Accepted for/Published in: JMIR Human Factors
Date Submitted: Oct 8, 2019
Date Accepted: Feb 28, 2020
Date Submitted to PubMed: May 8, 2020
Cyber-Physical System for Near Real-Time Monitoring of At-home Orthopedic Rehabilitation and mHealth-based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation
ABSTRACT
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 with 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:
To develop a cyber-physical system to monitor at-home adherence with 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 consists of 4 components: 1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; 2) an iOS-based mobile Health (mHealth) application 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 backend server to store data, enable adherence analysis and send automated push notifications to the patient. These 4 elements were designed to be fully HIPAA-compliant. The system underwent formative testing in a cohort of patients following anterior cruciate ligament (ACL) rupture (n=7) to begin to assess face validity.
Results:
Compared to NMES device software-tracked adherence, the RehabTracker system recorded 83% of rehabilitation sessions, with 100% of all reported sessions being logged by the system in 4 out of 7 patients. In patients whom tracking of automated push notifications was enabled, 100% of push notifications sent by the back-end server were received by the patient.
Conclusions:
This report describes the design and functionality of RehabTracker, which provides near real-time monitoring of adherence with at-home NMES rehabilitation and offers a HIPAA-compliant conduit for automated and manual patient-provider communication. This cyber-physical system is a promising mHealth application for improving adherence with at-home NMES rehabilitation programs. Clinical Trial: NCT02945553
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