%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66037 %T Effect of Digital Exercise Therapy on the Pain and Physical Function of Patients With Osteoarthritis: Systematic Review and Meta-Analysis %A Long,Jing %A You,Jikai %A Yang,Yanan %+ School of Physical Education, Jiangxi Normal University, No. 99 Ziyang Avenue, Nanchang, 330022, China, 86 15201739275, yangyanan_sus@163.com %K exercise program %K telerehabilitation %K rehabilitation %K digital care %K physical activity %K health app %K physical therapy %K systematic review %K meta-analysis %D 2025 %7 25.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Osteoarthritis (OA) is a chronic degenerative bone and joint disease that significantly impacts patients’ quality of life and mental health, while also imposing a substantial economic burden on society. However, access to rehabilitation for patients with OA is challenging upon hospital discharge. Digital exercise therapy represents a promising telemedicine strategy for enhancing the management of OA, but its effect on OA is not yet clear. Objective: This study aimed to systematically evaluate the therapeutic effects of digital exercise therapy on pain and physical function in patients with OA. Methods: Databases including PubMed, Embase, Cochrane Library, Web of Science, and SPORTDiscus were searched for randomized controlled trials on using digital exercise therapy for OA until October 25, 2023. The primary outcomes included the measures of pain scores or physical function scores immediately after the intervention and at full follow-up. The risk of bias was evaluated using the Physiotherapy Evidence Database scale. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software (Cochrane Collaboration). Results: A total of 9 studies with 1604 patients were included in the final meta-analysis. Compared with the conventional treatment group, digital exercise therapy significantly reduced numerical rating scale pain scores (mean difference [MD]=–1.07, 95% CI –1.35 to –0.78; P<.001) and Western Ontario and McMaster Universities Osteoarthritis Index physical function scores (MD=–2.39, 95% CI –3.68 to –1.10; P<.001) in patients with OA immediately after the intervention. However, follow-up results revealed no statistically significant difference in numerical rating scale pain scores (MD=–0.20, 95% CI –0.59 to 0.20; P=.34), while Western Ontario and McMaster Universities Osteoarthritis Index physical function scores showed a significant improvement in the digital exercise therapy group compared with the control group (MD=–1.89, 95% CI –3.52 to –0.26; P=.02). These findings suggest that digital exercise therapy provides immediate benefits for both pain and physical function in patients with OA, with sustained improvements in physical function observed during follow-up, though pain relief may not persist long term. Conclusions: Digital exercise therapy can alleviate the pain and improve the physical function in patients with OA and can be used as an auxiliary means in the rehabilitation treatment of OA. It provides great convenience for patients with OA who need long-term treatment, allowing them to exercise at home for rehabilitation training. Trial Registration: PROSPERO CRD42023484819; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023484819 %M 40279572 %R 10.2196/66037 %U https://www.jmir.org/2025/1/e66037 %U https://doi.org/10.2196/66037 %U http://www.ncbi.nlm.nih.gov/pubmed/40279572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64576 %T The Efficacy of Virtual Reality on the Rehabilitation of Musculoskeletal Diseases: Umbrella Review %A Tang,Peiyuan %A Cao,Yangbin %A Vithran,Djandan Tadum Arthur Vithran %A Xiao,Wenfeng %A Wen,Ting %A Liu,Shuguang %A Li,Yusheng %+ , Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, 410000, China, 86 13975889696, liyusheng@csu.edu.cn %K virtual reality %K VR %K umbrella review %K musculoskeletal diseases %K orthopedics %K efficacy %D 2025 %7 25.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Musculoskeletal disorders cause pain, disability, and financial burdens, with rising prevalence. Virtual reality (VR) offers immersive, digital rehabilitation potential, improving motor functions and pain management. Objective: To evaluate the impact of VR on the rehabilitation of musculoskeletal disorders and to assess the consistency of evidence provided by existing systematic reviews and meta-analyses, this study focuses on musculoskeletal disorders, which encompass conditions affecting the locomotor system, such as arthritis, joint deformities, and injuries. VR therapy leverages immersive digital environments to enhance rehabilitation through digital exercises and simulations. Methods: The PubMed or MEDLINE, Embase, and Cochrane Library databases were systematically searched for relevant papers published up to April 2024. Literature screening, quality assessment, and data extraction were conducted according to predefined inclusion and exclusion criteria. The methodological quality of the included meta-analyses was evaluated using the Measurement Tool to Assess Systematic Reviews 2. The Grading of Recommendations Assessment, Development, and Evaluation system was used to classify the evidence level for each outcome as high, moderate, low, or very low. Additionally, the evidence was categorized into 5 levels based on classification criteria: I (convincing), II (highly suggestive), III (suggestive), IV (weak), and nonsignificant. Results: This umbrella review synthesized data from 14 meta-analyses published between 2019 and 2024, involving a total of 13,184 patients. In total, 7 meta-analyses received high Measurement Tool to Assess Systematic Reviews 2 ratings, 7 were rated moderate, and the remainder were rated low. VR demonstrated promising results in musculoskeletal rehabilitation, significantly reducing knee pain (mean difference [MD] –1.38, 95% CI –2.32 to –0.44; P=.004; I2=94%) and improving balance. For patients with fibromyalgia syndrome, VR effectively reduced pain (standardized mean difference [SMD] –0.45, 95% CI –0.70 to –0.20; P<.001), fatigue (SMD –0.58, 95% CI –1.01 to –0.14; P=.01), anxiety (SMD –0.50, 95% CI –0.908 to –0.029; P=.04), and depression (SMD –0.62, 95% CI –0.76 to –0.15; P=.003) while also enhancing quality of life. In individuals with back pain, VR alleviated pain-related fears (MD –5.46, 95% CI –9.40 to –1.52; P=.007; I2=90%) and reduced pain intensity (MD –1.43, 95% CI –1.86 to –1.00; P<.001; I2=95%). After arthroplasty, VR improved knee functionality (MD 8.30, 95% CI 6.92-9.67; P<.001; I2=24%) and decreased anxiety (MD –3.95, 95% CI –7.76 to –0.13; P=.04; I2=0%). Conclusions: VR demonstrates significant potential in the rehabilitation of various musculoskeletal conditions. It effectively alleviates pain, enhances psychological well-being, and facilitates the recovery of motor function in patients. Trial Registration: PROSPERO CRD42024538469; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024538469 %M 40279163 %R 10.2196/64576 %U https://www.jmir.org/2025/1/e64576 %U https://doi.org/10.2196/64576 %U http://www.ncbi.nlm.nih.gov/pubmed/40279163 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 10 %N %P e67481 %T Can Artificial Intelligence Diagnose Knee Osteoarthritis? %A Tandon,Mihir %A Chetla,Nitin %A Mallepally,Adarsh %A Zebari,Botan %A Samayamanthula,Sai %A Silva,Jonathan %A Vaja,Swapna %A Chen,John %A Cullen,Matthew %A Sukhija,Kunal %+ Albany Medical College, 43 New Scotland Ave, Albany, NY, 12208, United States, 1 3322488708, tandonm@amc.edu %K large language model %K ChatGPT %K GPT-4o %K radiology %K osteoarthritis %K machine learning %K X-rays %K osteoarthritis detection %D 2025 %7 23.4.2025 %9 Research Letter %J JMIR Biomed Eng %G English %X This study analyzed the capability of GPT-4o to properly identify knee osteoarthritis and found that the model had good sensitivity but poor specificity in identifying knee osteoarthritis; patients and clinicians should practice caution when using GPT-4o for image analysis in knee osteoarthritis. %M 40266670 %R 10.2196/67481 %U https://biomedeng.jmir.org/2025/1/e67481 %U https://doi.org/10.2196/67481 %U http://www.ncbi.nlm.nih.gov/pubmed/40266670 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e62659 %T Effectiveness of Stromal Vascular Fraction (SVF) and Platelet-Rich Plasma (PRP) in Patients With Knee Osteoarthritis: Protocol for a Phase 3, Prospective, Randomized, Controlled, Multicenter Study (SPOST Study) %A Schwitzguebel,Adrien %A Ramirez Cadavid,David Andres %A Da Silva,Tamara %A Decavel,Pierre %A Benaim,Charles %+ , Sports Medicine Division, Hôpital de la Providence, Av. du Premier-Mars 29, Neuchâtel, 2000, Switzerland, 41 32 720 327, adrien.schwitzguebel@gmail.com %K stromal vascular fraction %K platelet-rich plasma %K osteoarthritis %K adjuvant therapy %K tissue regeneration %K clinical efficacy %D 2025 %7 8.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Available evidence on the conservative treatment of knee osteoarthritis still leaves questions about the efficacy of platelet-rich plasma (PRP) and whether stromal vascular fraction (SVF) offers a superior therapeutic tool. Objective: This study aims to assess the clinical efficacy of SVF as adjuvant therapy to PRP on functionality and tissue regeneration for knee osteoarthritis. Methods: In a multicenter, randomized, triple-blind, controlled trial, 108 individuals with knee osteoarthritis will be block-randomized in a 1:1 ratio. Patients will receive an initial single PRP or PRP + SVF injection followed by PRP doses at 1 month and 2 months. The primary endpoint is functional improvement measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at the 6-month follow-up. Secondary endpoints, collected at the 1-month, 2-month, 3-month, 6-month, and 12-month follow-ups, will include the pain visual analogue scale during maximal physical activity, WOMAC score, length of time to return to work and sports in days, magnetic resonance imaging (MRI)–based Whole-Organ Magnetic Resonance Imaging Score (WORMS), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, MRI Area Measurement and Depth and Underlying Structures (AMADEUS) score at 6 months and at 12 months, adverse events, and serious adverse events. Results: Participant recruitment and data collection are expected to begin in July 2025 and finish in July 2027. Final end points will be gathered in August 2027, and the results are expected to be published in late 2027. Conclusions: The study results will provide insight into the clinical efficacy of SVF as adjuvant therapy to PRP on functionality and tissue regeneration in patients with knee osteoarthritis. Trial Registration: ClinicalTrials.gov (NCT05660824); https://clinicaltrials.gov/study/NCT05660824 International Registered Report Identifier (IRRID): PRR1-10.2196/62659 %M 40198111 %R 10.2196/62659 %U https://www.researchprotocols.org/2025/1/e62659 %U https://doi.org/10.2196/62659 %U http://www.ncbi.nlm.nih.gov/pubmed/40198111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63937 %T Explainable AI for Intraoperative Motor-Evoked Potential Muscle Classification in Neurosurgery: Bicentric Retrospective Study %A Parduzi,Qendresa %A Wermelinger,Jonathan %A Koller,Simon Domingo %A Sariyar,Murat %A Schneider,Ulf %A Raabe,Andreas %A Seidel,Kathleen %+ , Department of Neurosurgery, Lucerne Cantonal Hospital, Spitalstrasse, Lucerne, 6000, Switzerland, 41 412056631, qendresa.parduzi@students.unibe.ch %K intraoperative neuromonitoring %K motor evoked potential %K artificial intelligence %K machine learning %K deep learning %K random forest %K convolutional neural network %K explainability %K medical informatics %K personalized medicine %K neurophysiological %K monitoring %K orthopedic %K motor %K neurosurgery %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Intraoperative neurophysiological monitoring (IONM) guides the surgeon in ensuring motor pathway integrity during high-risk neurosurgical and orthopedic procedures. Although motor-evoked potentials (MEPs) are valuable for predicting motor outcomes, the key features of predictive signals are not well understood, and standardized warning criteria are lacking. Developing a muscle identification prediction model could increase patient safety while allowing the exploration of relevant features for the task. Objective: The aim of this study is to expand the development of machine learning (ML) methods for muscle classification and evaluate them in a bicentric setup. Further, we aim to identify key features of MEP signals that contribute to accurate muscle classification using explainable artificial intelligence (XAI) techniques. Methods: This study used ML and deep learning models, specifically random forest (RF) classifiers and convolutional neural networks (CNNs), to classify MEP signals from routine supratentorial neurosurgical procedures from two medical centers according to muscle identity of four muscles (extensor digitorum, abductor pollicis brevis, tibialis anterior, and abductor hallucis). The algorithms were trained and validated on a total of 36,992 MEPs from 151 surgeries in one center, and they were tested on 24,298 MEPs from 58 surgeries from the other center. Depending on the algorithm, time-series, feature-engineered, and time-frequency representations of the MEP data were used. XAI techniques, specifically Shapley Additive Explanation (SHAP) values and gradient class activation maps (Grad-CAM), were implemented to identify important signal features. Results: High classification accuracy was achieved with the RF classifier, reaching 87.9% accuracy on the validation set and 80% accuracy on the test set. The 1D- and 2D-CNNs demonstrated comparably strong performance. Our XAI findings indicate that frequency components and peak latencies are crucial for accurate MEP classification, providing insights that could inform intraoperative warning criteria. Conclusions: This study demonstrates the effectiveness of ML techniques and the importance of XAI in enhancing trust in and reliability of artificial intelligence–driven IONM applications. Further, it may help to identify new intrinsic features of MEP signals so far overlooked in conventional warning criteria. By reducing the risk of muscle mislabeling and by providing the basis for possible new warning criteria, this study may help to increase patient safety during surgical procedures. %M 40127441 %R 10.2196/63937 %U https://www.jmir.org/2025/1/e63937 %U https://doi.org/10.2196/63937 %U http://www.ncbi.nlm.nih.gov/pubmed/40127441 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53074 %T Patient Experiences With a Mobile Self-Care Solution for Low-Complex Orthopedic Injuries: Mixed Methods Study %A Spierings,Jelle %A Willinge,Gijs %A Kokke,Marike %A Repping,Sjoerd %A de Lange,Wendela %A Geerdink,Thijs %A van Veen,Ruben %A van der Velde,Detlef %A Goslings,J Carel %A Twigt,Bas %A , %K self-care application %K mHealth %K experience %K traumasurgery %K orthopedic surgery %K virtual fracture clinic %K patient perspective %K direct discharge %K musculoskeletal injury %K mobile self-care %K method study %K health care system %K hospital %K mobile health %K app %K smartphone %K satisfactory %K effectiveness %K treatment %K virtual clinic %K virtual care %K digital health %D 2025 %7 14.3.2025 %9 %J JMIR Hum Factors %G English %X Background: The Dutch acute health care system faces challenges with limited resources and increasing patient numbers. To reduce outpatient follow-up, direct discharge (DD) has been implemented in over 30 out of 80 Dutch hospitals. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit for low-complex, isolated, and stable musculoskeletal injuries. This policy is supported by information leaflets, a smartphone app, and a telephone helpline with human support. Growing evidence shows that DD is satisfactory, safe, and effective in reducing secondary health care use, but thorough patient experiences are lacking. Objective: The aim of this study was to explore the experiences of patients with DD to ensure durable adoption and to improve the treatment protocol. Methods: A mixed method study was conducted parallel to the implementation of DD in 3 hospitals. Data were collected through a survey directly after the ED visit, a survey 3 months post injury, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data used thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptance, preliminary efficacy, and demand. All patients who consented to the study face-to-face with one of the 12 low-complex musculoskeletal injuries were included in the study during the implementation period. Results: Of the 429 patients who started the primary survey, 138 patients completed both surveys. A total of 18 semistructured interviews were conducted and analyzed. Patients reported a median treatment satisfaction score of 7.8 (IQR 6.6-8.8) on a 10-point scale of DD at the ED. Information quality was experienced as good (106/138, 77%), and most preferred DD over face-to-face follow-up (79/138, 59%). Patient information demands and app use varied among patients, with a median frequency of use of 4 times (ranging from 1 to 30). Conclusions: This study shows that patients consider DD a feasible and safe alternative to traditional treatment, with a favorable perception of its acceptability, efficacy, applicability, and demand. Nevertheless, response rates were relatively low, and personal nuances and preferences must be considered when implementing DD. Clinicians and policy makers can use the insights to improve DD and work towards the integration of DD into clinical practice and future guidelines. %R 10.2196/53074 %U https://humanfactors.jmir.org/2025/1/e53074 %U https://doi.org/10.2196/53074 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e64705 %T Assessing Total Hip Arthroplasty Outcomes and Generating an Orthopedic Research Outcome Database via a Natural Language Processing Pipeline: Development and Validation Study %A Mast,Nicholas H %A Oeste,Clara L. %A Hens,Dries %K total hip arthroplasty %K THA %K direct anterior approach %K electronic health records %K EHR %K natural language processing %K NLP %K complication rate %K single-surgeon registry %K hip arthroplasty %K orthopedic %K validation %K surgeon %K outpatient visits %K hospitalizations %K surgery %D 2025 %7 12.3.2025 %9 %J JMIR Med Inform %G English %X Background: Processing data from electronic health records (EHRs) to build research-grade databases is a lengthy and expensive process. Modern arthroplasty practice commonly uses multiple sites of care, including clinics and ambulatory care centers. However, most private data systems prevent obtaining usable insights for clinical practice. Objective: This study aims to create an automated natural language processing (NLP) pipeline for extracting clinical concepts from EHRs related to orthopedic outpatient visits, hospitalizations, and surgeries in a multicenter, single-surgeon practice. The pipeline was also used to assess therapies and complications after total hip arthroplasty (THA). Methods: EHRs of 1290 patients undergoing primary THA from January 1, 2012 to December 31, 2019 (operated and followed by the same surgeon) were processed using artificial intelligence (AI)–based models (NLP and machine learning). In addition, 3 independent medical reviewers generated a gold standard using 100 randomly selected EHRs. The algorithm processed the entire database from different EHR systems, generating an aggregated clinical data warehouse. An additional manual control arm was used for data quality control. Results: The algorithm was as accurate as human reviewers (0.95 vs 0.94; P=.01), achieving a database-wide average F1-score of 0.92 (SD 0.09; range 0.67‐0.99), validating its use as an automated data extraction tool. During the first year after direct anterior THA, 92.1% (1188/1290) of our population had a complication-free recovery. In 7.9% (102/1290) of cases where surgery or recovery was not uneventful, lateral femoral cutaneous nerve sensitivity (47/1290, 3.6%), intraoperative fractures (13/1290, 1%), and hematoma (9/1290, 0.7%) were the most common complications. Conclusions: Algorithm evaluation of this dataset accurately represented key clinical information swiftly, compared with human reviewers. This technology may provide substantial value for future surgeon practice and patient counseling. Furthermore, the low early complication rate of direct anterior THA in this surgeon’s hands was supported by the dataset, which included data from all treated patients in a multicenter practice. %R 10.2196/64705 %U https://medinform.jmir.org/2025/1/e64705 %U https://doi.org/10.2196/64705 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e64415 %T Disparities in Clinical and Experimental Pain Between Non-Hispanic White and Asian American Individuals With Knee Osteoarthritis and the Role of Pain Catastrophizing: Pilot Study in Florida %A Lee,Chiyoung %A Kwoh,C. Kent %A Park,Juyoung %A Park,Lindsey %A Ahn,Hyochol %+ College of Nursing, University of Arizona, 1305 N Martin Avenue, Tucson, AZ, 85721, United States, 1 5206266154, clee33@arizona.edu %K Asian American %K non-Hispanic White %K osteoarthritis %K pain %K pain catastrophizing %D 2025 %7 25.2.2025 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Although a few studies have delineated the disparities in knee osteoarthritis (KOA) pain between non-Hispanic White and Asian American individuals, a significant research gap persists in elucidating the mechanisms underlying these differences. Objective: This pilot study aims to examine psychological factors, specifically pain catastrophizing and negative affect, as potential explanatory mechanisms for these dissimilarities. Methods: A cross-sectional design was used. Forty community-dwelling participants aged 50-70 years with self-reported KOA pain, including 20 non-Hispanic White and 20 Asian American individuals, were recruited in North Central Florida. Clinical KOA pain intensity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the 4 subscales of the Short-Form McGill Pain Questionnaire-2. Quantitative sensory testing was conducted to measure experimental sensitivity to heat- and mechanically induced pain, including heat pain, pressure pain threshold, and punctate mechanical pain, as well as inhibitory pain processes through conditioned pain modulation. Pain catastrophizing was evaluated using the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale, while negative affect was assessed using the Positive and Negative Affect Schedule. Bayesian mediation analyses were used to examine both direct and indirect effects (mediation) between variables. Results: Asian American individuals exhibited higher pain catastrophizing scores than non-Hispanic White individuals. Pain catastrophizing, at high levels, contributed to WOMAC and Short-Form McGill Pain Questionnaire-2, which measured clinical pain. Race had no direct effects on these pain scores but exerted significant indirect effects via pain catastrophizing (WOMAC pain: 0.96, 95% CI 0.03-2.16; continuous pain: 0.84, 95% CI 0.18-1.70; intermittent pain: 0.78, 95% CI 0.03-1.71; neuropathic pain: 0.43, 95% CI 0.03-0.95; and affective pain: 1.05, 95% CI 0.24-1.99); thus, pain catastrophizing likely fully mediated the relationship between race and these pain measures. While Asian American individuals reported greater experimental pain sensitivity (heat pain, pressure pain threshold, and punctate mechanical pain) than non-Hispanic White individuals, these racial effects were not mediated by pain catastrophizing. Asian American individuals reported higher negative affect scores compared with non-Hispanic White individuals; however, negative affect did not mediate the relationship between race and any pain measures. Conclusions:  The results demonstrate the contribution of pain catastrophizing to clinical pain in Asian American individuals with KOA and identify it as a potential mechanism underlying group differences in KOA pain between non-Hispanic White and Asian American individuals. However, caution is warranted due to the exploratory nature of this study and the treatment of Asian American individuals as a monolithic sample. Hence, future replication with larger and more diverse samples is necessary. Additionally, the lack of mediation effects of pain catastrophizing in the relationship between race and experimental pain suggests the need to explore other factors, such as biological, genetic, social, and environmental influences. Moreover, further research is essential to clarify the role of negative affect. %M 39999436 %R 10.2196/64415 %U https://apinj.jmir.org/2025/1/e64415 %U https://doi.org/10.2196/64415 %U http://www.ncbi.nlm.nih.gov/pubmed/39999436 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 8 %N %P e67921 %T Cutaneous Atrophy Following Corticosteroid Injections for Tendonitis: Report of Two Cases %A Colwell,Rebecca %A Gullickson,Mitchell %A Cutlan,Jonathan %A Stratman,Erik %K lipoatrophy %K cutaneous atrophy %K corticosteroid %K adverse effects %K tendonitis %K musculoskeletal %D 2025 %7 13.2.2025 %9 %J JMIR Dermatol %G English %X Cutaneous atrophy resulting from corticosteroid injections for musculoskeletal indications is an underrecognized adverse effect among orthopedists and dermatologists. We present two cases of cutaneous atrophy following corticosteroid injections for wrist tendonitis. Patients presenting with cutaneous atrophy following orthopedic corticosteroid injections may be misdiagnosed with linear morphea, atrophoderma, or vascular disorders and receive unnecessary workups and delays in appropriate management. Dermatologists play an essential role in the evaluation of these patients. %R 10.2196/67921 %U https://derma.jmir.org/2025/1/e67921 %U https://doi.org/10.2196/67921 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59935 %T Effectiveness of Anti-Gravity Treadmill Exercise After Total Knee Arthroplasty: Protocol for a Randomized Controlled Trial %A Jääskeläinen,Elina %A Manninen,Mikko %A Hurri,Heikki %A Rantasalo,Mikko %A Zhou,Yun %A Kautiainen,Hannu %A Ristolainen,Leena %+ Laurea University of Applied Sciences, Metsänpojankuja 3, Espoo, 02130, Finland, 358 504798893, elina.m.jaaskelainen@gmail.com %K total knee arthroplasty %K AlterG %K anti-gravity treadmill %K postoperative rehabilitation %K walking ability %K quality of life %K pain %D 2025 %7 11.