subjective evaluations from different clinicians often show low consistency owing to a lack of accurate detection technology. Hence, it is of great significance to develop methods to make monitoring easier and more accessible. Objective: The study aimed to develop a markerless 2D video, facial feature recognition–based, artificial intelligence (AI) model to assess facial features of PD patients and investigate how AI could help neurologists improve the performance of early PD diagnosis. Methods: We collected 140 videos of facial expressions from 70 PD patients and 70 matched controls from 3 hospitals using a single 2D video camera. We developed and tested an AI model that performs masked face recognition of PD patients based on the acquisition and evaluation of facial features including geometric and texture features. Random forest, support vector machines, and k-nearest neighbor were used to train the model. The diagnostic performance of the AI model was compared with that of 5 neurologists. Results: The experimental results showed that our AI models can achieve feasible and effective facial feature recognition ability to assist with PD diagnosis. The accuracy of PD diagnosis can reach 83% using geometric features. And with the model trained by random forest, the accuracy of texture features is up to 86%. When these 2 features are combined, an F1 value of 88% can be reached, where the random forest algorithm is used. Further, the facial features of patients with PD were not associated with the motor and nonmotor symptoms of PD. Conclusions: PD patients commonly exhibit masked facial features. Videos of a facial feature recognition–based AI model can provide a valuable tool to assist with PD diagnosis and the potential of realizing remote monitoring of the patient’s condition, especially during the COVID-19 pandemic. %M 34806994 %R 10.2196/29554 %U https://www.jmir.org/2021/11/e29554 %U https://doi.org/10.2196/29554 %U http://www.ncbi.nlm.nih.gov/pubmed/34806994 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27674 %T Detecting Tonic-Clonic Seizures in Multimodal Biosignal Data From Wearables: Methodology Design and Validation %A Böttcher,Sebastian %A Bruno,Elisa %A Manyakov,Nikolay V %A Epitashvili,Nino %A Claes,Kasper %A Glasstetter,Martin %A Thorpe,Sarah %A Lees,Simon %A Dümpelmann,Matthias %A Van Laerhoven,Kristof %A Richardson,Mark P %A Schulze-Bonhage,Andreas %A , %+ Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau, 79106, Germany, 49 76127052410, sebastian.boettcher@uniklinik-freiburg.de %K wearables %K epilepsy %K seizure detection %K multimodal data %K mHealth %K mobile health %K digital health %K eHealth %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Video electroencephalography recordings, routinely used in epilepsy monitoring units, are the gold standard for monitoring epileptic seizures. However, monitoring is also needed in the day-to-day lives of people with epilepsy, where video electroencephalography is not feasible. Wearables could fill this gap by providing patients with an accurate log of their seizures. Objective: Although there are already systems available that provide promising results for the detection of tonic-clonic seizures (TCSs), research in this area is often limited to detection from 1 biosignal modality or only during the night when the patient is in bed. The aim of this study is to provide evidence that supervised machine learning can detect TCSs from multimodal data in a new data set during daytime and nighttime. Methods: An extensive data set of biosignals from a multimodal watch worn by people with epilepsy was recorded during their stay in the epilepsy monitoring unit at 2 European clinical sites. From a larger data set of 243 enrolled participants, those who had data recorded during TCSs were selected, amounting to 10 participants with 21 TCSs. Accelerometry and electrodermal activity recorded by the wearable device were used for analysis, and seizure manifestation was annotated in detail by clinical experts. Ten accelerometry and 3 electrodermal activity features were calculated for sliding windows of variable size across the data. A gradient tree boosting algorithm was used for seizure detection, and the optimal parameter combination was determined in a leave-one-participant-out cross-validation on a training set of 10 seizures from 8 participants. The model was then evaluated on an out-of-sample test set of 11 seizures from the remaining 2 participants. To assess specificity, we additionally analyzed data from up to 29 participants without TCSs during the model evaluation. Results: In the leave-one-participant-out cross-validation, the model optimized for sensitivity could detect all 10 seizures with a false alarm rate of 0.46 per day in 17.3 days of data. In a test set of 11 out-of-sample TCSs, amounting to 8.3 days of data, the model could detect 10 seizures and produced no false positives. Increasing the test set to include data from 28 more participants without additional TCSs resulted in a false alarm rate of 0.19 per day in 78 days of wearable data. Conclusions: We show that a gradient tree boosting machine can robustly detect TCSs from multimodal wearable data in an original data set and that even with very limited training data, supervised machine learning can achieve a high sensitivity and low false-positive rate. This methodology may offer a promising way to approach wearable-based nonconvulsive seizure detection. %M 34806993 %R 10.2196/27674 %U https://mhealth.jmir.org/2021/11/e27674 %U https://doi.org/10.2196/27674 %U http://www.ncbi.nlm.nih.gov/pubmed/34806993 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30394 %T Practice Effects of Mobile Tests of Cognition, Dexterity, and Mobility on Patients With Multiple Sclerosis: Data Analysis of a Smartphone-Based Observational Study %A Woelfle,Tim %A Pless,Silvan %A Wiencierz,Andrea %A Kappos,Ludwig %A Naegelin,Yvonne %A Lorscheider,Johannes %+ Research Center for Clinical Neuroimmunology and Neuroscience Basel, University of Basel, University Hospital Basel, Spitalstrasse 2, Basel, 4056, Switzerland, 41 612652525, johannes.lorscheider@usb.ch %K multiple sclerosis %K digital biomarkers %K practice effects %K learning effects %K learning curves %K nonlinear mixed models %K quantile regression %K information processing speed %K symbol digit modalities test %K smartphones %K wearable electronic devices %K mobile phones %D 2021 %7 18.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphones and their built-in sensors allow for measuring functions in disease-related domains through mobile tests. This could improve disease characterization and monitoring, and could potentially support treatment decisions for multiple sclerosis (MS), a multifaceted chronic neurological disease with highly variable clinical manifestations. Practice effects can complicate the interpretation of both improvement over time by potentially exaggerating treatment effects and stability by masking deterioration. Objective: The aim of this study is to identify short-term learning and long-term practice effects in 6 active tests for cognition, dexterity, and mobility in user-scheduled, high-frequency smartphone-based testing. Methods: We analyzed data from 264 people with self-declared MS with a minimum of 5 weeks of follow-up and at least 5 repetitions per test in the Floodlight Open study, a self-enrollment study accessible by smartphone owners from 16 countries. The collected data are openly available to scientists. Using regression and bounded growth mixed models, we characterized practice effects for the following tests: electronic Symbol Digit Modalities Test (e-SDMT) for cognition; Finger Pinching and Draw a Shape for dexterity; and Two Minute Walk, U-Turn, and Static Balance for mobility. Results: Strong practice effects were found for e-SDMT (n=4824 trials), Finger Pinching (n=19,650), and Draw a Shape (n=19,019) with modeled boundary improvements of 40.8% (39.9%-41.6%), 86.2% (83.6%-88.7%), and 23.1% (20.9%-25.2%) over baseline, respectively. Half of the practice effect was reached after 11 repetitions for e-SDMT, 28 repetitions for Finger Pinching, and 17 repetitions for Draw a Shape; 90% was reached after 35, 94, and 56 repetitions, respectively. Although baseline performance levels were highly variable across participants, no significant differences between the short-term learning effects in low performers (5th and 25th percentile), median performers, and high performers (75th and 95th percentile) were found for e-SDMT up to the fifth trial (β=1.50-2.00). Only small differences were observed for Finger Pinching (β=1.25-2.5). For U-Turn (n=15,051) and Static Balance (n=16,797), only short-term learning effects could be observed, which ceased after a maximum of 5 trials. For Two Minute Walk (n=14,393), neither short-term learning nor long-term practice effects were observed. Conclusions: Smartphone-based tests are promising for monitoring the disease trajectories of MS and other chronic neurological diseases. Our findings suggest that strong long-term practice effects in cognitive and dexterity functions have to be accounted for to identify disease-related changes in these domains, especially in the context of personalized health and in studies without a comparator arm. In contrast, changes in mobility may be more easily interpreted because of the absence of long-term practice effects, even though short-term learning effects might have to be considered. %M 34792480 %R 10.2196/30394 %U https://www.jmir.org/2021/11/e30394 %U https://doi.org/10.2196/30394 %U http://www.ncbi.nlm.nih.gov/pubmed/34792480 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e33861 %T Adjusting to the Reign of Webinars: Viewpoint %A Karabacak,Mert %A Ozkara,Burak Berksu %A Ozcan,Zeynep %+ Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa Caddesi, No 53, Fatih, Istanbul, 34098, Turkey, 90 5396102138, mertkarabacak@gmail.com %K virtual conference %K student-based organization %K neuroscience conference %K COVID-19 %K medical education %K webinars %K web-based education %D 2021 %7 12.11.2021 %9 Viewpoint %J JMIR Med Educ %G English %X Background: With the integration of COVID-19 into our lives, the way events are organized has changed. The Cerrahpaşa Neuroscience Days held on May 8-9, 2021, was one of the conferences that was affected. The annual conference of the student-based Cerrahpaşa Neuroscience Society transitioned to the internet for the first time and had the premise of going international. Objective: With this study, we aim to both discuss how a virtual conference is organized and perceived, and where our conference stands within the literature as a completely student-organized event. Methods: The conference was planned in accordance with virtual standards and promoted to primarily medical schools. During the execution, there were no major issues. The feedback was collected via a form developed with Google Forms. Results: Out of 2195 registrations, 299 qualified to receive a certificate. The feedback forms revealed a general satisfaction; the overall quality of the event was rated an average of 4.6 out of 5, and the ratings of various Likert scale–based questions were statistically analyzed. Open-ended questions provided improvement suggestions for future events. Conclusions: The virtual Cerrahpaşa Neuroscience Days was a success in organization and received positive feedback from the participants. We aim to ground future events on this experience. %M 34766916 %R 10.2196/33861 %U https://mededu.jmir.org/2021/4/e33861 %U https://doi.org/10.2196/33861 %U http://www.ncbi.nlm.nih.gov/pubmed/34766916 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30259 %T Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study %A Widmann,Catherine N %A Wieberneit,Michelle %A Bieler,Luzie %A Bernsen,Sarah %A Gräfenkämper,Robin %A Brosseron,Frederic %A Schmeel,Carsten %A Tacik,Pawel %A Skowasch,Dirk %A Radbruch,Alexander %A Heneka,Michael T %+ Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Venusberg-Campus-1, Building 80, Bonn, 53127, Germany, 49 228 287 13093, catherine.widmann@ukbonn.de %K SARS-CoV-2 %K COVID-19 %K postacute COVID-19 syndrome %K cognition %K neuropsychology %K lung %K magnetic resonance imaging %D 2021 %7 11.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective: This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods: A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results: At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions: To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration: International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID): DERR1-10.2196/30259 %M 34559059 %R 10.2196/30259 %U https://www.researchprotocols.org/2021/11/e30259 %U https://doi.org/10.2196/30259 %U http://www.ncbi.nlm.nih.gov/pubmed/34559059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28315 %T A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study %A Goh,Lina %A Allen,Natalie E %A Ahmadpour,Naseem %A Ehgoetz Martens,Kaylena A %A Song,Jooeun %A Clemson,Lindy %A Lewis,Simon J G %A MacDougall,Hamish G %A Canning,Colleen G %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 7 Susan Wakil Health Building D18, Camperdown, 2006, Australia, 61 9351 9016, natalie.allen@sydney.edu.au %K Parkinson disease %K freezing of gait %K action observation %K video self-modelling %K virtual reality %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective: The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods: The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results: The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions: Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease. %M 34730537 %R 10.2196/28315 %U https://formative.jmir.org/2021/11/e28315 %U https://doi.org/10.2196/28315 %U http://www.ncbi.nlm.nih.gov/pubmed/34730537 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29695 %T A New Tool for Safety Evaluation and a Combination of Measures for Efficacy Assessment of Cotransplanting Human Allogenic Neuronal Stem Cells and Mesenchymal Stem Cells for the Treatment of Parkinson Disease: Protocol for an Interventional Study %A Jamali,Fatima %A Aldughmi,Mayis %A Khasawneh,Mohammad W %A Dahbour,Said %A Salameh,Alaa A %A Awidi,Abdalla %+ Cell Therapy Center, University of Jordan, Queen Rania St, Amman, 11942, Jordan, 962 6 535 5000 ext 23960, ftmjamali@gmail.com %K Parkinson disease %K neurodegenerative disease %K regenerative medicine %K mesenchymal stem cells %K MSCs %K neuronal stem cells %K NSCs %K Unified Parkinson Disease Rating Scale %K UPDRS %K Mobility Lab %K α-synuclein %K PARK-7 %K stem cells %K stem cell therapy %K therapeutics %K Parkinson’s %K neurological diseases %D 2021 %7 22.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) is a neurodegenerative disorder associated with a broad spectrum of motor and nonmotor symptoms. Any proposed cure needs to address the many aspects of the disease. Stem cell therapy may have potential in this regard as indicated in recent preclinical and clinical studies. Objective: This protocol aims to examine the safety and therapeutic benefit of human Wharton jelly-derived mesenchymal stem cells (WJ-MScs) and their derivatives, neuronal stem cells (NSCs) in PD. Methods: This clinical trial is a double-arm, single-blinded, phase I-II interventional study. Participants have been allocated to 1 of 2 groups: one receiving allogeneic WJ-MSCs alone, the other receiving NSCs and WJ-MScs. Participants are being followed-up and assessed over a period of 6 months. To assess safety, an incidence of treatment-emergent adverse events (TEAEs) tool tailored for PD is being used immediately and up to 6 months after treatment. For efficacy assessment, a number of factors are being used, including the gold standard severity test and the Unified Parkinson Disease Rating Scale. In addition, the following standardized assessments for different common symptoms in PD are being included: motor (both subjectively and objectively assessed with wearable sensors), sensory, quality of life and psychological well-being, cognition, and sleep quality. Furthermore, immune-modulatory cytokines and neuronal damage versus regeneration markers in PD, including the neuronal protein linked to PD, α-synuclein, are being monitored. Results: Ten patients have been enrolled in this study and thus participant recruitment has been completed. The study status is active and beyond the recruiting stage. Study chart implementation, data collection, and analysis are ongoing. Conclusions: The combination of NSCs and MSCs in PD may be useful for harnessing the best of the immunomodulation and neural repair characteristics of these cell types. The tailored comprehensive and scaled TEAEs and the variety of evaluation tools used enables a comprehensive assessment of this cellular therapy treatment protocol. A consideration of this expanded tool set is important in the design of future clinical studies for PD. Trial Registration: ClinicalTrials.gov NCT03684122; https://clinicaltrials.gov/ct2/show/NCT03684122 International Registered Report Identifier (IRRID): DERR1-10.2196/29695 %M 34677138 %R 10.2196/29695 %U https://www.researchprotocols.org/2021/10/e29695 %U https://doi.org/10.2196/29695 %U http://www.ncbi.nlm.nih.gov/pubmed/34677138 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e26709 %T Diagnosis and Management of Traumatic Subarachnoid Hemorrhage: Protocol for a Scoping Review %A Griswold,Dylan P %A Fernandez,Laura %A Rubiano,A M %+ Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Av Cra 9 No 131 A - 02, Bogota, 018000, Colombia, 57 300 6154775, rubianoam@gmail.com %K diagnostic criteria %K management %K neurosurgery %K neurotrauma %K SAH %K scoping review %K TBI %K trauma %D 2021 %7 20.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, 69 million people suffer from traumatic brain injury (TBI) each year and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and an increase in morbidity and mortality, but there are a limited number of studies which evaluate recent trends in the diagnostic and management of SAH in the context of trauma. Objective: The objective of this scoping review was to understand the extent and type of evidence in relation to the diagnostic criteria and management of TSAH. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A 3-step search strategy (an initial limited search in PubMed and Scopus databases; a main search of EMBASE, Web of Science, EBSCO, MEDLINE; and manual searches of reference lists of included articles) will be utilized. The search will be limited to studies with human participants and published in English, Spanish, and French between 2005 and 2020. This review will consider studies of adolescent and adult patients with SAH secondary to trauma. Study selection will be performed by 2 authors (DG and LF) in a 2-phase process; if any disagreement arises, a third author (AR) will be consulted. Data to be extracted from each study will include population, intervention, comparator and outcome measures, and a summary of findings. Citation screening, full-text review, risk of bias assessment, and extraction of study characteristics and outcomes will be carried out using a web-based software platform that streamlines the production of scoping reviews. Results: Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in December 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at conferences that engage the most pertinent stakeholders. Conclusions: This scoping review will serve as an initial step in providing more evidence for health care professionals, economists, and policymakers so that they might devote more resources toward this significant problem affecting both health and economic outcomes worldwide. International Registered Report Identifier (IRRID): PRR1-10.2196/26709 %M 34668871 %R 10.2196/26709 %U https://www.researchprotocols.org/2021/10/e26709 %U https://doi.org/10.2196/26709 %U http://www.ncbi.nlm.nih.gov/pubmed/34668871 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e24969 %T Efficacy of Cladribine Tablets as a Treatment for People With Multiple Sclerosis: Protocol for the CLOBAS Study (Cladribine, a Multicenter, Long-term Efficacy and Biomarker Australian Study) %A Maltby,Vicki E %A Lea,Rodney A %A Monif,Mastura %A Fabis-Pedrini,Marzena J %A Buzzard,Katherine %A Kalincik,Tomas %A Kermode,Allan G %A Taylor,Bruce %A Hodgkinson,Suzanne %A McCombe,Pamela %A Butzkueven,Helmut %A Barnett,Michael %A Lechner-Scott,Jeannette %+ School for Medicine and Public Health, University of Newcastle, Medical Genetics, Hunter Medical Research Institute building, c/- University Drive, Callaghan, 2305, Australia, 61 240420286, jeannette.lechner-scott@health.nsw.gov.au %K multiple sclerosis %K cladribine %K biomarkers %D 2021 %7 19.