Computer-assisted training as a complement in rehabilitation of patients with chronic vestibular dizziness--a randomized controlled trial.

OBJECTIVE: To compare a computer-assisted home exercise program with conservative home-training following printed instructions in the rehabilitation of elderly patients with vestibular dysfunction. DESIGN: Single-blind, randomized, controlled trial. SETTING: Geriatric department of a university hospital. PARTICIPANTS: Patients with chronic dizziness due to vestibular dysfunction (N=63) were randomly assigned to either rehabilitation in the clinic followed by computer-assisted home exercises (intervention group: n=32) or rehabilitation in the clinic followed by home exercises according to printed instructions (control group: n=31). INTERVENTIONS: Patients in the intervention group received assisted rehabilitation by a computer program. MAIN OUTCOME MEASURES: Measurements at baseline and at 8 and 16 weeks were compared. These included the One Leg Stand Test, Dynamic Gait Index, Chair Stand Test, Motion Sensitivity Test, Short Form-12, Dizziness Handicap Inventory, and visual analog scale. RESULTS: Both groups improved significantly during 16 weeks of rehabilitation. However, neither t tests nor repeated-measures analysis of variance demonstrated any significant differences between the 2 groups. The overall compliance rate to computer program exercises during 16 weeks was 57%. CONCLUSIONS: A computer-assisted program to support the home training of elderly patients with vestibular dysfunction did not improve rehabilitation more than did printed instructions.

Treatment of diabetic foot ulcers in the home: video consultations as an alternative to outpatient hospital care.

The aim of this study was to investigate whether video consultations in the home can support a viable alternative to visits to the hospital outpatient clinic for patients with diabetic foot ulcers. And furthermore whether patients, relatives, visiting nurses, and experts at the hospital will experience satisfaction and increased confidence with this new course of treatment. Participatory design methods were applied as well as field observations, semistructured interviews, focus groups, and qualitative analysis of transcriptions of telemedical consultations conducted during a pilot test. This study shows that it is possible for experts at the hospital to conduct clinical examinations and decision making at a distance, in close cooperation with the visiting nurse and the patient. The visiting nurse experienced increased confidence with the treatment of the foot ulcer and characterized the consultations as a learning situation. All patients expressed satisfaction and felt confidence with this new way of working.

Telemedical teamwork between home and hospital: a synergetic triangle emerges.

The aim of this paper is to describe the effect on the clinical cooperation when introducing video consultations in the home of the patient. The study was conducted as a Participatory Design process containing workshops, field studies, clinical experiments and pilot tests involving participants from the Danish primary and secondary care sectors as well as patients and relatives. The video consultation set-up constitutes a new organisational way of working, described as "a new triangle", based on immediate inter-individual cooperation and team-work. In the triangle, competences were combined which led to a more holistic treatment and a more active role of the patient. Furthermore, a spreading of knowledge between all participants was seen, resulting in an upgrading of the competences of especially the visiting nurse. The introduction of a real-time, on-line link between hospital and home constitutes the basis for simultaneous communication between all participants, resulting in a "witnessing" situation potentially securing or even enhancing quality of treatment.

Participatory design in health sciences: Using cooperative experimental methods in developing health services and computer technology.

Participatory design (PD) is a research approach to the development of technological solutions to real-world problems, an approach that shares many concerns and some of its roots with action research. In this article, the authors discuss their experience in conducting a PD research project intended to develop a technological and a related organizational intervention to support the treatment of foot ulcers for people with diabetes at home. They provide a historical overview of the PD approach and a description of how they used it in their research study. They describe their experience in conducting the research, including the participants' responses, the outcomes of the research, and the challenges confronted in bridging the practical and disciplinary issues that arose. In the conclusion, they propose that PD holds potential as a research approach that might effectively merge computer technology and health-related interventional research.

A feasibility study of UMTS mobile phones for supporting nurses doing home visits to patients with diabetic foot ulcers.

We tested the feasibility of Universal Mobile Telephone System (UMTS) mobile phones for video consultations in the home. Five patients with diabetic foot ulcers were included in the study. Each of them was offered three video consultations instead of visits to the hospital outpatient clinic. The consultations took from 5 to 18 min. In all 15 consultations, the hospital experts were able to assess the ulcer in cooperation with the visiting nurse and to decide on the treatment. However, technical problems sometimes made it difficult for them. Connectivity problems occurred in seven of the 15 consultations. Also, the audio signal was rather unstable at times. In all situations except one, however, the clinicians were able to reach a decision that the expert felt confident about, and after all consultations the atmosphere and participants' attitudes were very positive.

Telemedical treatment at home of diabetic foot ulcers.

The treatment of diabetic foot ulcers may not always be well organized and not all patients have access to expert evaluation. We investigated the use of telemedicine to enable a visiting nurse (in the patient's home) to coordinate the treatment with experts (at the hospital). The equipment consisted of a UMTS videophone and an Internet-based patient record. Field studies were carried out at the outpatient clinic and by following visiting nurses. A total of 15 participants were invited to five workshops and experiments held in our laboratories, at the hospital, and between hospital and patients' homes. Finally, in a pilot test, five patients were offered three teleconsultations at their homes in lieu of visits to the hospital. Preliminary results were promising: (1) both clinicians and patients found the equipment easy to use; (2) the doctor could prescribe treatment at a distance; (3) the visiting nurse had realtime contact with the hospital and treatment could begin immediately according to the doctor's orders; (4) the patient saved time in not having to travel to the hospital.