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postoperative rehabilitation following total knee arthroplasty (TKA) varies worldwide. In Finland, patients receive guidance on safe walking and home exercises from a physiotherapist both before and after TKA. These are performed independently after surgery. However, a sedentary lifestyle is rather common among patients who have undergone TKA, with pain often limiting postoperative walking, training, and activities of daily living. Objective: This randomized controlled trial aimed to investigate the effectiveness of anti-gravity exercise, precisely the AlterG anti-gravity treadmill, on postoperative rehabilitation following TKA and to obtain new knowledge on this form of rehabilitation to better use it in the future. Methods: This randomized controlled trial study divided the patients into two groups: the intervention group and the control group. The follow-up period was 12 months. Research data were collected through questionnaires and functional tests. All patients in both groups responded to the questionnaires and participated in functional tests before surgery as well as 4 and 12 months after surgery. Patients in the intervention group exercised on the AlterG treadmill 10 times after the surgery. All the patients in this study performed the exercises as instructed when they were in the hospital. The primary outcomes were perceived pain, walking ability, and quality of life. Results: The data collection process began in 2018 and concluded in 2022, intending to obtain valuable information regarding the effect of AlterG training after TKA and determine whether it, along with traditional exercises, could be an effective form of rehabilitation that can be performed at home. We hypothesized that AlterG training would lead to faster rehabilitation, better walking quality, improved quality of life, improved physical activity, and improved overall functioning. The results of this study will be analyzed in 2025 and 2026. Conclusions: This study provides information on how AlterG training can be used in rehabilitation after TKA, further enhancing the rehabilitation program for patients undergoing TKA in general. Trial Registration: ClinicalTrials.gov NCT03904030; https://clinicaltrials.gov/study/NCT03904030 International Registered Report Identifier (IRRID): DERR1-10.2196/59935 %M 39932768 %R 10.2196/59935 %U https://www.researchprotocols.org/2025/1/e59935 %U https://doi.org/10.2196/59935 %U http://www.ncbi.nlm.nih.gov/pubmed/39932768 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 8 %N %P e66440 %T Agreement Between Provider-Completed and Patient-Completed Preoperative Frailty Screening Using the Clinical Risk Analysis Index: Cross-Sectional Questionnaire Study %A Khalighi,Mehraneh %A Thomas,Amy C %A Brown,Karl J %A Ritchey,Katherine C %+ Hospital and Specialty Medicine, VA Puget Sound Health Care System, 1660 South Columbian Way, S-112-SDU, Seattle, WA, 98108, United States, 1 206 764 2183, mehraneh.khalighi@va.gov %K Risk Analysis Index %K preoperative screening %K questionnaire %K frailty %K self-reported %K veteran %K hip %K knee %K arthroplasty %K elective surgery %K cross-sectional %K quality improvement %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Frailty is associated with postoperative morbidity and mortality. Preoperative screening and management of persons with frailty improves postoperative outcomes. The Clinical Risk Analysis Index (RAI-C) is a validated provider-based screening tool for assessing frailty in presurgical populations. Patient self-screening for frailty may provide an alternative to provider-based screening if resources are limited; however, the agreement between these 2 methods has not been previously explored. Objective: The objective of our study was to examine provider-completed versus patient-completed RAI-C assessments to identify areas of disagreement between the 2 methods and inform best practices for RAI-C screening implementation. Methods: Orthopedic physicians and physician assistants completed the RAI-C assessment on veterans aged 65 years and older undergoing elective total joint arthroplasty (eg, total hip or knee arthroplasty) and documented scores into the electronic health record during their preoperative clinic evaluation. Participants were then mailed the same RAI-C form after preoperative evaluation and returned responses to study coordinators. Agreement between provider-completed and patient-completed RAI-C assessments and differences within individual domains were compared. Results: A total of 49 participants aged 65 years and older presenting for total joint arthroplasty underwent RAI-C assessment between November 2022 and August 2023. In total, 41% (20/49) of participants completed and returned an independent postvisit RAI-C assessment before surgery and within 180 days of their initial evaluation. There was a moderate but statistically significant correlation between provider-completed and patient-completed RAI-C assessments (r=0.62; 95% CI 0.25-0.83; P=.003). Provider-completed and patient-completed RAI-C assessments resulted in the same frailty classification in 60% (12/20) of participants, but 40% (8/20) of participants were reclassified to a more frail category based on patient-completed assessment. Agreement was the lowest between provider-completed and patient-completed screening questions regarding memory and activities of daily living. Conclusions: RAI-C had moderate agreement when completed by providers versus the participants themselves, with more than a third of patient-completed screens resulting in a higher frailty classification. Future studies will need to explore the differences between and accuracy of RAI-C screening approaches to inform best practices for preoperative RAI-C assessment implementation. %M 39928399 %R 10.2196/66440 %U https://periop.jmir.org/2025/1/e66440 %U https://doi.org/10.2196/66440 %U http://www.ncbi.nlm.nih.gov/pubmed/39928399 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e63560 %T Quantifying Patient Demand for Orthopedics Care by Region Through Google Trends Analysis: Descriptive Epidemiology Study %A Qiu,Abram %A Meadows,Kristopher %A Ye,Fei %A Iyawe,Osasu %A Kenneth-Nwosa,Kenneth %K orthopedics %K geographic factors %K health care disparities %K medical schools %K internship and residency %K epidemiology %K public health informatics %K physicians %K assessment of health care needs %K resource allocation %D 2025 %7 31.1.2025 %9 %J Online J Public Health Inform %G English %X Background: There is a growing gap between the supply of surgeons and the demand for orthopedic services in the United States. Objective: We analyzed publicly available online data to assess the correlation between the supply of orthopedic surgeons and patient demand across the United States. The geographic trends of this gap were assessed by using the relative demand index (RDI) to guide precision public health interventions such as resource allocation, residency program expansion, and workforce planning to specific regions. Methods: The data used were from the US Census Bureau, Association of American Medical Colleges (AAMC) through their 2024 Electronic Residency Application Service (ERAS) directory, AAMC State Physician Workforce Data Report, and Google Trends. We calculated the normalized relative search volume (RSV) and the RDI and compared them to the densities of orthopedic surgeons across the United States. We examined the disparities with the Spearman rank correlation coefficient. Results: The supply of orthopedic surgeons varied greatly across the United States, with a significantly higher demand for them in southern states (P=.02). The orthopedic surgeon concentration, normalized to the highest density, was the highest in Alaska (n=100), the District of Columbia (n=96), and Wyoming (n=72); and the lowest in Texas (n=0), Arkansas (n=6), and Oklahoma (n=64). The highest RDI values were observed in Utah (n=97), Florida (n=88), and Texas (n=83), while the lowest were observed in Alaska (n=0), the District of Columbia (n=5), and New Hampshire (n=7). The 7 states of Alaska, Maine, South Dakota, Wyoming, Montana, Delaware, and Idaho lacked orthopedic surgery residencies. In 2023, New York (n=19), Michigan (n=17), Ohio (n=17), Pennsylvania (n=16), and California (n=16) had the most residency programs. Demand and supply, represented by the RDI and orthopedic surgeon concentration, respectively, were strongly correlated negatively (ρ=−0.791, P<.001). States that were in the top quartile of residency programs (≥4 residency programs) exhibited a high demand for orthopedic surgeons (ρ=.6035, P=.02). Conclusions: This study showed that regional disparities in access to orthopedic care can be addressed by increasing orthopedic residencies. The study highlights the novel application of the RDI to mapping the regional need for orthopedics, and this map allows for better targeted resource allocation to expand orthopedic surgery training. %R 10.2196/63560 %U https://ojphi.jmir.org/2025/1/e63560 %U https://doi.org/10.2196/63560 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e59850 %T Case-Based Virtual Reality Simulation for Severe Pelvic Trauma Clinical Skill Training in Medical Students: Design and Pilot Study %A Teng,Peng %A Xu,Youran %A Qian,Kaoliang %A Lu,Ming %A Hu,Jun %+ , Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Guang Zhou Road 300, Nanjing, , China, 86 02568303196, junhu89@vip.sina.com %K case-based learning %K virtual reality %K pelvic fracture %K severe pelvic trauma %K hemodynamic instability %K clinical skill training %K VR %K pelvic trauma %K medical student %K pilot study %K orthopedic surgery %K theoretical teaching %K acceptability %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Med Educ %G English %X Background: Teaching severe pelvic trauma poses a significant challenge in orthopedic surgery education due to the necessity of both clinical reasoning and procedural operational skills for mastery. Traditional methods of instruction, including theoretical teaching and mannequin practice, face limitations due to the complexity, the unpredictability of treatment scenarios, the scarcity of typical cases, and the abstract nature of traditional teaching, all of which impede students’ knowledge acquisition. Objective: This study aims to introduce a novel experimental teaching methodology for severe pelvic trauma, integrating virtual reality (VR) technology as a potent adjunct to existing teaching practices. It evaluates the acceptability, perceived ease of use, and perceived usefulness among users and investigates its impact on knowledge, skills, and confidence in managing severe pelvic trauma before and after engaging with the software. Methods: A self-designed questionnaire was distributed to 40 students, and qualitative interviews were conducted with 10 teachers to assess the applicability and acceptability. A 1-group pretest-posttest design was used to evaluate learning outcomes across various domains, including diagnosis and treatment, preliminary diagnosis, disease treatment sequencing, emergency management of hemorrhagic shock, and external fixation of pelvic fractures. Results: A total of 40 students underwent training, with 95% (n=38) affirming that the software effectively simulated real-patient scenarios. All participants (n=40, 100%) reported that completing the simulation necessitated making the same decisions as doctors in real life and found the VR simulation interesting and useful. Teacher interviews revealed that 90% (9/10) recognized the VR simulation’s ability to replicate complex clinical cases, resulting in enhanced training effectiveness. Notably, there was a significant improvement in the overall scores for managing hemorrhagic shock (t39=37.6; 95% CI 43.6-48.6; P<.001) and performing external fixation of pelvic fractures (t39=24.1; 95% CI 53.4-63.3; P<.001) from pre- to postsimulation. Conclusions: The introduced case-based VR simulation of skill-training methodology positively influences medical students’ clinical reasoning, operative skills, and self-confidence. It offers an efficient strategy for conserving resources while providing quality education for both educators and learners. %M 39823600 %R 10.2196/59850 %U https://mededu.jmir.org/2025/1/e59850 %U https://doi.org/10.2196/59850 %U http://www.ncbi.nlm.nih.gov/pubmed/39823600 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58038 %T Skeletal Muscle Mass Loss and Physical Function in Young to Middle-Aged Adult Patients With Diabetes: Cross-Sectional Observational Study %A Naruse,Aki %A Yamada,Yuka %A Miyamoto,Takeshi %+ Division of Medical Technology, Department of Rehabilitation Technology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 8600811, Japan, 81 096 373 7084, aki-naruse@kuh.kumamoto-u.ac.jp %K type 2 diabetes mellitus %K middle-aged adults %K physical function %K skeletal muscle mass %K sarcopenia %D 2024 %7 18.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Recently, it has been reported that older adults with type 2 diabetes mellitus (T2DM) have lower skeletal muscle mass than healthy individuals. Although skeletal muscle mass in older adults with diabetes is occasionally reported, similar reports on young to middle-aged adults are limited. Objective: This study aims to assess the prevalence of skeletal muscle loss in young to middle-aged adults with diabetes, examine the relationship between skeletal muscle loss and physical function in these patients, and examine whether there are differences in these characteristics between men and women. Methods: This cross-sectional, observational study included patients younger than 65 years with T2DM who were admitted to our hospital between 2014 and 2022 for educational admission for glycemic control and requested rehabilitation by the Department of Metabolic Medicine. The control group consisted of patients who received rehabilitation during their hospitalization at our hospital and did not have diabetes. The main parameters included skeletal muscle mass, muscle strength, physical function, and activities of daily living. Results: The prevalence of skeletal muscle mass loss in this study was 18.2% (10/55) in men and 7.7% (4/52) in women. The skeletal muscle mass index (SMI) was 7.7 (SD 0.8) and 8.4 (SD 0.5) for men in the T2DM and control groups, respectively, and 7.0 (SD 0.9) and 6.8 (SD 0.7) for women in the T2DM and control groups, respectively. Therefore, compared with the nondiabetes group, a significant difference was observed in men but not in women (men: P<.001, women: P=.35). Nonetheless, the diabetes group exhibited significantly lower physical functions, such as a walking speed of 1.3 (SD 0.2) m/s and 1.2 (SD 0.43) m/s for men and women in the T2DM group and 1.6 (SD 0.2) m/s and 1.5 (SD 0.1) m/s for men and women in the control group, respectively (men: P<.001, women: P<.001). One-leg standing time was measured as 30.7 (SD 26.9) seconds and 29.4 (SD 25.5) seconds for men and women in the T2DM group, compared with 100.5 (SD 30.6) seconds and 82.5 (SD 39.8) seconds for men and women in the control group, respectively, with the T2DM group’s times being significantly lower (men: P<.001, women: P<.001). Univariate logistic regression analysis showed that SMI was significantly associated with age, BMI, and peripheral neuropathy (all P≤.002). Multiple logistic regression analysis showed that BMI exhibited the strongest association (odds ratio 1.15, 95% CI 1.07-1.23; P<.001), and peripheral neuropathy was also significantly associated with SMI (P=.009). Conclusions: Patients with diabetes, even those who are not older adults, face an elevated rate of skeletal muscle mass loss, muscle weakness, and a decline in physical function; moreover, they are susceptible to dynapenia and presarcopenia. Therefore, early intervention focusing on muscle evaluation and exercise is crucial. %M 39693147 %R 10.2196/58038 %U https://www.i-jmr.org/2024/1/e58038 %U https://doi.org/10.2196/58038 %U http://www.ncbi.nlm.nih.gov/pubmed/39693147 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e51771 %T Real-Time Digitized Visual Feedback in Exercise Therapy for Lower Extremity Functional Deficits: Qualitative Study of Usability Factors During Prototype Testing %A Widhalm,Klaus %A Maul,Lukas %A Durstberger,Sebastian %A Putz,Peter %A Klupper,Carissa %A Werner,Franz %+ Research Center Digital Health and Care, FH Campus Wien, University of Applied Sciences, Favoritenstraße 232, Vienna, 1100, Austria, 43 1 606 68 77 ext 4387, lukas.maul@fh-campuswien.ac.at %K visualization %K lower extremity %K digitized visual feedback %K exercise therapy %K functional deficit %K serious game %K rehabilitation %K osteoarthritis %K usability %K physiotherapy %K mobile phone %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Osteoarthritis is one of the most common degenerative diseases of the musculoskeletal system and can ultimately lead to the need for surgery, such as total knee or hip arthroplasty. Functional movement deficits can be a prognostic factor for osteoarthritis in the lower extremities. Thus, training physiological movement patterns may help in the treatment of such functional deficits. Motivation to exercise frequently is of utmost importance and can be promoted by using digital real-time feedback. Objective: This qualitative study aims to gather user recommendations for prototype feedback visualizations in a real-time exercise-feedback system called homeSETT for the treatment of functional deficits. The system provides real-time feedback to participants while performing exercises that focus on functional deficits, such as lateral trunk lean, pelvic drop, and valgus thrust. The findings of this study should help to optimize the prototype feedback visualizations. Thus, the main research questions were how patients, physiotherapists, and physicians evaluate the presented, current state of prototype feedback visualizations for selected functional exercises, and what improvements and variations would be recommended. Methods: Testing of the prototype feedback visualizations took place at a movement laboratory using a 3D optoelectronic movement analysis system. Data on usability factors were acquired using the thinking aloud method during and semistructured interviews after prototype testing. Transcribed audio recordings of semistructured interviews as well as scribing logs of the thinking aloud method were examined using qualitative content analysis. Results: Data were analyzed from 9 participants, comprising 2 (22%) patients, 2 (22%) physicians, and 5 (56%) physiotherapists. The mean age of the participants was 45 (SD 9) years and the mean work experience among the participating physiotherapists and physicians was 22 (SD 5) years. Each participant tested 11 different exercise-feedback combinations. Overall, results indicated that participants enjoyed the prototype feedback visualizations and believed that they could be used in therapeutic settings. Participants appreciated the simplicity, clarity, and self-explanatory nature of the feedback visualizations. While most participants quickly familiarized themselves, some struggled to recognize the feedback goals and connect the visualizations to their movements. Recommendations for improvement included optimizing color schemes, sensitivity, and difficulty adjustments. Adding instructional information and game design elements, such as repetition counting and reward systems, was deemed useful. The main study limitations were the small sample size and the use of feedback on performance as the sole feedback modality. Conclusions: The prototype feedback visualizations were positively perceived by the participants and were considered applicable in therapy settings. Insights were gathered on improving the color scheme, sensitivity, and recognizability of the feedback visualizations. The implementation of additional gamification and instructional elements was emphasized. Future work will optimize the prototype feedback visualizations based on study results and evaluate the homeSETT system’s efficacy in eligible patient populations. %R 10.2196/51771 %U https://games.jmir.org/2024/1/e51771 %U https://doi.org/10.2196/51771 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56522 %T Factors Influencing Outcome After Shoulder Arthroplasty (FINOSA Study): Protocol of a Prospective Longitudinal Study With Randomized Group Allocation %A Claes,Anke %A De Mesel,Annelien %A Struyf,Thomas %A Verborgt,Olivier %A Struyf,Filip %+ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein, 1, Wilrijk, 2610, Belgium, 32 32652783, filip.struyf@uantwerpen.be %K shoulder arthroplasty %K influencing factors %K rehabilitation %K arthroplasty %K shoulder %K FINOSA-study %K evidence based %K post-operative rehabilitation %K rehabilitation protocols %K shoulder pain %K clinical outcomes %K geriatrics %K longitudinal study %K shoulder dysfunction %D 2024 %7 18.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction. Objective: This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery. Methods: To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner. Results: Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed. Conclusions: Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty. Trial Registration: ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267 International Registered Report Identifier (IRRID): DERR1-10.2196/56522 %M 39556824 %R 10.2196/56522 %U https://www.researchprotocols.org/2024/1/e56522 %U https://doi.org/10.2196/56522 %U http://www.ncbi.nlm.nih.gov/pubmed/39556824 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59607 %T Examining the Role of Large Language Models in Orthopedics: Systematic Review %A Zhang,Cheng %A Liu,Shanshan %A Zhou,Xingyu %A Zhou,Siyu %A Tian,Yinglun %A Wang,Shenglin %A Xu,Nanfang %A Li,Weishi %+ Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China, 86 01082267360, puh3liweishi@163.com %K large language model %K LLM %K orthopedics %K generative pretrained transformer %K GPT %K ChatGPT %K digital health %K clinical practice %K artificial intelligence %K AI %K generative AI %K Bard %D 2024 %7 15.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Large language models (LLMs) can understand natural language and generate corresponding text, images, and even videos based on prompts, which holds great potential in medical scenarios. Orthopedics is a significant branch of medicine, and orthopedic diseases contribute to a significant socioeconomic burden, which could be alleviated by the application of LLMs. Several pioneers in orthopedics have conducted research on LLMs across various subspecialties to explore their performance in addressing different issues. However, there are currently few reviews and summaries of these studies, and a systematic summary of existing research is absent. Objective: The objective of this review was to comprehensively summarize research findings on the application of LLMs in the field of orthopedics and explore the potential opportunities and challenges. Methods: PubMed, Embase, and Cochrane Library databases were searched from January 1, 2014, to February 22, 2024, with the language limited to English. The terms, which included variants of “large language model,” “generative artificial intelligence,” “ChatGPT,” and “orthopaedics,” were divided into 2 categories: large language model and orthopedics. After completing the search, the study selection process was conducted according to the inclusion and exclusion criteria. The quality of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials and CONSORT-AI (Consolidated Standards of Reporting Trials–Artificial Intelligence) guidance. Data extraction and synthesis were conducted after the quality assessment. Results: A total of 68 studies were selected. The application of LLMs in orthopedics involved the fields of clinical practice, education, research, and management. Of these 68 studies, 47 (69%) focused on clinical practice, 12 (18%) addressed orthopedic education, 8 (12%) were related to scientific research, and 1 (1%) pertained to the field of management. Of the 68 studies, only 8 (12%) recruited patients, and only 1 (1%) was a high-quality randomized controlled trial. ChatGPT was the most commonly mentioned LLM tool. There was considerable heterogeneity in the definition, measurement, and evaluation of the LLMs’ performance across the different studies. For diagnostic tasks alone, the accuracy ranged from 55% to 93%. When performing disease classification tasks, ChatGPT with GPT-4’s accuracy ranged from 2% to 100%. With regard to answering questions in orthopedic examinations, the scores ranged from 45% to 73.6% due to differences in models and test selections. Conclusions: LLMs cannot replace orthopedic professionals in the short term. However, using LLMs as copilots could be a potential approach to effectively enhance work efficiency at present. More high-quality clinical trials are needed in the future, aiming to identify optimal applications of LLMs and advance orthopedics toward higher efficiency and precision. %M 39546795 %R 10.2196/59607 %U https://www.jmir.org/2024/1/e59607 %U https://doi.org/10.2196/59607 %U http://www.ncbi.nlm.nih.gov/pubmed/39546795 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e60655 %T Completion Rate and Satisfaction With Online Computer-Assisted History Taking Questionnaires in Orthopedics: Multicenter Implementation Report %A Craamer,Casper %A Timmers,Thomas %A Siebelt,Michiel %A Kool,Rudolf Bertijn %A Diekerhof,Carel %A Caron,Jan Jacob %A Gosens,Taco %A van der Weegen,Walter %K computer-assisted history taking %K history taking %K digital medical interview %K orthopedics %K digital health %K computer-assisted %K cohort study %K orthopedic %K outpatient %K satisfaction %K patient engagement %K medical record %D 2024 %7 13.11.2024 %9 %J JMIR Med Inform %G English %X Background: Collecting the medical history during a first outpatient consultation plays an important role in making a diagnosis. However, it is a time-consuming process, and time is scarce in today’s health care environment. The computer-assisted history taking (CAHT) systems allow patients to share their medical history electronically before their visit. Although multiple advantages of CAHT have been demonstrated, adoption in everyday medical practice remains low, which has been attributed to various barriers. Objective: This study aimed to implement a CAHT questionnaire for orthopedic patients in preparation for their first outpatient consultation and analyze its completion rate and added value. Methods: A multicenter implementation study was conducted in which all patients who were referred to the orthopedic department were invited to self-complete the CAHT questionnaire. The primary outcome of the study is the completion rate of the questionnaire. Secondary outcomes included patient and physician satisfaction. These were assessed via surveys and semistructured interviews. Implementation (Results): In total, 5321 patients were invited, and 4932 (92.7%) fully completed the CAHT questionnaire between April 2022 and July 2022. On average, participants (n=224) rated the easiness of completing the questionnaire at 8.0 (SD 1.9; 0‐10 scale) and the satisfaction of the consult at 8.0 (SD 1.7; 0‐10 scale). Satisfaction with the outpatient consultation was higher in cases where the given answers were used by the orthopedic surgeon during this consultation (median 8.3, IQR 8.0‐9.1 vs median 8.0, IQR 7.0‐8.5; P<.001). Physicians (n=15) scored the average added value as 