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cladribine tablets (marketed as Mavenclad) are a new oral therapy, which has recently been listed on the pharmaceutical benefits scheme in Australia for the treatment of relapsing multiple sclerosis (MS). The current dosing schedule is for 2 courses given a year apart, which has been shown to be effective for treatment of MS for up to 4 years in 75% of patients (based on annualized relapse rate). However, the reinitiation of therapy after year 4 has not been studied. Objective: This study aims to evaluate the safety and efficacy of cladribine tablets over a 6-year period, according to no evidence of disease activity 3. Methods: This will be a multicenter, 6-year, phase IV, low interventional, observational study that incorporates clinical, hematological, biochemical, epigenetic, radiological and cognitive biomarkers of disease. Participants considered for treatment with cladribine as part of their routine clinical care will be consented to take part in the study. They will be monitored at regular intervals during the initial course of medication administration in years 1 and 2. After year 3, patients will have the option of redosing, if clinically indicated, or to switch to another disease-modifying therapy. Throughout the duration of the study, we will assess blood-based biomarkers including lymphocyte subsets, serum neurofilament light chain, DNA methylation, and RNA analysis as well as magnetic resonance imaging findings (brain volume and/or lesion load) and cognitive performance. Results: This study has been approved by the Hunter New England Local Health District Human Research Ethics Committee. Recruitment began in March of 2019 and was completed by June 2021. Conclusions: This will be the first long-term efficacy trial of cladribine, which offers reinitiation of therapy in the 3rd year, based on disease activity, after the initial 2 courses. We expect that this study will indicate whether any of the assessed biomarkers can be used to predict treatment efficacy or the need for future reinitiation of cladribine in people with MS. Trial Registration: This study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000257167) with Universal Trial Number (U1111-1228-2165). International Registered Report Identifier (IRRID): DERR1-10.2196/24969 %M 34665152 %R 10.2196/24969 %U https://www.researchprotocols.org/2021/10/e24969 %U https://doi.org/10.2196/24969 %U http://www.ncbi.nlm.nih.gov/pubmed/34665152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28923 %T General Practice and Digital Methods to Recruit Stroke Survivors to a Clinical Mobility Study: Comparative Analysis %A Reuter,Katja %A Liu,Chang %A Le,NamQuyen %A Angyan,Praveen %A Finley,James M %+ Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Weiskotten Hall Rm. 2263, 766 Irving Avenue, Syracuse, NY, 13210, United States, 1 315 464 5540, reuterk@upstate.edu %K clinical trial %K stroke %K falls %K digital media %K social media %K advertising %K participant recruitment %K Facebook %K Google %K clinical research %K research methods %K recruitment practices %K enrollment %D 2021 %7 13.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Participant recruitment remains a barrier to conducting clinical research. The disabling nature of a stroke, which often includes functional and cognitive impairments, and the acute stage of illness at which patients are appropriate for many trials make recruiting patients particularly complex and challenging. In addition, people aged 65 years and older, which includes most stroke survivors, have been identified as a group that is difficult to reach and is commonly underrepresented in health research, particularly clinical trials. Digital media may provide effective tools to support enrollment efforts of stroke survivors in clinical trials. Objective: The objective of this study was to compare the effectiveness of general practice (traditional) and digital (online) methods of recruiting stroke survivors to a clinical mobility study. Methods: Recruitment for a clinical mobility study began in July 2018. Eligible study participants included individuals 18 years and older who had a single stroke and were currently ambulatory in the community. General recruiting practice included calling individuals listed in a stroke registry, contacting local physical therapists, and placing study flyers throughout a university campus. Between May 21, 2019, and June 26, 2019, the study was also promoted digitally using the social network Facebook and the search engine marketing tool Google AdWords. The recruitment advertisements (ads) included a link to the study page to which users who clicked were referred. Primary outcomes of interest for both general practice and digital methods included recruitment speed (enrollment rate) and sample characteristics. The data were analyzed using the Lilliefors test, the Welch two-sample t test, and the Mann-Whitney test. Significance was set at P=.05. All statistical analyses were performed in MATLAB 2019b. Results: Our results indicate that digital recruitment methods can address recruitment challenges regarding stroke survivors. Digital recruitment methods allowed us to enroll study participants at a faster rate (1.8 participants/week) compared to using general practice methods (0.57 participants/week). Our findings also demonstrate that digital and general recruitment practices can achieve an equivalent level of sample representativeness. The characteristics of the enrolled stroke survivors did not differ significantly by age (P=.95) or clinical scores (P=.22; P=.82). Comparing the cost-effectiveness of Facebook and Google, we found that the use of Facebook resulted in a lower cost per click and cost per enrollee per ad. Conclusions: Digital recruitment can be used to expedite participant recruitment of stroke survivors compared to more traditional recruitment practices, while also achieving equivalent sample representativeness. Both general practice and digital recruitment methods will be important to the successful recruitment of stroke survivors. Future studies could focus on testing the effectiveness of additional general practice and digital media approaches and include robust cost-effectiveness analyses. Examining the effectiveness of different messaging and visual approaches tailored to culturally diverse and underrepresented target subgroups could provide further data to move toward evidence-based recruitment strategies. %M 34643544 %R 10.2196/28923 %U https://www.jmir.org/2021/10/e28923 %U https://doi.org/10.2196/28923 %U http://www.ncbi.nlm.nih.gov/pubmed/34643544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29558 %T Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey %A Ziemssen,Tjalf %A Giovannoni,Gavin %A Alvarez,Enrique %A Bhan,Virender %A Hersh,Carrie %A Hoffmann,Olaf %A Oreja-Guevara,Celia %A Robles-Cedeño,Rene R %A Trojano,Maria %A Vermersch,Patrick %A Dobay,Pamela %A Khwaja,Mudeer %A Stadler,Bianca %A Rauser,Benedict %A Hach,Thomas %A Piani-Meier,Daniela %A Burton,Jason %+ Center of Clinical Neuroscience, Neurological University Clinic Carl-Gustav Carus, Dresden University of Technology, Helmholtzstr. 10, Dresden, 01069, Germany, 49 3514584465, Ziemssen@web.de %K multiple sclerosis %K relapsing remitting multiple sclerosis %K secondary progressive multiple sclerosis %K transition %K progression %K digital %K usability %D 2021 %7 6.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective: The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods: In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs’ overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results: In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3% (6786/6974; initial) to 98.2% (269/274; final) of the cases. In 93.54% (6524/6974; initial) to 97.1% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76% initial and 252/274, 92% final) and cognitive function (5482/6974, 78.61% initial and 271/274, 79.2% final), as well as in discussing progression in general (6102/6974, 87.49% initial and 246/274, 89.8% final). While completing the final questionnaire, 94.9% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9%) and cognitive function (220/274, 80.3%). Overall, 92% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8% (235/274) were willing to integrate it into their clinical practice. Conclusions: MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice. %M 34612826 %R 10.2196/29558 %U https://www.jmir.org/2021/10/e29558 %U https://doi.org/10.2196/29558 %U http://www.ncbi.nlm.nih.gov/pubmed/34612826 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e28335 %T Certified Examination Assistants in the Age of Telemedicine: A Blueprint Through Neurology %A Bragin,Ilya %A Cohen,Dylan T %+ St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA, 18015, United States, 1 347 853 0163, ilyabragin@gmail.com %K telemedicine %K physical examination %K neurological exam %K telemedicine assistants %K telemedicine implementation %K telemedicine certification %K telemedicine jobs %K telemedicine education %K telehealth %K teleneurology %D 2021 %7 6.10.2021 %9 Viewpoint %J JMIR Med Educ %G English %X The optimal approach to a clinical physical examination via telemedicine is still being explored. The medical community has no standardized or widely followed criteria for telemedicine examinations, so a broad spectrum of approaches is used. Unfortunately, the need for telemedicine is outpacing physical examination validation research. Given that certain specialties have been using telemedicine longer than others, lessons from those specialties might aid in developing standardized protocols for telemedicine. Neurology has been at the forefront of telemedicine use, initially through stroke care and later in multiple subspecialties. We present a framework for optimizing the history taking and physical examination process via telemedicine based on our experience in neurology. This mainly includes remotely examining a patient unassisted or with an untrained assistant present on the patient side of the connection. We also discuss the need for trained, certified assistants to assist the off-site physician in history taking and physical examination. These certified assistants would be allied health professionals who perform high-quality cued patient examinations under direct physician supervision with no responsibility to diagnose or treat. This contrasts with the approach seen in advanced practice providers such as physician assistants and nurse practitioners who undergo years of training to diagnose and treat patients under supervision. This training process would serve as a stepping stone for the development of dedicated certification programs for neurology and other medical specialties; however, assessments of practical training, costs, implementation, and longitudinal quality are warranted. %M 34612828 %R 10.2196/28335 %U https://mededu.jmir.org/2021/4/e28335 %U https://doi.org/10.2196/28335 %U http://www.ncbi.nlm.nih.gov/pubmed/34612828 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32085 %T Noisy Galvanic Vestibular Stimulation Combined With a Multisensory Balance Program in Older Adults With Moderate to High Fall Risk: Protocol for a Feasibility Study for a Randomized Controlled Trial %A McLaren,Ruth %A Smith,Paul F %A Lord,Sue %A Kaur,Preet Kamal %A Zheng,Yiwen %A Taylor,Denise %+ Rehabilitation Innovation Centre, School of Clinical Sciences, Auckland University of Technology, AA115, AA Building, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 9 9210 9680, denise.taylor@aut.ac.nz %K older adult %K balance %K rehabilitation %K noisy galvanic vestibular stimulation %K nGVS %K brain stimulation %D 2021 %7 5.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reduced mobility and falls are common among older adults. Balance retraining programs are effective in reducing falls and in improving balance and mobility. Noisy galvanic vestibular stimulation is a low-level electrical stimulation used to reduce the threshold for the firing of vestibular neurons via a mechanism of stochastic resonance. Objective: This study aims to determine the feasibility of using noisy galvanic vestibular stimulation to augment a balance training program for older adults at risk of falls. We hypothesize that noisy galvanic vestibular stimulation will enhance the effects of balance retraining in older adults at risk of falls Methods: In this 3-armed randomized controlled trial, community dwelling older adults at risk of falling will be randomly assigned to a noisy galvanic vestibular stimulation plus balance program (noisy galvanic vestibular stimulation group), sham plus balance program (sham group), or a no treatment group (control). Participants will attend the exercise group twice a week for 8 weeks with assessment of balance and gait pretreatment, posttreatment, and at 3 months postintervention. Primary outcome measures include postural sway, measured by center of pressure velocity, area and root mean square, and gait parameters such as speed, step width, step variability, and double support time. Spatial memory will also be measured using the triangle completion task and the 4 Mountains Test. Results: Recruitment began in November 2020. Data collection and analysis are expected to be completed by December 2022. Conclusions: This study will evaluate the feasibility of using noisy galvanic vestibular stimulation alongside balance retraining in older adults at risk of falls and will inform the design of a fully powered randomized controlled trial. Trial Registration: New Zealand Clinical Trials Registry (ACTRN12620001172998); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379944 International Registered Report Identifier (IRRID): DERR1-10.2196/32085 %M 34609323 %R 10.2196/32085 %U https://www.researchprotocols.org/2021/10/e32085 %U https://doi.org/10.2196/32085 %U http://www.ncbi.nlm.nih.gov/pubmed/34609323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28766 %T A Road Map for Remote Digital Health Technology for Motor Neuron Disease %A van Eijk,Ruben P A %A Beelen,Anita %A Kruitwagen,Esther T %A Murray,Deirdre %A Radakovic,Ratko %A Hobson,Esther %A Knox,Liam %A Helleman,Jochem %A Burke,Tom %A Rubio Pérez,Miguel Ángel %A Reviers,Evy %A Genge,Angela %A Steyn,Frederik J %A Ngo,Shyuan %A Eaglesham,John %A Roes,Kit C B %A van den Berg,Leonard H %A Hardiman,Orla %A McDermott,Christopher J %+ UMC Utrecht Brain Centre, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 88 75 579 39, r.p.a.vaneijk-2@umcutrecht.nl %K amyotrophic lateral sclerosis %K digital health care technology %K e-health %D 2021 %7 22.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X Despite recent and potent technological advances, the real-world implementation of remote digital health technology in the care and monitoring of patients with motor neuron disease has not yet been realized. Digital health technology may increase the accessibility to and personalization of care, whereas remote biosensors could optimize the collection of vital clinical parameters, irrespective of patients’ ability to visit the clinic. To facilitate the wide-scale adoption of digital health care technology and to align current initiatives, we outline a road map that will identify clinically relevant digital parameters; mediate the development of benefit-to-burden criteria for innovative technology; and direct the validation, harmonization, and adoption of digital health care technology in real-world settings. We define two key end products of the road map: (1) a set of reliable digital parameters to capture data collected under free-living conditions that reflect patient-centric measures and facilitate clinical decision making and (2) an integrated, open-source system that provides personalized feedback to patients, health care providers, clinical researchers, and caregivers and is linked to a flexible and adaptable platform that integrates patient data in real time. Given the ever-changing care needs of patients and the relentless progression rate of motor neuron disease, the adoption of digital health care technology will significantly benefit the delivery of care and accelerate the development of effective treatments. %M 34550089 %R 10.2196/28766 %U https://www.jmir.org/2021/9/e28766 %U https://doi.org/10.2196/28766 %U http://www.ncbi.nlm.nih.gov/pubmed/34550089 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31690 %T Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial %A Fleisher,Jori E %A Hess,Serena %A Sennott,Brianna J %A Myrick,Erica %A Wallace,Ellen Klostermann %A Lee,Jeanette %A Sanghvi,Maya %A Woo,Katheryn %A Ouyang,Bichun %A Wilkinson,Jayne R %A Beck,James %A Johnson,Tricia J %A Hall,Deborah A %A Chodosh,Joshua %+ Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W Harrison Street, Suite 755, Chicago, IL, 60612, United States, 1 3125632900, jorifleisher@gmail.com %K home visits %K telehealth, Parkinson disease %K homebound %K palliative care %K quality of life %K interdisciplinary care %K caregiver %K caregiver strain %D 2021 %7 14.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. Objective: The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. Methods: In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage–matched control dyads drawn from US participants in the longitudinal Parkinson’s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. Results: The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. Conclusions: To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. Trial Registration: ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. International Registered Report Identifier (IRRID): PRR1-10.2196/31690 %M 34238753 %R 10.2196/31690 %U https://www.researchprotocols.org/2021/9/e31690 %U https://doi.org/10.2196/31690 %U http://www.ncbi.nlm.nih.gov/pubmed/34238753 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30726 %T Using Electronically Delivered Therapy and Brain Imaging to Understand Obsessive-Compulsive Disorder Pathophysiology: Protocol for a Pilot Study %A Stephenson,Callum %A Malakouti,Niloufar %A Nashed,Joseph Y %A Salomons,Tim %A Cook,Douglas J %A Milev,Roumen %A Alavi,Nazanin %+ Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Botterell Hall, 18 Stuart Street, Kingston, ON, K7L 3N6, Canada, 1 2894075895, callum.stephenson@queensu.ca %K mental health %K obsessive-compulsive disorder %K cognitive behavioral therapy %K exposure ritual prevention %K electronic %K functional magnetic resonance imaging %K eHealth %K brain imaging %D 2021 %7 14.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obsessive-compulsive disorder (OCD) is a debilitating and prevalent anxiety disorder. Although the basal ganglia and frontal cortex are the brain regions that are most commonly hypothesized to be involved in OCD, the exact pathophysiology is unknown. By observing the effects of proven treatments on brain activation levels, the cause of OCD can be better understood. Currently, the gold standard treatment for OCD is cognitive behavioral therapy (CBT) with exposure and response prevention. However, this is often temporally and geographically inaccessible, time consuming, and costly. Fortunately, CBT can be effectively delivered using the internet (electronically delivered CBT [e-CBT]) because of its structured nature, thus addressing these barriers. Objective: The aims of this study are to implement an e-CBT program for OCD and to observe its effects on brain activation levels using functional magnetic resonance imaging (MRI). It is hypothesized that brain activation levels in the basal ganglia and frontal cortex will decrease after treatment. Methods: Individuals with OCD will be offered a 16-week e-CBT program with exposure and response prevention mirroring in-person CBT content and administered through a secure web-based platform. The efficacy of the treatment will be evaluated using clinically validated symptomology questionnaires at baseline, at week 8, and after treatment (week 16). Using functional MRI at baseline and after treatment, brain activation levels will be assessed in the resting state and while exposed to anxiety-inducing images (eg, dirty dishes if cleanliness is an obsession). The effects of treatment on brain activation levels and the correlation between symptom changes and activation levels will be analyzed. Results: The study received initial ethics approval in December 2020, and participant recruitment began in January 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 5 participants have been recruited. Data collection is expected to conclude by January 2022, and data analysis is expected to be completed by February 2022. Conclusions: The findings from this study can further our understanding of the causation of OCD and help develop more effective treatments for this disorder. Trial Registration: ClinicalTrials.gov NCT04630197; https://clinicaltrials.gov/ct2/show/NCT04630197. International Registered Report Identifier (IRRID): PRR1-10.2196/30726 %M 34348889 %R 10.2196/30726 %U https://www.researchprotocols.org/2021/9/e30726 %U https://doi.org/10.2196/30726 %U http://www.ncbi.nlm.nih.gov/pubmed/34348889 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26608 %T Exploring Test-Retest Reliability and Longitudinal Stability of Digital Biomarkers for Parkinson Disease in the m-Power Data Set: Cohort Study %A Sahandi Far,Mehran %A Eickhoff,Simon B %A Goni,Maria %A Dukart,Juergen %+ Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Wilhelm-Johnen-Strasse, Jülich, 52425, Germany, 49 1632874330, juergen.dukart@gmail.com %K health sciences %K medical research %K biomarkers %K diagnostic markers %K neurological disorders %K Parkinson disease %K mobile phone %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital biomarkers (DB), as captured using sensors embedded in modern smart devices, are a promising technology for home-based sign and symptom monitoring in Parkinson disease (PD). Objective: Despite extensive application in recent studies, test-retest reliability and longitudinal stability of DB have not been well addressed in this context. We utilized the large-scale m-Power data set to establish the test-retest reliability and longitudinal stability of gait, balance, voice, and tapping tasks in an unsupervised and self-administered daily life setting in patients with PD and healthy controls (HC). Methods: Intraclass correlation coefficients were computed to estimate the test-retest reliability of features that also differentiate between patients with PD and healthy