Correction: Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Students' Perceived Knowledge, Skills, Attitudes, and Experience.

[This corrects the article DOI: 10.2196/51112.].

Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Students' Perceived Knowledge, Skills, Attitudes, and Experience.

BACKGROUND: The COVID-19 pandemic has highlighted the growing relevance of telehealth in health care. Assessing health care and nursing students' telehealth competencies is crucial for its successful integration into education and practice. OBJECTIVE: We aimed to assess students' perceived telehealth knowledge, skills, attitudes, and experiences. In addition, we aimed to examine students' preferences for telehealth content and teaching methods within their curricula. METHODS: We conducted a cross-sectional web-based study in May 2022. A project-specific questionnaire, developed and refined through iterative feedback and face-validity testing, addressed topics such as demographics, personal perceptions, and professional experience with telehealth and solicited input on potential telehealth course content. Statistical analyses were conducted on surveys with at least a 50% completion rate, including descriptive statistics of categorical variables, graphical representation of results, and Kruskal Wallis tests for central tendencies in subgroup analyses. RESULTS: A total of 261 students from 7 bachelor's and 4 master's health care and nursing programs participated in the study. Most students expressed interest in telehealth (180/261, 69% very or rather interested) and recognized its importance in their education (215/261, 82.4% very or rather important). However, most participants reported limited knowledge of telehealth applications concerning their profession (only 7/261, 2.7% stated profound knowledge) and limited active telehealth experience with various telehealth applications (between 18/261, 6.9% and 63/261, 24.1%). Statistically significant differences were found between study programs regarding telehealth interest (P=.005), knowledge (P<.001), perceived importance in education (P<.001), and perceived relevance after the pandemic (P=.004). Practical training with devices, software, and apps and telehealth case examples with various patient groups were perceived as most important for integration in future curricula. Most students preferred both interdisciplinary and program-specific courses. CONCLUSIONS: This study emphasizes the need to integrate telehealth into health care education curricula, as students state positive telehealth attitudes but seem to be not adequately prepared for its implementation. To optimally prepare future health professionals for the increasing role of telehealth in practice, the results of this study can be considered when designing telehealth curricula.

Validity of assessing level walking with the 2D motion analysis software TEMPLO and reliability of 3D marker application.

In gait analysis, knowledge on validity and reliability of instruments and influences caused by the examiner's performance is of crucial interest. These measurement properties are not yet known for commonly used, low-cost two-dimensional (2D) video-based systems. The purpose of this study was to assess the concurrent validity of a video-based 2D system against a three-dimensional (3D) reference standard, as well as the inter-rater reliability, and test-retest reliability of 3D marker application. Level walking was captured simultaneously by a 2D and a 3D system. Reflective markers were applied independently by three raters and repeated by one rater on a second day. We assessed the agreement between the two systems, as well as reproducibility, and inter-rater agreement of derived spatio-temporal parameters and sagittal kinematics. Nineteen healthy participants completed this study. 2D gait analysis provides a possibility to accurately assess parameters such as stride time, stride length, gait velocity, and knee RoM. Interrater and test-retest reliability of 3D gait analysis are generally acceptable, except for the parameters toe-off and pelvic RoM. This is the first study to publish measurement properties of a commercially available 2D video-based gait analysis system, which can support interpretation of gait pattern near the sagittal plane.

Effects of smartphone use while walking on external knee abduction moment peak: A crossover randomized trial on an instrumented treadmill.

Introduction: In addition to its effects on cognitive awareness, smartphone use while walking may reduce the speed, regularity, and symmetry of walking. Although its effects on spatiotemporal gait parameters, such as walking speed and step width, have already been studied, little is currently known about the impact of smartphone dual tasking on lower limb kinetics. Research question: Does smartphone use during walking alter gait patterns (i.e., walking speed and step width) and consequently external knee moments? Methods: In a four-period crossover trial, external knee moment peaks, walking speed, and step width were assessed in 27 healthy adults during matched-speed walking, self-paced walking, self-paced walking with spoken calculation tasks, and self-paced walking with smartphone-entered calculation tasks. Differences between the smartphone use condition and all other conditions were determined using repeated measures ANOVA with predefined contrasts. Results: Decreased walking speed and increased step width were observed during smartphone use. The mean external knee abduction moment peak (Nm/kg) differed significantly (p < 0.01) across the intervention condition, namely walking with smartphone-entered calculations (0.15; 95 % CI: 0.12, 0.18), and the control conditions, namely matched-speed walking (0.11; 95 % CI: 0.08, 0.13), self-paced walking (0.11; 95 % CI: 0.09, 0.14), and walking with spoken calculations (0.14; 95 % CI: 0.12, 0.16). After confounder adjustment for walking speed, step width, gender, and age, this primary outcome was significantly different between using the smartphone and self-paced walking (p < 0.01, r = 0.51). This effect size was reduced when comparing smartphone use with spoken calculations (p = 0.04, r = 0.32). Conclusion: When using a smartphone while walking, walking speed is slowed down, step width is increased, and knee moments are adversely altered compared to walking without dual tasking. These altered knee moments are partially, but not entirely, attributable to the cognitive calculation task. These effects are age-independent, but women are more affected than men. Nevertheless, it remains unclear whether sustained walking while using a smartphone adversely affects the development of knee joint pathologies.

Real-Time Digital Feedback for Exercise Therapy of Lower Extremity Functional Deficits: A Mixed Methods Study of User Requirements.