7.8 (SD 1.7; 0‐10 scale) and unanimously recognized increased efficiency, better patient engagement, and better medical record completeness. Implementing the patient’s answers into the electronic health record was deemed necessary. Conclusions: In this study, we have shown that previously recognized barriers to implementing and adapting CAHT can now be effectively overcome. We demonstrated that almost all patients completed the CAHT questionnaire. This results in reported improvements in both the efficiency and personalization of outpatient consultations. Given the pressing need for personalized health care delivery in today’s time-constrained medical environment, we recommend implementing CAHT systems in routine medical practice. %R 10.2196/60655 %U https://medinform.jmir.org/2024/1/e60655 %U https://doi.org/10.2196/60655 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57359 %T Sex-Specific Trends in the Prevalence of Osteoarthritis and Rheumatoid Arthritis From 2005 to 2021 in South Korea: Nationwide Cross-Sectional Study %A Park,Seoyoung %A Son,Yejun %A Lee,Hyeri %A Lee,Hayeon %A Lee,Jinseok %A Kang,Jiseung %A Smith,Lee %A Rahmati,Masoud %A Dragioti,Elena %A Tully,Mark A %A Fond,Guillaume %A Boyer,Laurent %A Lee,Jun Hyuk %A Pizzol,Damiano %A Park,Jaeyu %A Woo,Selin %A Yon,Dong Keon %+ Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, 23 Kyungheedae–ro, Dongdaemun–gu, Seoul, 02447, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K epidemiology %K osteoarthritis %K rheumatoid arthritis %K South Korea %K trend %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Osteoarthritis and rheumatoid arthritis (RA) are prevalent chronic joint disorders, with prevalence rates varying by sex. However, few studies have comprehensively documented the factors contributing to the sex-specific prevalence of osteoarthritis and RA, including sociological factors and the impact of the COVID-19 pandemic. Objective: This study aims to identify long-term trends in the sex-specific prevalence of osteoarthritis and RA from 2005 to 2021 while examining the factors that serve as vulnerabilities specific to each sex within the context of the COVID-19 pandemic. Methods: Data were collected from a nationally representative sample of 110,225 individuals through the Korea National Health and Nutrition Examination Survey from 2005 to 2021. The study included patients aged 19 years and older diagnosed with osteoarthritis or RA in South Korea. Data were analyzed using weighted trends to accurately represent the sample population, with a 95% CI. Weighted logistic and regression models were used to identify vulnerable groups at risk of osteoarthritis or RA during the pandemic to assess sex-specific trends. Results: In total, 110,225 individuals (n=48,410, 43.92% male participants) were analyzed from 2005 to 2021, with prevalence rates remaining stable over time and higher in female than in male participants. Notably, during the pandemic, female participants aged 60 years and older exhibited a prevalence of osteoarthritis that was 4.92 times greater than male participants and a prevalence of RA that was 6.44 times greater (osteoarthritis: prevalence ratio [PR] 69.78, 95% CI 41.66-116.88; RA: PR 17.27, 95% CI 8.75-34.07). In terms of osteoarthritis, male participants did not show a significant association with BMI (PR 1.40, 95% CI 1.21-1.61; P=.47), whereas female participants exhibited a significantly higher vulnerability within the obese group (PR 1.68, 95% CI 1.55-1.83; P<.001). Regarding RA, lower education levels were associated with increased vulnerability, with male participants showing a greater risk than female participants (male participants: PR 2.29, 95% CI 1.61-3.27 and female participants: PR 1.50, 95% CI 1.23-1.84). Conclusions: This study reveals that women in South Korea have a higher prevalence of osteoarthritis and RA than men. Understanding these sex-specific trends and identifying vulnerability factors can enhance preventive efforts and patient care. %M 39486025 %R 10.2196/57359 %U https://publichealth.jmir.org/2024/1/e57359 %U https://doi.org/10.2196/57359 %U http://www.ncbi.nlm.nih.gov/pubmed/39486025 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58340 %T Effectiveness of Self-Management Programs Among Athletes With Patellofemoral Pain Syndrome: Protocol for a Systematic Review %A Masoudi,Ameen %A Chemane,Nomzamo %A Useh,Ushotanefe %A Bello,Bashir %A Magida,Nontembiso %+ Physiotherapy Department, University of KwaZulu-Natal, E Block Westville Campus, Durban, 3629, South Africa, 27 312608147, aa.masoudi22@gmail.com %K patellofemoral pain syndrome %K athletes %K self-management %K chronic pain %K pain management %K systematic review %D 2024 %7 1.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patellofemoral pain syndrome is a highly prevalent overuse knee injury in athletic populations associated with pain and functional limitations, exacerbated by activities such as running, pivoting, cycling, and jumping. Self-management programs empowering athletes to take an active role in controlling their symptoms for chronic musculoskeletal conditions such as patellofemoral pain syndrome have grown in popularity. However, the efficacy of self-management programs specifically for athletes with patellofemoral pain syndrome is unclear due to limited and heterogeneous evidence. Objective: The systematic review study will evaluate the effectiveness of self-management programs on pain and function, in athletes with patellofemoral pain syndrome. Methods: PubMed/MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases will be systematically searched using terms related to “patellofemoral pain syndrome,” “self-management,” and “athletes.” Interventional studies that are randomized and nonrandomized controlled trials will be included, comparing self-management programs to other treatments or control conditions among athletes with patellofemoral pain syndrome. Four reviewers will independently screen studies, extract data using the COVIDENCE software, and assess the quality of the study and evidence using the Pedro scale of risk of bias tool and GRADE approach, respectively. If feasible, a meta-analysis will be performed using the RevMan (version 5.4; the Cochrane Collaboration). Results: The systematic review is currently in the search phase, with the authors refining search strings for the selected databases. The final search strings are expected to be ready by March 2024, and the review is projected to be completed by July 2024. Conclusions: This systematic review protocol outlines a rigorous methodology for evaluating the effectiveness of self-management programs among athletes with patellofemoral pain syndrome. The findings will inform clinical practice and guide the development of tailored interventions to optimize outcomes for athletes with patellofemoral pain syndrome. Trial Registration: PROSPERO CRD42023492746; https://tinyurl.com/c5jze9ca International Registered Report Identifier (IRRID): PRR1-10.2196/58340 %M 39485375 %R 10.2196/58340 %U https://www.researchprotocols.org/2024/1/e58340 %U https://doi.org/10.2196/58340 %U http://www.ncbi.nlm.nih.gov/pubmed/39485375 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59016 %T Development of the Happy Hands Self-Management App for People with Hand Osteoarthritis: Feasibility Study %A Tveter,Anne Therese %A Varsi,Cecilie %A Maarnes,Marit Kristin %A Pedersen,Stein Jarle %A Christensen,Barbara S %A Blanck,Thale Beate %A Nyheim,Sissel B %A Pelle,Tim %A Kjeken,Ingvild %+ Health Service Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Diakonveien 12, Oslo, 0319, Norway, 47 22451500, a.t.tveter@medisin.uio.no %K Osteoarthritis %K hand exercises %K home exercise %K first-line treatment %K mHealth %K eHealth %K self-management %K app development %K design %K usefulness %K satisfaction %K activity performance %K social cognitive theory %K behavior change %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient education, hand exercises, and the use of assistive devices are recommended as first-line treatments for individuals with hand osteoarthritis (OA). However, the quality of care services for this patient group is suboptimal in primary care. Objective: The overarching goal was to develop and evaluate feasibility of an app-based self-management intervention for people with hand OA. This feasibility study aims to assess self-reported usability and satisfaction, change in outcomes and quality-of-care, exercise adherence and patients’ experiences using the app. Methods: The development and feasibility testing followed the first 2 phases of the Medical Research Council framework for the development and evaluation of complex interventions and were conducted in close collaboration with patient research partners (PRPs). A 3-month pre-post mixed methods design was used to evaluate feasibility. Men and women over 40 years of age diagnosed with painful, symptomatic hand OA were recruited. Usability was assessed using the System Usability Scale (0-100), while satisfaction, usefulness, pain, and stiffness were evaluated using a numeric rating scale (NRS score from 0 to 10). The activity performance of the hand was measured using the Measure of Activity Performance of the Hand (MAP-Hand) (1-4), grip strength was assessed with a Jamar dynamometer (kg), and self-reported quality of care was evaluated using the Osteoarthritis Quality Indicator questionnaire (0-100). Participants were deemed adherent if they completed at least 2 exercise sessions per week for a minimum of 8 weeks. Focus groups were conducted to explore participants’ experiences using the app. Changes were analyzed using a paired sample t test (mean change and 95% CI), with the significance level set at P<.05. Results: The first version of the Happy Hands app was developed based on the needs and requirements of the PRPs, evidence-based treatment recommendations, and the experiences of individuals living with hand OA. The app was designed to guide participants through a series of informational videos, exercise videos, questionnaires, quizzes, and customized feedback over a 3-month period. The feasibility study included 71 participants (mean age 64 years, SD 8; n=61, 86%, women), of whom 57 (80%) completed the assessment after 3 months. Usability (mean 91.5 points, SD 9.2 points), usefulness (median 8, IQR 7-10), and satisfaction (median 8, IQR 7-10) were high. Significant improvements were observed in self-reported quality of care (36.4 points, 95% CI 29.7-43.1, P<.001), grip strength (right: 2.9 kg, 95% CI 1.7-4.1; left: 3.2 kg, 95% CI 1.9-4.6, P<.001), activity performance (0.18 points, 95% CI 0.11-0.25, P<.001), pain (1.7 points, 95% CI 1.2-2.2, P<.001), and stiffness (1.9 points, 95% CI 1.3-2.4, P=.001) after 3 months. Of the 71 participants, 53 (75%) were adherent to the exercise program. The focus groups supported these results and led to the implementation of several enhancements in the second version of the app. Conclusions: The app-based self-management intervention was deemed highly usable and useful by patients. The results further indicated that the intervention may improve quality of care, grip strength, activity performance, pain, and stiffness. However, definitive conclusions need to be confirmed in a powered randomized controlled trial. Trial Registration: NCT05150171 %M 39470716 %R 10.2196/59016 %U https://formative.jmir.org/2024/1/e59016 %U https://doi.org/10.2196/59016 %U http://www.ncbi.nlm.nih.gov/pubmed/39470716 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57635 %T Patient Engagement in a Mobile App–Based Rehabilitation Program for Total Hip or Knee Arthroplasty: Secondary Data Analysis of a Randomized Controlled Trial %A Wang,Qingling %A Lee,Regina Lai-Tong %A Hunter,Sharyn %A Zhu,Aiyong %A Chan,Sally Wai-Chi %+ School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, No. 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China, 86 13918170613, my_wql0719@163.com %K total hip arthroplasty %K total knee arthroplasty %K rehabilitation %K mobile health %K social media application %K patient engagement %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care professionals use mobile apps to support patients’ rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients. Objective: This study aimed to investigate patient engagement in a mobile app–based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics. Methods: Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])–based program to support patients’ rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants’ posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics. Results: The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95% CI 1.98-15.35; χ21=11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95% CI 0.45-5.48; χ21=5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy. Conclusions: Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the design of mobile arthroplasty rehabilitation programs to enhance patient engagement in such interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000867897; https://tinyurl.com/mtdw25fp %M 39353187 %R 10.2196/57635 %U https://mhealth.jmir.org/2024/1/e57635 %U https://doi.org/10.2196/57635 %U http://www.ncbi.nlm.nih.gov/pubmed/39353187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55576 %T Effectiveness of Internet-Based Telehealth Programs in Patients With Hip or Knee Osteoarthritis: Systematic Review and Meta-Analysis %A Wang,Hao-Nan %A Luo,Pei %A Liu,Shuyue %A Liu,Yunyi %A Zhang,Xiao %A Li,Jian %+ Sports Medicine Center, West China Hospital, Sichuan University, No 37, Guoxue Lane, Wuhou District, Chengdu, 610041, China, 86 18980601388, lijian_sportsmed@163.com %K osteoarthritis %K knee %K hip %K telehealth %K telemedicine %K telerehabilitation %K eHealth %K exercise %K PRISMA %D 2024 %7 30.9.2024 %9 Review %J J Med Internet Res %G English %X Background: Osteoarthritis (OA) is a chronic musculoskeletal disease that causes pain, functional disability, and an economic burden. Nonpharmacological treatments are at the core of OA management. However, limited access to these services due to uneven regional local availability has been highlighted. Internet-based telehealth (IBTH) programs, providing digital access to abundant health care resources, offer advantages, such as convenience and cost-effectiveness. These characteristics make them promising strategies for the management of patients with OA. Objective: This study aimed to evaluate the effectiveness of IBTH programs in the management of patients with hip or knee OA. Methods: We systematically searched 6 electronic databases to identify trials comparing IBTH programs with conventional interventions for hip and knee OA. Studies were selected based on inclusion and exclusion criteria, focusing on outcomes related to function, pain, and self-efficacy. Standardized mean differences (SMDs) with 95% CIs were calculated to compare outcome measures. Heterogeneity was assessed using I² and χ² tests. The methodological quality of the selected studies and the quality of evidence were also evaluated. Results: A total of 21 studies with low-to-high risk of bias were included in this meta-analysis. The pooled results showed that IBTH has a superior effect on increasing function (SMD 0.30, 95% CI 0.23-0.37, P<.001), relieving pain (SMD –0.27, 95% CI –0.34 to –0.19, P<.001), and improving self-efficacy for pain (SMD 0.21, 95% CI 0.08-0.34, P<.001) compared to the conventional intervention group. Subgroup analysis revealed that IBTH with exercise can significantly alleviate pain and improve function and self-efficacy, but IBTH with cognitive-behavioral therapy only had the effect of reducing pain. Conclusions: The meta-analysis provides moderate-quality evidence that IBTH programs have a beneficial effect on improving function, relieving pain, and improving self-efficacy compared to conventional interventions in patients with hip or knee OA. Limited evidence suggests that the inclusion of exercise regimens in IBTH programs is recommended. Trial Registration: PROSPERO CRD42024541111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=541111 %M 39348685 %R 10.2196/55576 %U https://www.jmir.org/2024/1/e55576 %U https://doi.org/10.2196/55576 %U http://www.ncbi.nlm.nih.gov/pubmed/39348685 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55322 %T Development of a 12-Week Unsupervised Online Tai Chi Program for People With Hip and Knee Osteoarthritis: Mixed Methods Study %A Zhu,Shiyi Julia %A Bennell,Kim L %A Hinman,Rana S %A Harrison,Jenny %A Kimp,Alexander J %A Nelligan,Rachel K %+ Department of Physiotherapy, School of Health Sciences, Centre for Health, Exercise and Sports Medicine, University of Melbourne, 161 Barry Street, Parkville, Melbourne, 3010, Australia, 61 3 8344 0556, k.bennell@unimelb.edu.au %K intervention development %K osteoarthritis %K Tai Chi %K web-based intervention %K online %K telehealth %K unsupervised exercise %K exercise %K physical activity %K arthritis %K development %K web based %K hip %K knee %K gerontology %K geriatric %K older adult %K aging %K bone %K workout %K digital health %K eHealth %K literature review %K telemedicine %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Osteoarthritis is a leading contributor to global disability. While evidence supports the effectiveness of Tai Chi in improving symptoms for people with hip/knee osteoarthritis, access to in-person Tai Chi classes may be difficult for many people. An unsupervised online Tai Chi intervention for people with osteoarthritis can help overcome accessibility barriers. The Approach to Human-Centered, Evidence-Driven Adaptive Design (AHEAD) framework provides a practical guide for co-designing such an intervention. Objective: This study aims to develop an unsupervised online Tai Chi program for people with hip/knee osteoarthritis. Methods: An iterative process was conducted using the AHEAD framework. Initially, a panel of Tai Chi instructors and people with osteoarthritis was assembled. A literature review was conducted to inform the content of a survey (survey 1), which was completed by the panel and additional Australian Tai Chi instructors to identify Tai Chi movements for potential inclusion. Selection of Tai Chi movements was based on 3 criteria: those that were appropriate (for people with hip/knee osteoarthritis aged 45+ years), safe (to be performed at home unsupervised), and practical (to be delivered online using prerecorded videos). Movements that met these criteria were then ranked in a second survey (survey 2; using conjoint analysis methodology). Survey findings were discussed in a focus group, and the Tai Chi movements for program use were identified. A draft of the online Tai Chi program was developed, and a final survey (survey 3) was conducted with the panel to rate the appropriateness and safety of the proposed program. The final program was developed, and usability testing (think-aloud protocol) was conducted with people with knee osteoarthritis. Results: The panel consisted of 10 Tai Chi instructors and 3 people with osteoarthritis. The literature review identified Yang Style 24 as a common and effective Tai Chi style used in hip/knee osteoarthritis studies. Surveys 1 (n=35) and 2 (n=27) produced a ranked list of 24 Tai Chi movements for potential inclusion. This list was refined and informed by a focus group, with 10 Tai Chi movements being selected for inclusion (known as the Yang Style 10 form). Survey 3 (n=13) found that 92% (n=12) of the panel members believed that the proposed draft Tai Chi program was appropriate and safe, resulting in its adoption. The final program was produced and hosted on a customized website, “My Joint Tai Chi,” which was further refined based on user feedback (n=5). “My Joint Tai Chi” is currently being evaluated in a randomized controlled trial. Conclusions: This study demonstrates the use of the AHEAD framework to develop an unsupervised online Tai Chi intervention (“My Joint Tai Chi”) for people with hip/knee osteoarthritis. This intervention is now being tested for effectiveness and safety in a randomized controlled trial. %M 39348676 %R 10.2196/55322 %U https://aging.jmir.org/2024/1/e55322 %U https://doi.org/10.2196/55322 %U http://www.ncbi.nlm.nih.gov/pubmed/39348676 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57820 %T Improving the Care of Severe, Open Fractures and Postoperative Infections of the Lower Extremities: Protocol for an Interdisciplinary Treatment Approach %A Rosslenbroich,Steffen %A Laumann,Marion %A Hasebrook,Joachim %A Rodde,Sibyll %A Grosser,John %A Greiner,Wolfgang %A Hirsch,Tobias %A Windrich,Stefan %A Raschke,Michael J %+ ZEB Business School, Steinbeis University, Breitscheidstr 51, Madgeburg, 39114, Germany, 49 15152647546, jhasebrook@zeb-bs.de %K open fracture %K open soft tissue damage %K telemedicine %K plastic surgery %K infectiology %K limb function %K health-related quality of life %K workload %K work engagement %K health economic evaluation %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with open fractures often experience complications during their injury. The treatments incur high costs. Interdisciplinary cooperation between different medical disciplines may improve treatment outcomes. Such cooperation has not yet been envisaged in the German health care system. Objective: The aim of the study is to improve the treatment of fractures with open soft tissue damage or postoperative complications in terms of duration and sustainability in a region in northwest Germany. Largely standardized diagnostics and therapy are intended to optimize processes in hospitals. In addition, a reduction in the duration of treatment and treatment costs is to be achieved. Methods: Using a digital platform, physicians from 31 hospitals present patient cases to an interdisciplinary group of experts from the fields of plastic surgery, infectiology, hygiene, and others. The group of experts from the environment of the University Hospital Münster promptly makes a joint treatment recommendation for the individual case. The plan is to examine 3300 patients with open fractures or surgical complications. As consortium partners, there are also 3 statutory health insurance companies. The extent to which the therapy recommendations are effective and contribute to cost reduction in the health care system will be empirically investigated in a stepped-wedge cluster-randomized design. In addition, medical and nonmedical professional groups involved in the project will be asked about their work in the project (in total, 248 clinic employees). The primary outcome is the complication rate of open fractures or the occurrence of postoperative complications. As secondary outcomes, the number of antibiotics administered, limb function, and quality of life will be assessed. The health economic evaluation refers to the costs of health services and absenteeism. For the work-related evaluation, workload, work engagement, work-related resources, readiness for technology, and ergonomic aspects of the new telemedical technology will be collected. In addition, clinic employees will give their assessments of the success of the project in a structured telephone interview based on scaled and open-ended questions. Results: The project started in June 2022; data collection started in April 2023. As of mid-June 2024, data from 425 patients had been included. In total, 146 members of staff had taken part in the questionnaire survey and 15 had taken part in the interviews. Conclusions: Standardized treatment pathways in the standard care of patients with open fractures and postoperative infections will be established to reduce complications, improve chances of recovery, and reduce costs. Unnecessary and redundant treatment steps will be avoided through standardized diagnostics and therapy. The interdisciplinary treatment perspective allows for a more individualized therapy. In the medium term, outpatient or inpatient treatment centers specialized in the patient group could be set up where the new diagnostic and therapeutic pathways could be competently applied. Trial Registration: German Clinical Trials Register DRKS00031308; https://drks.de/search/de/trial/DRKS00031308 International Registered Report Identifier (IRRID): DERR1-10.2196/57820 %R 10.2196/57820 %U https://www.researchprotocols.org/2024/1/e57820 %U https://doi.org/10.2196/57820 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51898 %T Implementation and Evaluation of a Gait Training Assistant for the Use of Crutches: Usability Study %A Wolf,Milan Anton %A Sauerwald,Leon %A Kosmalla,Felix %A Daiber,Florian %A Krüger,Antonio %A Landgraeber,Stefan %+ Department of Ortopedic Surgery, Saarland University Medical Center, Kirrberger Straße, Homburg, 66421, Germany, 49 068411624500, milan.wolf@uks.eu %K telerehabilitation %K orthopedics %K digital gait trainer %K orthopedic %K gait %K movement %K walk %K walking %K crutch %K crutches %K sensor %K sensors %K rehabilitation %K usability %K digital health %K physiotherapy %K physical therapy %K telehealth %K telemedicine %K eHealth %K virtual %K locomotor %K locomotion %D 2024 %7 16.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Surgical procedures on the lower extremities often require weight-bearing on crutches as part of the rehabilitation process. Orthopedic elective procedures enable patients to learn the correct use of crutches in a controlled preoperative setting. Digital assistance systems can safely circumvent a shortage of skilled staff and any contact restrictions that may be necessary. Objective: The usability of a newly developed gait training assistant (GTA) for the use of crutches will be evaluated. An intervention group trained to use crutches by the digital trainer will be compared with a control group trained to use crutches conventionally by a physiotherapist. Methods: As part of the development and implementation of a novel GTA, 14 patients learned to walk with crutches by completing specific exercises while receiving live feedback. Their movements were detected by a depth sensor and evaluated in real time. Specific parameters (step length, synchronous movement, crutch angle, and crutch distance to the feet) were compared with a control group (n=14) trained to use crutches by physiotherapists. The intervention group was also assessed by a physiotherapist. At the end of the study, the patients completed questionnaires to evaluate the usability of the system (Brooke’s System Usability Scale score) and patient satisfaction. Results: All patients trained by the novel GTA were able to use crutches correctly. The intervention group showed significantly better values for crutch angle (mean –6.3°, SD 3.5° vs mean –12.4°, SD 4.5°; P<.001) and crutch position (mean 3.3, SD 5.1 cm vs mean –8.5, SD 4.9 cm; P=.02). Both groups reported that they felt confident in the use of crutches, were able to follow the instructions, and enjoyed the training. Even though the majority (12/14, 86%) preferred physical therapy over a purely digital approach, most participants enjoyed using the system (13/14, 93%) and were interested in trying out other digital assistants (11/14, 79%). The usability of the GTA was rated above average by the majority (9/14, 64%) of the patients. Conclusions: The newly designed GTA is a safe method of teaching the use of crutches and is statistically superior to training by a physiotherapist. Even if patients prefer interaction with a physiotherapist over a purely digital approach, digital devices provide a safe and motivating opportunity to learn the essential locomotor skills for rehabilitation. %M 39150759 %R 10.2196/51898 %U https://humanfactors.jmir.org/2024/1/e51898 %U https://doi.org/10.2196/51898 %U http://www.ncbi.nlm.nih.gov/pubmed/39150759 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49482 %T Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis %A Pliannuom,Suphawita %A Pinyopornpanish,Kanokporn %A Buawangpong,Nida %A Wiwatkunupakarn,Nutchar %A Mallinson,Poppy Alice Carson %A Jiraporncharoen,Wichuda %A Angkurawaranon,Chaisiri %+ Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand, 66 53935462, kanokporn.pinyopo@cmu.ac.th %K home-based intervention %K digital health interventions %K postoperative care %K older adults %K hip fracture %D 2024 %7 12.