System for Tracking and Evaluating Performance (Step-App®): validation and clinical application of a mobile telemonitoring system in patients with knee and hip total arthroplasty. A prospective cohort study.

BACKGROUND: Technological advances and digital solutions have been proposed to overcome barriers to sustainable rehabilitation programs in patients with musculoskeletal disorders. However, to date, standardized telemonitoring systems able to precisely assess physical performance and functioning are still lacking. AIM: To validate a new mobile telemonitoring system, named System for Tracking and Evaluating Performance (Step-App®), to evaluate physical performance in patients undergone knee and hip total arthroplasty. DESIGN: Prospective cohort study. METHODS: A consecutive series of older adults with knee and hip total arthroplasty participated in a comprehensive rehabilitation program. The Step-App®, a mobile telemonitoring system, was used to remotely monitor the effects of rehabilitation, and the outcomes were assessed before (T0) and after the rehabilitation treatment (T1). The primary outcomes were the 6-Minute Walk Test (6MWT), the 10-Meter Walk Test (10MWT), and the 30-Second Sit-To-Stand Test (30SST). RESULTS: Out of 42 patients assessed, 25 older patients were included in the present study. The correlation analysis between the Step-App® measurements and the traditional in-person assessments demonstrated a strong positive correlation for the 6MWT (T0: r2=0.9981, P<0.0001; T1: r2=0.9981, P<0.0001), 10MWT (T0: r2=0.9423, P<0.0001; T1: r2=0.8634, P<0.0001), and 30SST (T0: r2=1, P<0.0001; T1: r2=1, P<0.0001). The agreement analysis, using Bland-Altman plots, showed a good agreement between the Step-App® measurements and the in-person assessments. CONCLUSIONS: Therefore, we might conclude that Step-App® could be considered as a validated mobile telemonitoring system for remote assessment that might have a role in telemonitoring personalized rehabilitation programs for knee and hip replacement patients. CLINICAL REHABILITATION IMPACT: Our findings might guide clinicians in remote monitoring of physical performance in patients with musculoskeletal conditions, providing new insight into tailored telerehabilitation programs.

The Environmental Health Literacy of Italian General Population: The SPeRA Cross-Sectional Study.

Environmental health literacy (EHL) includes knowledge of health effects due to environmental exposure and skills to protect health from environmental risks. This study investigated some aspects about EHL of the Italian adult population. Data were collected through questionnaires (n = 672) and analysed through multivariable logistic regression models. Results showed that participants with incomplete/insufficient self-perceived knowledge of health effects due to environmental risks verified less information about this topic (adjOR = 0.38 (CI95% 0.25-0.59)/0.09 (0.04-0.21); p < 0.001/<0.001), potentially spreading fake news. The self-perceived exposure to pollution was higher in participants living in towns than in rural areas (small, medium, big towns adjOR = 2.37 (1.41-3.97), 2.10 (1.11-3.96), 3.11 (1.53-6.31); p = 0.001, 0.022, 0.002) and lower in participants with incomplete/insufficient knowledge about pollution effects (adjOR = 0.54 (0.32-0.92)/0.30 (0.13-0.67); p = 0.022/0.004), confirming that knowledge is essential to achieve awareness. Since insufficient self-perceived knowledge of pollution effects was negatively associated with the adoption of pro-environmental behaviours (adjOR = 0.37 (0.15-0.90); p = 0.028), EHL was proven to be a virtuous behaviour promoter. Finally, a lack of institutional support, time and cost were identified as barriers to pro-environmental behaviours. This study provided useful data to design prevention programmes, underlined some barriers to pro-environmental behaviours and highlighted the need to promote attitudes and behaviours aimed at contrasting environmental pollution, thus protecting human health.