A mobile app for home-based exercise in spinal cord injured persons: Proposal and pilot study.

BACKGROUND AND OBJECTIVE: To preserve cardiovascular health in persons with spinal cord injury (SCI), it is important to promote physical activity programs adapted to them. Home-based exercise programs allow patients to perform clinician-prescribed physical activity without going to a hospital. However, they make it difficult for the clinician to guide and monitor the patient. To face this issue, this paper proposes a novel smartphone-based mobile application (Fisiofriend), and evaluates its feasibility with a pilot study in a real clinical intervention. METHODS: Fourteen SCI male subjects were involved in a 6-weeks home-based intervention, based on upper limbs exercises: 7 subjects (APP group) used Fisiofriend, and 7 subjects used traditional pictorial instructions on paper (PAPER group). At the beginning (t1) and end (t2) of the study period, we measured: (i) biceps and triceps brachii strength and endurance parameters with an isokinetic dynamometer (Biodex System 4), (ii) O2 maximal consumption with a crank ergometer stress test (VO2000, Medgraphics). Moreover, we collected subjective data about subjects' perception of the support (app or paper) in the home-based program. RESULTS: Physiological results were encouraging for both groups. Questionnaire data suggests a possible advantage of the app in terms of pleasantness, engagement and perception of positive effects. Practical clinical experience with the subjects and their informal reports highlighted which features of the app could be of particular benefit in real interventions, as we discuss in the paper. CONCLUSIONS: The study showed the feasibility of using a mobile app in home-based exercise programs involving SCI patients. We discuss implications of introducing such kind of apps into clinical practice.

Web-Based Specialist Support for Spinal Cord Injury Person's Care: Lessons Learned.

Persons with disability from spinal cord injury (SCI) are subject to high risk of pathological events and need a regular followup even after discharge from the rehabilitation hospital. To help in followup, we developed a web portal for providing online specialist as well as GP support to SCI persons. After a feasibility study with 13 subjects, the portal has been introduced in the regional healthcare network in order to make it compliant with current legal regulations on data protection, including smartcard authentication. Although a number of training courses have been made to introduce SCI persons to portal use (up to 50 users), the number of accesses remained very low. Reasons for that have been investigated by means of a questionnaire submitted to the initial feasibility study subjects and included the still easier use of telephone versus our web-based smartcard-authenticated portal, in particular, because online communications are still perceived as an unusual way of interacting with the doctor. To summarize, the overall project has been appreciated by the users, but when it is time to ask for help to, the specialist, it is still much easier to make a phone call.

Exercise prescription in subjects with spinal cord injuries.

OBJECTIVE: To evaluate the effect of training with ergometers on subjects with spinal cord injury (SCI) in the postacute phase. DESIGN: Cohort study. SETTING: A spinal unit at a physical medicine and rehabilitation institute. PARTICIPANTS: Twenty-one subjects with SCI in the postacute phase as a consecutive sample were chosen on a strict first-come, first-chosen basis. All patients completed the study. INTERVENTIONS: A 6-week (5d/wk, 90 min/d) program consisting of exercises with the ergometers formulated (as intensity and duration) for each patient on the basis of the results obtained in specific cardiovascular tests. MAIN OUTCOME MEASURES: Parameters of workload levels, as well as hematologic and hormonal parameters, recorded during the first 6 weeks of training. RESULTS: The workload performed during the training showed an initial increase, but it reached a plateau in week 4. No statistically meaningful variations in the workload emerged between the fourth and the sixth weeks of monitoring. There were no hematologic or hormonal signs of overtraining. CONCLUSIONS: Strengthening and aerobic rehabilitation programs for patients with subacute SCI should be limited to 4 weeks, followed by an independent maintenance exercise program. The strengthening program is safe for these patients.