volunteers. In addition, we tested for longitudinal stability of DB measures in PD and HC, as well as for their sensitivity to PD medication effects. Results: Among the features differing between PD and HC, only a few tapping and voice features had good to excellent test-retest reliabilities and medium to large effect sizes. All other features performed poorly in this respect. Only a few features were sensitive to medication effects. The longitudinal analyses revealed significant alterations over time across a variety of features and in particular for the tapping task. Conclusions: These results indicate the need for further development of more standardized, sensitive, and reliable DB for application in self-administered remote studies in patients with PD. Motivational, learning, and other confounders may cause variations in performance that need to be considered in DB longitudinal applications. %M 34515645 %R 10.2196/26608 %U https://www.jmir.org/2021/9/e26608 %U https://doi.org/10.2196/26608 %U http://www.ncbi.nlm.nih.gov/pubmed/34515645 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28192 %T Using a Smartphone Application for the Accurate and Rapid Diagnosis of Acute Anterior Intracranial Arterial Occlusion: Usability Study %A Komatsu,Teppei %A Sakai,Kenichiro %A Iguchi,Yasuyuki %A Takao,Hiroyuki %A Ishibashi,Toshihiro %A Murayama,Yuichi %+ Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan, 81 334331111, teppeinoieni.coicoi@jikei.ac.jp %K stroke %K infarction %K teleradiology %K smartphone %K telehealth %K reperfusion %K neurology %K mHealth %K application %K mobile health %K mobile applications %K diagnosis %K diagnostics %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telestroke has developed rapidly as an assessment tool for patients eligible for reperfusion therapy. Objective: To investigate whether vascular neurologists can diagnose intracranial large vessel occlusion (LVO) as quickly and accurately using a smartphone application compared to a hospital-based desktop PC monitor. Methods: We retrospectively enrolled 108 consecutive patients with acute ischemic stroke in the middle cerebral artery territory who underwent magnetic resonance imaging (MRI) within 24 hours of their stroke onset. Two vascular neurologists, blinded to all clinical information, independently evaluated magnetic resonance angiography and fluid-attenuated inversion recovery images for the presence or absence of LVO in the internal carotid artery and middle cerebral artery (M1, M2, or M3) on both a smartphone application (Smartphone-LVO) and a hospital-based desktop PC monitor (PC-LVO). To evaluate the accuracy of an arterial occlusion diagnosis, interdevice variability between Smartphone-LVO and PC-LVO was analyzed using κ statistics, and image interpretation time was compared between Smartphone-LVO and PC-LVO. Results: There was broad agreement between Smartphone-LVO and PC-LVO evaluations regarding the presence or absence of arterial occlusion (Reader 1: κ=0.94; P<.001 vs Reader 2: κ=0.89; P<.001), and interpretation times were similar between Smartphone-LVO and PC-LVO. Conclusions: The results indicate the evaluation of neuroimages using a smartphone application can provide an accurate and timely diagnosis of anterior intracranial arterial occlusion that can be shared immediately with members of the stroke team to support the management of patients with hyperacute ischemic stroke. %M 34448716 %R 10.2196/28192 %U https://www.jmir.org/2021/8/e28192 %U https://doi.org/10.2196/28192 %U http://www.ncbi.nlm.nih.gov/pubmed/34448716 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30617 %T Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial %A Douglas,Sara L %A Plow,Matthew %A Packer,Tanya %A Lipson,Amy R %A Lehman,Michelle J %+ School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, United States, 1 216 368 0702, sld4@case.edu %K multiple sclerosis %K caregivers %K distress %K anxiety %K depression %K psycho-education %K website %K coaching %K mobile phone %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Of the approximately 1 million people living with multiple sclerosis in the United States, more than half receive informal, unpaid care or support from family or friends (caregivers). These caregivers report high levels of stress, anxiety, and negative emotions. Few researchers have conducted psychoeducational interventions for these caregivers. Objective: This paper presents a protocol for a randomized clinical trial that aims to test the efficacy of two interventions for improving stress, anxiety, depression, and negative emotions for caregivers of persons with multiple sclerosis. Methods: Participants included any self-identified family or friend caregiver of a person with multiple sclerosis. Data collection began in April 2021 and is expected to continue until November 2021. Participants will be randomized to receive either a website-only or a website-coaching intervention delivered for 6 weeks. Data will be collected at baseline, 6 weeks after baseline (after delivery of intervention), and 6 weeks later. Results: The protocol was approved by the institutional review board of the Case Western Reserve University on January 21, 2021 (protocol 20201484). As of May 2021, 66 participants were enrolled. Conclusions: Our findings will have implications for identifying the efficacy of two types of interventions developed for caregivers of persons with multiple sclerosis to reduce negative psychological outcomes associated with caregiving. Trial Registration: ClinicalTrials.gov NCT04662008; http://clinicaltrials.gov/ct2/show/NCT04662008 International Registered Report Identifier (IRRID): DERR1-10.2196/30617 %M 34435971 %R 10.2196/30617 %U https://www.researchprotocols.org/2021/8/e30617 %U https://doi.org/10.2196/30617 %U http://www.ncbi.nlm.nih.gov/pubmed/34435971 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e31183 %T Repeated Transcranial Magnetic Stimulation for Improving Cognition in Alzheimer Disease: Protocol for an Interim Analysis of a Randomized Controlled Trial %A Moussavi,Zahra %A Koski,Lisa %A Fitzgerald,Paul B %A Millikin,Colleen %A Lithgow,Brian %A Jafari-Jozani,Mohammad %A Wang,Xikui %+ Biomedical Engineering Program, Faculty of Engineering, University of Manitoba, 75 Chancellor Circle, Winnipeg, MB, R3T5V6, Canada, 1 204 474 7023, Zahra.Moussavi@umanitoba.ca %K interim analysis, treatment efficacy, repetitive transcranial magnetic stimulation %K Alzheimer disease %K double blind %K treatment %K placebo controlled %K randomized %D 2021 %7 9.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many clinical trials investigating treatment efficacy require an interim analysis. Recently we have been running a large, multisite, randomized, placebo-controlled, double-blind clinical trial investigating the effect of repetitive transcranial magnetic stimulation (rTMS) treatment for improving or stabilizing the cognition of patients diagnosed with Alzheimer disease. Objective: The objectives of this paper are to report on recruitment, adherence, and adverse events (AEs) to date, and to describe in detail the protocol for interim analysis of the clinical trial data. The protocol will investigate whether the trial is likely to reach its objectives if continued to the planned maximum sample size. Methods: The specific requirements of the analytic protocol are to (1) ensure the double-blind nature of the data while doing the analysis, (2) estimate the predictive probabilities of success (PPoSs), (3) estimate the numbers needed to treat, (4) re-estimate the initial required sample size. The initial estimate of sample size was 208. The interim analysis will be based on 150 patients who will be enrolled in the study and finish at least 8 weeks of the study. Our protocol for interim analysis, at the very first stage, is to determine the response rate for each participant to the treatment (either sham or active), while ensuring the double-blind nature of the data. The blinded data will be analyzed by a statistician to investigate the treatment efficacy. We will use Bayesian PPoS to predict the success rate and determine whether the study should continue. Results: The enrollment has been slowed significantly due to the COVID-19 pandemic and lockdown. Nevertheless, so far 133 participants have been enrolled, while 22 of these have been withdrawn or dropped out for various reasons. In general, rTMS has been found tolerable with no serious AE. Only 2 patients dropped out of the study due to their intolerability to rTMS pulses. Conclusions: Overall, the study with the same protocol is going as expected with no serious AE or any major protocol deviation. Trial Registration: ClinicalTrials.gov NCT02908815; https://clinicaltrials.gov/ct2/show/NCT02908815 International Registered Report Identifier (IRRID): DERR1-10.2196/31183 %M 34383681 %R 10.2196/31183 %U https://www.researchprotocols.org/2021/8/e31183 %U https://doi.org/10.2196/31183 %U http://www.ncbi.nlm.nih.gov/pubmed/34383681 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29965 %T Cranial Nerve Noninvasive Neuromodulation in Adults With Neurological Conditions: Protocol for a Scoping Review %A Boughen,Keaton %A Neil,Tyler %A Dullemond,Shayan %A Lutowicz,Kevin %A Bilgasem,Ahmed %A Hastings,Tyler %A Brooks,Dina %A Vaughan-Graham,Julie %+ Department of Physical Therapy, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada, 1 416 464 1167, julie.vaughan.graham@utoronto.ca %K cranial nerve %K neurological conditions %K neurology %K neuromodulation %K neurorehabilitation %K physical therapy %K portable neuromodulation stimulation device %K rehabilitation %K scoping review %K translingual neurostimulation %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cranial nerve noninvasive neuromodulation (CN-NINM) via translingual nerve stimulation (TLNS) is a promising new intervention combined with neurological rehabilitation to improve outcomes for persons with neurological conditions. A portable neuromodulation stimulation (PoNS) device rests on the tongue and stimulates cranial nerves V and VII (trigeminal and facial nerves, respectively). Emerging evidence suggests that CN-NINM using the PoNS device, combined with targeted physical therapy, improves balance and gait outcomes but has not yet been comprehensively reviewed. Objective: This review will describe CN-NINM via TLNS and its applications, effects, and implications for rehabilitation science in adult populations with neurological conditions. We will identify how CN-NINM via TLNS is currently being incorporated into neurological rehabilitation and identify gaps in evidence with respect to this novel technology. Methods: Joanna Briggs Institute methodology will be used to conduct this scoping review. Electronic databases MEDLINE, AMED, CINAHL, Embase, and Web of Science will be searched, as well as gray literature databases ProQuest, DuckDuckGo, and Google. Studies published in English and French between 2000 and 2021 will be included. Two reviewers will independently screen all titles and abstracts and full-text papers that meet the inclusion criteria. Data will be extracted and collated in a table to synthesize the results. Extracted data will be reported in a comprehensive summary. Results: The final manuscript is intended for submission to an indexed journal in September 2021. Conclusions: This scoping review will be the first, to our knowledge, to address the current evidence on CN-NINM. The results will inform the use of CN-NINM in neurological rehabilitation and the development of recommendations for future research. Trial Registration: Open Science Framework 10.17605/OSF.IO/XZQFM; https://osf.io/xzqfm International Registered Report Identifier (IRRID): PRR1-10.2196/29965 %M 34319251 %R 10.2196/29965 %U https://www.researchprotocols.org/2021/7/e29965 %U https://doi.org/10.2196/29965 %U http://www.ncbi.nlm.nih.gov/pubmed/34319251 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25700 %T Status Quo and Research Trends of Neurosurgical Departments in China: Bibliometric and Scientometric Analyses %A Ni,Bowen %A He,Minyi %A Cao,Bei %A He,Jianmin %A Liu,Yawei %A Zhao,Zhen %+ Institute of Scientific Research, Southern Medical University, 1838 Guangzhou Dadao Bei Street, Guangzhou, 510515, China, 86 020 61648165, nfykdxchengguo@126.com %K neurosurgery %K bibliometric analysis %K co-word biclustering analysis %K visualized analysis %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Modern neurosurgery is a relatively young discipline characterized by finesse and complexity. In recent years, neurosurgery in China has made continuous developments, with long-term progress and outstanding discoveries in many aspects of the field. Objective: This scientometric investigation aimed to comprehensively provide insight into the development trends of neurosurgery in China, to demonstrate how the field has evolved. Methods: PubMed database was searched to retrieve relevant papers published between 1988 and 2018 from neurosurgery institutions in China. The database of the National Natural Science Foundation of China was also retrieved for funding information. Information (eg, year of publication, journal, institute of origin) and keywords were collected from each paper after removing duplicates and filtering unintentional words. Co-word analysis was performed on the papers’ keywords, and a time distribution matrix of coexisting keywords in a given paper (ie, termed co-words) was established. Co-words were clustered according to their growth rate within years and visually presented with a mountain plot and a heatmap. Trends and potential subspecialties were identified, and each topic, represented either by a co-word from publications or funding from the National Natural Science Foundation of China during the period from 2011 to 2018, was collected and analyzed. Results: Within 15,972 publications on neurosurgery from institutions in China, diagnostic image was found to coexist the most with other keywords. Cluster 0, represented by diagnostic image with retrospective study, contained emerging topics with great developmental potential and demonstrated high growth rates in recent years. This finding suggests that the topics represented in Cluster 0 may represent future areas of important neurosurgical research. We also found that the developmental trend of China’s neurosurgical research is highly correlated with National Natural Science Foundation of China funding acquisition. Conclusions: Co-word analysis and visualization results provided insight into the emerging research topics that are of vital importance, which can be used as a reference by neurosurgeons and researchers for future investigations. In this study, our analysis strategy based on co-word biclustering was able to clearly demonstrate current academic subject development; therefore, co-word biclustering is a reliable bibliometric analysis strategy. %M 36260378 %R 10.2196/25700 %U https://www.jmir.org/2021/7/e25700 %U https://doi.org/10.2196/25700 %U http://www.ncbi.nlm.nih.gov/pubmed/36260378 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25520 %T Psychometric Evaluation and Workflow Integration Study of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Protocol for a Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Holyoke,Paul %+ Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T3Y3, Canada, 1 5192427477, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia %K neuropsychological tests %K evaluation study %K technology %K aged %K primary health care %D 2021 %7 21.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the rapid aging of the global population, experts anticipate a surge in the prevalence of mild cognitive impairment (MCI) and dementia worldwide. It is argued that developing more sensitive, easy to administer, and valid MCI screening tools for use in primary care settings may initiate timely clinical and personal care planning and treatment, enabling early access to programs and services. Including functional competence measures in screening tests makes them more ecologically valid and may help to identify cognitive deficits at an earlier stage. Objective: We aim to conduct a preliminary evaluative study comparing the sensitivity, specificity, and reliability of the BrainFx Screen (referred to as SCREEN hereafter), a novel digital tool designed to assess functional competence and detect early signs of cognitive impairment, with the Quick Mild Cognitive Impairment, a validated and highly sensitive tool that detects MCI in the older adult population. We will also investigate the perceived usefulness and integration of the SCREEN into primary care practice to identify demonstrable impacts on clinical workflow and health care providers’ (HCP) perceptions of its success as a screening tool. Patients’ perceptions of completing the SCREEN and its impact on their quality of life will also be explored. Methods: This study has a concurrent, mixed methods, prospective, and quasi-experimental design. Participants will be recruited from 5 primary care family health teams (FHTs; defined by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants will include HCPs, patients, care partners, and FHT administrative executives. Patients 55 years and older with no history of diagnoses for MCI, dementia, or Alzheimer disease rostered in one of the FHTs participating in the study will be eligible to participate. Their care partners will help triangulate the qualitative data collected from patients. Participating FHTs will identify an occupational therapist from their site to participate in the study; this HCP will both administer the research protocol and participate in semistructured in-depth interviews and questionnaires. Principal component analysis will be conducted on the SCREEN data to understand the test components better. Tests comparing sensitivity, specificity, and test-retest reliability will assess the validity of SCREEN as a screening tool for MCI. Results: This paper describes the study protocol and its activities to date. Data collection was halted early because of COVID-19 restrictions on research activity, and data analysis is currently in progress. Conclusions: At the end of the project, we anticipate having an initial comparative evaluation of the SCREEN as a tool for early detection of MCI in primary care older adult patient populations. Resource constraints on this research study limit our ability to conduct a randomized controlled trial; however, the results will assist developers of the SCREEN in determining whether rigorous controlled testing is warranted. International Registered Report Identifier (IRRID): DERR1-10.2196/25520 %M 34018966 %R 10.2196/25520 %U https://www.researchprotocols.org/2021/5/e25520 %U https://doi.org/10.2196/25520 %U http://www.ncbi.nlm.nih.gov/pubmed/34018966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25229 %T Use of Twitter in Neurology: Boon or Bane? %A Mishra,Biswamohan %A Saini,Monica %A Doherty,Carolynne M %A Pitceathly,Robert D S %A Rajan,Roopa %A Siddiqi,Omar K %A Ramdharry,Gita %A Asranna,Ajay %A Tomaselli,Pedro Jose %A Kermode,Allan G %A Bajwa,Jawad A %A Garg,Divyani %A Vishnu,Venugopalan Y %+ Department of Neurology, All India Institute of Medical Sciences, Room No. 704, CN Centre, New Delhi, 110029, India, 91 9855480361, vishnuvy16@yahoo.com %K Twitter %K neurology %K tweet chats %K research %K tweetorials %K contemporary issues %D 2021 %7 14.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X Twitter is a free, open access social media platform that is widely used in medicine by physicians, scientists, and patients. It provides an opportunity for advocacy, education, and collaboration. However, it is likely not utilized to its full advantage by many disciplines in medicine, and pitfalls exist in its use. In particular, there has not been a review of Twitter use and its applications in the field of neurology. This review seeks to provide an understanding of the current use of Twitter in the field of neurology to assist neurologists in engaging with this potentially powerful application to support their work. %M 33988522 %R 10.2196/25229 %U https://www.jmir.org/2021/5/e25229 %U https://doi.org/10.2196/25229 %U http://www.ncbi.nlm.nih.gov/pubmed/33988522 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26404 %T A National Comparative Investigation of Twins With Congenital Heart Defects for Neurodevelopmental Outcomes and Quality of Life (Same Same, but Different?): Protocol for a Prospective Observational Study %A Remmele,Julia %A Helm,Paul Christian %A Oberhoffer-Fritz,Renate %A Bauer,Ulrike MM %A Pickardt,Thomas %A Ewert,Peter %A Tutarel,Oktay %+ Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center of Munich, Lazarettstraße 36, Munich, 80636, Germany, 49 89 1218 1570, remmele@dhm.mhn.de %K congenital heart defect %K twin siblings with CHD %K twin study %K neurodevelopmental outcome %K same same %K cardiology %K heart defect %K twin %D 2021 %7 13.