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. Objective: This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. Methods: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results: Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=–7.89; 95% CI –10.34 to –5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). Conclusions: Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population. %M 38865706 %R 10.2196/49482 %U https://www.jmir.org/2024/1/e49482 %U https://doi.org/10.2196/49482 %U http://www.ncbi.nlm.nih.gov/pubmed/38865706 %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 %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50430 %T A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study %A Papadopoulos,Petros %A Soflano,Mario %A Connolly,Thomas %+ University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 7920756076, petros.papadopoulos@gmail.com %K mobile health %K mHealth %K digital health intervention %K total knee replacement %K TKR %K total hip replacement %K THR %K dynamic hip screw %K DHS %K rehabilitation %K usability %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. Objective: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. Methods: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. Results: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range −3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. Conclusions: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw. %M 38743479 %R 10.2196/50430 %U https://humanfactors.jmir.org/2024/1/e50430 %U https://doi.org/10.2196/50430 %U http://www.ncbi.nlm.nih.gov/pubmed/38743479 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53336 %T Professional Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Questionnaire-Based Study %A Youssef,Yasmin %A Gehlen,Tobias %A Ansorg,Jörg %A Back,David Alexander %A Scherer,Julian %+ Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 762030775, julian.scherer@usz.ch %K social media %K digitalization %K digital communication %K orthopedics %K traumatology %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has been recognized as a professional communication tool in the field of orthopedic and trauma surgery that can enhance communication with patients and peers, and increase the visibility of research and offered services. The specific purposes of professional SM use and the benefits and concerns among orthopedic and trauma surgeons, however, remain unexplored. Objective: This study aims to demonstrate the specific uses of different SM platforms among orthopedic and trauma surgeons in Germany as well as the advantages and concerns. Methods: A web-based questionnaire was developed on the use of SM in a professional context by considering the current literature and the authors’ topics of interest. The final questionnaire consisted of 33 questions and was distributed among German orthopedic and trauma surgeons via the mail distributor of the Berufsverband für Orthopädie und Unfallchirurgie (Professional Association of Orthopaedic Surgeons in Germany). The study was conducted between June and July 2022. A subgroup analysis was performed for sex (male vs female), age (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Results: A total of 208 participants answered the questionnaire (male: n=166, 79.8%; younger than 60 years: n=146, 70.2%). In total, all of the participants stated that they use SM for professional purposes. In contrast, the stated specific uses of SM were low. Overall, the most used platforms were employment-oriented SM, messenger apps, and Facebook. Instagram emerged as a popular choice among female participants and participants working in hospital settings. The highest specific use of SM was for professional networking, followed by receiving and sharing health-related information. The lowest specific use was for education and the acquisition of patients. Conventional websites occupied a dominating position, exceeding the use of SM across all specific uses. The key benefit of SM was professional networking. Under 50% of the participants stated that SM could be used to enhance communication with their patients, keep up-to-date, or increase their professional visibility. In total, 65.5% (112/171) of participants stated that SM use was time-consuming, 43.9% (76/173) stated that they lacked application knowledge, and 45.1% (78/173) stated that they did not know what content to post. Additionally, 52.9% (91/172) mentioned medicolegal concerns. Conclusions: Overall, SM did not seem to be used actively in the professional context among orthopedic and trauma surgeons in Germany. The stated advantages were low, while the stated concerns were high. Adequate education and information material are needed to elucidate the possible professional applications of SM and to address legal concerns. %M 38639987 %R 10.2196/53336 %U https://formative.jmir.org/2024/1/e53336 %U https://doi.org/10.2196/53336 %U http://www.ncbi.nlm.nih.gov/pubmed/38639987 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48947 %T Sex- and Age-Specific Prevalence of Osteopenia and Osteoporosis: Sampling Survey %A Fan,Yao %A Li,Qun %A Liu,Yu %A Miao,Jing %A Zhao,Ting %A Cai,Jinxin %A Liu,Min %A Cao,Jun %A Xu,Haifeng %A Wei,Lai %A Li,Mengxia %A Shen,Chong %+ Department of Epidemiology, School of Public Health, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 25 86868443, sc@njmu.edu.cn %K cross-sectional study %K osteopenia %K osteoporosis %K prevalence %K quantitative ultrasound %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Osteopenia and osteoporosis are posing a long-term influence on the aging population’s health contributing to a higher risk of mortality, loss of autonomy, hospitalization, and huge health system costs and social burden. Therefore, more pertinent data are needed to demonstrate the current state of osteoporosis. Objective: This sampling survey seeks to assess the trends in the prevalence of osteopenia and osteoporosis in a Chinese Han population. Methods: A community-based cross-sectional study involving 16,377 participants used a multistage sampling method. Bone mineral density was measured using the quantitative ultrasonic densitometry. Student t test and Mann-Whitney U test were used to test the difference between normally and nonnormally distributed quantitative variables between male and female participants. A chi-square (χ2) test was used to compare categorized variables. Stratified analysis was conducted to describe the prevalence rates of osteoporosis (T score ≤–2.5) and osteopenia (T score –2.5 to –1.0) across age, sex, calcium intake, and menopause. A direct standardization method was used to calculate the age-standardized prevalence rates of osteoporosis and osteopenia. T-score was further categorized into quartiles (T1-T4) by age- and sex-specified groups. Results: The prevalence rates of osteopenia and osteoporosis were 40.5% (6633/16,377) and 7.93% (1299/16,377), respectively, and the age-standardized prevalence rates were 27.32% (287,877,129.4/1,053,861,940) and 3.51% (36,974,582.3/1,053,861,940), respectively. There was an increase in osteopenia and osteoporosis prevalence from 21.47% (120/559) to 56.23% (754/1341) and 0.89% (5/559) to 17.23% (231/1341), respectively, as age increased from 18 years to 75 years old. The prevalence rates of osteopenia and osteoporosis were significantly higher in female participants (4238/9645, 43.94% and 1130/9645, 11.72%) than in male participants (2395/6732, 35.58% and 169/6732, 2.51%; P<.001), and in postmenopausal female participants (3638/7493, 48.55% and 1053/7493, 14.05%) than in premenopausal female participants (538/2026, 26.55% and 53/2026, 2.62%; P<.001). In addition, female participants with a history of calcium intake had a lower osteoporosis prevalence rate than female participants without any history of calcium intake in all age groups (P=.004). From low quartile to high quartile of T-score, the prevalence of diabetes mellitus (752/4037, 18.63%; 779/4029, 19.33%; 769/3894, 19.75%; and 869/3879, 22.4%) and dyslipidemia (2228/4036, 55.2%; 2304/4027, 57.21%; 2306/3891, 59.26%; and 2379/3878, 61.35%) were linearly increased (P<.001), while the prevalence of cancer (112/4037, 2.77%; 110/4029, 2.73%; 103/3894, 2.65%; and 77/3879, 1.99%) was decreased (P=.03). Conclusions: Our data imply that as people age, osteopenia and osteoporosis are more common in females than in males, particularly in postmenopausal females than in premenopausal females, and bone mineral density significantly affects the prevalence of chronic diseases. These findings offer information that can be applied to intervention programs meant to prevent or lessen the burden of osteoporosis in China. %M 38578689 %R 10.2196/48947 %U https://publichealth.jmir.org/2024/1/e48947 %U https://doi.org/10.2196/48947 %U http://www.ncbi.nlm.nih.gov/pubmed/38578689 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49696 %T Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study %A Jensen,Lili Worre Høpfner %A Rahbek,Ole %A Lauritsen,Rikke Emilie Kildahl %A Kold,Søren %A Dinesen,Birthe %+ Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark, 45 60229406, lili.jensen@rn.dk %K digital communication %K patient-provider communication %K continuity of care %K interdisciplinary communication %K hospital discharge %K orthopedic surgery %K postoperative care %K text messaging %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. Objective: This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients’ experiences and use of team-based digital communication following hospital discharge (eDialogue). Methods: A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. Results: Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. Conclusions: In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery. %M 38551641 %R 10.2196/49696 %U https://humanfactors.jmir.org/2024/1/e49696 %U https://doi.org/10.2196/49696 %U http://www.ncbi.nlm.nih.gov/pubmed/38551641 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52917 %T Let’s Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study %A van Veelen,Nicole Maria %A van de Wall,Bryan J M %A Hoepelman,Ruben J %A IJpma,Frank F A %A Link,Björn-Christian %A Babst,Reto %A Groenwold,Rolf H H %A van der Velde,Detlef %A Diwersi,Nadine %A van Heijl,Mark %A Houwert,R Marijn %A Beeres,Frank J P %+ Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, 6000, Switzerland, 41 412054770, nicole.vanveelen@luks.ch %K distal radius fracture %K older patients %K natural experiment %K study protocol %K observational study %D 2024 %7 13.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. Objective: This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. Methods: This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. Results: Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. Conclusions: Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. International Registered Report Identifier (IRRID): DERR1-10.2196/52917 %M 38349719 %R 10.2196/52917 %U https://www.researchprotocols.org/2024/1/e52917 %U https://doi.org/10.2196/52917 %U http://www.ncbi.nlm.nih.gov/pubmed/38349719 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47222 %T Minimally Invasive Posterior Spinal Nonfusion Surgery in Patients With Adolescent Idiopathic Scoliosis Using a Bipolar One-Way Self-Expanding Rod System: Protocol for a Single-Center Clinical Cohort Study %A Post,Anne Mareille %A Berends,Hanneke I %A van Royen,Barend J %+ Department of Orthopedic Surgery and Sports Medicine, University Medical Center Amsterdam, room K1-207, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 205662672, a.m.post@amsterdamumc.nl %K adolescent idiopathic scoliosis %K minimally invasive %K nonfusion %K posterior spinal surgery %K protocol %K one-way self-expanding rod %K scoliosis %K idiopathic scoliosis %K spinal fusion %K spinal deformity surgery %K nonfusion techniques %K surgery %K intraoperative %K surgical technique %K operation %K musculoskeletal %K orthopedic %D 2023 %7 25.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The current surgical treatment for patients diagnosed with progressive and severe adolescent idiopathic scoliosis (AIS) consists of the correction of the spinal curvature, followed by posterior spinal fusion (PSF). However, research has uncovered short- and long-term complications of posterior spinal fusion in patients with AIS. Minimally invasive growing rod techniques have successfully been used to treat patients with early-onset scoliosis and neuromuscular scoliosis. It may be questioned if minimally invasive posterior spinal nonfusion (PSnF) surgery with bipolar instrumentation can be used for the treatment of AIS. Objective: This study will be performed to monitor the efficacy and safety of PSnF surgery by using a commercially available Conformité Européenne-certified spinal implant consisting of bilateral bipolar one-way self-expanding rods (OWSER) for the treatment of patients diagnosed with AIS. Methods: In 14 selected patients with AIS with Lenke 1-6 curves, minimally invasive PSnF surgery with the OWSER system is performed after the failure of conservative treatment (curve progression of >5° within 1 year). The patients are over 7 years of age, with a major Cobb angle of ≥30°, sufficient flexibility, and a Risser stage of ≤2. Patients will be followed over time, according to the standard medical care. Efficacy will be measured using radiological and patient satisfaction assessments and safety will be determined by the amount of perioperative complications. Results: Patient inclusion started on November 17, 2021 and we hope to finalize patient inclusion by the beginning of 2025. The first results will be expected by the beginning of 2024. Conclusions: Minimally invasive PSnF in patients with AIS is presented as a less invasive surgical technique that prevents the progression of the scoliotic curve and that allows minor posture correction of coronal imbalance. This will be the first study to examine whether the PSnF bipolar OWSER instrumentation will be the next generation of surgical instrumentation in AIS. Trial Registration: ClinicalTrials.gov NCT04441411; https://clinicaltrials.gov/study/NCT04441411 International Registered Report Identifier (IRRID): DERR1-10.2196/47222 %M 38145474 %R 10.2196/47222 %U https://www.researchprotocols.org/2023/1/e47222 %U https://doi.org/10.2196/47222 %U http://www.ncbi.nlm.nih.gov/pubmed/38145474 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43632 %T Patients’ Views on AI for Risk Prediction in Shared Decision-Making for Knee Replacement Surgery: Qualitative Interview Study %A Gould,Daniel J %A Dowsey,Michelle M %A Glanville-Hearst,Marion %A Spelman,Tim %A Bailey,James A %A Choong,Peter F M %A Bunzli,Samantha %+ St Vincent's Hospital, Department of Surgery, University of Melbourne, 29 Regent Street, Melbourne, 3065, Australia, 61 9231 3955, daniel.gould@unimelb.edu.au %K artificial intelligence %K qualitative research %K semistructured interviews %K knee replacement %K risk prediction %K patient perception %K patient understanding %K patient preference %K patient perspective %D 2023 %7 18.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of artificial intelligence (AI) in decision-making around knee replacement surgery is increasing, and this technology holds promise to improve the prediction of patient outcomes. Ambiguity surrounds the definition of AI, and there are mixed views on its application in clinical settings. Objective: In this study, we aimed to explore the understanding and attitudes of patients who underwent knee replacement surgery regarding AI in the context of risk prediction for shared clinical decision-making. Methods: This qualitative study involved patients who underwent knee replacement surgery at a tertiary referral center for joint replacement surgery. The participants were selected based on their age and sex. Semistructured interviews explored the participants’ understanding of AI and their opinions on its use in shared clinical decision-making. Data collection and reflexive thematic analyses were conducted concurrently. Recruitment continued until thematic saturation was achieved. Results: Thematic saturation was achieved with 19 interviews and confirmed with 1 additional interview, resulting in 20 participants being interviewed (female participants: n=11, 55%; male participants: n=9, 45%; median age: 66 years). A total of 11 (55%) participants had a substantial postoperative complication. Three themes captured the participants’ understanding of AI and their perceptions of its use in shared clinical decision-making. The theme Expectations captured the participants’ views of themselves as individuals with the right to self-determination as they sought therapeutic solutions tailored to their circumstances, needs, and desires, including whether to use AI at all. The theme Empowerment highlighted the potential of AI to enable patients to develop realistic expectations and equip them with personalized risk information to discuss in shared decision-making conversations with the surgeon. The theme Partnership captured the importance of symbiosis between AI and clinicians because AI has varied levels of interpretability and understanding of human emotions and empathy. Conclusions: Patients who underwent knee replacement surgery in this study had varied levels of familiarity with AI and diverse conceptualizations of its definitions and capabilities. Educating patients about AI through nontechnical explanations and illustrative scenarios could help inform their decision to use it for risk prediction in the shared decision-making process with their surgeon. These findings could be used in the process of developing a questionnaire to ascertain the views of patients undergoing knee replacement surgery on the acceptability of AI in shared clinical decision-making. Future work could investigate the accuracy of this patient group’s understanding of AI, beyond their familiarity with it, and how this influences their acceptance of its use. Surgeons may play a key role in finding a place for AI in the clinical setting as the uptake of this technology in health care continues to grow. %M 37721797 %R 10.2196/43632 %U https://www.jmir.org/2023/1/e43632 %U https://doi.org/10.2196/43632 %U http://www.ncbi.nlm.nih.gov/pubmed/37721797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47621 %T The Potential of ChatGPT as a Self-Diagnostic Tool in Common Orthopedic Diseases: Exploratory Study %A Kuroiwa,Tomoyuki %A Sarcon,Aida %A Ibara,Takuya %A Yamada,Eriku %A Yamamoto,Akiko %A Tsukamoto,Kazuya %A Fujita,Koji %+ Division of Medical Design Innovations, Open Innovation Center, Institute of Research Innovation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan, 81 358035279, fujiorth@tmd.ac.jp %K ChatGPT %K generative pretrained transformer %K natural language processing %K artificial intelligence %K chatbot %K diagnosis %K self-diagnosis %K accuracy %K precision %K language model %K orthopedic disease %K AI model %K health information %D 2023 %7 15.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) has gained tremendous popularity recently, especially the use of natural language processing (NLP). ChatGPT is a state-of-the-art chatbot capable of creating natural conversations using NLP. The use of AI in medicine can have a tremendous impact on health care delivery. Although some studies have evaluated ChatGPT’s accuracy in self-diagnosis, there is no research regarding its precision and the degree to which it recommends medical consultations. Objective: The aim of this study was to evaluate ChatGPT’s ability to accurately and precisely self-diagnose common orthopedic diseases, as well as the degree of recommendation it provides for medical consultations. Methods: Over a 5-day course, each of the study authors submitted the same questions to ChatGPT. The conditions evaluated were carpal tunnel syndrome (CTS), cervical myelopathy (CM), lumbar spinal stenosis (LSS), knee osteoarthritis (KOA), and hip osteoarthritis (HOA). Answers were categorized as either correct, partially correct, incorrect, or a differential diagnosis. The percentage of correct answers and reproducibility were calculated. The reproducibility between days and raters were calculated using the Fleiss κ coefficient. Answers that recommended that the patient seek medical attention were recategorized according to the strength of the recommendation as defined by the study. Results: The ratios of correct answers were 25/25, 1/25, 24/25, 16/25, and 17/25 for CTS, CM, LSS, KOA, and HOA, respectively. The ratios of incorrect answers were 23/25 for CM and 0/25 for all other conditions. The reproducibility between days was 1.0, 0.15, 0.7, 0.6, and 0.6 for CTS, CM, LSS, KOA, and HOA, respectively. The reproducibility between raters was 1.0, 0.1, 0.64, –0.12, and 0.04 for CTS, CM, LSS, KOA, and HOA, respectively. Among the answers recommending medical attention, the phrases “essential,” “recommended,” “best,” and “important” were used. Specifically, “essential” occurred in 4 out of 125, “recommended” in 12 out of 125, “best” in 6 out of 125, and “important” in 94 out of 125 answers. Additionally, 7 out of the 125 answers did not include a recommendation to seek medical attention. Conclusions: The accuracy and reproducibility of ChatGPT to self-diagnose five common orthopedic conditions were inconsistent. The accuracy could potentially be improved by adding symptoms that could easily identify a specific location. Only a few answers were accompanied by a strong recommendation to seek medical attention according to our study standards. Although ChatGPT could serve as a potential first step in accessing care, we found variability in accurate self-diagnosis. Given the risk of harm with self-diagnosis without medical follow-up, it would be prudent for an NLP to include clear language alerting patients to seek expert medical opinions. We hope to shed further light on the use of AI in a future clinical study. %M 37713254 %R 10.2196/47621 %U https://www.jmir.org/2023/1/e47621 %U https://doi.org/10.2196/47621 %U http://www.ncbi.nlm.nih.gov/pubmed/37713254 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43501 %T Association Between the Dietary Inflammatory Index and the Risk of Fracture in Chinese Adults: Longitudinal Study %A Wang,Lu %A Ye,Chen %A Zhao,Fanghong %A Wu,Hongjing %A Wang,Ruoyu %A Zhang,Zhaofeng %A Li,Jie %+ Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road,Haidian District, Beijing, 100191, China, 86 10 82801575, zhangzhaofeng@bjmu.edu.cn %K dietary inflammatory index %K fractures %K diet %K risk %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Chronic inflammation plays a crucial role in tissue injury, osteoporosis, and fracture. The dietary inflammatory index (DII) is a tool for assessing the potential for inflammation in the diet. However, the association between the DII and fractures remains controversial from previous studies. Objective: We aimed to explore the correlation between the DII and fracture risk in Chinese adults. Methods: We included 11,999 adults (5519 men and 6480 women) who were a part of the China Health and Nutrition Survey (1997-2015) prospective cohort. A 3-day, 24-hour meal review method was used to calculate the DII score. The fractures were identified using a questionnaire. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for fractures. Subgroup, sensitivity, and restricted cubic spline analyses were performed. Results: During the 18 years of follow-up (median follow-up 9.0 years), 463 men and 439 women developed fractures. The median DII score was 0.64 (IQR −1.74 to 1.46) for the total sample, 0.75 (IQR −1.68 to 1.50) for men, and 0.53 (IQR −1.79 to 1.42) for women. The DII score had a positive correlation with the risk of fracture among women but not among men. For men, after adjusting for covariates, the HRs for quintiles of DII were 1, 0.96 (95% CI 0.66-1.41), 1.05 (95% CI 0.74-1.49), 0.89 (95% CI 0.62-1.26), and 0.94 (95% CI 0.67-1.34; trend: P=.62). The HRs for women were 1, 1.13 (95% CI 0.72-1.79), 1.24 (95% CI 0.83-1.86), 1.51 (95% CI 1.02-2.22), and 1.62 (95% CI 1.10-2.39; trend: P=.004). The restricted cubic spline analysis showed a significant association between fracture risk and DII score in women (overall association: P=.01); as the DII scores were >0.53, HRs showed a significant upward trend. Women aged <50 years or who are nonsmokers, who are nondrinkers, or with nonabdominal obesity had a positive association between fracture risk and the DII score. In sensitivity analyses, after excluding people with diabetes or hypertension, there was still a positive association between fracture risk and the DII score in women. Among the DII components, the DII scores of protein (trend: P=.03), niacin (trend: P=.002), and iron (trend: P=.02) showed significant associations with the risk of fracture in women. Conclusions: Proinflammatory diet consumption increased the fracture risk in Chinese women aged <50 years. The high consumption of anti-inflammatory foods and low consumption of proinflammatory foods may be an important strategy to prevent fractures in women. %M 37590048 %R 10.2196/43501 %U https://publichealth.jmir.org/2023/1/e43501 %U https://doi.org/10.2196/43501 %U http://www.ncbi.nlm.nih.gov/pubmed/37590048 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38282 %T Transfer Validity of Pediatric Supracondylar Humeral Fracture Pin Placement Practice on In-Theater Performance by Orthopedic Trainees Using an Augmented Reality Simulator: Protocol for a Pilot Interventional Cohort Study With a Retrospective Comparator Cohort %A Guo,Joyce %A Blyth,Phil %A Clifford,Kari %A Hooper,Nikki %A Crawford,Haemish %+ Department of the Dean, Otago Medical School, University of Otago, 201 Great King Street, Central Dunedin, Dunedin, 9016, New Zealand, 64 273635352, joyce.guo@postgrad.otago.ac.nz %K pediatric orthopedics %K augmented reality simulator %K supracondylar humeral fractures %K closed reduction and percutaneous pinning %K transfer validity %K fracture %K surgeons %K education %K practice %K trainees %K pediatric %K orthopedic %K training %K surgical procedure %D 2023 %7 2.