BACKGROUND: Relearning physiological movement patterns is a key factor to success in the treatment of functional deficits. Motivation to train sustainably is essential for successful motor re-education and can be promoted by instrumentally supported real-time feedback. OBJECTIVES: Study findings should improve the understanding of real-time feedback visualization for exercises targeting the lower extremities. METHODS: A mixed-methods survey on recognition, comprehensibility, color scheme and shape of six real-time feedback prototype visualizations was conducted among three user groups (physicians, physiotherapists, and patients). RESULTS: The mean correct recognition of body regions visualized in the feedback was 55 %, ranging from 29 % to 74 %. Comprehensibility, color scheme and shape were best received for feedback with clear visual guidance, sympathetic and motivating color schemes and abstract visualizations of body regions. CONCLUSION: Insights were gathered for the design, optimization, and customization of visualizations to develop a real-time feedback prototype.

Effects of real-time feedback during decline walking on kinematic and kinetic gait parameters in a healthy population: study protocol for a randomized trial - up and down.

BACKGROUND: The control of the dynamic functional leg alignment (dFLA) and biomechanical load are important joint-related aspects regarding the development of osteoarthritis (OA). Research on level walking with feedback on load-related parameters has provided innovative treatment possibilities. With regard to walking on sloped surfaces, fundamental biomechanical knowledge exists. However, comprehensive data on the agreement of kinematics and kinetics of self-paced ramp versus sloped treadmill walking is lacking. Further, deeper insights into the control of the dFLA during decline walking and the usefulness of real-time feedback are missing. METHODS/DESIGN: Thirty healthy participants aged between 18 and 35 years will be included. They will complete a three-dimensional gait analysis walking self-paced up and down on a 5-m ramp with a 10° inclination. Subsequently, speed-matched to ramp-up walking and self-paced 10° incline split-belt treadmill walking will be assessed. Afterwards, the participants will be observed under four different conditions of 10° declined walking on the same treadmill (a) self-paced walking, (b) self-paced walking with an internal focus of attention, (c) self-paced walking with real-time feedback, and (d) condition c speed-matched walking. The primary outcome parameter will be the frontal knee range of motion (fKROM). Secondary outcomes include the ground reaction force loading rate, spatial-temporal parameters, as well as sagittal, frontal and transversal kinematics, and kinetics for the lower extremities. DISCUSSION: The findings aim at improving the understanding of the effects of real-time feedback on the control of the dFLA and lower limb loading. Following clinical practicable methods for effective feedback devices can be developed and evaluated. Additionally, the first dataset comparing kinematic and kinetic parameters for decline and incline ramp walking versus walking on an instrumented treadmill will be available for appropriate intervention planning. TRIAL REGISTRATION: ClinicalTrials.gov NCT04763850 . Prospectively registered on 21 February 2021.

3D gait analysis, haemophilia joint health score, leg muscle laterality and biomarkers of joint damage: A cross-sectional comparative assessment of haemophilic arthropathy.

INTRODUCTION: 3D gait analysis has been proposed as a reproducible and valid method to assess abnormal gait patterns and to monitor disease progression in patients with haemophilia (PWH). AIM: This study aimed at comparing Gait Deviation Index (GDI) between adult PWH and healthy controls, and at assessing the agreement between outcome measures of haemophilic arthropathy. METHODS: Male PWH aged 18-49 years (prespecified subgroups: 18-25 vs 26-49 years) on prophylactic replacement therapy, and male healthy age-matched controls passed through a cross-sectional assessment panel. Besides the 3D gait analysis derived GDI, secondary outcomes included kinematic, kinetic and spatio-temporal gait parameters, the Haemophilia Joint Health Score (HJHS), electric impedance derived leg muscle laterality and inflammatory biomarkers. RESULTS: Patients with haemophilia (n = 18) walked slower, in shorter steps and accordingly with less functional range of motion in the hips and ankles, as compared to healthy controls (n = 24). Overall, PWH did not differ significantly in GDI and specific gait parameters. PWH had a higher mean HJHS (18.8 vs 2.6, P = .000) and leg muscle laterality (4.3% vs 1.5%, P = .004). A subgroup analysis revealed progressed gait pathology in PWH aged 26-49 years (not statistically significant). Leg muscle laterality was strongly correlated with HJHS (r = .76, P = .000), whereas GDI just moderately (r = -.39, P = .110). PWH had higher levels of the inflammatory markers CRP and IL-6. CONCLUSION: Progressed gait pathology was found in PWH, mainly those aged 26-49 years. Leg muscle laterality correlated strongly with HJHS and was identified as a promising tool for detecting progression and physiological consequences of haemophilic joint arthropathy.

Intrarater and Interrater Reliability of Angular Measures Using TEMPLO Two-dimensional Motion Analysis Software.

OBJECTIVE: The purpose of this study was to assess the intrarater and interrater reliability of marking 2 angles with the TEMPLO software and to provide relevant information for clinical practice. METHODS: A prospective test-retest study has been conducted. Four raters took measures on 2 days, with 2 weeks in between. Craniovertebral angle and trunk forward lean were drawn on 22 video frames using TEMPLO. Reliability was examined using intraclass correlation coefficients including standard errors of measurement and minimal detectable change values as measures of precision expressed in the unit of the test (°). RESULTS: Intraclass correlation coefficients for intrarater and interrater reliability ranged from 0.98 to 1.00. Standard errors of measurement and minimal detectable change values ranged from 0.4° to 0.8° and 0.8° to 2.3°, respectively. CONCLUSION: These results indicate excellent reliability for craniovertebral angle and trunk forward lean assessed with TEMPLO software. Changes exceeding 2.3° may be expected to fall outside the test's variability.