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to the increased survival rates of patients with congenital heart defects (CHD), associated disorders are an increasing focus of research. Existing studies figured out an association between CHD and its treatment, and neurodevelopmental outcomes including motor competence impairments. All these studies, however, compared their test results with reference values or results of healthy control groups. This comparison is influenced by socioeconomic and genetic aspects, which do have a known impact on neurodevelopmental outcomes. Objective: This study protocol describes a setting that aims to find out the role of CHD and its treatments on neurodevelopmental outcomes, excluding socioeconomic and genetic aspects. Only a twin comparison provides the possibility to exclude these confounding factors. Methods: In a German-wide prospective cohort study, 129 twin siblings registered in the National Register for Congenital Heart Defects will undergo testing on cognitive function (Wechsler Intelligence Tests age-dependent: Wechsler Adult Intelligence Scale, fourth edition; Wechsler Intelligence Scale for Children, fifth edition; and Wechsler Preschool and Primary Scale of Intelligence, fourth edition) and motor competence (Movement Assessment Battery for Children, second edition). Additionally, the self-reported health-related quality of life (KINDL-R for children, Short Form 36 for adults) and the parent-reported strength and difficulties of the children (Strength and Difficulties Questionnaire, German version) will be assessed by standardized questionnaires. CHD data on the specific diagnosis, surgeries, transcatheter procedures, and additional medical information will be received from patient records. Results: The approval of the Medical Ethics Committee Charité Mitte was obtained in June 2018. After getting funded in April 2019, the first enrollment was in August 2019. The study is still ongoing until June 2022. Final results are expected in 2022. Conclusions: This study protocol provides an overview of the study design’s technical details, offering an option to exclude confounding factors on neurodevelopmental outcomes in patients with CHD. This will enable a specific analysis focusing on CHD and clinical treatments to differentiate in terms of neurodevelopmental outcomes of patients with CHD compared to twin siblings with healthy hearts. Finally, we aim to clearly define what is important to prevent patients with CHD in terms of neurodevelopmental impairments to be able to develop targeted prevention strategies for patients with CHD. Trial Registration: German Clinical Trials Register DRKS00021087; https://tinyurl.com/2rdw8w67 International Registered Report Identifier (IRRID): DERR1-10.2196/26404 %M 33983133 %R 10.2196/26404 %U https://www.researchprotocols.org/2021/5/e26404 %U https://doi.org/10.2196/26404 %U http://www.ncbi.nlm.nih.gov/pubmed/33983133 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25011 %T The Smartphone App haMSter for Tracking Patient-Reported Outcomes in People With Multiple Sclerosis: Protocol for a Pilot Study %A Altmann,Patrick %A Hinterberger,Werner %A Leutmezer,Fritz %A Ponleitner,Markus %A Monschein,Tobias %A Zrzavy,Tobias %A Zulehner,Gudrun %A Kornek,Barbara %A Lanzenberger,Rupert %A Berek,Klaus %A Rommer,Paulus Stefan %A Berger,Thomas %A Bsteh,Gabriel %+ Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria, 43 14040031450, gabriel.bsteh@meduniwien.ac.at %K mHealth %K mobile health %K remote monitoring %K patient-reported outcomes %K multiple sclerosis %K telemedicine %D 2021 %7 7.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Treatment and monitoring decisions in people with multiple sclerosis (MS) are based commonly on clinician-reported outcomes. These reflect physical and radiological disease activity and are the most relevant endpoints in clinical trials. Over the past few years, the number of studies evaluating so-called patient-reported outcomes (PROs) has been increasing. PROs are reports from patients concerning their own health perception. They are typically obtained by means of questionnaires and aim to quantify symptoms such as fatigue, depression, and sexual dysfunction. The emergence of PROs has made a tremendous contribution to understanding the individual impact of disease in people with MS and their health-related quality of life. However, the assessment of PROs consumes resources, including time and personnel. Thus, useful ways to conveniently introduce PROs into clinical practice are needed. Objective: We aim to provide a rationale and pilot study protocol for a mobile health (mHealth) solution named “haMSter” that allows for remote monitoring of PROs in people with MS. Methods: The core function of haMSter is to provide three scientifically validated PRO questionnaires relevant to MS for patients to fill out at home once a month. Thereby, longitudinal and remote documentation of PROs is enabled. A scoring algorithm graphically plots PRO scores over time and makes them available at the next visit. Results: The pilot study is currently ongoing and will evaluate adherence to this mHealth solution in 50 patients over a period of 6 months. Results from the haMSter pilot study are expected in 2021. Conclusions: haMSter is a novel mHealth-based solution for modern PRO research, which may constitute the first step in achieving the ability to integrate PROs in clinical practice. This allows for a more problem-oriented approach in monitoring visits, which addresses patient needs and ultimately saves time. Trial Registration: ClinicalTrials.gov NCT04555863; https://clinicaltrials.gov/ct2/show/NCT04555863 International Registered Report Identifier (IRRID): DERR1-10.2196/25011 %M 33960949 %R 10.2196/25011 %U https://www.researchprotocols.org/2021/5/e25011 %U https://doi.org/10.2196/25011 %U http://www.ncbi.nlm.nih.gov/pubmed/33960949 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24727 %T Correlations Between Facial Expressivity and Apathy in Elderly People With Neurocognitive Disorders: Exploratory Study %A Zeghari,Radia %A König,Alexandra %A Guerchouche,Rachid %A Sharma,Garima %A Joshi,Jyoti %A Fabre,Roxane %A Robert,Philippe %A Manera,Valeria %+ Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d’Azur, 10 Rue Molière, Nice, France, 33 4 92 03 47 66, radia.zeghari@univ-cotedazur.fr %K apathy %K action units %K assessment %K ICT %K facial video analysis %K neurocognitive disorders %K neurocognitive %K facial analysis %D 2021 %7 31.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurocognitive disorders are often accompanied by behavioral symptoms such as anxiety, depression, and/or apathy. These symptoms can occur very early in the disease progression and are often difficult to detect and quantify in nonspecialized clinical settings. Objective: We focus in this study on apathy, one of the most common and debilitating neuropsychiatric symptoms in neurocognitive disorders. Specifically, we investigated whether facial expressivity extracted through computer vision software correlates with the severity of apathy symptoms in elderly subjects with neurocognitive disorders. Methods: A total of 63 subjects (38 females and 25 males) with neurocognitive disorder participated in the study. Apathy was assessed using the Apathy Inventory (AI), a scale comprising 3 domains of apathy: loss of interest, loss of initiation, and emotional blunting. The higher the scale score, the more severe the apathy symptoms. Participants were asked to recall a positive and a negative event of their life, while their voice and face were recorded using a tablet device. Action units (AUs), which are basic facial movements, were extracted using OpenFace 2.0. A total of 17 AUs (intensity and presence) for each frame of the video were extracted in both positive and negative storytelling. Average intensity and frequency of AU activation were calculated for each participant in each video. Partial correlations (controlling for the level of depression and cognitive impairment) were performed between these indexes and AI subscales. Results: Results showed that AU intensity and frequency were negatively correlated with apathy scale scores, in particular with the emotional blunting component. The more severe the apathy symptoms, the less expressivity in specific emotional and nonemotional AUs was displayed from participants while recalling an emotional event. Different AUs showed significant correlations depending on the sex of the participant and the task’s valence (positive vs negative story), suggesting the importance of assessing male and female participants independently. Conclusions: Our study suggests the interest of employing computer vision-based facial analysis to quantify facial expressivity and assess the severity of apathy symptoms in subjects with neurocognitive disorders. This may represent a useful tool for a preliminary apathy assessment in nonspecialized settings and could be used to complement classical clinical scales. Future studies including larger samples should confirm the clinical relevance of this kind of instrument. %M 33787499 %R 10.2196/24727 %U https://formative.jmir.org/2021/3/e24727 %U https://doi.org/10.2196/24727 %U http://www.ncbi.nlm.nih.gov/pubmed/33787499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e13999 %T Googling for Neurological Disorders: From Seeking Health-Related Information to Patient Empowerment, Advocacy, and Open, Public Self-Disclosure in the Neurology 2.0 Era %A Martini,Mariano %A Bragazzi,Nicola Luigi %+ Department of Health Sciences, School of Public Health, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy, 39 3279769965, robertobragazzi@gmail.com %K advocacy %K health information seeking %K neurological disorders %K open self-disclosure %D 2021 %7 26.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X Since its introduction, the internet has played a major role in reshaping patient-physician communication and interactions, having fostered a shift from a paternalistic to a patient-centered model. Because of its dynamic nature, the internet has been used as a platform to not only disseminate knowledge—favored by improved access to an increasing wealth of available resources—but also to spread advocacy and awareness, contribute to fund-raising, and facilitate open, public self-disclosure of one’s own disease, thus eliminating any taboo and reducing the stigma associated with it. The era of Medicine 2.0 is characterized by openness, collaboration, participation, and social networking. The current situation is completely different from the time when Lorenzo Odone’s parents, after his diagnosis of adrenoleukodystrophy, decided to attend medical school in order to collect information about a devastating, unknown disease and had to contend with medical authorities at that establishment to convince them of the alleged effectiveness and safety of their discovered therapeutics. Orphan and rare neurological diseases have currently received recognition on web-based resources. However, while the intention is not to ridicule Odone’s family legacy and the “complicated lessons” they have reported, some issues should be carefully addressed by health authorities, such as the reputability, reliability, and accuracy of material available on the internet and prevention of the dissemination of material that could instill illusions and unjustified hopes in individuals seeking medical treatment. Neurologists should be aware of such digital resources, participate in web-based activities, and recommend select high-quality websites to their patients. %M 30946019 %R 10.2196/13999 %U https://www.jmir.org/2021/3/e13999 %U https://doi.org/10.2196/13999 %U http://www.ncbi.nlm.nih.gov/pubmed/30946019 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25576 %T The Implementation Science for Genomic Health Translation (INSIGHT) Study in Epilepsy: Protocol for a Learning Health Care System %A Feofanova,Elena Valeryevna %A Zhang,Guo-Qiang %A Lhatoo,Samden %A Metcalf,Ginger A %A Boerwinkle,Eric %A Venner,Eric %+ Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, RAS E-435, Houston, TX, 77030, United States, 1 713 500 982, elena.v.feofanova@uth.tmc.edu %K genomic medicine %K electronic health record %K implementation %K genetics %K prototype %K decision support %D 2021 %7 26.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Genomic medicine is poised to improve care for common complex diseases such as epilepsy, but additional clinical informatics and implementation science research is needed for it to become a part of the standard of care. Epilepsy is an exemplary complex neurological disorder for which DNA diagnostics have shown to be advantageous for patient care. Objective: We designed the Implementation Science for Genomic Health Translation (INSIGHT) study to leverage the fact that both the clinic and testing laboratory control the development and customization of their respective electronic health records and clinical reporting platforms. Through INSIGHT, we can rapidly prototype and benchmark novel approaches to incorporating clinical genomics into patient care. Of particular interest are clinical decision support tools that take advantage of domain knowledge from clinical genomics and can be rapidly adjusted based on feedback from clinicians. Methods: Building on previously developed evidence and infrastructure components, our model includes the following: establishment of an intervention-ready genomic knowledge base for patient care, creation of a health informatics platform and linking it to a clinical genomics reporting system, and scaling and evaluation of INSIGHT following established implementation science principles. Results: INSIGHT was approved by the Institutional Review Board at the University of Texas Health Science Center at Houston on May 15, 2020, and is designed as a 2-year proof-of-concept study beginning in December 2021. By design, 120 patients from the Texas Comprehensive Epilepsy Program are to be enrolled to test the INSIGHT workflow. Initial results are expected in the first half of 2023. Conclusions: INSIGHT’s domain-specific, practical but generalizable approach may help catalyze a pathway to accelerate translation of genomic knowledge into impactful interventions in patient care. International Registered Report Identifier (IRRID): PRR1-10.2196/25576 %M 33769305 %R 10.2196/25576 %U https://www.researchprotocols.org/2021/3/e25576 %U https://doi.org/10.2196/25576 %U http://www.ncbi.nlm.nih.gov/pubmed/33769305 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25309 %T Remote and Long-Term Self-Monitoring of Electroencephalographic and Noninvasive Measurable Variables at Home in Patients With Epilepsy (EEG@HOME): Protocol for an Observational Study %A Biondi,Andrea %A Laiou,Petroula %A Bruno,Elisa %A Viana,Pedro F %A Schreuder,Martijn %A Hart,William %A Nurse,Ewan %A Pal,Deb K %A Richardson,Mark P %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, United Kingdom, 44 7753986485, andrea.2.biondi@kcl.ac.uk %K epilepsy %K EEG %K electroencephalography %K brain ictogenicity %K wearables %K seizure prediction %K brain %K seizures %K mobile technology %D 2021 %7 19.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epileptic seizures are spontaneous events that severely affect the lives of patients due to their recurrence and unpredictability. The integration of new wearable and mobile technologies to collect electroencephalographic (EEG) and extracerebral signals in a portable system might be the solution to prospectively identify times of seizure occurrence or propensity. The performances of several seizure detection devices have been assessed by validated studies, and patient perspectives on wearables have been explored to better match their needs. Despite this, there is a major gap in the literature on long-term, real-life acceptability and performance of mobile technology essential to managing chronic disorders such as epilepsy. Objective: EEG@HOME is an observational, nonrandomized, noninterventional study that aims to develop a new feasible procedure that allows people with epilepsy to independently, continuously, and safely acquire noninvasive variables at home. The data collected will be analyzed to develop a general model to predict periods of increased seizure risk. Methods: A total of 12 adults with a diagnosis of pharmaco-resistant epilepsy and at least 20 seizures per year will be recruited at King’s College Hospital, London. Participants will be asked to self-apply an easy and portable EEG recording system (ANT Neuro) to record scalp EEG at home twice daily. From each serial EEG recording, brain network ictogenicity (BNI), a new biomarker of the propensity of the brain to develop seizures, will be extracted. A noninvasive wrist-worn device (Fitbit Charge 3; Fitbit Inc) will be used to collect non-EEG biosignals (heart rate, sleep quality index, and steps), and a smartphone app (Seer app; Seer Medical) will be used to collect data related to seizure occurrence, medication taken, sleep quality, stress, and mood. All data will be collected continuously for 6 months. Standardized questionnaires (the Post-Study System Usability Questionnaire and System Usability Scale) will be completed to assess the acceptability and feasibility of the procedure. BNI, continuous wrist-worn sensor biosignals, and electronic survey data will be correlated with seizure occurrence as reported in the diary to investigate their potential values as biomarkers of seizure risk. Results: The EEG@HOME project received funding from Epilepsy Research UK in 2018 and was approved by the Bromley Research Ethics Committee in March 2020. The first participants were enrolled in October 2020, and we expect to publish the first results by the end of 2022. Conclusions: With the EEG@HOME study, we aim to take advantage of new advances in remote monitoring technology, including self-applied EEG, to investigate the feasibility of long-term disease self-monitoring. Further, we hope our study will bring new insights into noninvasively collected personalized risk factors of seizure occurrence and seizure propensity that may help to mitigate one of the most difficult aspects of refractory epilepsy: the unpredictability of seizure occurrence. International Registered Report Identifier (IRRID): PRR1-10.2196/25309 %M 33739290 %R 10.2196/25309 %U https://www.researchprotocols.org/2021/3/e25309 %U https://doi.org/10.2196/25309 %U http://www.ncbi.nlm.nih.gov/pubmed/33739290 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e22805 %T The Neurostimulation of the Brain in Depression Trial: Protocol for a Randomized Controlled Trial of Transcranial Direct Current Stimulation in Treatment-Resistant Depression %A Suleman,Raheem %A Tucker,Benjamin V %A Dursun,Serdar M %A Demas,Michael L %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7804076504, rsuleman@ualberta.ca %K neuromodulation %K neurostimulation %K transcranial direct current stimulation %K electrical stimulation therapy %K psychiatric somatic therapies %K depression %K depressive disorder %K major depressive disorder %K depressive disorder, treatment resistant %K randomized controlled trial %K therapeutics %K clinical trial protocol %D 2021 %7 17.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major depressive disorder (MDD) is the second highest cause of disability worldwide. Standard treatments for MDD include medicine and talk therapy; however, approximately 1 in 5 Canadians fail to respond to these approaches and must consider alternatives. Transcranial direct current stimulation (tDCS) is a safe, noninvasive method that uses electrical stimulation to change the activation pattern of different brain regions. By targeting those regions known to be affected in MDD, tDCS may be useful in ameliorating treatment-resistant depression. Objective: The objective of the Neurostimulation of the Brain in Depression trial is to compare the effectiveness of active versus sham tDCS in treating patients with ultraresistant MDD. The primary outcome will be the improvement in depressive symptoms, as measured by the change on the Mongtomery-Asberg Depression Rating Scale. Secondary outcomes will include changes in the Quick Inventory of Depressive Symptomatology Scale (subjective assessment), the World Health Organization Disability Assessment Schedule 2.0 (functional assessment), and the Screen for Cognitive Impairment in Psychiatry (cognitive assessment). Adverse events will be captured using the Young Mania Rating Scale; tDCS Adverse Events Questionnaire; Frequency, Intensity, and Burden of Side Effects Rating Scale; and Patient-Rated Inventory of Side Effects Scale. A parallel component of the study will involve assaying for baseline language function and the effect of treatment on language using an exploratory acoustic and semantic corpus analysis on recorded interviews. Participant accuracy and response latency on an auditory lexical decision task will also be evaluated. Methods: We will recruit inpatients and outpatients in the city of Edmonton, Alberta, and will deliver the study interventions at the Grey Nuns and University of Alberta Hospitals. Written informed consent will be obtained from all participants before enrollment. Eligible participants will be randomly assigned, in a double-blinded fashion, to receive active or sham tDCS, and they will continue receiving their usual pharmacotherapy and psychotherapy throughout the trial. In both groups, participants will receive 30 weekday stimulation sessions, each session being 30 minutes in length, with the anode over the left dorsolateral prefrontal cortex and the cathode over the right. Participants in the active group will be stimulated at 2 mA throughout, whereas the sham group will receive only a brief period of stimulation to mimic skin sensations felt in the active group. Measurements will be conducted at regular points throughout the trial and 30 days after trial completion. Results: The trial has been approved by the University of Alberta Research Ethics Board and is scheduled to commence in June 2021. The target sample size is 60 participants. Conclusions: This is a protocol for a multicenter, double-blinded, randomized controlled superiority trial comparing active versus sham tDCS in patients with treatment-resistant MDD. Trial Registration: ClinicalTrials.gov NCT04159012; http://clinicaltrials.gov/ct2/show/NCT04159012. International Registered Report Identifier (IRRID): PRR1-10.2196/22805 %M 33729165 %R 10.2196/22805 %U https://www.researchprotocols.org/2021/3/e22805 %U https://doi.org/10.2196/22805 %U http://www.ncbi.nlm.nih.gov/pubmed/33729165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24328 %T Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation %A Saliba-Gustafsson,Erika A %A Miller-Kuhlmann,Rebecca %A Kling,Samantha M R %A Garvert,Donn W %A Brown-Johnson,Cati G %A Lestoquoy,Anna Sophia %A Verano,Mae-Richelle %A Yang,Laurice %A Falco-Walter,Jessica %A Shaw,Jonathan G %A Asch,Steven M %A Gold,Carl A %A Winget,Marcy %+ Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Stanford MSOB, 1265 Welch Rd, Mail Code 5475, Palo Alto, CA, 94305, United States, 1 650 723 1146, esalgus@stanford.edu %K teleneurology %K telemedicine %K telehealth %K ambulatory neurology %K video visits %K COVID-19 %K implementation %K outcomes %K video %K neurology %K mixed methods %K acceptability %K sustainability %D 2020 %7 9.