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray–guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of “see one, do one, teach one” are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. Objective: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. Methods: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort’s performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. Results: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). Conclusions: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb International Registered Report Identifier (IRRID): DERR1-10.2196/38282 %M 37531159 %R 10.2196/38282 %U https://www.researchprotocols.org/2023/1/e38282 %U https://doi.org/10.2196/38282 %U http://www.ncbi.nlm.nih.gov/pubmed/37531159 %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 %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38798 %T mHealth for the Self-management of Knee Osteoarthritis: Scoping Review %A Kitagawa,Takashi %A Hayashi,Masateru %+ Department of Physical Therapy, School of Health Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto, 390-8621, Japan, 81 263 37 2413, tkitagawa@shinshu-u.ac.jp %K knee osteoarthritis %K mobile health %K mHealth %K self-management %K knee joint %K scoping review %K pain %K physical function %K quality of life %K mobile phone app %K patient education %D 2023 %7 8.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Educating patients on the self-management of knee osteoarthritis (OA) reportedly reduces pain, improves activities of daily living, and even reduces health care costs. Objective: This scoping review will summarize the current evidence on mobile health (mHealth) and smartphone app–based disease self-management for patients with knee OA. Methods: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and CINAHL were systematically searched in May 2021 using the keywords “knee osteoarthritis,” “mobile health,” and “self-management.” Studies that investigated patients with knee OA based on radiography or clinical diagnosis were included. The following criteria were applied to the mobile phone apps included in the search-derived studies: the ability to (1) record and manage symptoms, (2) provide patient education, and (3) guide and record activities of daily living. Studies eligible for inclusion in this scoping review were interventional trials or observational studies published in English. Results: This scoping review included 8 reports, of which 3 were randomized controlled trials and 1 was a conference abstract. Most studies provided data on the outcomes of pain, physical function, and quality of life. Conclusions: An increasing number of reports are addressing the effectiveness of mHealth in patients with knee OA, and the data suggest that mHealth efficacy is similar to conventional management of health. International Registered Report Identifier (IRRID): RR2-10.17504/protocols.io.buuxnwxn %M 37155233 %R 10.2196/38798 %U https://www.jmir.org/2023/1/e38798 %U https://doi.org/10.2196/38798 %U http://www.ncbi.nlm.nih.gov/pubmed/37155233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35718 %T Satisfaction With Telemedicine in Patients With Orthopedic Trauma During the COVID-19 Lockdown: Interview Study %A Rauer,Thomas %A Scherer,Julian %A Stäubli,Pascal %A Gerber,Jonas %A Pape,Hans-Christoph %A Heining,Sandro-Michael %+ Department of Trauma Surgery, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 0442551111, Thomas.Rauer@usz.ch %K COVID-19 %K digital %K survey %K telehealth %K follow-up %K orthopedic trauma %K trauma %K attitude %D 2022 %7 12.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine can take many forms, from telephone-only consultations to video consultations via a smartphone or personal computer, depending on the goals of the treatment. One of the advantages of videoconferencing is the direct visual contact between patients and therapists even over long distances. Although some telemedicine models require specially designed add-on devices, others get by with off-the-shelf equipment and software and achieve similarly successful successful results. This depends, among other things, on the nature of the injury, the desired outcome of therapy, and the medical consultation. In the last decade, the science and practice of telemedicine have grown exponentially and even more so during the COVID-19 pandemic. Depending on the traumatic lesion, posttraumatic and postoperative treatment and care of patients who experience trauma may require medical or physical therapy consultations in a clinic or office. However, due to the COVID-19 lockdown, direct physical follow-up was more difficult, and therefore, telemedicine solutions were sought and implemented. Objective: The aim of this study was to assess satisfaction with telemedical aftercare in patients with orthopedic trauma. Methods: Between March and July 2020, a standardized interview using a standardized questionnaire—Freiburg Index of Patient Satisfaction (FIPS)—among patients with orthopedic trauma who received telemedical postsurgical or physiotherapeutic care was conducted. The FIPS is composed of 5 questions regarding treatment and 1 question on the overall treatment satisfaction. Furthermore, we assessed patients’ demographics and their telemedical use. Subgroup analysis was performed for age groups (<65 years vs ≥65 years), the used device, and gender. Results: In total, we assessed 25 patients with a mean age of 43 (SD 24.31) years (14 female). The majority of patients (n=19, 76%) used their smartphone for consultations. The mean overall FIPS score assessed was 2.14 (SD 0.87). The mean FIPS score for younger patients was 2.23 (SD 0.90) vs 1.91 (SD 0.82) for older patients. The vast majority of the surveyed patients (n=20, 80%) were absolutely confident with their smartphone or tablet use. Conclusions: Most patients surveyed stated a high satisfaction with the telemedical follow-up. Older patients showed a higher satisfaction rate than their younger counterparts. It seems that telemedical postsurgical or physiotherapeutic care is a viable option, especially in times of reduced contact, like the current COVID-19 pandemic. Thus, telemedicine offers the opportunity to ensure access to effective patient care, even over long distances, while maintaining patient satisfaction. %M 36040961 %R 10.2196/35718 %U https://formative.jmir.org/2022/9/e35718 %U https://doi.org/10.2196/35718 %U http://www.ncbi.nlm.nih.gov/pubmed/36040961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e28851 %T A Psychological Support Intervention to Help Injured Athletes “Get Back in the Game”: Design and Development Study %A Ardern,Clare L %A Hooper,Nicholas %A O'Halloran,Paul %A Webster,Kate E %A Kvist,Joanna %+ Department of Family Practice, University of British Columbia, Robert H.N. Ho Research Centre (level 6), 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 6046752575, clare.ardern@liu.se %K sports %K medicine %K rehabilitation %K sports injury %K psychological support %K mental health %K postoperative medicine %K feasibility %K eHealth %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support. Objective: We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery. Methods: Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population–based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes’ experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases—(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31). Results: The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features. Conclusions: The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies. %M 35943769 %R 10.2196/28851 %U https://formative.jmir.org/2022/8/e28851 %U https://doi.org/10.2196/28851 %U http://www.ncbi.nlm.nih.gov/pubmed/35943769 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37092 %T Using Artificial Intelligence to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY): Protocol for the Development of a Clinical Prediction Model %A Farrow,Luke %A Ashcroft,George Patrick %A Zhong,Mingjun %A Anderson,Lesley %+ Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom, 44 01224552908, luke.farrow@abdn.ac.uk %K orthopedics %K prediction modelling %K machine learning %K artificial intelligence %K imaging %K hip %K knee %K arthroplasty %K health care %K patient care %K arthritis %D 2022 %7 11.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hip and knee osteoarthritis is substantially prevalent worldwide, with large numbers of older adults undergoing joint replacement (arthroplasty) every year. A backlog of elective surgery due to the COVID-19 pandemic, and an aging population, has led to substantial issues with access to timely arthroplasty surgery. A potential method to improve the efficiency of arthroplasty services is by increasing the percentage of patients who are listed for surgery from primary care referrals. The use of artificial intelligence (AI) techniques, specifically machine learning, provides a potential unexplored solution to correctly and rapidly select suitable patients for arthroplasty surgery. Objective: This study has 2 objectives: (1) develop a cohort of patients with referrals by general practitioners regarding assessment of suitability for hip or knee replacement from National Health Service (NHS) Grampian data via the Grampian Data Safe Haven and (2) determine the demographic, clinical, and imaging characteristics that influence the selection of patients to undergo hip or knee arthroplasty, and develop a tested and validated patient-specific predictive model to guide arthroplasty referral pathways. Methods: The AI to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY) project will be delivered through 2 linked work packages conducted within the Grampian Data Safe Haven and Safe Haven Artificial Intelligence Platform. The data set will include a cohort of individuals aged ≥16 years with referrals for the consideration of elective primary hip or knee replacement from January 2015 to January 2022. Linked pseudo-anonymized NHS Grampian health care data will be acquired including patient demographics, medication records, laboratory data, theatre records, text from clinical letters, and radiological images and reports. Following the creation of the data set, machine learning techniques will be used to develop pattern classification and probabilistic prediction models based on radiological images. Supplemental demographic and clinical data will be used to improve the predictive capabilities of the models. The sample size is predicted to be approximately 2000 patients—a sufficient size for satisfactory assessment of the primary outcome. Cross-validation will be used for development, testing, and internal validation. Evaluation will be performed through standard techniques, such as the C statistic (area under curve) metric, calibration characteristics (Brier score), and a confusion matrix. Results: The study was funded by the Chief Scientist Office Scotland as part of a Clinical Research Fellowship that runs from August 2021 to August 2024. Approval from the North Node Privacy Advisory Committee was confirmed on October 13, 2021. Data collection started in May 2022, with the results expected to be published in the first quarter of 2024. ISRCTN registration has been completed. Conclusions: This project provides a first step toward delivering an automated solution for arthroplasty selection using routinely collected health care data. Following appropriate external validation and clinical testing, this project could substantially improve the proportion of referred patients that are selected to undergo surgery, with a subsequent reduction in waiting time for arthroplasty appointments. Trial Registration: ISRCTN Registry ISRCTN18398037; https://www.isrctn.com/ISRCTN18398037 International Registered Report Identifier (IRRID): PRR1-10.2196/37092 %M 35544289 %R 10.2196/37092 %U https://www.researchprotocols.org/2022/5/e37092 %U https://doi.org/10.2196/37092 %U http://www.ncbi.nlm.nih.gov/pubmed/35544289 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e28338 %T Frailty Factors and Outcomes in Patients Undergoing Orthopedic Surgery: Protocol for a Systematic Review and Meta-analysis %A Wang,Duanyang %A Yin,Pengbin %A Li,Yi %A Chen,Ming %A Cui,Xiang %A Cheng,Shi %A Lin,Yuan %A Yan,Jinglong %A Zhang,Licheng %A Tang,Peifu %+ Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150001, China, 86 0451 86296061, yjl_g6@aliyun.com %K frailty %K orthopedic surgery %K systemic review %K meta-analysis %K older adults %K elderly %K surgery %K orthopedics %D 2022 %7 15.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Frailty is an aggregate expression of susceptibility to adverse health outcomes because of age- and disease-related deficits that accumulate across multiple domains. Previous studies have found the presence of preoperative frailty is associated with an increased risk of adverse outcomes. The number of older adults undergoing orthopedic surgery is rapidly increasing. However, there has been no evidence-based study on the relationship between frailty and outcomes in patients undergoing orthopedic surgery. Objective: The aims of this study are to investigate the association between frailty and outcomes in patients who underwent orthopedic surgery as well as patient factors associated with frailty. Methods: The methods to be used for this systematic review are reported according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) 2015 checklist. An extensive search will be conducted in PubMed, Embase, the Cochrane Library, and other mainstream databases. Any study where patients undergoing orthopedic surgery were assessed using a defined or validated measure of frailty and the association of frailty with patient factors and/or outcomes was reported will be included. A total of 2 researchers will independently screen articles for inclusion, with disagreements resolved by a third reviewer. We will perform a narrative synthesis of the factors associated with frailty, prevalence of frailty, effect of frailty on patient outcomes, and interventions for patients who are frail. A meta-analysis focusing on individual factors associated with frailty and the effect of frailty on patient outcomes will be performed, if applicable. The risk of bias will be evaluated. A subgroup analysis and sensitivity analysis will be performed. Results: Literature searches were conducted in September 2021 and the review is anticipated to be completed by the end of July 2022. Conclusions: This systematic review and meta-analysis will provide an overview of frailty and investigate the relationship between frailty and patient outcomes as well as the relationship between patient factors and frailty in patients undergoing orthopedic surgery. This study could potentially increase patients’ awareness of the outcomes associated with frailty, compel clinical specialties to further acknowledge the concept of frailty, and enhance the development of assessment instruments and tools for frailty. Trial Registration: PROSPERO CRD42020181846; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=181846 International Registered Report Identifier (IRRID): DERR1-10.2196/28338 %M 35436222 %R 10.2196/28338 %U https://www.researchprotocols.org/2022/4/e28338 %U https://doi.org/10.2196/28338 %U http://www.ncbi.nlm.nih.gov/pubmed/35436222 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e34576 %T Casting Without Reduction Versus Closed Reduction With or Without Fixation in the Treatment of Distal Radius Fractures in Children: Protocol for a Randomized Noninferiority Trial %A Garcia-Rueda,Maria Fernanda %A Bohorquez-Penaranda,Adriana Patricia %A Gil-Laverde,Jacky Fabian Armando %A Aguilar-Sierra,Francisco Javier %A Mendoza-Pulido,Camilo %+ Department of Orthopedics, Instituto Roosevelt, Carrera 4 Este No. 17-50, Bogotá, 110321, Colombia, 57 353 40 00 ext 6252, m-garciar@javeriana.edu.co %K radius fractures %K distal radius %K pediatric %K remodeling %K surgical reduction %K cast immobilization %K outcome measure %D 2022 %7 14.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Acute treatment for distal radius fractures, the most frequent fractures in the pediatric population, represents a challenge to the orthopedic surgeon. Deciding on surgical restoration of the alignment or cast immobilization without reducing the fracture is a complex concern given the remodeling potential of bones in children. In addition, the lack of evidence-based safe boundaries of shortening and angulation, that will not jeopardize upper-extremity functionality in the future, further complicates this decision. Objective: The authors aim to measure functional outcomes, assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Physical Function v2.0 instrument. The authors hypothesize that outcomes will not be worse in children treated with cast immobilization in situ compared with those treated with closed reduction with or without percutaneous fixation. The authors also aim to compare the following as secondary outcomes: ulnar variance and fracture alignment in the sagittal and coronal planes, range of motion, pressure ulcers, pain control, radius osteotomy due to deformity, pseudoarthrosis cure, and remanipulation. Methods: This is the protocol of a randomized noninferiority trial comparing upper-extremity functionality in children aged 5 to 10 years, after sustaining a distal radius fracture, treated with either cast immobilization in situ or closed reduction with or without fixation in a single orthopedic hospital. Functional follow-up is projected at 6 months, while clinical and radiographic follow-up will occur at 2 weeks, 3 months, and 9 months. Results: Recruitment commenced in July 2021. As of January 2022, 23 children have been randomized. Authors expect an average of 5 patients to be recruited monthly; therefore, recruitment and analysis should be complete by October 2024. Conclusions: This experimental design that addresses upper-extremity functionality after cast immobilization in situ in children who have sustained a distal fracture of the radius may yield compelling information that could aid the clinician in deciding on the most suitable orthopedic treatment. Trial Registration: ClinicalTrials.gov NCT05008029; https://clinicaltrials.gov/ct2/show/NCT05008029 International Registered Report Identifier (IRRID): DERR1-10.2196/34576 %M 35436224 %R 10.2196/34576 %U https://www.researchprotocols.org/2022/4/e34576 %U https://doi.org/10.2196/34576 %U http://www.ncbi.nlm.nih.gov/pubmed/35436224 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e34096 %T Pilot Project for a Web-Based Dynamic Nomogram to Predict Survival 1 Year After Hip Fracture Surgery: Retrospective Observational Study %A McLeod,Graeme %A Kennedy,Iain %A Simpson,Eilidh %A Joss,Judith %A Goldmann,Katriona %+ Department of Anaesthesia, Ninewells Hospital, National Health Service Tayside, James Arnott Drive, Dundee, DD1 9SY, United Kingdom, 44 1382 632175, g.a.mcleod@dundee.ac.uk %K hip fracture %K survival %K prediction %K nomogram %K web %K surgery %K postoperative %K machine learning %K model %K survival %K mortality %K hip %K fracture %D 2022 %7 30.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Hip fracture is associated with high mortality. Identification of individual risk informs anesthetic and surgical decision-making and can reduce the risk of death. However, interpreting mathematical models and applying them in clinical practice can be difficult. There is a need to simplify risk indices for clinicians and laypeople alike. Objective: Our primary objective was to develop a web-based nomogram for prediction of survival up to 365 days after hip fracture surgery. Methods: We collected data from 329 patients. Our variables included sex; age; BMI; white cell count; levels of lactate, creatinine, hemoglobin, and C-reactive protein; physical status according to the American Society of Anesthesiologists Physical Status Classification System; socioeconomic status; duration of surgery; total time in the operating room; side of surgery; and procedure urgency. Thereafter, we internally calibrated and validated a Cox proportional hazards model of survival 365 days after hip fracture surgery; logistic regression models of survival 30, 120, and 365 days after surgery; and a binomial model. To present the models on a laptop, tablet, or mobile phone in a user-friendly way, we built an app using Shiny (RStudio). The app showed a drop-down box for model selection and horizontal sliders for data entry, model summaries, and prediction and survival plots. A slider represented patient follow-up over 365 days. Results: Of the 329 patients, 24 (7.3%) died within 30 days of surgery, 65 (19.8%) within 120 days, and 94 (28.6%) within 365 days. In all models, the independent predictors of mortality were age, BMI, creatinine level, and lactate level. The logistic model also incorporated white cell count as a predictor. The Cox proportional hazards model showed that mortality differed as follows: age 80 vs 60 years had a hazard ratio (HR) of 0.6 (95% CI 0.3-1.1), a plasma lactate level of 2 vs 1 mmol/L had an HR of 2.4 (95% CI 1.5-3.9), and a plasma creatinine level of 60 vs 90 mol/L had an HR of 2.3 (95% CI 1.3-3.9). Conclusions: In conclusion, we provide an easy-to-read web-based nomogram that predicts survival up to 365 days after hip fracture. The Cox proportional hazards model and logistic models showed good discrimination, with concordance index values of 0.732 and 0.781, respectively. %M 35238320 %R 10.2196/34096 %U https://www.i-jmr.org/2022/1/e34096 %U https://doi.org/10.2196/34096 %U http://www.ncbi.nlm.nih.gov/pubmed/35238320 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32683 %T One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study %A Dimet-Wiley,Andrea %A Golovko,George %A Watowich,Stanley J %+ Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0645, United States, 1 832 613 5356, watowich@xray.utmb.edu %K hip %K fracture %K mortality %K aging %K older adults %K elderly %K mortality risk %K electronic health record %K EHR %K survival probability %K postfracture mortality rate %K fall %K bone %K injury %K dementia %K diabetes %K type 2 diabetes %K trauma %K treatment %K comorbidity %K mobility %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies but is critical to determining current unmet needs for therapeutic intervention. Objective: This study examined whether hip fracture increases the 1-year postfracture mortality rate relative to several other fracture types and determined whether dementia or type 2 diabetes (T2D) exacerbates postfracture mortality risk. Methods: TriNetX Diamond Network data were used to identify patients with a single event of fracture of the hip, the upper humerus, or several regions near and distal to the hip occurring from 60 to 89 years of age from 2010 to 2019. Propensity score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year postfracture mortality rates in elderly populations with dementia or T2D were established. Results: One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were significantly lower in the hip fracture groups, even after propensity score matching was performed on cohorts for a variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate the 1-year mortality risk. T2D did not exacerbate the 1-year mortality risk beyond mere additive effects. Conclusions: Elderly patients with hip fracture have a significantly decreased survival probability. Greatly increased 1-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, postfracture treatments or diagnoses, restoration of prefracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations for these 2 comorbidities. Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia. %M 35293865 %R 10.2196/32683 %U https://aging.jmir.org/2022/1/e32683 %U https://doi.org/10.2196/32683 %U http://www.ncbi.nlm.nih.gov/pubmed/35293865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31232 %T A Patient-Reported Outcome Tool to Triage Total Hip Arthroplasty Patients to Hospital or Video Consultation: Pilot Study With Expert Panels and a Cohort of 1228 Patients %A Pronk,Yvette %A Pilot,Peter %A van der Weegen,Walter %A Brinkman,Justus-Martijn %A Schreurs,Berend Willem %+ Research Department, Kliniek ViaSana, Hoogveldseweg 1, Mill, 5451 AA, Netherlands, 31 485476330, y.pronk@viasana.nl %K PROMs %K total hip arthroplasty %K triage tool %K video consultation %K telemedicine %K digital transformation %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The digital transformation in health care has been accelerated by the COVID-19 pandemic. Video consultation has become the alternative for hospital consultation. It remains unknown how to select patients suitable for video consultation. Objective: This study aimed to develop a tool based on patient-reported outcomes (PROs) to triage total hip arthroplasty (THA) patients to hospital or video consultation. Methods: A pilot study with expert panels and a retrospective cohort with prospectively collected data from 1228 THA patients was executed. The primary outcome was a PRO triage tool to allocate THA patients to hospital or video consultation 6 weeks postoperatively. Expert panels defined the criteria and selected the patient-reported outcome measure (PROM) questions including thresholds. Data were divided into training and test cohorts. Distribution, floor effect, correlation, responsiveness, PRO patient journey, and homogeneity of the selected questions were investigated in the training cohort. The test cohort was used to provide an unbiased evaluation of the final triage tool. Results: The expert panels selected moderate or severe pain and using 2 crutches as the triage tool criteria. PROM questions included in the final triage tool were numeric rating scale (NRS) pain during activity, 3-level version of the EuroQol 5 dimensions (EQ-5D-3L) questions 1 and 4, and Oxford Hip Score (OHS) questions 6, 8, and 12. Of the training cohort, 201 (201/703, 28.6%) patients needed a hospital consultation, which was statistically equal to the 150 (150/463, 32.4%) patients in the test cohort who needed a hospital consultation (P=.19). Conclusions: A PRO triage tool based on moderate or severe pain and using 2 crutches was developed. Around 70% of THA patients could safely have a video consultation, and 30% needed a hospital consultation 6 weeks postoperatively. This tool is promising for selecting patients for video consultation while using an existing PROM infrastructure. %M 34931989 %R 10.2196/31232 %U https://formative.jmir.org/2021/12/e31232 %U https://doi.org/10.2196/31232 %U http://www.ncbi.nlm.nih.gov/pubmed/34931989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31878 %T Accuracy of Physical Assessment in Nursing for Cervical Spine Joint Pain and Stiffness: Pilot Study Protocol %A Soares,Bruno %A Fonseca,Raquel %A Fonseca,Patrícia %A Alves,Paulo %+ Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho, 1327, Porto, 4169-005, Portugal, 351 933880937, brunomgsoares@gmail.com %K nursing process %K nursing assessment %K pain %K referred pain %K range of motion %K neck pain %K stomatognathic system %K viscerosomatic reflexes %K cervical spine dysfunction %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cervical spine dysfunction is a condition with high personal, social, and economic impact worldwide. Although its etiology is described as multifactorial, there is a need for further clarification. The literature has demonstrated the anatomical, physiological, and pathophysiological relationship among the cervical spine, temporomandibular joint, and visceral system. To guide and contribute to the accuracy of the physical assessment performed by nurses, we will study the influence of the stomatognathic system and viscerosomatic reflexes on pain and joint stiffness of the cervical spine. Objective: The aim of this study is to describe a pilot study protocol to investigate the influence of the stomatognathic system and viscerosomatic reflexes on cervical structures. Methods: A pilot study with a quasi-experimental design was conducted with 50 volunteers from the university population of the Universidade Católica Portuguesa-Porto. We studied the influence of changes in the usual intercuspation, the occlusal deprogramming, and the pressure stimulus of the reflex skin region of the ilium/colon in the cervical spine. This study was divided into 2 phases. In the first phase, we performed the kinematic and pain analysis during the passive mobilization of the upper cervical spine using the Motion Capture System at the Motion Capture Laboratory at UCP-Porto and the Visual Analog Scale. In the second phase, we evaluated the pain threshold on palpation of the erector neck muscles and the structures of the stomatognathic system using algometry. The influence of viscerosomatic reflexes on the structures of the stomatognathic system was also analyzed. Results: Selection and preparation of the data collection site, acquisition of materials, constitution of the sample group and data collection were completed. The analysis of the results is being carried out. Conclusions: The data from this study will allow for the detection of the possible influence of the stomatognathic system and viscerosomatic reflexes on pain and range of motion of the upper cervical spine, providing data for future randomized studies. We have also identified potential limitations of this study. International Registered Report Identifier (IRRID): RR1-10.2196/31878 %M 34927588 %R 10.2196/31878 %U https://www.researchprotocols.org/2021/12/e31878 %U https://doi.org/10.2196/31878 %U http://www.ncbi.nlm.nih.gov/pubmed/34927588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30768 %T Moderators of the Effect of a Self-directed Digitally Delivered Exercise Program for People With Knee Osteoarthritis: Exploratory Analysis of a Randomized Controlled Trial %A Nelligan,Rachel K %A Hinman,Rana S %A McManus,Fiona %A Lamb,Karen E %A Bennell,Kim L %+ Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Parkville, 3010, Australia, 61 403652115, rachel.nelligan@unimelb.edu.au %K digital %K text messaging %K exercise %K moderators %K osteoarthritis %K RCT %K clinical trial %K subgroups %K pain %K function %K knee osteoarthritis %K rehabilitation %K digital health %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A 24-week self-directed digitally delivered intervention was found to improve pain and function in people with knee osteoarthritis (OA). However, it is possible that this intervention may be better suited to certain subgroups of people with knee OA compared to others. Objective: The aim of this study was to explore whether certain individual baseline characteristics moderate the effects of a self-directed digitally delivered intervention on changes in pain and function over 24 weeks in people with knee OA. Methods: An exploratory analysis was conducted on data from a randomized controlled trial involving 206 people with a clinical diagnosis of knee OA. This trial compared a self-directed digitally delivered intervention comprising of web-based education, exercise, and physical activity program supported by automated exercise behavior change mobile phone text messages to web-based education alone (control). The primary outcomes were changes in overall knee pain (assessed on an 11-point numerical rating scale) and physical function (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale [WOMAC]) at 24 weeks. Five baseline patient characteristics were selected as the potential moderators: (1) number of comorbidities, (2) number of other painful joints, (3) pain self-efficacy, (4) exercise self-efficacy, and (5) self-perceived importance of exercise. Separate linear regression models for each primary outcome and each potential moderator were fit, including treatment group, moderator, and interaction between treatment group and moderator, adjusting for the outcome at baseline. Results: There was evidence that pain self-efficacy moderated the effect of the intervention on physical function compared to the control at 24 weeks (interaction P=.02). Posthoc assessment of the mean change in WOMAC function by treatment arm showed that each 1-unit increase in baseline pain self-efficacy was associated with a 1.52 (95% CI 0.27 to 2.78) unit improvement in the control group. In contrast, a reduction of 0.62 (95% CI –1.93 to 0.68) units was observed in the intervention group with each unit increase in pain self-efficacy. There was only weak evidence that pain self-efficacy moderated the effect of the intervention on pain and that number of comorbidities, number of other painful joints, exercise self-efficacy, or exercise importance moderated the effect of the intervention on pain or function. Conclusions: With the exception of pain self-efficacy, which moderated changes in function but not pain, we found limited evidence that our selected baseline patient characteristics moderated intervention outcomes. This indicates that people with a range of baseline characteristics respond similarly to the unsupervised digitally delivered exercise intervention. As these findings are exploratory in nature, they require confirmation in future studies. %M 34714252 %R 10.2196/30768 %U https://www.jmir.org/2021/10/e30768 %U https://doi.org/10.2196/30768 %U http://www.ncbi.nlm.nih.gov/pubmed/34714252 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26886 %T Identifying Opportunities, and Motivation to Enhance Capabilities, Influencing the Development of a Personalized Digital Health Hub Model of Care for Hip Fractures: Mixed Methods Exploratory Study %A Yadav,Lalit %A Gill,Tiffany K %A Taylor,Anita %A De Young,Jennifer %A Chehade,Mellick J %+ NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, University of Adelaide, Level 5G 581, Royal Adelaide Hospital, Adelaide, 5000, Australia, 61 870742006, Lalit.yadav@adelaide.edu.au %K digital health %K mixed-methods %K hip fractures %K behavior change %K patient education %K model of care %K mobile phone %K patient networked units %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation. Objective: This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub. Methods: We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use. Results: This study recruited 100 participants—55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=–0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ρ=0.71; P<.001) and by society, including friends and family members (Spearman ρ=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub–enabled model of care. Conclusions: This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios. %M 34709183 %R 10.2196/26886 %U https://www.jmir.org/2021/10/e26886 %U https://doi.org/10.2196/26886 %U http://www.ncbi.nlm.nih.gov/pubmed/34709183 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e24553 %T Satisfaction, Usability, and Compliance With the Use of Smartwatches for Ecological Momentary Assessment of Knee Osteoarthritis Symptoms in Older Adults: Usability Study %A Rouzaud Laborde,Charlotte %A Cenko,Erta %A Mardini,Mamoun T %A Nerella,Subhash %A Kheirkhahan,Matin %A Ranka,Sanjay %A Fillingim,Roger B %A Corbett,Duane B %A Weber,Eric %A Rashidi,Parisa %A Manini,Todd %+ Department of Pharmacy, University of Toulouse, Hopital Paule de Viguier, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse, 31059, France, 33 625088692, charlotte.laborde@yahoo.fr %K ehealth %K mobile health %K ecological momentary assessment %K real-time online assessment and mobility monitor %K ROAMM %K older adults %K compliance %K personal satisfaction %K usability %K smartwatch %K knee osteoarthritis %K pain %K fatigue %K wearable electronic device %K mobile application %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Smartwatches enable physicians to monitor symptoms in patients with knee osteoarthritis, their behavior, and their environment. Older adults experience fluctuations in their pain and related symptoms (mood, fatigue, and sleep quality) that smartwatches are ideally suited to capture remotely in a convenient manner. Objective: The aim of this study was to evaluate satisfaction, usability, and compliance using the real-time, online assessment and mobility monitoring (ROAMM) mobile app designed for smartwatches for individuals with knee osteoarthritis. Methods: Participants (N=28; mean age 73.2, SD 5.5 years; 70% female) with reported knee osteoarthritis were asked to wear a smartwatch with the ROAMM app installed. They were prompted to report their prior night’s sleep quality in the morning, followed by ecological momentary assessments (EMAs) of their pain, fatigue, mood, and activity in the morning, afternoon, and evening. Satisfaction, comfort, and usability were evaluated using a standardized questionnaire. Compliance with regard to answering EMAs was calculated after excluding time when the watch was not being worn for technical reasons (eg, while charging). Results: A majority of participants reported that the text displayed was large enough to read (22/26, 85%), and all participants found it easy to enter ratings using the smartwatch. Approximately half of the participants found the smartwatch to be comfortable (14/26, 54%) and would consider wearing it as their personal watch (11/24, 46%). Most participants were satisfied with its battery charging system (20/26, 77%). A majority of participants (19/26, 73%) expressed their willingness to use the ROAMM app for a 1-year research study. The overall EMA compliance rate was 83% (2505/3036 responses). The compliance rate was lower among those not regularly wearing a wristwatch (10/26, 88% vs 16/26, 71%) and among those who found the text too small to read (4/26, 86% vs 22/26, 60%). Conclusions: Older adults with knee osteoarthritis positively rated the ROAMM smartwatch app and were generally satisfied with the device. The high compliance rates coupled with the willingness to participate in a long-term study suggest that the ROAMM app is a viable approach to remotely collecting health symptoms and behaviors for both research and clinical endeavors. %M 34259638 %R 10.2196/24553 %U https://aging.jmir.org/2021/3/e24553 %U https://doi.org/10.2196/24553 %U http://www.ncbi.nlm.nih.gov/pubmed/34259638 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e27544 %T Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial %A Mok,Tsz-Ngai %A Chen,Junyuan %A Pan,Jinghua %A Ming,Wai-Kit %A He,Qiyu %A Sin,Tat-Hang %A Deng,Jialin %A Li,Jieruo %A Zha,Zhengang %+ Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, 613 West Huangpu Avenue, Tianhe District, Guangzhou, China, 86 2038688563, ilorugaie@163.com %K virtual reality simulators %K tendon suture %K medical education %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective: The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods: In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the “Kessler tendon repair with 2 interrupted tendon repair knots” (KS) method and the “Bunnell tendon repair with figure 8 tendon repair” (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results: Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions: Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180 %M 34255649 %R 10.2196/27544 %U https://games.jmir.org/2021/3/e27544 %U https://doi.org/10.2196/27544 %U http://www.ncbi.nlm.nih.gov/pubmed/34255649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e28140 %T Teleconsultation in the Management of Elective Orthopedic and Spinal Conditions During the COVID-19 Pandemic: Prospective Cohort Study of Patient Experiences %A Melian,Christina %A Frampton,Christopher %A Wyatt,Michael Charles %A Kieser,David %+ Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, Health Sciences Center, Level 4, Stony Brook, NY, 11794-8434, United States, 1 631 444 2111, christina.melian@stonybrookmedicine.edu %K telemedicine %K patient satisfaction %K orthopedic surgery %K telehealth %K COVID-19 %K pandemic %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. Objective: The aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures. Methods: This was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results: We report that 91% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3% (446/807) of all patients preferred teleconsultation compared to 31.2% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95% CI 4.73-5.42 (P<.001). Conclusions: Patients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic. %M 34048355 %R 10.2196/28140 %U https://formative.jmir.org/2021/6/e28140 %U https://doi.org/10.2196/28140 %U http://www.ncbi.nlm.nih.gov/pubmed/34048355 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 5 %P e21455 %T Application of Intelligent Computer-Assisted Taylor 3D External Fixation in the Treatment of Tibiofibular Fracture: Retrospective Case Study %A Sheng,Hongfeng %A Xu,Weixing %A Xu,Bin %A Song,Hongpu %A Lu,Di %A Ding,Weiguo %A Mildredl,Henry %+ Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, China, 86 0571 89972000, hongpusongzj@yeah.net %K intelligent computer-assisted instruction %K Taylor three-dimensional external fixation %K tibial fracture %K internal fixation %K external fixation %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the development of modern society, severe and complex tibial fractures caused by high-energy injuries such as traffic accidents have gradually increased. At present, the commonly used methods for the treatment of tibial fractures include plate fixation, intramedullary nail fixation, and external fixation. Most of these fractures are open wounds with severe soft tissue injury and wound contamination, and some involve bone defects, which makes internal fixation treatment difficult. Objective: This study aims to explore the use of intelligent computer-assisted Taylor 3D external fixation for the treatment of tibiofibular fractures. Methods: In total, 70 patients were included and divided into the Taylor 3D external fixation (TSF) group (28 patients with severe tibial fractures treated with TSF) and the internal fixation group (42 patients with complicated tibiofibular fractures treated by internal fixation). After the treatment, the follow-up evaluation of TSF for the treatment of tibiofibular fractures noted the incidence of complications, as well as the efficacy and occurrence of internal fixation for the treatment of tibial fractures in our hospital. Results: The results showed that TSF was superior to orthopedics in the treatment of tibiofibular fractures in terms of efficacy and complications. Conclusions: TSF for the treatment of tibiofibular fractures is more effective than internal fixation and the incidence of complications is low. This is a new technology for the treatment of tibiofibular fractures that is worthy of clinical promotion. %M 33988516 %R 10.2196/21455 %U https://medinform.jmir.org/2021/5/e21455 %U https://doi.org/10.2196/21455 %U http://www.ncbi.nlm.nih.gov/pubmed/33988516 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e27075 %T Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review %A Maleki,Arash %A Qoreishy,Seyyed Mohammad %A Bahrami,Mohammad Nabi %+ Orthopedic Department, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, Iran, 98 9178851457, mnabibahrami1364@gmail.com %K surgical treatment %K Legg-Calvé-Perthes disease %K pediatric %K hip %K treatment outcome %D 2021 %7 3.5.2021 %9 Review %J Interact J Med Res %G English %X Background: Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective: The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods: An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results: A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions: This review provides clinicians with a brief guideline for the treatment of patients with LCPD. %M 33938444 %R 10.2196/27075 %U https://www.i-jmr.org/2021/2/e27075 %U https://doi.org/10.2196/27075 %U http://www.ncbi.nlm.nih.gov/pubmed/33938444 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18732 %T Prevailing Outcome Themes Reported by People With Degenerative Cervical Myelopathy: Focus Group Study %A Khan,Danyal Zaman %A Fitzpatrick,Siobhan Mairead %A Hilton,Bryn %A McNair,Angus GK %A Sarewitz,Ellen %A Davies,Benjamin Marshall %A Kotter,Mark RN %A , %+ Academic Neurosurgery Department, University of Cambridge, Box 167, Cambridge Biomedical Campus, Addenbrooke’s Hospital, Cambridge, United Kingdom, 44 122 333 6946, mrk25@cam.ac.uk %K cervical %K myelopathy %K spondylosis %K spondylotic %K stenosis %K disc herniation %K ossification posterior longitudinal ligament %K qualitative %K thematic analysis %K core outcomes set %K consensus %K Delphi %K patient perspectives %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) arises when arthritic changes of the cervical spine cause compression and a progressive injury to the spinal cord. It is common and potentially disabling. People with DCM have among the lowest quality of life scores (Short Form Health Survey–36 item [SF-36]) of chronic disease, although the drivers of the imapact of DCM are not entirely understood. DCM research faces a number of challenges, including the heterogeneous reporting of study data. The AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM) project is an international consensus process that aims to improve research efficiency through formation of a core outcome set (COS). A key part of COS development process is organizing outcomes into domains that represent key aspects of the disease. To facilitate this, we sought to qualitatively explore the context and impact of patient-reported outcomes in DCM on study participants. Objective: The goal of the research was to qualitatively explore the patient-reported outcomes in DCM to improve understanding of patient perspective and assist the organization of outcomes into domains for the consensus process. Methods: Focus group sessions were hosted in collaboration with Myelopathy.org, a charity and support group for people with DCM. A 40-minute session was audiorecorded and transcribed verbatim. Two authors familiarized themselves with the data and then performed data coding independently. Codes were grouped into themes and a thematic analysis was performed guided by Braun and Clarke’s 6-phase approach. The themes were subsequently reviewed with an independent stakeholder with DCM, assisting in the process of capturing the true context and importance of themes. Results: Five people with DCM (3 men and 2 women) participated in the focus group session. The median age was 53 years, and the median score on the modified Japanese Orthopaedic Association scale was 11 (interquartile range 9.5-11.5), indicating the participants had moderate to severe DCM. A total of 54 codes were reviewed and grouped into 10 potential themes that captured the impact of the disability on people with DCM: acceptance of symptoms, anticipatory anxiety, coping mechanisms/resilience, feelings of helplessness, financial consequences, lack of recognition, mental health impact, loss of life control, social reclusiveness and isolation, and social stigma. Conclusions: This qualitative analysis of the perspectives of people with DCM has highlighted a number of prevailing themes currently unmeasured in clinical research or care. The determinants of low quality of life in DCM are currently unknown, and these findings provide a novel and so far, unique perspective. Continued inclusion of online communities and use of targeted digital software will be important in establishing a consensus-based COS for patients with DCM that is inclusive of all relevant stakeholders including people with DCM. %M 33533719 %R 10.2196/18732 %U https://formative.jmir.org/2021/2/e18732 %U https://doi.org/10.2196/18732 %U http://www.ncbi.nlm.nih.gov/pubmed/33533719 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 11 %P e19761 %T Predicting Unplanned Readmissions Following a Hip or Knee Arthroplasty: Retrospective Observational Study %A Mohammadi,Ramin %A Jain,Sarthak %A Namin,Amir T %A Scholem Heller,Melissa %A Palacholla,Ramya %A Kamarthi,Sagar %A Wallace,Byron %+ Northeastern University, 2208, 177 Huntington Ave, Boston, MA, , United States, 1 6173732402, b.wallace@northeastern.edu %K deep learning %K natural language processing %K electronic health records %K auto ML %K 30-days readmission %K hip arthroplasty %K knee arthroplasty %D 2020 %7 27.11.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Total joint replacements are high-volume and high-cost procedures that should be monitored for cost and quality control. Models that can identify patients at high risk of readmission might help reduce costs by suggesting who should be enrolled in preventive care programs. Previous models for risk prediction have relied on structured data of patients rather than clinical notes in electronic health records (EHRs). The former approach requires manual feature extraction by domain experts, which may limit the applicability of these models. Objective: This study aims to develop and evaluate a machine learning model for predicting the risk of 30-day readmission following knee and hip arthroplasty procedures. The input data for these models come from raw EHRs. We empirically demonstrate that unstructured free-text notes contain a reasonably predictive signal for this task. Methods: We performed a retrospective analysis of data from 7174 patients at Partners Healthcare collected between 2006 and 2016. These data were split into train, validation, and test sets. These data sets were used to build, validate, and test models to predict unplanned readmission within 30 days of hospital discharge. The proposed models made predictions on the basis of clinical notes, obviating the need for performing manual feature extraction by domain and machine learning experts. The notes that served as model inputs were written by physicians, nurses, pathologists, and others who diagnose and treat patients and may have their own predictions, even if these are not recorded. Results: The proposed models output readmission risk scores (propensities) for each patient. The best models (as selected on a development set) yielded an area under the receiver operating characteristic curve of 0.846 (95% CI 82.75-87.11) for hip and 0.822 (95% CI 80.94-86.22) for knee surgery, indicating reasonable discriminative ability. Conclusions: Machine learning models can predict which patients are at a high risk of readmission within 30 days following hip and knee arthroplasty procedures on the basis of notes in EHRs with reasonable discriminative power. Following further validation and empirical demonstration that the models realize predictive performance above that which clinical judgment may provide, such models may be used to build an automated decision support tool to help caretakers identify at-risk patients. %M 33245283 %R 10.2196/19761 %U https://medinform.jmir.org/2020/11/e19761 %U https://doi.org/10.2196/19761 %U http://www.ncbi.nlm.nih.gov/pubmed/33245283 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e15365 %T Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis %A Safari,Reza %A Jackson,Jessica %A Sheffield,David %+ Health and Social Care Research Centre, University of Derby, Kedleston Road, Derby, DE22 1GB, United Kingdom, 44 1332 592418, m.safari@derby.ac.uk %K osteoarthritis %K self-management %K internet-based intervention %K mobile phone %K eHealth %K mHealth %K systematic review %K meta-analysis %D 2020 %7 20.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. Objective: This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. Methods: A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. Results: A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] –0.28, 95% CI –0.38 to –0.18 and SMD –0.26, 95% CI –0.35 to –0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD –0.10, 95% CI –0.17 to 0.03 and SMD –0.17, 95% CI –0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. Conclusions: Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes. %M 32706657 %R 10.2196/15365 %U http://www.jmir.org/2020/7/e15365/ %U https://doi.org/10.2196/15365 %U http://www.ncbi.nlm.nih.gov/pubmed/32706657 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19333 %T Assessing the Impact of Patient-Facing Mobile Health Technology on Patient Outcomes: Retrospective Observational Cohort Study %A Bruce,Courtenay R %A Harrison,Patricia %A Nisar,Tariq %A Giammattei,Charlie %A Tan,Neema M %A Bliven,Caitlin %A Shallcross,Jamie %A Khleif,Aroub %A Tran,Nhan %A Kelkar,Sayali %A Tobias,Noreen %A Chavez,Ana E %A Rivera,Dana %A Leong,Angela %A Romano,Angela %A Desai,S Nicholas %A Sol,Josh R %A Gutierrez,Kayla %A Rappel,Christopher %A Haas,Eric %A Zheng,Feibi %A Park,Kwan J %A Jones,Stephen %A Barach,Paul %A Schwartz,Roberta %+ System Quality & Patient Safety, Houston Methodist Hospital System, 6565 Fannin Street, Houston, TX, 77030, United States, 1 2816209040, crbruce@houstonmethodist.org %K mHealth %K patient-centered care %K patient satisfaction %K length of stay %K patient activation %K patient empowerment %K patient engagement %K patient involvement %K hospital stay %K communication programs %D 2020 %7 26.