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Clinical Trial ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01206

Efficiency and Patient-Reported Outcome Measures from clinic to home: the Human Empowerment Aging and Disability program for digital-health rehabilitation

 Sara Isernia1, Chiara Pagliari1,  Johanna Jonsdottir1, Carlotta Castiglioni2, Patrizia Gindri2,  Cristina Gramigna3, Giovanna Palumbo3, Marco Salza2,  Franco Molteni3 and  Francesca Baglio1*
  • 1Fondazione Don Carlo Gnocchi Onlus (IRCCS), Italy
  • 2Presidio Sanitario San Camillo, Italy
  • 3Villa Beretta Centro di Riabilitazione, Italy

Background
The recent exponential growth of Digital Health (DH) in the healthcare system provides a crucial transformation in healthcare, answering to alarming threats related to the increasing number of Chronic Neurological Diseases (CNDs). New long-term integrated DH-care approaches, including rehabilitation, are warranted to address these concerns.
Methods
The Human Empowerment Aging and Disability (HEAD) rehabilitation program, a new long-term integrated care including DH-care system, was evaluated in terms of efficiency and patient-reported outcome measures (PROMs) in 107 CND patients (30 with Parkinson’s Disease, PD; 32 with Multiple Sclerosis, MS; 45 with stroke in chronic stage). All participants followed 1-month of HEAD rehabilitation in clinic (ClinicHEAD: 12 sessions, 3/week), then 1:3 patient was consecutively allocated to 3-months telerehabilitation at home (HomeHEAD: 60 sessions, 5/week). Efficiency (i.e. adherence, usability and acceptability) and PROMs (i.e. perceived functioning in real-world) were analyzed.
Results
The rate of adherence to HEAD treatment in clinic (≥ 90%) and at home (77%) was high. Usability of HEAD system was judged as good (System Usability Scale, median 70.00) in clinic and even more at home (median 80.00). Similarly, administering the Technology Acceptance Model 3 questionnaire we found high scores both in clinic/at home (Usefulness, mean 5.39±1.41 SD/ mean 5.33±1.29 SD; Ease of use, mean 5.55±1.05 SD/ mean 5.45±1.17 SD, External Control, mean 4.94±1.17 SD/ mean 5.07±1.01 SD, Relevance, mean 5.68±1.29 SD/ mean 5.70±1.13 SD and Enjoyment, mean 5.70±1.40 SD/ mean 6.01±1.08 SD). After ClinicHEAD, participation and autonomy in daily routine was maintained or even ameliorated (PD and stroke> MS). Whereas, increased functionality and participation in the MS group was found only after HomeHEAD intervention.
Discussion
Our results suggest that a tele-health-based approach is both feasible and efficient in providing rehabilitation care to CNDs from clinic to home. Increasing and maintaining participation as well as autonomy in daily routine are promising findings that open up scenarios for the continuity of care at home through DH-care for CNDs.

Keywords: Rehabilitation, Technology, telerehabilitation, Nervous System Diseases, Multiple Sclerosis, Parkinson's disease, Stroke, non-communicable chronic disease (NCD)

Received: 06 Aug 2019; Accepted: 29 Oct 2019.

Copyright: © 2019 Isernia, Pagliari, Jonsdottir, Castiglioni, Gindri, Gramigna, Palumbo, Salza, Molteni and Baglio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Francesca Baglio, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, 20162, Lombardy, Italy, fbaglio@dongnocchi.it