A smartphone oximeter with a fingertip probe for use during exercise training: usability, validity and reliability in individuals with chronic lung disease and healthy controls.

BACKGROUND AND AIM: Telehealth is a strategy to expand the reach of pulmonary rehabilitation (PR). Smartphones can monitor and transmit oxygen saturation (SpO2) and heart rate (HR) data to ensure patient safety during home-based or other exercise. The purpose of this study was to evaluate the usability, validity and reliability of a Kenek O2 pulse oximeter and custom prototype smartphone application (smartphone oximeter) during rest and exercise in healthy participants and those with chronic lung disease. METHODS: Fifteen individuals with chronic lung disease and 15 healthy controls were recruited. SpO2 and HR were evaluated at rest and during cycling and walking. SpO2 was valid if the mean bias was within +±2%, the level of agreement (LoA) was within ±4%; HR was valid if the mean bias was within ±5 beats per min (bpm), LoA was within ±10bpm. Usability was assessed with a questionnaire and direct observation. RESULTS: The smartphone oximeter was deemed easy to use. At rest, SpO2 measures were valid in both groups (bias <2%, lower bound LoA -2 to 3%). During exercise, SpO2 measurement did not meet validity and reliability thresholds in the patients with chronic lung disease, but was accurate for the healthy controls. HR recording during exercise or rest was not valid (LoA>10bpm) in either group. CONCLUSIONS: The smartphone oximeter did not record HR or SpO2 accurately in patients with chronic lung disease during exercise, although SpO2 was valid at rest. During exercise, patients with chronic lung disease should pause to ensure greatest accuracy of SpO2 and HR measurement.

Patient and health care professional perspectives on using telehealth to deliver pulmonary rehabilitation.

The objective of this study was to identify the necessary features of pulmonary telerehabilitation (P-TR) from the perspectives of individuals living with chronic lung disease and health care professionals (HCPs) who deliver pulmonary rehabilitation (PR). Focus groups were carried out with patients ( n = 26) and HCPs ( n = 26) to elicit and explore their opinions about the critical elements of in-person PR and ideas for how these elements could be supported using technology. A questionnaire was used to assess technology use, PR experience, and general health status. Four key elements of PR were identified as critical to P-TR: the social aspect of PR; communicating with HCPs for education and support; using biosensors for monitoring and promoting self-knowledge; and the evolution of support with progress over time. A range of technology-enabled devices and programs were suggested as means to recreate aspects of these integral elements. Consultations with patients and HCPs suggest that users are interested in technology and want to ensure it recreates the important aspects of PR. Patients and HCPs identified similar key elements for P-TR. The opinions and suggestions of patients and HCPs should be the driving force of innovation if P-TR is to succeed in improving health outcomes.

A survey of physiotherapists' experience using outcome measures in total hip and knee arthroplasty.

PURPOSE: To identify physiotherapists' familiarity with and experience using outcome measures (OMs) along the care continuum for patients undergoing total joint arthroplasty (TJA) of the hip and knee. Views on future use and barriers were also captured. METHODS: A stratified random sample of physiotherapists in one Canadian province completed a questionnaire about 19 standardized and clinically feasible OMs. Analyses included descriptive statistics and chi-square and McNemar tests to compare use of OMs for clinical decision making and program evaluation. RESULTS: Of 694 physiotherapists surveyed, 298 (43%) responded. Of these, 172 (58%) treated TJA clients and completed the full questionnaire. A majority worked in public practice settings and >1 care phase (e.g., pre-op, acute, rehab). All physiotherapists reported using ≥1 OM and having greater experience using performance-based measures than patient-reported OMs. OMs were used more often for clinical decision making than for program evaluation. Dissatisfaction with available tools was evident from respondents' comments. Several barriers to using OMs were identified in varied clinical settings and care phases. CONCLUSIONS: While physiotherapists use a variety of OMs along the TJA continuum, there remain challenges to routine use across clinical settings, care phases, and patient sub-groups.

Objectif : Déterminer dans quelle mesure les physiothérapeutes savent bien utiliser les mesures des résultats (MR) sur le continuum des soins chez les patients qui subissent une arthroplastie totale (AT) de la hanche et du genou, ainsi que leur expérience en la matière. On a saisi aussi leur opinion sur l'utilisation future et les obstacles. Méthodes : Un échantillon aléatoire stratifié de physiothérapeutes d'une province du Canada a répondu à un questionnaire sur 19 MR normalisées et faisables sur le plan clinique. Les analyses ont inclus des statistiques descriptives et des tests du chi-carré et de McNemar afin de comparer l'utilisation des MR pour la prise de décisions cliniques et l'évaluation de programmes. Résultats : Sur 694 physiothérapeutes sondés, 298 (43%) ont répondu, dont 172 (58%) ont traité des clients qui ont subi une AT et répondu au questionnaire au complet. Une majorité d'entre eux travaillait en pratique publique et dans >1 phase de soins (p. ex., préopératoires, actifs, réadaptation). Tous les physiothérapeutes ont déclaré utiliser ≥1 MR et avoir plus d'expérience des mesures fondées sur le rendement que des MR déclarées par les patients. Les MR étaient utilisées plus souvent dans la prise de décisions cliniques que dans l'évaluation de programmes. Les commentaires des répondants ont révélé leur insatisfaction face aux outils disponibles. On a défini un certain nombre d'obstacles à l'utilisation des MR dans divers contextes cliniques et phases de soins. Conclusions : Les physiothérapeutes utilisent un éventail de MR sur tout le continuum de l'AT, mais il reste des défis à relever sur le plan de l'utilisation de routine entre les contextes cliniques, les phases de soins et les sous-groupes de patients.

Objective evaluation of functional capacity: medical, occupational, and legal settings.

Clinicians are called upon to perform objective evaluation of functional capacity in a variety of treatment and evaluation settings. To assist the clinician in selecting the appropriate testing methods for assessment of functional capacity in different settings, a survey of available techniques is presented. It is structured around the goals of treatment as the patient progresses from the stage of acute injury or disease through early postacute care to long-term rehabilitation. The role of the clinician in treatment of the patient is contrasted to the role of the clinician in evaluation of the patient for reasons other than making clinical decisions. In particular, the specific demands of workers fitness and risk evaluation are described. The goal-related differences in the design and the correct use of clinical dynamometers vs. work simulators are presented. The key concepts are the professional role of the clinician, reliability of measurements, and validity in the sense of the decisions one is justified in making based on the results of these measurements in a particular context.

An isokinetic evaluation of trunk strength in elite female field hockey players.

A Kin-Corn dynamometer was used to evaluate trunk extensor and flexor strength in 11 elite female field hockey players. Average torques during maximal concentric and eccentric muscle actions through a range of movement from 25° of extension to 30° of flexion were measured at angular velocities of 30°.s(-1) and 60°.s(-1). Strength curve shape, average torque values and derived eccentric/concentric and trunk extensor/flexor ratios were analysed. The strength curves displayed greatest torques in the lengthened position for both muscle groups. Statistical analysis revealed no significant difference in strength between first and second test occasions (p=0.9920). Muscle action (eccentric versus concentric) and group (extensors versus flexors) were significant main effects (p <0.0001). There was no significant difference between torques at 30°.s(-1) and 60°.s(-1). The trunk extensor/flexor ratio approximated 1.75 for eccentric muscle action and 1.82 for concentric muscle actions. Gravity correction did not affect strength data but did affect strength curve shape. The results can be utilised to design individual prophylactic exercise programs for back pain.