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the growth of and media hype about mobile health (mHealth), there is a paucity of literature supporting the effectiveness of widespread implementation of mHealth technologies. Objective: This study aimed to assess whether an innovative mHealth technology system with several overlapping purposes can impact (1) clinical outcomes (ie, readmission rates, revisit rates, and length of stay) and (2) patient-centered care outcomes (ie, patient engagement, patient experience, and patient satisfaction). Methods: We compared all patients (2059 patients) of participating orthopedic surgeons using mHealth technology with all patients of nonparticipating orthopedic surgeons (2554 patients). The analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model for continuous variables. All models were adjusted for patient demographics and comorbidities. Results: The inpatient readmission rates for the nonparticipating group when compared with the participating group were higher and demonstrated higher odds ratios (ORs) for 30-day inpatient readmissions (nonparticipating group 106/2636, 4.02% and participating group 54/2048, 2.64%; OR 1.48, 95% CI 1.03 to 2.13; P=.04), 60-day inpatient readmissions (nonparticipating group 194/2636, 7.36% and participating group 85/2048, 4.15%; OR 1.79, 95% CI 1.32 to 2.39; P<.001), and 90-day inpatient readmissions (nonparticipating group 261/2636, 9.90% and participating group 115/2048, 5.62%; OR 1.81, 95% CI 1.40 to 2.34; P<.001). The length of stay for the nonparticipating cohort was longer at 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (mean 1.87, SD 2 vs mean 1.50, SD 1.37; P<.001). Patients treated by participating surgeons received and read text messages using mHealth 83% of the time and read emails 84% of the time. Patients responded to 60% of the text messages and 53% of the email surveys. Patients were least responsive to digital monitoring questions when the hospital asked them to do something, and they were most engaged with emails that did not require action, including informational content. A total of 96% (558/580) of patients indicated high satisfaction with using mHealth technology to support their care. Only 0.40% (75/2059) patients opted-out of the mHealth technology program after enrollment. Conclusions: A novel, multicomponent, pathway-driven, patient-facing mHealth technology can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes. There is a deep need, however, for a better understanding of the interactions between patients, technology, and health care providers. Future research is needed to (1) help identify, address, and improve technology usability and effectiveness; (2) understand patient and provider attributes that support adoption, uptake, and sustainability; and (3) understand the factors that contribute to barriers of technology adoption and how best to overcome them. %M 32589161 %R 10.2196/19333 %U http://mhealth.jmir.org/2020/6/e19333/ %U https://doi.org/10.2196/19333 %U http://www.ncbi.nlm.nih.gov/pubmed/32589161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16896 %T Artificial Intelligence–Assisted System in Postoperative Follow-up of Orthopedic Patients: Exploratory Quantitative and Qualitative Study %A Bian,Yanyan %A Xiang,Yongbo %A Tong,Bingdu %A Feng,Bin %A Weng,Xisheng %+ Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No 1 Shuaifuyuan, Dongcheng District, Beijing, 100073, China, 86 13021159994, doctorwxs@163.com %K artificial intelligence %K conversational agent %K follow-up %K cost-effectiveness %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient follow-up is an essential part of hospital ward management. With the development of deep learning algorithms, individual follow-up assignments might be completed by artificial intelligence (AI). We developed an AI-assisted follow-up conversational agent that can simulate the human voice and select an appropriate follow-up time for quantitative, automatic, and personalized patient follow-up. Patient feedback and voice information could be collected and converted into text data automatically. Objective: The primary objective of this study was to compare the cost-effectiveness of AI-assisted follow-up to manual follow-up of patients after surgery. The secondary objective was to compare the feedback from AI-assisted follow-up to feedback from manual follow-up. Methods: The AI-assisted follow-up system was adopted in the Orthopedic Department of Peking Union Medical College Hospital in April 2019. A total of 270 patients were followed up through this system. Prior to that, 2656 patients were followed up by phone calls manually. Patient characteristics, telephone connection rate, follow-up rate, feedback collection rate, time spent, and feedback composition were compared between the two groups of patients. Results: There was no statistically significant difference in age, gender, or disease between the two groups. There was no significant difference in telephone connection rate (manual: 2478/2656, 93.3%; AI-assisted: 249/270, 92.2%; P=.50) or successful follow-up rate (manual: 2301/2478, 92.9%; AI-assisted: 231/249, 92.8%; P=.96) between the two groups. The time spent on 100 patients in the manual follow-up group was about 9.3 hours. In contrast, the time spent on the AI-assisted follow-up was close to 0 hours. The feedback rate in the AI-assisted follow-up group was higher than that in the manual follow-up group (manual: 68/2656, 2.5%; AI-assisted: 28/270, 10.3%; P<.001). The composition of feedback was different in the two groups. Feedback from the AI-assisted follow-up group mainly included nursing, health education, and hospital environment content, while feedback from the manual follow-up group mostly included medical consultation content. Conclusions: The effectiveness of AI-assisted follow-up was not inferior to that of manual follow-up. Human resource costs are saved by AI. AI can help obtain comprehensive feedback from patients, although its depth and pertinence of communication need to be improved. %M 32452807 %R 10.2196/16896 %U http://www.jmir.org/2020/5/e16896/ %U https://doi.org/10.2196/16896 %U http://www.ncbi.nlm.nih.gov/pubmed/32452807 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16605 %T A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile–Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation %A Stevens,Timothy %A McGinnis,Ryan S %A Hewgill,Blake %A Choquette,Rebecca H %A Tourville,Timothy W %A Harvey,Jean %A Lachapelle,Richard %A Beynnon,Bruce D %A Toth,Michael J %A Skalka,Christian %+ Department of Medicine, University of Vermont, Health Science Research Facility Rm 126B, 149 Beaumont Ave, Burlington, VT, 05405, United States, 1 (802) 656 7989, michael.toth@med.uvm.edu %K device use tracking %K internet of things %K neuromuscular electrical stimulation %K exercise %K smart devices %K mHealth %K rehabilitation %K mobile health %K digital health %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System–based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software–tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. %M 32384052 %R 10.2196/16605 %U http://humanfactors.jmir.org/2020/2/e16605/ %U https://doi.org/10.2196/16605 %U http://www.ncbi.nlm.nih.gov/pubmed/32384052 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17085 %T Analysis of Secure Apps for Daily Clinical Use by German Orthopedic Surgeons: Searching for the "Needle in a Haystack" %A Dittrich,Florian %A Beck,Sascha %A Harren,Anna Katharina %A Reinecke,Felix %A Serong,Sebastian %A Jung,Jochen %A Back,David Alexander %A Wolf,Milan %A Landgraeber,Stefan %+ Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstr. 100, Homburg, Germany, 49 68411624520, florian.dittrich@uks.eu %K smartphone %K mHealth %K app %K orthopedics %K app store %K screening %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. Objective: This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. Methods: We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the app synopsis–checklist for users and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. Results: The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformité Européenne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. Conclusions: The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice. %M 32379054 %R 10.2196/17085 %U https://mhealth.jmir.org/2020/5/e17085 %U https://doi.org/10.2196/17085 %U http://www.ncbi.nlm.nih.gov/pubmed/32379054 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15987 %T Exploring the Characteristics and Preferences for Online Support Groups: Mixed Method Study %A Plinsinga,Melanie Louise %A Besomi,Manuela %A Maclachlan,Liam %A Melo,Luciano %A Robbins,Sarah %A Lawford,Belinda J %A Teo,Pek Ling %A Mills,Kathryn %A Setchell,Jenny %A Egerton,Thorlene %A Eyles,Jillian %A Hall,Leanne %A Mellor,Rebecca %A Hunter,David J %A Hodges,Paul %A Vicenzino,Bill %A Bennell,Kim %+ Centre for Health, Exercise, and Sports Medicine, Department of Physiotherapy, University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, 3053, Australia, 61 3 8344 4135, k.bennell@unimelb.edu.au %K osteoarthritis %K self-help groups %K self-management %K surveys and questionnaires %D 2019 %7 3.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteoarthritis (OA) is a chronic, disabling, and prevalent disorder. As there is no cure for OA, long-term self-management is paramount. Support groups (SGs) can facilitate self-management among people living with OA. Understanding preferences in design and features of SGs, including online SGs (OSGs), among people with OA can inform future development of SG interventions for this condition. Objective: The objective of this study was to investigate health care– and health information–seeking behavior, digital literacy, and preferences for the design of SGs in people with OA. The study also explored the perceived barriers and enablers to being involved in OSGs. Methods: An online survey study was conducted with a mixed method design (quantitative and qualitative). Individuals aged ≥45 years with knee, hip, or back pain for ≥3 months were recruited from an extant patient database of the Institute of Bone and Joint Research via email invitations. Quantitative elements of the survey included questions about sociodemographic background; health care– and health information–seeking behavior; digital literacy; and previous participation in, and preferences for, SGs and OSGs. Respondents were classified into 2 groups (Yes-SG and No-SG) based on previous participation or interest in an SG. Group differences were assessed with Chi-square tests (significance level set at 5%). Responses to free-text questions relating to preferences regarding OSG engagement were analyzed qualitatively using an inductive thematic analysis. Results: A total of 415 people with OA completed the survey (300/415, 72.3% females; 252/415, 61.0% lived in a major city). The Yes-SG group included 307 (307/415, 73.9%) participants. Between the Yes-SG and No-SG groups, there were no differences in sociodemographic characteristics, health care– and health information–seeking behavior, and digital literacy. An online format was preferred by 126/259 (48.7%) of the Yes-SG group. Trained peer facilitators were preferred, and trustworthiness of advice and information were highly prioritized by the respondents. Qualitative analysis for OSG participation revealed 5 main themes. Lack of time and motivation were the main barriers identified. The main enablers were related to accessibility, enjoyment of the experience, and the content of the discussed information. Conclusions: These findings highlight the preferences in design features and content of SGs and OSGs and may assist in the further development of such groups. %M 31793893 %R 10.2196/15987 %U https://www.jmir.org/2019/12/e15987 %U https://doi.org/10.2196/15987 %U http://www.ncbi.nlm.nih.gov/pubmed/31793893 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 4 %P e14607 %T Osteopathic Considerations for Peripheral Neuropathy Due to Concomitant Diffuse Idiopathic Skeletal Hyperostosis Syndrome and Lumbar Epidural Lipomatosis: Case Report %A Chin,Justin %A Kviatkovsky,Bina %A Lomiguen,Christine %+ Touro College of Osteopathic Medicine, 230 West 125th Street, New York, NY, 10025, United States, 1 9259139989, jchin2@student.touro.edu %K diffuse idiopathic skeletal hyperostosis syndrome %K epidural lipamtosis %K ostepathic medicine %D 2019 %7 20.11.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Diffuse idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis are relatively asymptomatic neurological conditions, with findings often seen incidentally on radiological studies. Objective: The aim of this paper is to present unique findings of concomitant, symptomatic DISH syndrome and lumbar epidural lipomatosis and to discuss the osteopathic diagnosis and treatment implications. Methods: Concomitant, symptomatic variants are rare and present challenges to treatment and management, as seen with a 60-year-old African American woman who presented with worsening disequilibrium and new-onset bilateral fingertip numbness. Past medical history was significant for alcohol abuse disorder, hypertension, hyperlipidemia, and multiple episodes of self-resolving vertigo and lower extremity neuropathy. Results: The patient was referred to the neurology department for stroke workup, which was negative. Osteopathic structural exam revealed thoracolumbar and sacral dysfunctions. Magnetic resonance imaging revealed findings consistent with thoracic DISH syndrome and lumbar epidural lipomatosis in the areas of somatic dysfunctions. Conclusions: Due to minimal information on osteopathic manipulative treatment in rare neurological diseases, only gentle techniques of myofascial release, balanced ligamentous tension, and muscle energy were performed with resultant minimal improvement, thus highlighting the necessity for better guidelines and further research. %M 31746769 %R 10.2196/14607 %U http://www.i-jmr.org/2019/4/e14607/ %U https://doi.org/10.2196/14607 %U http://www.ncbi.nlm.nih.gov/pubmed/31746769 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 2 %P e14236 %T The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial %A Eichler,Sarah %A Salzwedel,Annett %A Rabe,Sophie %A Mueller,Steffen %A Mayer,Frank %A Wochatz,Monique %A Hadzic,Miralem %A John,Michael %A Wegscheider,Karl %A Völler,Heinz %+ Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Potsdam, 14469, Germany, 49 331977 ext 4062, heinz.voeller@uni-potsdam.de %K telerehabilitation %K home-based %K total hip replacement %K total knee replacement %K exercise therapy %K aftercare %K rehabilitation %D 2019 %7 7.11.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare. Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare. Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints. Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note. Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare. Trial Registration: German Clinical Trials Register DRKS00010009; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010009 %M 31697239 %R 10.2196/14236 %U http://rehab.jmir.org/2019/2/e14236/ %U https://doi.org/10.2196/14236 %U http://www.ncbi.nlm.nih.gov/pubmed/31697239 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e9805 %T Lumbar Spine Fusion Patients’ Use of an Internet Support Group: Mixed Methods Study %A Strøm,Janni %A Høybye,Mette Terp %A Laursen,Malene %A Jørgensen,Lene Bastrup %A Nielsen,Claus Vinther %+ Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, Silkeborg, 8800, Denmark, 45 41177137, japete@rm.dk %K spinal fusion %K medical informatics %K self-help groups %K eHealth %K online social networking %K social support %D 2019 %7 04.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet use within health care contexts offers the possibility to provide both health information and peer support. Internet Support Groups (ISGs) for patients may offer advantages, which are not found in face-to-face support. In patients undergoing lumbar spine fusion (LSF), ISGs could have a particular potential, as peer support on the web might bridge the decreased satisfaction with social life and social isolation found within these patients. ISGs might in this way contribute to increasing the functioning and overall health-related quality of life. However, LSF patients may generally belong to a group of citizens not prone to internet and online peer support. However, our knowledge of how LSF patients use ISGs is limited. Objective: The aim of this study was to describe the characteristics of users of an ISG and thematically explore the content of ISG interactions in Danish patients undergoing instrumented LSF because of degenerative spine disorders. Methods: Participants were recruited from a randomized controlled trial and included in a prospective cohort with a mixed methods design. Sociodemographic characteristics and information on psychological well-being (symptoms of anxiety and depression) were obtained at baseline and 1 to 5 weeks before surgery. Usage of the ISG was registered from baseline until 3 months after surgery. All posts and comments were collected, and content analysis was performed. Results: A total of 48 participants comprised the study population, with a mean age of 53 years (range 29-77). Of the participants, 54% (26/48) were female, 85% (41/48) were cohabitating, 69% (33/48) were unemployed, and the majority (69% [33/48]) had secondary education. Approximately one-third of the participants had symptoms of depression (35%, 17/48) and anxiety (29%, 14/48). Overall, 90% (43/48) of the participants accessed the ISG. No correlations were found between sociodemographic characteristics and access to the ISG. Women were more prone to be active users, contributing with posts (P=.04). Finally, active users contributing with posts or comments had viewed more pages, whereas passive users, users without posts or comments, had more interactions with the ISG (P<.001). The ISG contained 180 conversation threads, generating 354 comments. The 180 conversation threads in the ISG were constituted by 671 independent dialogue sequences. On the basis of those 671 dialogue sequences, 7 thematic categories emerged. Conclusions: Sociodemographic characteristics were not predictors of ISG use in this study, and active use was found to be gender dependent. Content of interactions on the ISG emerged within 7 thematic categories and focused on social recognition, experience of pain or use of pain medication, experience of physical activity or physical rehabilitation, expression of psychosocial well-being, advising on and exploring the ISG, and employment, which seemed to correspond well with the prevalent occurrence of symptoms of anxiety and depression. %M 31274113 %R 10.2196/jmir.9805 %U https://www.jmir.org/2019/7/e9805/ %U https://doi.org/10.2196/jmir.9805 %U http://www.ncbi.nlm.nih.gov/pubmed/31274113 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e9881 %T “As If Neck Injuries Did Not Exist”: An Interview Study of Patients’ and Relatives’ Perceptions of Web Information on and Management of Whiplash Injuries in Sweden %A Bernhoff,Gabriella %A Saripanidis,Christos %A Bertilson,Bo Christer %+ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Alfred Nobels allé 23, Stockholm, SE-14183, Sweden, 46 70 732 02 32, bo.bertilson@ki.se %K self care %K patient participation %K health communication %K patient portals %K patient education handout %K patient satisfaction %K whiplash injuries %K neck pain %K chronic pain %D 2019 %7 21.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: If purposefully designed, patient information can help individuals make well-founded health care decisions. This study was initiated to improve the information on whiplash injuries found in the national health care portal Healthcare Guide 1177, operated by the Swedish government. Objective: The objective of this study was to describe the thoughts of patients and relatives on (1) information about whiplash injuries presented in the portal and (2) the Swedish health care system’s management of whiplash injuries. Methods: A total of 5 interviews were conducted with patients (n=10) who had experienced a whiplash injury and with relatives (n=3) of such patients. The interviews were taped, transcribed verbatim, and analyzed by means of conventional content analysis. Results: The following two themes emerged from the latent content analysis: (1) confidence and trust in the public health care system and (2) a disappointment with health care encounters. Conclusions: We found that most of the study participants felt distress due to insufficient information; respondents perceived a discrepancy between the public health care system's authority and the information provided. The Web information on whiplash injuries may greatly impact patients' care decisions as well as their physical, mental, and social well-being. We would recommend detailed patient information on whiplash injuries, with less emphasis on psychology and more data on pathophysiology, prognosis, and treatment. %M 31115342 %R 10.2196/ijmr.9881 %U https://www.i-jmr.org/2019/2/e9881/ %U https://doi.org/10.2196/ijmr.9881 %U http://www.ncbi.nlm.nih.gov/pubmed/31115342 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e14028 %T Orthopedic Surgeons’ Perspectives on the Decision-Making Process for the Use of Bioprinter Cartilage Grafts: Web-Based Survey %A Salvador Verges,Àngels %A Fernández-Luque,Luis %A López Seguí,Francesc %A Yildirim,Meltem %A Salvador-Mata,Bertran %A García Cuyàs,Francesc %+ Digital Care Research Group, Universitat de Vic - Universitat Central de Catalunya, 11, Magi Casanovas, Barcelona, 08870, Spain, 34 630887995, angels.salvador@uvic.cat %K orthopedic surgeons %K online survey %K 3D bioprinting %K cartilage %K graft %D 2019 %7 15.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Traumatic and degenerative lesions in the cartilage are one of the most difficult and frustrating types of injuries for orthopedic surgeons and patients. Future developments in medical science, regenerative medicine, and materials science may allow the repair of human body parts using 3D bioprinting techniques and serve as a basis for new therapies for tissue and organ regeneration. One future possibility is the treatment of joint cartilage defects with in vivo 3D printing from biological/biocompatible materials to produce a suitable cell attachment and proliferation environment in the damaged site and employ the natural recovery potential of the body. This study focuses on the perspectives of orthopedic surgeons regarding the key factors/determinants and perceived clinical value of a new therapeutic option. Objective: This study aimed to determine the knowledge and expectations of orthopedic surgeons regarding the clinical use of bioprinted cartilage. Methods: The survey, conducted anonymously and self-managed, was sent to orthopedic surgeons from the Catalan Society of Orthopedic and Traumatology Surgery. In accordance with the method devised by Eysenbach, the Checklist for Reporting Results of Internet E-Surveys was used to analyze the results. The following factors were taken into consideration: the type and origin of the information received; its relevance; the level of acceptance of new technologies; and how the technology is related to age, years, and place of experience in the field. Results: Of the 86 orthopedic surgeons included, 36 believed the age of the patient was a restriction, 53 believed the size of the lesion should be between 1 and 2 cm to be considered for this type of technology, and 51 believed that the graft should last more than 5 years. Surgeons over 50 years of age (38/86, 44%) gave more importance to clinical evidence as compared to surgeons from the other age groups. Conclusions: The perspective of orthopedic surgeons depends highly on the information they receive and whether it is specialized and consistent, as this will condition their acceptance and implementation of the bioprinted cartilage. %M 31094326 %R 10.2196/14028 %U http://www.i-jmr.org/2019/2/e14028/ %U https://doi.org/10.2196/14028 %U http://www.ncbi.nlm.nih.gov/pubmed/31094326 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 4 %N 1 %P e12148 %T Perspectives of Orthopedic Surgeons on the Clinical Use of Bioprinted Cartilage: Qualitative Study %A Salvador Verges,Àngels %A Fernández-Luque,Luis %A Yildirim,Meltem %A Salvador-Mata,Bertran %A Garcia Cuyàs,Francesc %+ Digital Care Research Group, Universitat de Vic – Universitat Central de Catalunya, 11, Magi Casanovas, Barcelona, 08870, Spain, 34 630887995, angels.salvador@uvic.cat %K bioprinting %K orthopedic surgeons %K qualitative research %K cartilage %K expert testimony %D 2019 %7 28.02.2019 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Over the past 60 years, no technique used for treating cartilage disorders has been completely successful. Bioprinting provides a highly anticipated, novel alternative solution to this problem. However, identifying barriers to this new technology is crucial in order to overcome them when bioprinting reaches the implementation stage. This kind of research has been declared essential because clinical efficacy and safety studies alone do not always lead to successful implementation. Objective: This qualitative study aimed to explore the stance of orthopedic surgeons on the use of bioprinted cartilage grafts for cartilaginous lesions. The study sought to summarize and classify the barriers and facilitators of this technique and to identify the key factors for successful implementation of bioprinted cartilage in routine clinical practice. Methods: A qualitative thematic analysis method was used to evaluate data obtained from semistructured interviews and from focus groups. Data were collected between June 2017 and February 2018. Interviews focused on the collection of expert opinions on bioprinted cartilage. Results: The perceived barriers to the adoption of this technology were (1) awareness of a lack of information on the status and possibilities of this technology, (2) uncertainty regarding compliance with current health care regulations and policies, and (3) demands for clinical evidence. The facilitators were (1) lack of surgical alternatives, (2) the perception that research is the basis of the current health system, and (3) the hope of offering a better quality of life to patients. Conclusions: The results of this study are preliminary in nature and cannot be generalized without a broader group of participants. However, the key factors identified provide a frame of reference to help understand the challenges of bioprinted cartilage and help facilitate the transition toward its clinical use. These findings will also provide information for use at multidisciplinary meetings in scientific societies; create bridges between researchers, orthopedic surgeons, and regulators; and open a debate on the funding of this technique and the business model that needs to be developed. %R 10.2196/12148 %U http://biomedeng.jmir.org/2019/1/e12148/ %U https://doi.org/10.2196/12148 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 10 %N 4 %P e12338 %T The Impact of Visualization Format and Navigational Options on Laypeople’s Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey %A Eggeling,Marie %A Bientzle,Martina %A Shiozawa,Thomas %A Cress,Ulrike %A Kimmerle,Joachim %+ Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, Schleichstr 6, Tuebingen, 72076, Germany, 49 7071979 ext 363, j.kimmerle@iwm-tuebingen.de %K attitude %K decision aids %K emotions %K informed decision making %K knowledge acquisition %K medical decision making %K surgery %K video %D 2018 %7 22.11.2018 %9 Original Paper %J J Participat Med %G English %X Background: Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. Objective: We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients’ knowledge gain, emotions, attitude, and hypothetical decision-making ability. Methods: In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. Results: In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. Conclusion: Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. Trial Registration: Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN) %R 10.2196/12338 %U http://jopm.jmir.org/2018/4/e12338/ %U https://doi.org/10.2196/12338 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 3 %P e10522 %T Determining Physiological and Psychological Predictors of Time to Task Failure on a Virtual Reality Sørensen Test in Participants With and Without Recurrent Low Back Pain: Exploratory Study %A Applegate,Megan E %A France,Christopher R %A Russ,David W %A Leitkam,Samuel T %A Thomas,James S %+ Wyss Institute for Biologically Inspired Engineering, 60 Oxford Street, Cambridge, MA, 02138, United States, 1 815 474 6743, applegate@seas.harvard.edu %K fatigue %K low back pain %K Sørensen test %K trunk mass %K virtual reality %D 2018 %7 10.09.