ABSTRACT
BACKGROUND: Due to growing pressure on the healthcare system, a shift in rehabilitation to the home setting is essential. However, efficient support in home-based rehabilitation is still lacking. The COVID-19 pandemic has further exacerbated these challenges, and affected individuals and healthcare professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet the clients' needs and ease the growing pressure on the healthcare system it is necessary to give an overview of existing, relevant and future solutions shaping the constantly evolving market of technologies for home-based DR. OBJECTIVE: This scoping review identifies digital technologies for home-based DR, predicts new/emerging DR trends and reports the influences of the COVID-19 pandemic on Digital Rehabilitation. METHODS: The scoping review followed the framework of Arksey and O'Malley with the improvements of Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Cochrane library. The search spanned from January 2015 to January 2022. A bibliometric analysis was performed to give an overview of the included references and a co-occurrence analysis identified the technologies for home-based DR. A full-text-analysis of all included reviews filtered the trends for home-based DR. A grey literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic regarding the development of DR. RESULTS: 2.437 records were included in the bibliometric analysis, 95 for full-text-analysis and 40 as a result of the grey literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital/mobile applications are already used in home-based DR, but AI/machine learning, exoskeletons, and digital/mobile applications represent new/emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches, but has not led to the development of new technologies. CONCLUSIONS: Multiple tools are available and implemented for home-based DR, but some technologies face limitations in the application of home-based rehabilitation. However, AI and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the healthcare system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions even regardless of exceptional situations such as the COVID-19 pandemic.
ABSTRACT
IL-33 and ATP are alarmins, which are released upon damage of cellular barriers or are actively secreted upon cell stress. Due to high-density expression of the IL-33 receptor T1/ST2 (IL-33R), and the ATP receptor P2X7, mast cells (MCs) are one of the first highly sensitive sentinels recognizing released IL-33 or ATP in damaged peripheral tissues. Whereas IL-33 induces the MyD88-dependent activation of the TAK1-IKK2-NF-κB signalling, ATP induces the Ca2+ -dependent activation of NFAT. Thereby, each signal alone only induces a moderate production of pro-inflammatory cytokines and lipid mediators (LMs). However, MCs, which simultaneously sense (co-sensing) IL-33 and ATP, display an enhanced and prolonged activation of the TAK1-IKK2-NF-κB signalling pathway. This resulted in a massive production of pro-inflammatory cytokines such as IL-2, IL-4, IL-6 and GM-CSF as well as of arachidonic acid-derived cyclooxygenase (COX)-mediated pro-inflammatory prostaglandins (PGs) and thromboxanes (TXs), hallmarks of strong MC activation. Collectively, these data show that co-sensing of ATP and IL-33 results in hyperactivation of MCs, which resembles to MC activation induced by IgE-mediated crosslinking of the FcεRI. Therefore, the IL-33/IL-33R and/or the ATP/P2X7 signalling axis are attractive targets for therapeutical intervention of diseases associated with the loss of integrity of cellular barriers such as allergic and infectious respiratory reactions.