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology’s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. Objective: To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. Methods: Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. Results: Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient’s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. Conclusions: Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike. %M 33245699 %R 10.2196/24328 %U http://www.jmir.org/2020/12/e24328/ %U https://doi.org/10.2196/24328 %U http://www.ncbi.nlm.nih.gov/pubmed/33245699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e19715 %T Exploring Novel Funding Strategies for Innovative Medical Research: The HORAO Crowdfunding Campaign %A Schucht,Philippe %A Roccaro-Waldmeyer,Diana M %A Murek,Michael %A Zubak,Irena %A Goldberg,Johannes %A Falk,Stephanie %A Dahlweid,Fried-Michael %A Raabe,Andreas %+ Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, 3010, Switzerland, 41 31 664 02 21, philippe.schucht@insel.ch %K science funding %K crowdfunding %K neurosurgery %K neurosciences %K brain tumor %D 2020 %7 11.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise of the internet and social media has boosted online crowdfunding as a novel strategy to raise funds for kick-starting projects, but it is rarely used in science. Objective: We report on an online crowdfunding campaign launched in the context of the neuroscience project HORAO. The aim of HORAO was to develop a noninvasive real-time method to visualize neuronal fiber tracts during brain surgery in order to better delineate tumors and to identify crucial cerebral landmarks. The revenue from the crowdfunding campaign was to be used to sponsor a crowdsourcing campaign for the HORAO project. Methods: We ran a 7-week reward-based crowdfunding campaign on a national crowdfunding platform, offering optional material and experiential rewards in return for a contribution toward raising our target of Swiss francs (CHF) 50,000 in financial support (roughly equivalent to US $50,000 at the time of the campaign). We used various owned media (websites and social media), as well as earned media (press releases and news articles) to raise awareness about our project. Results: The production of an explanatory video took 60 hours, and 31 posts were published on social media (Facebook, Instagram, and Twitter). The campaign raised a total of CHF 69,109. Approximately half of all donations came from donors who forwent a reward (CHF 28,786, 48.74%); the other half came from donors who chose experiential and material rewards in similar proportions (CHF 14,958, 25.33% and CHF 15,315.69, 25.93%, respectively). Of those with an identifiable relationship to the crowdfunding team, patients and their relatives contributed the largest sum (CHF 17,820, 30.17%), followed by friends and family (CHF 9288, 15.73%) and work colleagues (CHF 6028, 10.21%), while 43.89% of funds came from donors who were either anonymous or had an unknown relationship to the crowdfunding team. Patients and their relatives made the largest donations, with a median value of CHF 200 (IQR 90). Conclusions: Crowdfunding proved to be a successful strategy to fund a neuroscience project and to raise awareness of a specific clinical problem. Focusing on potential donors with a personal interest in the issue, such as patients and their relatives in our project, is likely to increase funding success. Compared with traditional grant applications, new skills are needed to explain medical challenges to the crowd through video messages and social media. %M 33174857 %R 10.2196/19715 %U https://www.jmir.org/2020/11/e19715 %U https://doi.org/10.2196/19715 %U http://www.ncbi.nlm.nih.gov/pubmed/33174857 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15628 %T Mobile Health Daily Life Monitoring for Parkinson Disease: Development and Validation of Ecological Momentary Assessments %A Habets,Jeroen %A Heijmans,Margot %A Herff,Christian %A Simons,Claudia %A Leentjens,Albert FG %A Temel,Yasin %A Kuijf,Mark %A Kubben,Pieter %+ Department of Neurosurgery, School of Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, Netherlands, 31 43 3881348, j.habets@maastrichtuniversity.nl %K ecological momentary assessment %K experience sampling method %K electronic diary %K Parkinson’s disease monitoring %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parkinson disease monitoring is currently transitioning from periodic clinical assessments to continuous daily life monitoring in free-living conditions. Traditional Parkinson disease monitoring methods lack intraday fluctuation detection. Electronic diaries (eDiaries) hold the potential to collect subjective experiences on the severity and burden of motor and nonmotor symptoms in free-living conditions. Objective: This study aimed to develop a Parkinson disease–specific eDiary based on ecological momentary assessments (EMAs) and to explore its validation. Methods: An observational cohort of 20 patients with Parkinson disease used the smartphone-based EMA eDiary for 14 consecutive days without adjusting free-living routines. The eDiary app presented an identical questionnaire consisting of questions regarding affect, context, motor and nonmotor symptoms, and motor performance 7 times daily at semirandomized moments. In addition, patients were asked to complete a morning and an evening questionnaire. Results: Mean affect correlated moderate-to-strong and moderate with motor performance (R=0.38 to 0.75; P<.001) and motor symptom (R=0.34 to 0.50; P<.001) items, respectively. The motor performance showed a weak-to-moderate negative correlation with motor symptoms (R=−0.31 to −0.48; P<.001). Mean group answers given for on-medication conditions vs wearing-off-medication conditions differed significantly (P<.05); however, not enough questionnaires were completed for the wearing-off-medication condition to reproduce these findings on individual levels. Conclusions: We presented a Parkinson disease–specific EMA eDiary. Correlations between given answers support the internal validity of the eDiary and underline EMA’s potential in free-living Parkinson disease monitoring. Careful patient selection and EMA design adjustment to this targeted population and their fluctuations are necessary to generate robust proof of EMA validation in future work. Combining clinical Parkinson disease knowledge with practical EMA experience is inevitable to design and perform studies, which will lead to the successful integration of eDiaries in free-living Parkinson disease monitoring. %M 32339999 %R 10.2196/15628 %U https://mhealth.jmir.org/2020/5/e15628 %U https://doi.org/10.2196/15628 %U http://www.ncbi.nlm.nih.gov/pubmed/32339999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16724 %T Multidimensional Evaluation of Virtual Reality Paradigms in Clinical Neuropsychology: Application of the VR-Check Framework %A Krohn,Stephan %A Tromp,Johanne %A Quinque,Eva M %A Belger,Julia %A Klotzsche,Felix %A Rekers,Sophia %A Chojecki,Paul %A de Mooij,Jeroen %A Akbal,Mert %A McCall,Cade %A Villringer,Arno %A Gaebler,Michael %A Finke,Carsten %A Thöne-Otto,Angelika %+ Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 45050, stephan.krohn@charite.de %K virtual reality %K neuropsychology %K cognition %K research design %D 2020 %7 27.4.2020 %9 Viewpoint %J J Med Internet Res %G English %X Virtual reality (VR) represents a key technology of the 21st century, attracting substantial interest from a wide range of scientific disciplines. With regard to clinical neuropsychology, a multitude of new VR applications are being developed to overcome the limitations of classical paradigms. Consequently, researchers increasingly face the challenge of systematically evaluating the characteristics and quality of VR applications to design the optimal paradigm for their specific research question and study population. However, the multifaceted character of contemporary VR is not adequately captured by the traditional quality criteria (ie, objectivity, reliability, validity), highlighting the need for an extended paradigm evaluation framework. To address this gap, we propose a multidimensional evaluation framework for VR applications in clinical neuropsychology, summarized as an easy-to-use checklist (VR-Check). This framework rests on 10 main evaluation dimensions encompassing cognitive domain specificity, ecological relevance, technical feasibility, user feasibility, user motivation, task adaptability, performance quantification, immersive capacities, training feasibility, and predictable pitfalls. We show how VR-Check enables systematic and comparative paradigm optimization by illustrating its application in an exemplary research project on the assessment of spatial cognition and executive functions with immersive VR. This application furthermore demonstrates how the framework allows researchers to identify across-domain trade-offs, makes deliberate design decisions explicit, and optimizes the allocation of study resources. Complementing recent approaches to standardize clinical VR studies, the VR-Check framework enables systematic and project-specific paradigm optimization for behavioral and cognitive research in neuropsychology. %M 32338614 %R 10.2196/16724 %U https://www.jmir.org/2020/4/e16724 %U https://doi.org/10.2196/16724 %U http://www.ncbi.nlm.nih.gov/pubmed/32338614 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e14389 %T Longitudinal Magnetic Resonance Imaging as a Potential Correlate in the Diagnosis of Alzheimer Disease: Exploratory Data Analysis %A Khan,Afreen %A Zubair,Swaleha %+ Aligarh Muslim University, Department of Computer Science, Adjacent Computer Centre, Anoopshahr Road, Aligarh, 202002, India, 91 9410059635, swalehaowais123@gmail.com %K Alzheimer disease %K dementia %K longitudinal %K magnetic resonance imaging %K exploratory data analysis %K Mini-Mental State Examination %K Clinical Dementia Rating %K Atlas Scaling Factor %D 2020 %7 14.4.2020 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Alzheimer disease (AD) is a degenerative progressive brain disorder where symptoms of dementia and cognitive impairment intensify over time. Numerous factors exist that may or may not be related to the lifestyle of a patient that result in a higher risk for AD. Diagnosing the disorder in its beginning period is important, and several techniques are used to diagnose AD. A number of studies have been conducted on the detection and diagnosis of AD. This paper reports the empirical study performed on the longitudinal-based magnetic resonance imaging (MRI) Open Access Series of Brain Imaging dataset. Furthermore, the study highlights several factors that influence the prediction of AD. Objective: This study aimed to correlate the effect of various factors such as age, gender, education, and socioeconomic background of patients with the development of AD. The effect of patient-related factors on the severity of AD was assessed on the basis of MRI features, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), estimated total intracranial volume (eTIV), normalized whole brain volume (nWBV), and Atlas Scaling Factor (ASF). Methods: In this study, we attempted to establish the role of longitudinal MRI in an exploratory data analysis (EDA) of AD patients. EDA was performed on the dataset of 150 patients for 343 MRI sessions (mean age 77.01 [SD 7.64] years). The T1-weighted MRI of each subject on a 1.5-Tesla Vision (Siemens) scanner was used for image acquisition. Scores of three features, MMSE, CDR, and ASF, were used to characterize the AD patients included in this study. We assessed the role of various features (ie, age, gender, education, socioeconomic status, MMSE, CDR, eTIV, nWBV, and ASF) on the prognosis of AD. Results: The analysis further establishes the role of gender in the prevalence and development of AD in older people. Moreover, a considerable relationship has been observed between education and socioeconomic position on the progression of AD. Also, outliers and linearity of each feature were determined to rule out the extreme values in measuring the skewness. The differences in nWBV between CDR=0 (nondemented), CDR=0.5 (very mild dementia), and CDR=1 (mild dementia) are significant (ie, P<.01). Conclusions: A substantial correlation has been observed between the pattern and other related features of longitudinal MRI data that can significantly assist in the diagnosis and determination of AD in older patients. %R 10.2196/14389 %U http://biomedeng.jmir.org/2020/1/e14389/ %U https://doi.org/10.2196/14389 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17167 %T Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial %A Robert,Philippe %A Manera,Valeria %A Derreumaux,Alexandre %A Ferrandez Y Montesino,Marion %A Leone,Elsa %A Fabre,Roxane %A Bourgeois,Jeremy %+ Cognition Behaviour Technology Lab, Université Côte d'Azur, Institut Claude Pompidou, 10 Rue Moliere, Nice, 06100, France, 33 0492034770, Philippe.ROBERT@univ-cotedazur.fr %K neurocognitive disorders %K Alzheimer disease %K cognition %K motivation %K apathy %K intervention %D 2020 %7 11.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients. Objective: The objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders. Methods: MeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group). Results: When comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 × number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group. Conclusions: This study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation. Trial Registration: ClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801 %M 32159519 %R 10.2196/17167 %U https://www.jmir.org/2020/3/e17167 %U https://doi.org/10.2196/17167 %U http://www.ncbi.nlm.nih.gov/pubmed/32159519 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 1 %P e13029 %T Perceived Treatment Satisfaction and Effectiveness Facilitators Among Patients With Chronic Health Conditions: A Self-Reported Survey %A Volpicelli Leonard,Kathryn %A Robertson,Courtney %A Bhowmick,Amrita %A Herbert,Leslie Beth %+ Health Union LLC, 1 International Plaza Dr, #550, Philadelphia, PA, , United States, 1 4849859715, Kate.Leonard@health-union.com %K treatment effectiveness %K patient satisfaction %K migraine %K multiple sclerosis %K rheumatoid arthritis %D 2020 %7 6.3.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to improved adherence. However, how patients perceive effectiveness is poorly understood. Objective: The aim of this study was to elucidate factors associated with perceived treatment satisfaction and effectiveness among patients with chronic health conditions. Methods: We conducted a descriptive study using a cross-sectional survey design. We administered a Web-based survey to participants with migraine, multiple sclerosis (MS), or rheumatoid arthritis (RA). Patients were recruited from established online communities of Health Union. Descriptive statistics, correlations, and comparison tests were used to examine outcomes. Results: Data were collected from 1820 patients: 567 with migraine, 717 with MS, and 536 with RA. The majority of participants were female (1644/1820, 90.33%), >40 years old (1462/1820, 80.33%), and diagnosed >5 years ago (1189/1820, 65.33%). Treatment satisfaction and perceived medication effectiveness were highly correlated (r=0.90, P<.01). Overall, three temporal factors were positively correlated with satisfaction or perceived effectiveness: time on current medication (satisfaction rs=0.22, P<.01; effectiveness rs=0.25, P<.01), time since diagnosis (satisfaction rs=0.07, P<.01; effectiveness rs=0.09, P<.01), and time on treatment (effectiveness rs=0.08, P<.01). Conclusions: Findings validated the strong relationship between treatment satisfaction and perceived effectiveness. Understanding the (1) positive relationship between time and treatment satisfaction and effectiveness and (2) factors associated with determining medication effectiveness can help clinicians better understand the mindset of patients regarding treatment. Clinicians may be better prepared to elicit patient beliefs, which influence medication adherence, for people diagnosed with chronic health conditions. %M 32141836 %R 10.2196/13029 %U http://www.i-jmr.org/2020/1/e13029/ %U https://doi.org/10.2196/13029 %U http://www.ncbi.nlm.nih.gov/pubmed/32141836 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 4 %P e12381 %T Quality of Life Among Informal Caregivers of Patients With Degenerative Cervical Myelopathy: Cross-Sectional Questionnaire Study %A Mowforth,Oliver Daniel %A Davies,Benjamin Marshall %A Kotter,Mark Reinhard %+ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, United Kingdom, 44 01223763366, mrk25@cam.ac.uk %K spinal cord diseases %K spondylosis %K spinal osteophytosis %K surveys and questionnaires %K quality of life %K chronic disease %D 2019 %7 7.11.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a common, chronic neurological condition that severely affects individuals by causing a range of disabling symptoms, frequently at a time around the peak of their careers. Subsequently, individuals with DCM often become dependent on informal care arrangements. The significant economic contribution of informal care and its burden on care providers are becoming increasingly recognized. Objective: This study aimed to measure the quality of life of DCM informal caregivers and provide preliminary insight into possible contributing factors. Methods: Carers of individuals with DCM completed a Web-based survey hosted by Myelopathy.org, an international DCM charity. Carer quality of life was assessed in the form of caregiver happiness and 7 dimensions of carer burden using the Care-Related Quality of Life (CarerQol) instrument. The relationships between patient disease severity, patient pain, and carer quality of life were investigated. Differences in carer quality of life were assessed across patient and carer demographic groups, including between UK and US carers. Results: DCM caregivers experienced substantial burden as a result of their caregiving (mean CarerQol-7D=64.1; 95% CI 58.8-69.5) and low happiness (mean CarerQol-VAS [Visual Analog Scale]=6.3; 95% CI 5.7-6.9). Burden was high and happiness was low in DCM carers when compared with a large, mixed-disease study of adult informal carers where CarerQol-7D was 79.1 and CarerQol-VAS was 7.1. No significant relationship was found between DCM carer quality of life and patient disease severity and pain scores. DCM carer quality of life appeared uniform across all patient and carer demographic groups. Conclusions: Caring for individuals with DCM is associated with reduced quality of life in the form of significant burden and reduced happiness. Reductions appear greater in DCM than in other diseases investigated. However, no simple relationship was identified between individual patient or carer factors and carer quality of life. %M 31697240 %R 10.2196/12381 %U http://www.i-jmr.org/2019/4/e12381/ %U https://doi.org/10.2196/12381 %U http://www.ncbi.nlm.nih.gov/pubmed/31697240 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e14519 %T The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey %A Michiels,Sarah %A Harrison,Stephen %A Vesala,Markku %A Schlee,Winfried %+ Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium, 32 485840758, sarah.michiels@uantwerpen.be %K tinnitus %K self report %K surveys %D 2019 %7 30.07.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity. Objective: The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST. Methods: A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus. Results: In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night’s sleep (P=.01) and light intensity exercise (P=.01). Conclusions: Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise. %M 31364603 %R 10.2196/14519 %U http://www.i-jmr.org/2019/3/e14519/ %U https://doi.org/10.2196/14519 %U http://www.ncbi.nlm.nih.gov/pubmed/31364603 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e12408 %T Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans %A Reilly,Erin D %A Robinson,Stephanie A %A Petrakis,Beth Ann %A Kuhn,Eric %A Pigeon,Wilfred R %A Wiener,Renda Soylemez %A McInnes,D Keith %A Quigley,Karen S %+ Center for Social and Community Reintegration Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bldg 9, Room 106, Bedford, MA, 01730, United States, 1 781 687 4191, Erin.Reilly@va.gov %K cognitive behavioral therapy %K mobile apps %K insomnia %K sleep apnea %D 2019 %7 24.07.