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sørensen trunk extension endurance test performance predicts the development of low back pain and is a strong discriminator of those with and without low back pain. Performance may greatly depend on psychological factors, such as kinesiophobia, self-efficacy, and motivation. Virtual reality video games have been used in people with low back pain to encourage physical activity that would otherwise be avoided out of fear of pain or harm. Accordingly, we developed a virtual reality video game to assess the influence of immersive gaming on the Sørensen test performance. Objective: The objective of our study was to determine the physiological and psychological predictors of time to task failure (TTF) on a virtual reality Sørensen test in participants with and without a history of recurrent low back pain. Methods: We recruited 24 individuals with a history of recurrent low back pain and 24 sex-, age-, and body mass index–matched individuals without a history of low back pain. Participants completed a series of psychological measures, including the Center for Epidemiological Studies-Depression Scale, Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and a self-efficacy measure. The maximal isometric strength of trunk and hip extensors and TTF on a virtual reality Sørensen test were measured. Electromyography of the erector spinae, gluteus maximus, and biceps femoris was recorded during the strength and endurance trials. Results: A two-way analysis of variance revealed no significant difference in TTF between groups (P=.99), but there was a trend for longer TTF in females on the virtual reality Sørensen test (P=.06). Linear regression analyses were performed to determine predictors of TTF in each group. In healthy participants, the normalized median power frequency slope of erector spinae (beta=.450, P=.01), biceps femoris (beta=.400, P=.01), and trunk mass (beta=−.32, P=.02) predicted TTF. In participants with recurrent low back pain, trunk mass (beta=−.67, P<.001), Tampa Scale for Kinesiophobia (beta=−.43, P=.01), and self-efficacy (beta=.35, P=.03) predicted TTF. Conclusions: Trunk mass appears to be a consistent predictor of performance. Kinesiophobia appears to negatively influence TTF for those with a history of recurrent low back pain, but does not influence healthy individuals. Self-efficacy is associated with better performance in individuals with a history of recurrent low back pain, whereas a less steep median power frequency slope of the trunk and hip extensors is associated with better performance in individuals without a history of low back pain. %M 30201604 %R 10.2196/10522 %U http://games.jmir.org/2018/3/e10522/ %U https://doi.org/10.2196/10522 %U http://www.ncbi.nlm.nih.gov/pubmed/30201604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10405 %T Accuracy of Internet-Based Patient Self-Report of Postdischarge Health Care Utilization and Complications Following Orthopedic Procedures: Observational Cohort Study %A Rosner,Benjamin I %A Gottlieb,Marc %A Anderson,William N %+ HealthLoop Inc, 605 Ellis St #100, Mountain View, CA,, United States, 1 408 418 0998, ben@healthloop.com %K patient-generated health data %K patient reported outcome measures %K patient self-report %K complications %K utilization %K patient readmission %K emergency room %K hospital economics %D 2018 %7 20.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The accuracy of patient self-report of health care utilization and complications has yet to be determined. If patients are accurate and engaged self-reporters, collecting this information in a manner that is temporally proximate to the health care utilization events themselves may prove valuable to health care organizations undertaking quality improvement initiatives for which such data are often unavailable. Objective: The objective of this study was to measure the accuracy of patient self-report of health care utilization and complications in the 90 days following orthopedic procedures using an automated digital patient engagement platform. Methods: We conducted a multicenter real-world observational cohort study across 10 orthopedic practices in California and Nevada. A total of 371 Anthem members with claims data meeting inclusion criteria who had undergone orthopedic procedures between March 1, 2015, and July 1, 2016, at participating practices already routinely using an automated digital patient engagement platform for asynchronous remote guidance and telemonitoring were sent surveys through the platform (in addition to the other materials being provided to them through the platform) regarding 90-day postencounter health care utilization and complications. Their self-reports to structured survey questions of health care utilization and complications were compared to claims data as a reference. Results: The mean age of the 371 survey recipients was 56.5 (SD 15.7) years, 48.8% (181/371) of whom were female; 285 individuals who responded to 1 or more survey questions had a mean age of 56.9 (SD 15.4) years and a 49.5% (141/285) female distribution. There were no significant differences in demographics or event prevalence rates between responders and nonresponders. With an overall survey completion rate of 76.8% (285/371), patients were found to have accuracy of self-report characterized by a kappa of 0.80 and agreement of 0.99 and a kappa of 1.00 and agreement of 1.00 for 90-day hospital admissions and pulmonary embolism, respectively. Accuracy of self-report of 90-day emergency room/urgent care visits and of surgical site infection were characterized by a kappa of 0.45 and agreement of 0.96 and a kappa of 0.53 and agreement of 0.97, respectively. Accuracy for other complications such as deep vein thrombosis, hemorrhage, severe constipation, and fracture/dislocation was lower, influenced by low event prevalence rates within our sample. Conclusions: In this multicenter observational cohort study using an automated internet-based digital patient engagement platform, we found that patients were most accurate self-reporters of 90-day hospital admissions and pulmonary embolism, followed by 90-day surgical site infection and emergency room/urgent care visits. They were less accurate for deep vein thrombosis and least accurate for hemorrhage, severe constipation, and fracture/dislocation. A total of 76.8% (285/371) of patients completed surveys without the need for clinical staff to collect responses, suggesting the acceptability to patients of internet-based survey dissemination from and collection by clinical teams. While our methods enabled detection of events outside of index institutions, assessment of accuracy of self-report for presence and absence of events and nonresponse bias analysis, low event prevalence rates, particularly for several of the complications, limit the conclusions that may be drawn for some of the findings. Nevertheless, this investigation suggests the potential that engaging patients in self-report through such survey modalities may offer for the timely and accurate measurement of matters germane to health care organizations engaged in quality improvement efforts post discharge. %M 30030212 %R 10.2196/10405 %U http://www.jmir.org/2018/7/e10405/ %U https://doi.org/10.2196/10405 %U http://www.ncbi.nlm.nih.gov/pubmed/30030212 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e10 %T Factors Affecting Bone Mineral Density Among Snowy Region Residents in Japan: Analysis Using Multiple Linear Regression and Bayesian Network Model %A Suzuki,Teppei %A Shimoda,Tomoko %A Takahashi,Noriko %A Tsutsumi,Kaori %A Samukawa,Mina %A Yoshimura,Sadako %A Ogasawara,Katsuhiko %+ Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo,, Japan, 81 11 706 3409, oga@hs.hokudai.ac.jp %K health care promotion %K Bayesian network %K health behavior change %D 2018 %7 22.05.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: As the onset of osteoporosis leads to reduced activities of daily living and may result in patients being bedridden, efforts to prevent decreased bone density are necessary. Various studies on the relationship between sex, age, nutrients, and exercise habits and bone mineral density have been conducted to date. However, for snowy region residents, the magnitude of influence of various factors affecting bone mineral density and the influence level have not been clarified. Objective: This study aimed to clarify the degree of influence and factors influencing bone mineral density based on survey results on health conditions and lifestyle habits in heavy snow areas. Methods: A total of 354 citizens who visited a drugstore in the target area were included in a study that included using the brief-type self-administered diet history questionnaire on lifestyle and exercise habits. Height, weight, body composition, and bone densitometer values were analyzed using multiple regression to calculate their association with bone mineral density. In addition, a Bayesian network model was used to determine the influence level of each factor as a conditional probability. Results: Multiple regression analysis revealed that age, sex, fracture, and calcium intake significantly influenced bone mineral density. In addition, the result of Bayesian network analysis suggested that age and sex affected bone mineral density, whereas nutrients and exercise habits might not have a direct impact. However, calcium intake and the T-score were significant factors affecting the presence or absence of fracture experiences, suggesting that adequate calcium intake is essential for preventing fractures. Conclusions: In the multiple regression analysis, age, sex, fracture, and calcium intake were selected as factors; however, in the Bayesian analysis, only age and sex affected bone mineral density while nutrients did not. In addition, the fact that calcium intake and the T-score were shown to affect bone fracture history suggests that calcium intake is an important measure that can prevent bone fractures. Overall, these results suggest that measures such as ensuring a bone fracture–free environment and providing nutritional advice for calcium intake can be effective in preventing bone loss. %M 29789280 %R 10.2196/ijmr.8555 %U http://www.i-jmr.org/2018/1/e10/ %U https://doi.org/10.2196/ijmr.8555 %U http://www.ncbi.nlm.nih.gov/pubmed/29789280 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e159 %T Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study %A Li,Linda C %A Sayre,Eric C %A Xie,Hui %A Falck,Ryan S %A Best,John R %A Liu-Ambrose,Teresa %A Grewal,Navi %A Hoens,Alison M %A Noonan,Greg %A Feehan,Lynne M %+ Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada, 1 604 207 4020, lli@arthritisresearch.ca %K osteoarthritis %K physical activity %K wearables %K goal setting %K physiotherapy %K eHealth %D 2018 %7 30.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Current practice guidelines emphasize the use of physical activity as the first-line treatment of knee osteoarthritis; however, up to 90% of people with osteoarthritis are inactive. Objective: We aimed to assess the efficacy of a technology-enabled counseling intervention for improving physical activity in people with either a physician-confirmed diagnosis of knee osteoarthritis or having passed two validated criteria for early osteoarthritis. Methods: We conducted a proof-of-concept randomized controlled trial. The immediate group received a brief education session by a physical therapist, a Fitbit Flex, and four biweekly phone calls for activity counseling. The delayed group received the same intervention 2 months later. Participants were assessed at baseline (T0) and at the end of 2 months (T1), 4 months (T2), and 6 months (T3). Outcomes included (1) mean time on moderate-to-vigorous physical activity (MVPA ≥3 metabolic equivalents [METs], primary outcome), (2) mean time on MVPA ≥4 METs, (3) mean daily steps, (4) mean time on sedentary activities, (5) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (6) Partners in Health scale. Mixed-effects repeated measures analysis of variance was used to assess five planned contrasts of changes in outcome measures over measurement periods. The five contrasts were (1) immediate T1-T0 vs delayed T1-T0, (2) delayed T2-T1 vs delayed T1-T0, (3) mean of contrast 1 and contrast 2, (4) immediate T1-T0 vs delayed T2-T1, and (5) mean of immediate T2-T1 and delayed T3-T2. The first three contrasts estimate the between-group effects. The latter two contrasts estimate the effect of the 2-month intervention delay on outcomes. Results: We recruited 61 participants (immediate: n=30; delayed: n=31). Both groups were similar in age (immediate: mean 61.3, SD 9.4 years; delayed: mean 62.1, SD 8.5 years) and body mass index (immediate: mean 29.2, SD 5.5 kg/m2; delayed: mean 29.2, SD 4.8 kg/m2). Contrast analyses revealed significant between-group effects in MVPA ≥3 METs (contrast 1 coefficient: 26.6, 95% CI 4.0-49.1, P=.02; contrast 3 coefficient: 26.0, 95% CI 3.1-49.0, P=.03), daily steps (contrast 1 coefficient: 1699.2, 95% CI 349.0-3049.4, P=.02; contrast 2 coefficient: 1601.8, 95% CI 38.7-3164.9, P=.045; contrast 3 coefficient: 1650.5, 95% CI 332.3-2968.7; P=.02), KOOS activity of daily living subscale (contrast 1 coefficient: 6.9, 95% CI 0.1-13.7, P=.047; contrast 3 coefficient: 7.2, 95% CI 0.8-13.6, P=.03), and KOOS quality of life subscale (contrast 1 coefficient: 7.4, 95% CI 0.0-14.7, P=.049; contrast 3 coefficient: 7.3, 95% CI 0.1-14.6, P=.048). We found no significant effect in any outcome measures due to the 2-month delay of the intervention. Conclusions: Our counseling program improved MVPA ≥3 METs, daily steps, activity of daily living, and quality of life in people with knee osteoarthritis. These findings are important because an active lifestyle is an important component of successful self-management. Trial Registration: ClinicalTrials.gov NCT02315664; https://clinicaltrials.gov/ct2/show/NCT02315664 (Archived by WebCite at http://www.webcitation.org/6ynSgUyUC) %M 29712630 %R 10.2196/jmir.8514 %U http://www.jmir.org/2018/4/e159/ %U https://doi.org/10.2196/jmir.8514 %U http://www.ncbi.nlm.nih.gov/pubmed/29712630 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e152 %T The Efficacy of Electronic Health–Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review %A Schäfer,Axel Georg Meender %A Zalpour,Christoff %A von Piekartz,Harry %A Hall,Toby Maxwell %A Paelke,Volker %+ Course of Study Speech and Language Therapy, Occupational Therapy and Physiotherapy, Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Gebaeude Goschentor, 2nd Floor, Goschentor 1, Hildesheim, 31141, Germany, 49 5121 881 ext 510, axel.schaefer@hawk.de %K osteoarthritis, knee %K telemedicine %K exercise %K treatment outcome %K review %K meta-analysis %D 2018 %7 26.04.2018 %9 Review %J J Med Internet Res %G English %X Background: Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. Objective: The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. Methods: MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality). Conclusions: eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence. %M 29699963 %R 10.2196/jmir.9465 %U http://www.jmir.org/2018/4/e152/ %U https://doi.org/10.2196/jmir.9465 %U http://www.ncbi.nlm.nih.gov/pubmed/29699963 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 1 %P e9 %T Patients Using an Online Forum for Reporting Progress When Engaging With a Six-Week Exercise Program for Knee Conditioning: Feasibility Study %A Bright,Philip %A Hambly,Karen %+ Research Department, European School of Osteopathy, Boxley House, The Street, Boxley, Maidstone, ME14 3DZ, United Kingdom, 44 01622671558, philbright@eso.ac.uk %K eHealth; social media; exercise therapy; rehabilitation %D 2018 %7 26.04.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The use of electronic health (eHealth) and Web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual “sticky notes.” Objective: The primary aim of this study was to determine feasibility of patients in a 6-week knee exercise program using Padlet as an online forum for self-reporting on outcome progression. Methods: Undergraduate manual therapy students were recruited as part of a 6-week study into knee conditioning. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analyzed for association between engagement, entry frequency, and participant characteristics. Individual data facilitated single-subject, multiple-baseline analysis using statistical process control. Experiential narrative was analyzed thematically. Results: Nineteen participants were recruited (47%, 9/19 female); ages ranged from 19 to 53 years. Twelve individuals (63%) opted to engage with the forum (range 4-40 entries), with five (42%) reporting across all 6 weeks. Gender did not influence reporting (odds ratio [OR] 0.76, 95% CI 0.06-6.93). No significant difference manifested between body mass index and engagement P=.46); age and entry frequency did not correlate (R2=.054, 95% CI –0.42 to 0.51, P=.83). Statistically significant conditioning profiles arose in single participants. Themes of pain, mitigation, and response were inducted from the experiences posted. Conclusions: Patients will engage with an online forum for reporting progress when undertaking exercise programs. In contrast to related literature, no significant association was found with reporting and gender, age, or body mass index. Individual posted data allowed multiple-baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualized visual data to patients and the role of forums in monitoring patients’ progress in symptomatic knee pain populations need further consideration. %M 29699967 %R 10.2196/rehab.8567 %U http://rehab.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/rehab.8567 %U http://www.ncbi.nlm.nih.gov/pubmed/29699967 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e4 %T The Patient Perspective on the Impact of Tenosynovial Giant Cell Tumors on Daily Living: Crowdsourcing Study on Physical Function and Quality of Life %A Mastboom,Monique Josephine %A Planje,Rosa %A van de Sande,Michiel Adreanus %+ Department of Orthopedics, Leiden University Medical Center, University of Leiden, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 715264088, mjlmastboom@lumc.nl %K synovitis %K pigmented villonodular %K giant cell tumor of tendon sheath %K rare diseases %K crowdsourcing %K social media %K patient-reported outcome measures %K quality of life %K health-related quality of life %K social participation %K surveys and questionnaires %D 2018 %7 23.02.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Tenosynovial giant cell tumor (TGCT) is a rare, benign lesion affecting the synovial lining of joints, bursae, and tendon sheaths. It is generally characterized as a locally aggressive and often recurring tumor. A distinction is made between localized- and diffuse-type. The impact of TGCT on daily living is currently ill-described. Objective: The aim of this crowdsourcing study was to evaluate the impact of TGCT on physical function, daily activities, societal participation (work, sports, and hobbies), and overall quality of life from a patient perspective. The secondary aim was to define risk factors for deteriorated outcome in TGCT. Methods: Members of the largest known TGCT Facebook community, PVNS is Pants!!, were invited to an e-survey, partially consisting of validated questionnaires, for 6 months. To confirm disease presence and TGCT-type, patients were requested to share histological or radiological proof of TGCT. Unpaired t tests and chi-square tests were used to compare groups with and without proof and to define risk factors for deteriorated outcome. Results: Three hundred thirty-seven questionnaires, originating from 30 countries, were completed. Median age at diagnosis was 33 (interquartile range [IQR]=25-42) years, majority was female (79.8% [269/337]), diffuse TGCT (70.3% [237/337]), and affected lower extremities (knee 70.9% [239/337] and hip 9.5% [32/337]). In 299 lower-extremity TGCT patients (32.4% [97/299]) with disease confirmation, recurrence rate was 36% and 69.5% in localized and diffuse type, respectively. For both types, pain and swelling decreased after treatment; in contrast, stiffness and range of motion worsened. Patients were limited in their employment (localized 13% [8/61]; diffuse 11.0% [21/191]) and sport-activities (localized 58% [40/69]; diffuse 63.9% [147/230]). Compared with general US population, all patients showed lower Patient-Reported Outcomes Measurements Information System-Physical Function (PROMIS-PF), Short Form-12 (SF-12), and EuroQoL 5 Dimensions 5 Levels (EQ5D-5L) scores, considered clinically relevant, according to estimated minimal important difference (MID). Diffuse versus localized type scored almost 0.5 standard deviation lower for PROMIS-PF (P<.001) and demonstrated a utility score of 5% lower for EQ-5D-5L (P=.03). In localized TGCT, recurrent disease and ≥2 surgeries negatively influenced scores of Visual Analog Scale (VAS)-pain/stiffness, SF-12, and EQ-5D-5L (P<.05). In diffuse type, recurrence resulted in lower score for VAS, PROMIS-PF, SF-12, and EQ-5D-5L (P<.05). In both types, patients with treatment ≤1year had significantly lower SF-12. Conclusions: TGCT has a major impact on daily living in a relatively young and working population. Patients with diffuse type, recurrent disease, and ≥2 surgeries represent lowest functional and quality of life outcomes. Physicians should be aware that TGCT patients frequently continue to experience declined health-related quality of life and physical function and often remain limited in daily life, even after treatment(s). %M 29475829 %R 10.2196/ijmr.9325 %U http://www.i-jmr.org/2018/1/e4/ %U https://doi.org/10.2196/ijmr.9325 %U http://www.ncbi.nlm.nih.gov/pubmed/29475829 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e17 %T Relationship of Buckling and Knee Injury to Pain Exacerbation in Knee Osteoarthritis: A Web-Based Case-Crossover Study %A Zobel,Isabelle %A Erfani,Tahereh %A Bennell,Kim L %A Makovey,Joanna %A Metcalf,Ben %A Chen,Jian Sheng %A March,Lyn %A Zhang,Yuqing %A Eckstein,Felix %A Hunter,David J %+ Institute of Bone and Joint Research, Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, NSW Australia, 7C Clinical Administration, Department of Rheumatology, Royal North Shore Hospital, St Leonards, 2065, Australia, 61 2 94631788, David.Hunter@sydney.edu.au %K knee osteoarthritis %K injury %K buckling pain exacerbation %K case-crossover study %K web-based %D 2016 %7 24.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Knee osteoarthritis (OA) is one of the most frequent causes of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Evidence shows that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation. Objective: Our objective was to examine whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA. Methods: We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the Internet. Participants were asked to log-on to the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control periods)—a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experienced an isolated incident of knee pain exacerbation (case periods). A pain exacerbation “case” period was defined as an increase of ≥2 compared to baseline. At each contact the pain exacerbation was designated a case period, and at all other regular 10-day contacts (control periods) participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models. Results: The analysis included 157 participants (66% women, mean age: 62 years, mean BMI: 29.5 kg/m2). Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio [OR] 10.2, 95% CI 5.4, 19.3) compared with no injury. Knee buckling was associated with experiencing a pain exacerbation (OR 4.0, 95% CI 2.6, 6.2) compared with no buckling and the association increased with a greater number of buckling events (for ≥ 6 buckling events, OR 20.1, 95% CI 3.7, 110). Conclusions: Knee injury and buckling are associated with knee pain exacerbation. Reducing the likelihood of these mechanical events through avoidance of particular activities and/or appropriate rehabilitation programs may decrease the risk of pain exacerbation. %M 27342008 %R 10.2196/ijmr.5452 %U http://www.i-jmr.org/2016/2/e17/ %U https://doi.org/10.2196/ijmr.5452 %U http://www.ncbi.nlm.nih.gov/pubmed/27342008 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e20 %T Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk %A Akahane,Manabu %A Maeyashiki,Akie %A Yoshihara,Shingo %A Tanaka,Yasuhito %A Imamura,Tomoaki %+ Faculty of Medicine, Department of Public Health, Health Management and Policy, Nara Medical University, Shijo 840, Kashihara, Nara 6348521, Japan, 81 744 22 3051 ext 2224, makahane@naramed-u.ac.jp %K accidental falls %K disability evaluation %K self-assessment %K activity of daily living %D 2016 %7 20.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls. Objective: To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration. Methods: We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age. Results: One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling. Conclusions: Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures. %M 27323871 %R 10.2196/ijmr.5590 %U http://www.i-jmr.org/2016/2/e20/ %U https://doi.org/10.2196/ijmr.5590 %U http://www.ncbi.nlm.nih.gov/pubmed/27323871