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Sleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management–guided use of a mobile app (CBT-i Coach, which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans. Objective: The primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention. Methods: Subjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers). Results: Completer results indicated significant changes in subjective sleep measures, including reduced reports of insomnia (Z=–2.68, P=.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality (Z=–2.37, P=.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning (Z=2.675, P=.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention (χ22=7.8, P=.02). There were no significant changes in percent REM sleep or sleep efficiency. Conclusions: These findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea. Trial Registration: ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000 %M 31342904 %R 10.2196/12408 %U http://www.i-jmr.org/2019/3/e12408/ %U https://doi.org/10.2196/12408 %U http://www.ncbi.nlm.nih.gov/pubmed/31342904 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12135 %T A Mobile Phone App for the Self-Management of Pediatric Concussion: Development and Usability Testing %A Sandhu,Harminder %A Wilson,Katherine %A Reed,Nick %A Mihailidis,Alex %+ Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3861, nreed@hollandbloorview.ca %K brain concussion %K safety %K pediatrics %K youth %K children %K self-management %K mild traumatic brain injury %K mobile apps %K mobile health %D 2019 %7 31.05.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Concussion is a common injury among Canadian children and adolescents that leads to a range of neurobehavioral deficits. However, noticeable gaps continue to exist in the management of pediatric concussion, with poor health outcomes associated with the inadequate application of best practice guidelines. Objective: The aim of this study was to describe the development and assess the usability of a mobile phone app to aid youth in the self-management of concussion. A secondary objective was to assess the usefulness of the app. Methods: An agile user-centered design approach was used to develop the technology, followed by a formative lab-based usability study for assessment and improvement proposals. Youths aged 10 to 18 years with a history of concussion and health care professionals involved in concussion management were recruited. This study included participants performing 12 tasks with the mobile phone app while using the think aloud protocol and the administration of the System Usability Scale (SUS), posttest questionnaire, and a semistructured interview. Results: A mobile phone app prototype called NeuroCare, an easily accessible pediatric concussion management intervention that provides easy access to expert-informed concussion management strategies and helps guide youth in self-managing and tracking their concussion recovery, was developed. A total of 7 youths aged between 10 and 18 years with a history of concussion and 7 health care professionals were recruited. The mean SUS score was 81.9, mean task success rates were greater than 90% for 92% (11/12) of the tasks, 92% (11/12) of tasks had a total error frequency of less than 11 errors, and mean task completion times were less than 2 min for 100% of the tasks. Conclusions: Results suggest that participants rated this app as highly usable, acceptable to users, and that it may be useful in helping youth self-manage concussion. %M 31152527 %R 10.2196/12135 %U http://humanfactors.jmir.org/2019/2/e12135/ %U https://doi.org/10.2196/12135 %U http://www.ncbi.nlm.nih.gov/pubmed/31152527 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 2 %P e12272 %T Determining Best Practices for Management of Bacteriuria in Spinal Cord Injury: Protocol for a Mixed-Methods Study %A Skelton,Felicia %A Martin,Lindsey Ann %A Evans,Charlesnika T %A Kramer,Jennifer %A Grigoryan,Larissa %A Richardson,Peter %A Kunik,Mark E %A Poon,Ivy Oiyee %A Holmes,S Ann %A Trautner,Barbara W %+ Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Boulevard, Houston, TX,, United States, 1 713 794 1414 ext 10218, felicia.skelton@bcm.edu %K spinal cord injury %K urinary tract infection %K patient-focused care %K qualitative evaluation %K antimicrobial stewardship %D 2019 %7 14.02.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bacteriuria, either asymptomatic (ASB) or symptomatic, urinary tract infection (UTI), is common in persons with spinal cord injury (SCI). Current Veterans Health Administration (VHA) guidelines recommend a screening urinalysis and urine culture for every veteran with SCI during annual evaluation, even when asymptomatic, which is contrary to other national guidelines. Our preliminary data suggest that a positive urine culture (even without signs or symptoms of infection) drives antibiotic use. Objective: Through a series of innovative studies utilizing mixed methods, administrative databases, and focus groups, we will gain further knowledge about the attitudes driving current urine testing practices during the annual exam, as well as quantitative data on the clinical outcomes of these practices. Methods: Aim 1 will identify patient, provider, and facility factors driving bacteriuria testing and subsequent antibiotic use after the SCI annual evaluation through qualitative interviews and quantitative surveys. Aim 2 will use national VHA databases to identify the predictors of urine testing and subsequent antibiotic use during the annual examination and compare the clinical outcomes of those who received antibiotics with those who did not. Aim 3 will use the information gathered from the previous 2 aims to develop the Test Smart, Treat Smart intervention, a combination of patient and provider education and resources that will help stakeholders have informed conversations about urine testing and antibiotic use; feasibility will be tested at a single site. Results: This protocol received institutional review board and VHA Research and Development approval in July 2017, and Veterans Affairs Health Services Research and Development funding started on November 2017. As of submission of this manuscript, 10/15 (67%) of the target goal of provider interviews were complete, and 77/100 (77%) of the goal of surveys. With regard to patients, 5/15 (33%) of the target goal of interviews were complete, and 20/100 (20%) of the target goal of surveys had been completed. Preliminary analyses are ongoing; the study team plans to present these results in April 2019. Database analyses for aim 2 will begin in January 2019. Conclusions: The negative consequences of antibiotic overuse and antibiotic resistance are well-documented and have national and even global implications. This study will develop an intervention aimed to educate stakeholders on evidence-based management of ASB and UTI and guide antibiotic stewardship in this high-risk population. The next step will be to refine the intervention and test its feasibility and effectiveness at multiple sites as well as reform policy for management of this common but burdensome condition. International Registered Report Identifier (IRRID): DERR1-10.2196/12272 %M 30762584 %R 10.2196/12272 %U https://www.researchprotocols.org/2019/2/e12272/ %U https://doi.org/10.2196/12272 %U http://www.ncbi.nlm.nih.gov/pubmed/30762584 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 1 %P e10146 %T Health Topics on Facebook Groups: Content Analysis of Posts in Multiple Sclerosis Communities %A Della Rosa,Sara %A Sen,Falguni %+ Global Healthcare Innovation Management Center, Department of Management Systems, Fordham University, 45 Columbus Avenue, New York City, NY,, United States, 1 347 277 9131, sdellarosa@fordham.edu %K social network %K health information %K health care internet %K content analysis %K Facebook %D 2019 %7 11.02.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Social network sites (SNSs) are being increasingly used to exchange health information between patients and practitioners, pharmaceutical companies, and research centers. Research contributions have explored the contents of such exchanges discussed online. They have categorized the topics discussed and explored the engagement levels of these discussions. Objective: This research aimed at investigating the potential role of SNSs in health care. Specifically it provides an information-clustering analysis of the health information available on SNSs and develops a research design that allows an investigation of this information in enhancing health care research and delivery. In addition, this research aims at testing whether SNSs are valid tools for sharing drug-related information by patients. Methods: This research is based on a specific chronic disease: multiple sclerosis. We searched Facebook to identify and research the social media groups related to this condition. The analysis was restricted to public groups for privacy concerns. We created a database by downloading posts from two main groups (in the English language). Subsequently, we performed a content analysis and statistical analysis; this allowed us to explore the differences between categories, their engagement levels, and the types of posts shared. The mean level of engagement for each topic was analyzed using a 1-way analysis of variance. Results: From a sample of 7029 posts, initial results showed that there were 8 information categories that resonated (percentage of times the topic appears in our sample) with those who post on Facebook: information and awareness (4923/7029, 70.04%), event advertising and petitions (365/7029, 5.19%), fundraising (354/7029, 5.04%), patient support (217/7029, 3.09%), drug discussion (144/7029, 2.05%), clinical trials and research studies (59/7029, 0.84%), product and drug advertising (48/7029, 0.68%), and other (919/7029, 13.07%). Initial analysis showed that comments and likes (as measures of engagement level) are the most frequent indicators and measures of level of engagement. Our results show a high engagement level (in terms of views, likes, comments, etc) for patient support and information and awareness. In addition, although drug discussion had a low resonance, it had an unexpected highly engagement level which we found worthy of further exploration. Conclusions: SNSs have become important tools for patients and health care practitioners to share or seek information. We identified the type of information shared and how the public reacted to it. Our research confirmed that the topics discussed in social media related to specific diseases such as multiple sclerosis are similar to the information categories observed by other researchers. We unexpectedly found other categories such as drug discussion. These and other results of our study enhance our understanding of how content is disseminated and perceived within a specific disease-based community. We concluded that this information has useful implications in the design of prevention campaigns, educational programs, and chronic disease management. %M 30741640 %R 10.2196/10146 %U http://www.i-jmr.org/2019/1/e10146/ %U https://doi.org/10.2196/10146 %U http://www.ncbi.nlm.nih.gov/pubmed/30741640 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 1 %P e11146 %T Internet Usage by Polish Patients With Multiple Sclerosis: A Multicenter Questionnaire Study %A Potemkowski,Andrzej %A Brola,Waldemar %A Ratajczak,Anna %A Ratajczak,Marcin %A Zaborski,Jacek %A Jasińska,Elżbieta %A Pokryszko-Dragan,Anna %A Gruszka,Ewa %A Dubik-Jezierzańska,Marta %A Podlecka-Piętowska,Aleksandra %A Nojszewska,Monika %A Gospodarczyk-Szot,Krystyna %A Stępień,Adam %A Gocyła-Dudar,Katarzyna %A Maciągowska-Terela,Marzena %A Wencel,Jacek %A Kaźmierski,Radosław %A Kułakowska,Alina %A Kapica-Topczewska,Katarzyna %A Pawełczak,Witold %A Bartosik-Psujek,Halina %+ Institute of Physiotherapy, Faculty of Medicine and Health Sciences, Jan Kochanowski University, IX Wieków Kielc 19, Kielce, 25-317, Poland, 48 413902259, wbrola@wp.pl %K multiple sclerosis %K internet %K information seeking %K doctor-patient relationship %D 2019 %7 01.02.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: The internet is a source of knowledge and medium widely used in services that facilitate access to information and networking. Multiple sclerosis (MS) patients find the possibility of acquiring information relating to their condition particularly rewarding. Objective: We aimed to identify Polish MS patients’ preferences by analyzing a percentage of internet users and determining the most common search subjects and patients’ approach to information on the internet. Disability connected with the condition, its duration, and other factors that influence patients’ internet use were examined along with instances of relations established through the internet and their durability. Methods: The study examined 1045 patients (731 women, 314 men) treated in 10 Polish MS centers, of whom 932 (89.19%) declared to be internet users. Their average age was 40.65 (SD 11.06) and average MS duration was 9.08 (SD 6.97) years. The study used a proprietary survey on information seeking, the range of searched subjects, and internet usage frequency. Results: The majority of the patients (494/932, 53.0%) used the internet 6-7 times per week and 4.3% (40/932) declared they spent minimum 2 hours per day. The most commonly searched subjects were world news (604/932, 72.9% of patients using the internet); 60.8% (504/932) searched for information on their condition, particularly for new treatment methods (562/932, 67.8%) and the course of illness (520/932, 62.7%). One’s sex had no impact on internet usage (female vs male, odds ratio [OR] 1.13, 95% CI 0.72-1.77), although a patient’s age might, at varying degrees. We found several significant associations using a .05 significance level: a patient with higher education used the internet 9 times more often than one with primary education (OR 8.64, 95% CI 3.31-22.57); lasting relationships increased chances of internet usage by 10-fold compared to widowers (OR 0.12, 95% CI 0.05-0.31); living in a city with a population over 100,000 increased chances by nearly 6 times compared with the countryside (OR 5.59, 95% CI 2.72-11.48); the relapsing-remitting MS type saw a 2-fold increase compared with the primary progressive MS type (OR 0.47, 95% CI 0.29-0.75); and those needing assistance were 2 times less likely to use the internet than patients who could move independently (OR 0.53, 95% CI 0.31-0.89). More than half of the patients (489/932, 52.5%) did not discuss the information found on the internet with their neurologists; 15.9% (148/932) believed that relationships established through the internet can be stable. Conclusions: The majority of Polish patients use the internet as a crucial information source on their condition and innovative treatment methods. The internet can be helpful in establishing new relationships, which are usually short-lived. Polish patients do not frequently discuss the information gathered on the internet with their doctors. %M 30707107 %R 10.2196/11146 %U https://www.i-jmr.org/2019/1/e11146/ %U https://doi.org/10.2196/11146 %U http://www.ncbi.nlm.nih.gov/pubmed/30707107 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e10349 %T Views of People With Epilepsy About Web-Based Self-Presentation: A Qualitative Study %A McKinlay,Alison Ruth %A Ridsdale,Leone Lorna %+ Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, PO Box 57, Academic Neuroscience Centre, Denmark Hill, London, SE5 8AF, United Kingdom, 44 020 7848 0185, leone.ridsdale@kcl.ac.uk %K epilepsy %K internet %K social stigma %K social media %K eHealth %K social networking %K social support %K self-management %D 2018 %7 21.12.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Web-based media, particularly social networking sites (SNSs), are a source of support for people with long-term conditions, like epilepsy. Living with epilepsy can reduce opportunities for accessing information and social support owing to transportation difficulties and stigma leading to self-isolation. However, some people with epilepsy (PWE) overcome these barriers using SNSs and other Web-based media. At present, little is known about Web-based identity and self-presentation of PWE; this study aims to address this gap. Objective: This study aims to describe how the use of digital technologies, such as SNSs, impacts sense of identity in PWE. Methods: We used qualitative research methods to examine Web-based media use and self-presentation in a group of 14 PWE (age range: 33-73 years; 7 men and 7 women). The median diagnosis duration was 25 years. Semistructured interviews ranged from 40 to 120 minutes, held at participants’ homes or in a public place of their choice, in the United Kingdom. QSR Nvivo 11 software was used to perform an inductive thematic analysis. Results: In this study, 9 participants used Web-based media to “silently” learn from other PWE by reading user posts on SNSs and epilepsy-related forums. When asked about self-presentation, 7 participants described feeling cautious about disclosing their epilepsy to others online. Six participants presented themselves in the same manner irrespective of the situation and described their identity as being presented in the same way both online and offline. Conclusions: PWE can deploy SNSs and Web-based media to manage aspects of their condition by learning from others and obtaining social support that may otherwise be difficult to access. Some PWE share openly, whereas others silently observe, without posting. Both benefit from the shared experiences of others. Privacy concerns and stigma can act as a barrier to sharing using Web-based media and SNSs. For some, Web-based media offers a chance to experiment with identity and change self-presentation, leading to gradually “coming out” and feeling more comfortable discussing epilepsy with others. %M 30578229 %R 10.2196/10349 %U http://www.i-jmr.org/2018/2/e10349/ %U https://doi.org/10.2196/10349 %U http://www.ncbi.nlm.nih.gov/pubmed/30578229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e11168 %T The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study %A Simacek,Kristina F %A Ko,John J %A Moreton,Debbie %A Varga,Stefan %A Johnson,Kristen %A Katic,Bozena J %+ Research and Development, PatientsLikeMe, 160 2nd Street, Cambridge, MA, 02142, United States, 1 617 499 4003, ksimacek@patientslikeme.com %K cost sharing %K insurance %K mixed methods %K multiple sclerosis %K out-of-pocket costs %K patient adherence %K pharmaceutical services %K self-report %K surveys and questionnaires %D 2018 %7 30.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, people with relapsing-remitting multiple sclerosis (RRMS) can face difficulty accessing disease-modifying therapies (DMTs) because of insurance, pharmacy, or provider policies. These barriers have been associated with poor adherence and negative health outcomes. Objective: The goals of this study were to describe the overall occurrence of difficulties and delays associated with gaining access to DMTs among people with RRMS, to assess DMT adherence during periods of reduced access, and to contextualize the patients’ journey from receipt of a prescription for DMT to obtaining and taking their medication when faced with access barriers. Methods: We recruited US-based adults self-reporting RRMS from a Web-based health data-sharing social network, PatientsLikeMe. Individuals were invited to complete a Web-based survey if they reported a diagnosis of RRMS and were prescribed a DMT for MS. Follow-up phone interviews were conducted with 10 respondents who reported experiencing an MS-related relapse during the time they had experienced challenges accessing DMTs. Results: Among 507 survey completers, nearly half were either currently experiencing an issue related to DMT assess or had difficulty accessing a DMT in the past (233/507, 46.0%). The most frequently reported reasons for access difficulty were authorization requirements by insurance companies (past issues: 78/182, 42.9%; current issues: 9/42, 21%) and high out-of-pocket costs (past issues: 54/182, 29.7%; current issues: 13/42, 31%). About half (20/39, 51%) of participants with current access issues and over a third (68/165, 41.2%) of those with past issues went without their medication until they could access their prescribed DMT. Relapses were reported during periods of reduced DMT access for almost half (56/118, 47.5%) of those with past issues and nearly half (22/45, 49%) of those with current issues. Resolving access issues involved multiple stakeholder agents often coordinated in a patient-led effort. Among those who had resolved issues, about half (57/119, 47.9%) reported that doctors or office staff were involved, under half (48/119, 40.3%) were involved themselves, and about a third (39/119, 32.8%) reported the drug manufacturer was involved in resolving the issue. Follow-up interviews revealed that the financial burden associated with obtaining a prescribed DMT led to nonadherence. Additionally, participants felt that DMT treatment delays and stress associated with obtaining the DMT triggered relapses or worsened their MS. Conclusions: This study expands current research by using a patient-centered, mixed-methods approach to describe barriers to MS treatment, the process to resolve barriers, and the perceived impact of treatment barriers on outcomes. Issues related to DMT access occur frequently, with individuals often serving as their own agents when navigating access difficulties to obtain their medication(s). Support for resolution of DMT access is needed to prevent undue stress and nonadherence. %M 30377144 %R 10.2196/11168 %U http://www.jmir.org/2018/10/e11168/ %U https://doi.org/10.2196/11168 %U http://www.ncbi.nlm.nih.gov/pubmed/30377144 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e16 %T Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons %A Martens,Jill %A de Jong,Guido %A Rovers,Maroeska %A Westert,Gert %A Bartels,Ronald %+ Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Department of Neurosurgery, huispost 636, Postbus 9101, Nijmegen, 6500 HB, Netherlands, 31 681557132, jill.martens@radboudumc.nl %K evidence-based medicine %K neurosurgery %K levels of evidence %D 2018 %7 12.10.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: The publication rate of neurosurgical guidelines has increased tremendously over the past decade; however, only a small proportion of clinical decisions appear to be based on high-quality evidence. Objective: The aim was to evaluate the evidence available within neurosurgery and its value within clinical practice according to neurosurgeons. Methods: A Web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. Results: The response rate to the survey was 6.78% (173/2552). According to 48.6% (84/173) of the respondents, neurosurgery clinical practices are based on less evidence than other medical specialties and not enough high-quality evidence is available; however, 84.4% (146/173) of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59.0% (102/173) considered the neurosurgical guidelines in their hospital to be based on high-quality evidence, most of whom considered their own treatments to be based on high-quality (level I and/or level II) data (84.3%, 86/102; significantly more than for the neurosurgeons who did not consider the hospital guidelines to be based on high-quality evidence: 55%, 12/22; P<.001). Also, more neurosurgeons with formal training believed they could understand, criticize, and interpret statistical outcomes presented in journals than those without formal training (93%, 56/60 and 68%, 57/84 respectively; P<.001). Conclusions: According to the respondents, neurosurgery is based on high-quality evidence less often than other medical specialties. The results of the survey indicate that formal training in evidence-based medicine would enable neurosurgeons to better understand, criticize, and interpret statistical outcomes presented in journals. %M 30314961 %R 10.2196/ijmr.9617 %U http://www.i-jmr.org/2018/2/e16/ %U https://doi.org/10.2196/ijmr.9617 %U http://www.ncbi.nlm.nih.gov/pubmed/30314961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e89 %T Detecting Motor Impairment in Early Parkinson’s Disease via Natural Typing Interaction With Keyboards: Validation of the neuroQWERTY Approach in an Uncontrolled At-Home Setting %A Arroyo-Gallego,Teresa %A Ledesma-Carbayo,María J %A Butterworth,Ian %A Matarazzo,Michele %A Montero-Escribano,Paloma %A Puertas-Martín,Verónica %A Gray,Martha L %A Giancardo,Luca %A Sánchez-Ferro,Álvaro %+ Institute for Medical Engineering and Science, Massachusetts Institute of Technology, E25-413, 77 Massachusetts Avenue, Cambridge, MA, 02139, United States, 1 857 523 6281, tarroyog@mit.edu %K eHealth %K machine learning %K telemedicine %D 2018 %7 26.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease and one of the most common forms of movement disorder. Although there is no known cure for PD, existing therapies can provide effective symptomatic relief. However, optimal titration is crucial to avoid adverse effects. Today, decision making for PD management is challenging because it relies on subjective clinical evaluations that require a visit to the clinic. This challenge has motivated recent research initiatives to develop tools that can be used by nonspecialists to assess psychomotor impairment. Among these emerging solutions, we recently reported the neuroQWERTY index, a new digital marker able to detect motor impairment in an early PD cohort through the analysis of the key press and release timing data collected during a controlled in-clinic typing task. Objective: The aim of this study was to extend the in-clinic implementation to an at-home implementation by validating the applicability of the neuroQWERTY approach in an uncontrolled at-home setting, using the typing data from subjects’ natural interaction with their laptop to enable remote and unobtrusive assessment of PD signs. Methods: We implemented the data-collection platform and software to enable access and storage of the typing data generated by users while using their computer at home. We recruited a total of 60 participants; of these participants 52 (25 people with Parkinson’s and 27 healthy controls) provided enough data to complete the analysis. Finally, to evaluate whether our in-clinic-built algorithm could be used in an uncontrolled at-home setting, we compared its performance on the data collected during the controlled typing task in the clinic and the results of our method using the data passively collected at home. Results: Despite the randomness and sparsity introduced by the uncontrolled setting, our algorithm performed nearly as well in the at-home data (area under the receiver operating characteristic curve [AUC] of 0.76 and sensitivity/specificity of 0.73/0.69) as it did when used to evaluate the in-clinic data (AUC 0.83 and sensitivity/specificity of 0.77/0.72). Moreover, the keystroke metrics presented a strong correlation between the 2 typing settings, which suggests a minimal influence of the in-clinic typing task in users’ normal typing. Conclusions: The finding that an algorithm trained on data from an in-clinic setting has comparable performance with that tested on data collected through naturalistic at-home computer use reinforces the hypothesis that subtle differences in motor function can be detected from typing behavior. This work represents another step toward an objective, user-convenient, and quasi-continuous monitoring tool for PD. %M 29581092 %R 10.2196/jmir.9462 %U http://www.jmir.org/2018/3/e89/ %U https://doi.org/10.2196/jmir.9462 %U http://www.ncbi.nlm.nih.gov/pubmed/29581092 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 3 %N 1 %P e1 %T Wireless Surface Electromyography and Skin Temperature Sensors for Biofeedback Treatment of Headache: Validation Study with Stationary Control Equipment %A Stubberud,Anker %A Omland,Petter Moe %A Tronvik,Erling %A Olsen,Alexander %A Sand,Trond %A Linde,Mattias %+ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Nevro Øst, Edvard Griegs Gate 8, Trondheim, 7030, Norway, 47 73 59 20 20, ankers@stud.ntnu.no %K biofeedback %K mobile phone %K app %K migraine %K pediatric %D 2018 %7 23.02.2018 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: The use of wearables and mobile phone apps in medicine is gaining attention. Biofeedback has the potential to exploit the recent advances in mobile health (mHealth) for the treatment of headaches. Objectives: The aim of this study was to assess the validity of selected wireless wearable health monitoring sensors (WHMS) for measuring surface electromyography (SEMG) and peripheral skin temperature in combination with a mobile phone app. This proof of concept will form the basis for developing innovative mHealth delivery of biofeedback treatment among young persons with primary headache. Methods: Sensors fulfilling the following predefined criteria were identified: wireless, small size, low weight, low cost, and simple to use. These sensors were connected to an app and used by 20 healthy volunteers. Validity was assessed through the agreement with simultaneous control measurements made with stationary neurophysiological equipment. The main variables were (1) trapezius muscle tension during different degrees of voluntary contraction and (2) voluntary increase in finger temperature. Data were statistically analyzed using Bland-Altman plots, intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC). Results: The app was programmed to receive data from the wireless sensors, process them, and feed them back to the user through a simple interface. Excellent agreement was found for the temperature sensor regarding increase in temperature (CCC .90; 95% CI 0.83-0.97). Excellent to fair agreement was found for the SEMG sensor. The ICC for the average of 3 repetitions during 4 different target levels ranged from .58 to .81. The wireless sensor showed consistency in muscle tension change during moderate muscle activity. Electrocardiography artifacts were avoided through right-sided use of the SEMG sensors. Participants evaluated the setup as usable and tolerable. Conclusions: This study confirmed the validity of wireless WHMS connected to a mobile phone for monitoring neurophysiological parameters of relevance for biofeedback therapy. %R 10.2196/biomedeng.9062 %U http://biomedeng.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/biomedeng.9062 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e10 %T Health-Related Coping and Social Interaction in People with Multiple Sclerosis Supported by a Social Network: Pilot Study With a New Methodological Approach %A Lavorgna,Luigi %A Russo,Antonio %A De Stefano,Manuela %A Lanzillo,Roberta %A Esposito,Sabrina %A Moshtari,Fatemeh %A Rullani,Francesco %A Piscopo,Kyrie %A Buonanno,Daniela %A Brescia Morra,Vincenzo %A Gallo,Antonio %A Tedeschi,Gioacchino %A Bonavita,Simona %+ University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Piazza Miraglia 2, Naples,, Italy, 39 08 15665090, luigi.lavorgna@policliniconapoli.it %K social media %K eHealth %K digital health %K multiple sclerosis %K social network %K Web medicine %D 2017 %7 14.07.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Social media are a vital link for people with health concerns who find in Web communities a valid and comforting source for information exchange, debate, and knowledge enrichment. This aspect is important for people affected by chronic diseases like multiple sclerosis (MS), who are very well informed about the disease but are vulnerable to hopes of being cured or saved by therapies whose efficacy is not always scientifically proven. To improve health-related coping and social interaction for people with MS, we created an MS social network (SMsocialnetwork.com) with a medical team constantly online to intervene promptly when false or inappropriate medical information are shared. Objective: The goal of this study was to assess the impact of SMsocialnetwork.com on the health-related coping and social interaction of people with MS by analyzing areas of interest through a Web-based survey. Methods: Referring to previous marketing studies analyzing the online platform’s role in targeted health care, we conducted a 39-item Web-based survey. We then performed a construct validation procedure using a factorial analysis, gathering together like items of the survey related to different areas of interest such as utility, proximity, sharing, interaction, solving uncertainty, suggestion attitude, and exploration. Results: We collected 130 Web-based surveys. The areas of interest analysis demonstrated that the users positively evaluated SMsocialnetwork.com to obtain information, approach and solve problems, and to make decisions (utility: median 4.2); improve feeling of closeness (proximity: median 5); catalyze relationships and text general personal opinions (sharing: median 5.6); get in touch with other users to receive innovative, effective, and practical solutions (interaction, solving uncertainty, and suggestion attitude medians were respectively: 4.1, 3, and 3); and share information about innovative therapeutic approaches and treatment options (suggestion attitude: median: 3.3). Conclusions: SMsocialnetwork.com was perceived by users to be a useful tool to support health-related coping and social interaction, and may suggest a new kind of therapeutic alliance between physicians and people with MS. %M 28710056 %R 10.2196/ijmr.7402 %U http://www.i-jmr.org/2017/2/e10/ %U https://doi.org/10.2196/ijmr.7402 %U http://www.ncbi.nlm.nih.gov/pubmed/28710056 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 1 %P e2 %T Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System %A Kern,Raimar %A Haase,Rocco %A Eisele,Judith Christina %A Thomas,Katja %A Ziemssen,Tjalf %+ Multiple Sclerosis Center Dresden, Center of Clinical Neuroscience, Department of Neurology, University of Technology Dresden, Germany, Fetscherstrasse 74, Dresden, , Germany, 49 351 458 4465, Tjalf.Ziemssen@uniklinikum-dresden.de %K health information technology %K computers %K Internet %K multiple sclerosis %K eHealth %K disease management %D 2016 %7 08.01.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Objective: Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. Methods: We conducted a paper-and-pencil–based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians’ attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians’ knowledge about the Multiple Sclerosis Documentation System (3 items). Results: From 600 mailed surveys, 74 completed surveys were returned. As much as 9 of the 10 practices were already connected to the Internet (67/74), but only 49% preferred a permanent access. The most common type of HIT infrastructure was a complete practice network with several access points. Considering data sharing with research registers, 43% opted for an online interface, whereas 58% decided on an offline method of data transmission. eHealth services were perceived as generally useful for physicians and nurses in neurological practices with highest capabilities for improvements in clinical documentation, data acquisition, diagnosis of specific MS symptoms, physician-patient communication, and patient education. Practices specialized in MS in comparison with other neurological practices presented an increased interest in online documentation. Among the participating centers, 91% welcomed the opportunity of a specific clinical documentation for MS and 87% showed great interest in an extended and more interconnected electronic documentation of MS patients. Clinical parameters (59/74) were most important in documentation, followed by symptomatic parameters like measures of fatigue or depression (53/74) and quality of life (47/74). Conclusions: Physicians and nurses may significantly benefit from an electronically assisted documentation and patient management. Many aspects of patient documentation and education will be enhanced by eHealth services if the most informative measures are integrated in an easy-to-use and easily connectable approach. MS-specific eHealth services were highly appreciated, but the current level of adoption is still behind the level of interest in an extended and more interconnected electronic documentation of MS patients. %M 26746977 %R 10.2196/ijmr.4549 %U http://www.i-jmr.org/2016/1/e2/ %U https://doi.org/10.2196/ijmr.4549 %U http://www.ncbi.nlm.nih.gov/pubmed/26746977 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e159 %T Scientific Versus Experiential Evidence: Discourse Analysis of the Chronic Cerebrospinal Venous Insufficiency Debate in a Multiple Sclerosis Forum %A Koschack,Janka %A Weibezahl,Lara %A Friede,Tim %A Himmel,Wolfgang %A Makedonski,Philip %A Grabowski,Jens %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 5513914225, jkoscha@gwdg.de %K multiple sclerosis %K venous insufficiency %K Internet %K social media %K cognitive dissonance %K qualitative research %D 2015 %7 01.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The vascular hypothesis of multiple sclerosis (MS), called chronic cerebrospinal venous insufficiency (CCSVI), and its treatment (known as liberation therapy) was immediately rejected by experts but enthusiastically gripped by patients who shared their experiences with other patients worldwide by use of social media, such as patient online forums. Contradictions between scientific information and lay experiences may be a source of distress for MS patients, but we do not know how patients perceive and deal with these contradictions. Objective: We aimed to understand whether scientific and experiential knowledge were experienced as contradictory in MS patient online forums and, if so, how these contradictions were resolved and how patients tried to reconcile the CCSVI debate with their own illness history and experience. Methods: By using critical discourse analysis, we studied CCSVI-related posts in the patient online forum of the German MS Society in a chronological order from the first post mentioning CCSVI to the time point when saturation was reached. For that time period, a total of 117 CCSVI-related threads containing 1907 posts were identified. We analyzed the interaction and communication practices of and between individuals, looked for the relation between concrete subtopics to identify more abstract discourse strands, and tried to reveal discourse positions explaining how users took part in the CCSVI discussion. Results: There was an emotionally charged debate about CCSVI which could be generalized to 2 discourse strands: (1) the “downfall of the professional knowledge providers” and (2) the “rise of the nonprofessional treasure trove of experience.” The discourse strands indicated that the discussion moved away from the question whether scientific or experiential knowledge had more evidentiary value. Rather, the question whom to trust (ie, scientists, fellow sufferers, or no one at all) was of fundamental significance. Four discourse positions could be identified by arranging them into the dimensions “trust in evidence-based knowledge,” “trust in experience-based knowledge,” and “subjectivity” (ie, the emotional character of contributions manifested by the use of popular rhetoric that seemed to mask a deep personal involvement). Conclusions: By critical discourse analysis of the CCSVI discussion in a patient online forum, we reconstruct a lay discourse about the evidentiary value of knowledge. We detected evidence criteria in this lay discourse that are different from those in the expert discourse. But we should be cautious to interpret this dissociation as a sign of an intellectual incapability to understand scientific evidence or a naïve trust in experiential knowledge. Instead, it might be an indication of cognitive dissonance reduction to protect oneself against contradictory information. %M 26133525 %R 10.2196/jmir.4103 %U http://www.jmir.org/2015/7/e159/ %U https://doi.org/10.2196/jmir.4103 %U http://www.ncbi.nlm.nih.gov/pubmed/26133525 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e6 %T Preferred Features of Oral Treatments and Predictors of Non-Adherence: Two Web-Based Choice Experiments in Multiple Sclerosis Patients %A Wicks,Paul %A Brandes,David %A Park,Jinhee %A Liakhovitski,Dimitri %A Koudinova,Tatiana %A Sasane,Rahul %+ PatientsLikeMe, 155 2nd Street, Cambridge, MA, 02141, United States, 1 617 499 4003, pwicks@patientslikeme.com %K multiple sclerosis %K drug therapy %K decision making %K cross-sectional survey %D 2015 %7 05.03.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Oral disease modifying therapies (DMTs) for multiple sclerosis (MS) differ in efficacy, tolerability, and safety. Objective: We sought to understand how these attributes impact patient preference and predicted DMT non-adherence among oral-naïve MS patients. Methods: Adult MS patients from the “PatientsLikeMe” Web-based health data-sharing platform completed a discrete choice exercise where they were asked to express their preference for one of three hypothetical oral DMTs, each with a certain combination of levels of tested attributes. Another Web-based exercise tested a number of possible drivers of non-adherence, mainly side effects. Data from an MS clinic were used to adjust for sample bias. Respondents’ preferences were analyzed using Hierarchical Bayesian estimation. Results: A total of 319 patients completed all questions. Most respondents were female (77.7%, 248/319) with mean age 48 years (SD 10). Liver toxicity was the attribute that emerged as the most important driver of patient preference (25.8%, relative importance out of 100%), followed by severe side effects (15.3%), delay to disability progression (10.7%), and common side effects (10.4%). The most important drivers of predicted non-adherence were frequency of daily dosing (17.4% out of 100%), hair thinning (14.8%), use during pregnancy (14.1%), severe side effects (13.8%), and diarrhea (13.0%). Conclusions: Understanding the important concerns expressed by patients may help health care providers to understand and educate their patients more completely about these concerns. This knowledge may therefore improve both choices of appropriate therapy and adherence to therapy over time. %M 25749630 %R 10.2196/ijmr.3776 %U http://www.i-jmr.org/2015/1/e6/ %U https://doi.org/10.2196/ijmr.3776 %U http://www.ncbi.nlm.nih.gov/pubmed/25749630 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e1 %T Understanding Internet Use Among Dementia Caregivers: Results of Secondary Data Analysis Using the US Caregiver Survey Data %A Kim,Heejung %+ University of Kansas, School of Nursing, MS 4043, 3901 Rainbow Blvd, Kasnas City, KS, 66160, United States, 1 913 588 1657 ext 8, hkim2@kumc.edu %K Internet %K dementia %K caregiver %K stress %K consumer health information %D 2015 %7 23.02.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Informal caregivers of persons with dementia experience higher levels of chronic stress in the caregiving trajectory. The Internet provides diverse types of caregiver resources that may help ameliorate their stress and relevant negative outcomes. However, there is limited information about the prevalence and factors of using Internet-based resources for health- and caregiving-related purposes in informal caregivers of persons with dementia. Objective: Specific aims of this study were (1) to determine the prevalence and factors of caregiver’s health-related Internet use and (2) to compare sociodemographic and caregiving-related characteristics between health-related Internet users and non–health-related Internet users among informal caregivers of persons with dementia. Methods: This quantitative investigation was a descriptive correlational design using a secondary data analysis. Primary data were collected via a survey conducted in 2009 by the National Alliance for Caregiving and the American Association of Retired Persons. Telephone interviews utilizing standardized questionnaires were used to collect self-reported information about sociodemographics and caregiving-related history (N=450). Descriptive statistics and a hierarchical binary logistic regression analysis were completed based on the stress process model. Results: Approximately 59% (265/450) of dementia caregivers were identified as health-related Internet users. Caregivers’ sociodemographics and their subjective responses of caregiving stress were the most significant factors to identify health-related Internet users followed by workload assisting in instrumental activities of daily living of persons with dementia. There were significant differences for caregiver’s age, levels of education and income, hours spent caregiving, and the relationship to persons with dementia between health-related Internet users and non–health-related Internet users (P<.05 for all). After controlling for confounding effects, younger age of persons with dementia (OR 0.278, 95% CI 0.085-0.906), higher education levels of caregivers (OR 3.348, 95% CI 2.019-5.552), shorter caregiving time spent per week (OR 0.452, 95% CI 0.243-0.840), higher levels of caregiver’s emotional stress (OR 1.249, 95% CI 1.004-1.555), and financial hardship (OR 4.61, 95% CI 1.416-14.978) were identified as newly emerging factors of health-related Internet use. Conclusions: Although the Internet provided useful resources for caregivers of persons with dementia, dementia caregivers reported lower levels of health-related Internet use compared to the general public. Our findings confirmed the impact of age, education levels, and/or income on Internet use reported in previous studies. However, the predictive value of subjective responses of caregiving stress for health-related Internet use was a new addition. These findings will assist health care providers, researchers, and policy makers in identifying who is the least likely to access Internet-based resources and how Internet-based strategies can best be designed, implemented, and distributed to meet the needs of this group of users. %M 25707033 %R 10.2196/ijmr.3127 %U http://www.i-jmr.org/2015/1/e1/ %U https://doi.org/10.2196/ijmr.3127 %U http://www.ncbi.nlm.nih.gov/pubmed/25707033 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 3 %P e12 %T Web Search Behavior and Information Needs of People With Multiple Sclerosis: Focus Group Study and Analysis of Online Postings %A Colombo,Cinzia %A Mosconi,Paola %A Confalonieri,Paolo %A Baroni,Isabella %A Traversa,Silvia %A Hill,Sophie J %A Synnot,Anneliese J %A Oprandi,Nadia %A Filippini,Graziella %+ IRCCS-Mario Negri Institute for Pharmacological Research, Milano, Italy, Department of Public Health, Laboratory for medical research and consumer involvement, Via La Masa 19, Milano, 20156, Italy, 39 0239014503, paola.mosconi@marionegri.it %K multiple sclerosis %K evidence-based information %K information needs %K Web search behavior %K Internet %K patients’ involvement %D 2014 %7 24.07.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Multiple sclerosis (MS) patients and their family members increasingly seek health information on the Internet. There has been little exploration of how MS patients integrate health information with their needs, preferences, and values for decision making. The INtegrating and Deriving Evidence, Experiences, and Preferences (IN-DEEP) project is a collaboration between Italian and Australian researchers and MS patients, aimed to make high-quality evidence accessible and meaningful to MS patients and families, developing a Web-based resource of evidence-based information starting from their information needs. Objective: The objective of this study was to analyze MS patients and their family members’ experience about the Web-based health information, to evaluate how they asses this information, and how they integrate health information with personal values. Methods: We organized 6 focus groups, 3 with MS patients and 3 with family members, in the Northern, Central, and Southern parts of Italy (April-June 2011). They included 40 MS patients aged between 18 and 60, diagnosed as having MS at least 3 months earlier, and 20 family members aged 18 and over, being relatives of a person with at least a 3-months MS diagnosis. The focus groups were audio-recorded and transcribed verbatim (Atlas software, V 6.0). Data were analyzed from a conceptual point of view through a coding system. An online forum was hosted by the Italian MS society on its Web platform to widen the collection of information. Nine questions were posted covering searching behavior, use of Web-based information, truthfulness of Web information. At the end, posts were downloaded and transcribed. Results: Information needs covered a comprehensive communication of diagnosis, prognosis, and adverse events of treatments, MS causes or risk factors, new drugs, practical, and lifestyle-related information. The Internet is considered useful by MS patients, however, at the beginning or in a later stage of the disease a refusal to actively search for information could occur. Participants used to search on the Web before or after their neurologist’s visit or when a new therapy was proposed. Social networks are widely used to read others’ stories and retrieve information about daily management. A critical issue was the difficulty of recognizing reliable information on the Web. Many sources were used but the neurologist was mostly the final source of treatment decisions. Conclusions: MS patients used the Internet as a tool to integrate information about the illness. Information needs covered a wide spectrum, the searched topics changed with progression of the disease. Criteria for evaluating Internet accuracy and credibility of information were often lacking or generic. This may limit the empowerment of patients in health care choices. %M 25093374 %R 10.2196/ijmr.3034 %U http://www.i-jmr.org/2014/3/e12/ %U https://doi.org/10.2196/ijmr.3034 %U http://www.ncbi.nlm.nih.gov/pubmed/25093374 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e3 %T Health Literacy Association With Health Behaviors and Health Care Utilization in Multiple Sclerosis: A Cross-Sectional Study %A Marrie,Ruth Ann %A Salter,Amber %A Tyry,Tuula %A Fox,Robert J %A Cutter,Gary R %+ University of Manitoba, Departments of Internal Medicine and Community Health Sciences, GF 543 - Health Sciences Centre, Winnipeg, MB, R3R 0A1, Canada, 1 204 787 4951, rmarrie@hsc.mb.ca %K multiple sclerosis %K health literacy %K health care utilization %K comorbidity %K health behaviors %D 2014 %7 10.02.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Low health literacy is generally associated with poor health outcomes; however, health literacy has received little attention in multiple sclerosis (MS). Objective: The aim of this study was to investigate the health literacy of persons with MS using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Methods: In 2012, we conducted a cross-sectional study of health literacy among NARCOMS participants. Respondents completed the Medical Term Recognition Test (METER) which assesses the ability to distinguish medical and nonmedical words, and the Newest Vital Sign (NVS) instrument which evaluates reading, interpretation, and numeracy skills. Respondents reported their sociodemographic characteristics, health behaviors, comorbidities, visits to the emergency room (ER), and hospitalizations in the last 6 months. We used logistic regression to evaluate the characteristics associated with functional literacy, and the association between functional literacy and health care utilization. Results: Of 13,020 eligible participants, 8934 (68.6%) completed the questionnaire and were US residents. Most of them performed well on the instruments with 81.04% (7066/8719) having functional literacy on the METER and 74.62% (6666/8933) having adequate literacy on the NVS. Low literacy on the METER or the NVS was associated with smoking, being overweight or obese (all P<.001). After adjustment, low literacy on the METER was associated with ER visits (OR 1.28, 95% CI 1.10-1.48) and hospitalizations (OR 1.19, 95% CI 0.98-1.44). Findings were similar for the NVS. Conclusions: In the NARCOMS cohort, functional health literacy is high. However, lower levels of health literacy are associated with adverse health behaviors and greater health care utilization. %M 24513479 %R 10.2196/ijmr.2993 %U http://www.i-jmr.org/2014/1/e3/ %U https://doi.org/10.2196/ijmr.2993 %U http://www.ncbi.nlm.nih.gov/pubmed/24513479 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e2 %T Designing Consumer Health Technologies for the Treatment of Patients With Depression: A Health Practitioner's Perspective %A White,Ginger %A Caine,Kelly %A Connelly,Kay %A Selove,Rebecca %A Doub,Tom %+ School of Informatics and Computing, Indiana University, 919 E 10th Street, Bloomington, IN, , United States, 1 812 855 0739, Connelly@indiana.edu %K depression %K health care providers %K technology %K user-computer interface %D 2014 %7 10.01.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: The consumer health technologies used by patients on a daily basis can be effectively leveraged to assist them in the treatment of depression. However, because treatment for depression is a collaborative endeavor, it is important to understand health practitioners’ perspectives on the benefits, drawbacks, and design of such technologies. Objective: The objective of this research was to understand how patients and health practitioners can effectively and successfully influence the design of consumer health treatment technologies for treating patients with depression. Methods: A group of 10 health practitioners participated in individual semistructured contextual interviews at their offices. Health practitioners rated an a priori identified list of depression indicators using a 7-point Likert scale and generated a list of depression indicators. Finally, health practitioners were asked to rate the perceived usefulness of an a priori identified list of depression treatment technologies using a 7-point Likert scale. Results: Of the 10 health practitioners interviewed, 5 (50%) were mental health practitioners, 3 (30%) nurses, and 2 (20%) general practitioners. A total of 29 unique depression indicators were generated by the health practitioners. These indicators were grouped into 5 high-level categories that were identified by the research team and 2 clinical experts: (1) daily and social functioning, (2) medication, (3) nutrition and physical activity, (4) demographics and environment, and (5) suicidal thoughts. These indicators represent opportunities for designing technologies to support health practitioners who treat patients with depression. The interviews revealed nuances of the different health practitioners’ clinical practices and also barriers to using technology to guide the treatment of depression. These barriers included (1) technology that did not fit within the current practice or work infrastructure, (2) technology that would not benefit the current treatment process, (3) patients forgetting to use the technology, and (4) patients not being able to afford the technology. Conclusions: In order to be successful in the treatment of depression, consumer health treatment technologies must address health practitioners’ technology concerns early on in the design phase, account for the various types of health practitioners, treatment methods, and clinical practices, and also strive to seamlessly integrate traditional and nontraditional depression indicators within various health practitioners’ clinical practices. %M 24413087 %R 10.2196/ijmr.2368 %U http://www.i-jmr.org/2014/1/e2/ %U https://doi.org/10.2196/ijmr.2368 %U http://www.ncbi.nlm.nih.gov/pubmed/24413087 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e1 %T Feasibility of a Web-Based Survey of Hallucinations and Assessment of Visual Function in Patients With Parkinson’s Disease %A Jackson,Mary Lou %A Bex,Peter J %A Ellison,James M %A Wicks,Paul %A Wallis,Jennifer %+ Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, United States, 1 617 573 4177 ext 4177, marylou_jackson@meei.harvard.edu %K Parkinson’s disease %K hallucinations %K contrast sensitivity %K Charles Bonnet Syndrome %D 2014 %7 06.01.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Patients with Parkinson’s disease (PD) experience visual hallucinations, which may be related to decreased contrast sensitivity (ie, the ability to discern shades of grey). Objective: The objective of this study was to investigate if an online research platform can be used to survey patients with Parkinson’s disease regarding visual hallucinations, and also be used to assess visual contrast perception. Methods: From the online patient community, PatientsLikeMe, 964 members were invited via email to participate in this study. Participants completed a modified version of the University of Miami Parkinson’s disease hallucinations questionnaire and an online vision test. Results: The study was completed by 27.9% (269/964) of those who were invited: 56.9% of this group had PD (153/269) and 43.1% (116/269) were non-Parkinson’s controls. Hallucinations were reported by 18.3% (28/153) of the Parkinson’s group. Although 10 subjects (9%) in the control group reported experiencing hallucinations, only 2 of them actually described formed hallucinations. Participants with Parkinson’s disease with a mean of 1.75 (SD 0.35) and the control group with a mean of 1.85 (SD 0.36) showed relatively good contrast perception as measured with the online letter test (P=.07). People who reported hallucinations showed contrast sensitivity levels that did not differ from levels shown by people without hallucinations (P=.96), although there was a trend towards lower contrast sensitivity in hallucinators. Conclusions: Although more Parkinson's responders reported visual hallucinations, a significant number of non-Parkinson's control group responders also reported visual hallucinations. The online survey method may have failed to distinguish between formed hallucinations, which are typical in Parkinson's disease, and non-formed hallucinations that have less diagnostic specificity. Multiple questions outlining the nature of the hallucinations are required. In a clinical interview, the specific nature of the hallucination would be further refined to rule out a vague description that does not indicate a true, formed visual hallucination. Contrary to previous literature, both groups showed relatively good contrast sensitivity, perhaps representing a ceiling effect or limitations of online testing conditions that are difficult to standardize. Steps can be taken in future trials to further standardize online visual function testing, to refine control group parameters and to take steps to rule out confounding variables such as comorbid disease that could be associated with hallucinations. Contacting subjects via an online health social network is a novel, cost-effective method of conducting vision research that allows large numbers of individuals to be contacted quickly, and refinement of questionnaires and visual function testing may allow more robust findings in future research. %M 24394559 %R 10.2196/ijmr.2744 %U http://www.i-jmr.org/2014/1/e1/ %U https://doi.org/10.2196/ijmr.2744 %U http://www.ncbi.nlm.nih.gov/pubmed/24394559 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e8 %T Severe Loss of Appetite in Amyotrophic Lateral Sclerosis Patients: Online Self-Assessment Study %A Holm,Teresa %A Maier,André %A Wicks,Paul %A Lang,Dirk %A Linke,Peter %A Münch,Christoph %A Steinfurth,Laura %A Meyer,Robert %A Meyer,Thomas %+ Department of Neurology, Charité, University Hospital, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30 450 660032, Thomas.Meyer@charite.de %K amyotrophic lateral sclerosis %K nutrition %K loss of appetite %K weight loss %K online self-assessment %D 2013 %7 17.04.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: Undesirable loss of weight is a major challenge in amyotrophic lateral sclerosis (ALS). However, little is known about loss of appetite in ALS patients. Objective: We investigated loss of appetite in ALS patients by means of an online self-assessment and whether ALS-related symptoms were associated with it. Methods: Loss of appetite in 51 ALS patients was assessed using the Council on Nutrition Appetite Questionnaire (CNAQ). Loss of appetite is defined as a CNAQ-score of 28 or less with a predicted weight loss of at least 5% within 6 months. We developed an Internet portal to facilitate self-assessment. Results: Approximately half of the ALS patients (47%, 24/51) suffered from severe loss of appetite; after 6 months this increased to nearly two-thirds (65%, 22/34). An average weight loss of 5% was found in the group with severe loss of appetite as compared to only 2% of patients with normal appetite. Interestingly, loss of appetite was associated with respiratory dysfunction (P=.001, R2=.223). Conclusions: Loss of appetite was more common and more severe than expected. It was found to be an independent risk factor for unintended weight loss and may be related to dyspnea. The impact of severe loss of appetite on survival and quality of life should be established in further studies. %M 23608722 %R 10.2196/ijmr.2463 %U http://www.i-jmr.org/2013/1/e8/ %U https://doi.org/10.2196/ijmr.2463 %U http://www.ncbi.nlm.nih.gov/pubmed/23608722 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 1 %N 2 %P e4 %T Born to Yawn? Understanding Yawning as a Warning of the Rise in Cortisol Levels: Randomized Trial %A Thompson,Simon BN %A Bishop,Phil %+ Psychology Research Centre, & Dementia Institute, Bournemouth University, Talbot Campus, Poole House (P315), Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202961558, simont@bournemouth.ac.uk %K Clinical practice %K cortisol %K electromyography %K neural pathway %K saliva %K yawning %D 2012 %7 20.09.2012 %9 Original Paper %J Interact J Med Res %G English %X Background: Yawning consistently poses a conundrum to the medical profession and neuroscientists. Despite neurological evidence such as parakinesia brachialis oscitans in stroke patients and thermo-irregulation in multiple sclerosis patients, there is considerable debate over the reasons for yawning with the mechanisms and hormonal pathways still not fully understood. Cortisol is implicated during yawning and may link many neurological disorders. Evidence was found in support of the Thompson cortisol hypothesis that proposes cortisol levels are elevated during yawning just as they tend to rise during stress and fatigue. Objectives: To investigate whether saliva cortisol levels rise during yawning and, therefore, support the Thompson cortisol hypothesis. Methods: We exposed 20 male and female volunteers aged between 18 and 53 years to conditions that provoked a yawning response in a randomized controlled trial. Saliva samples were collected at the start and again after the yawning response, or at the end of the stimuli presentations if the participant did not yawn. In addition, we collected electromyographic data of the jaw muscles to determine rest and yawning phases of neural activity. Yawning susceptibility scale, Hospital Anxiety and Depression Scale, General Health Questionnaire, and demographic and health details were also collected from each participant. A comprehensive data set allowed comparison between yawners and nonyawners, as well as between rest and yawning phases. Collecting electromyographic data from the yawning phase is novel, and we hope this will provide new information about neuromuscular activity related to cortisol levels. Exclusion criteria included chronic fatigue, diabetes, fibromyalgia, heart conditions, high blood pressure, hormone replacement therapy, multiple sclerosis, and stroke. We compared data between and within participants. Results: In the yawning group, there was a significant difference between saliva cortisol samples (t10 = –3.071, P = .01). Power and effect size were computed based on repeated-measures t tests for both the yawning and nonyawning groups. There was a medium effect size for the nonyawners group (r = .467) but low power (36%). Results were similar for the yawners group: medium effect size (r = .440) and low power (33%). Conclusions: There was significant evidence in support of the Thompson cortisol hypothesis that suggests cortisol levels are elevated during yawning. A further longitudinal study is planned to test neurological patients. We intend to devise a diagnostic tool based on changes in cortisol levels that may assist in the early diagnosis of neurological disorders based on the data collected. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 61942768; http://www.controlled-trials.com/ISRCTN61942768/61942768 (Archived by WebCite at http://www.webcitation.org/6A75ZNYvr) %M 23611879 %R 10.2196/ijmr.2241 %U http://www.jmir.org/2012/2/e4/ %U https://doi.org/10.2196/ijmr.2241 %U http://www.ncbi.nlm.nih.gov/pubmed/23611879